Translation and validation of the Finnish version of index of dental anxiety and fear (IDAF-4C+) among dental students

Psychometric Assessment of the Romanian Version of the Index of Dental Anxiety and Fear (IDAF-4C+)

BACKGROUND AND OBJECTIVES

The goal of this study was to assess the validity of the Romanian version of the Index of Dental Anxiety and Fear (IDAF-4C+) questionnaire.

MATERIALS AND METHODS

This study was conducted on a convenience sample of past patients and their acquaintances through an online questionnaire administered on the Google Forms platform between May 2021 and September 2022. The sections of the survey were demographic characteristics, the dental anxiety scale questionnaire, the IDAF-4C+ questionnaire, a single question about dental fear, and previous dental treatments.

RESULTS

In total, 239 participants were included in the study, and the mean age was 37. The IDAF-4C questionnaire had good internal validity (Cronbach alpha was 0.945). The IDAF-4C had good convergent validity, and it was positively correlated with the dental anxiety scale (r = 0.825, p < 0.001) and the question about the fear of going to the dentist (r = 0.738, p < 0.001). The questionnaire had good reliability, and the intraclass correlation was 0.985. Lower levels of dental anxiety were associated with scaling, orthodontic treatment, and dental implants. A confirmatory factor analysis was conducted after the removal of the first question from the phobia module, and residual covariance was added between items four and nine of the stimulus module, showing a good fit for the retained questions of the IDAF-4C+, grouped by module.

CONCLUSIONS

The Romanian version of the IDAF-4C+ showed acceptable psychometric properties.

Factors Associated with Patients' Rejection of Root Canal Treatment in a Tertiary Hospital, Southwest Nigeria: A Pilot Survey

Objective

Root canal treatment (RCT) is a major procedure in dentistry. It aims to relieve the pain of pulpal origin and maintain the affected tooth as a functional unit on the arch. Despite these achievable goals, RCT is sometimes rejected by patients. This study, therefore, sought to assess the reasons for rejection in patients planned for endodontic/RCT.

Materials and Methods

This was a cross-sectional pilot survey of patients planned for RCT using a self-administered questionnaire. The questionnaire included sociodemographics, the Index for Dental Anxiety and Fear (IDAF-4C), and questions to assess the reasons for rejection of endodontic treatment. Data collected were analysed with IBM Statistical Package for the Social Sciences software program, version 23.0. Descriptive statistics were used; chi-square was used to test the association between categorical variables. Statistical significance was set at P ≤ 0.05.

Result

Thirty-one patients between the age range of 16 and 81 years, with a mean age of 38.16 ± 17.87, participated in the survey. Only nine (29.03%) of the participants declined to have the treatment. The majority 6(66.7%), and 7(77.8%) of those that refused the treatment did so, due to fear of drilling (P = 0.014) and cost of treatment (P = 0.001), respectively. Mean IDAF-4C was 1.86 ± 0.9 (standard deviation).The rejection was, however, not affected by past experience, the risk of taking multiple radiographs, and the number of hours or visits for the procedure.

Conclusion

The cost of treatment and fear of drilling were the major reasons for the rejection of RCT in this study. Therefore, there is a need to further look into making endodontic treatment a more comfortable, less costly, and less fear-provoking procedure for patients.

The effectiveness of a diagnostic interview and modified one-session treatment for dental anxiety in primary dental care-A pilot study

AIMS

To investigate the effectiveness of a cognitive-behavioral intervention that included either a diagnostic interview (DI) or a DI combined with modified one-session treatment (M-OST) for dental anxiety among adults in a primary care setting.

METHODS AND RESULTS

Nineteen participants were assigned to either a DI before conventional dental treatment (group T1) or DI and M-OST (group T2). The severity of dental anxiety was measured with three self-reported measures before and after the intervention: the Modified Dental Anxiety Scale (MDAS), the Index of Dental Anxiety and Fear (IDAF-4C), and the Visual Analogue Scale-Anxiety (VAS-A). Dental care attendance was enquired in a 1-year follow-up. The scores for all three scales decreased among both study groups, with the largest decrease recorded in treatment group T1 assessed with the VAS-A. A higher dental anxiety score measured before the intervention associated most significantly with a higher dental anxiety score after the intervention. At the 1-year follow-up, 82% of participants in T1 and 67% in T2 had visited a dentist.

CONCLUSION

A DI alone and combined with M-OST is potentially effective in reducing dental anxiety and in supporting the engagement of adult patients with dental treatment in primary dental care.

Dental fear and anxiety in Asian youths: response components and inducing stimuli

OBJECTIVES

This study estimated the prevalence of dental fear/anxiety (DFA) and phobia in Asian youths and investigated the fear/anxiety response components and triggers for those with DFA.

MATERIALS AND METHODS

A convenience sample of youths, aged 17 to 24 years old, was recruited from a local polytechnic. The Index of Dental Anxiety and Fear-4C + (IDAF-4C +) was employed to assess the occurrence of DFA (IDAF-4C) and phobia (IDAF-P) as well as to ascertain fear/anxiety-inducing stimuli (IDAF-S). Psychological distress was determined with the Patient Health Questionnaire-4 (PHQ-4). Sociodemographic, IDAF-4C + , dental attendance patterns, and PHQ-4 data were gathered electronically. Statistical analyses were conducted with chi-square, Kruskal-Wallis, and relevant post hoc tests (α = 0.05).

RESULTS

A total of 215 participants were enrolled (mean age of 18.9 ± 2.0 years; 87.4% women). Of these, 12.6/6.0% had moderate-to-high (MH)/high-to-extreme (HE) DFA and 0.9% experienced dental phobia. Significant differences in scores were observed between the HE/MH and no-to-moderate (NM) groups for all IDAF-4C components. Apart from the cost of dental treatment, IDAF-4S scores varied significantly among the three DFA groups. The two most highly rated DFA stimuli were painful/uncomfortable procedures and needles/injections for the HE group, while they were needles/injections and the cost of dental treatment for the MH and NM groups.

CONCLUSIONS

Moderate-to-extreme DFA existed in 18.6% of the Asian youths examined. The emotional and physiological components of the IDAF-4C appear to contribute more to the DFA response. Dental pain including needles/injections and the cost of dental treatment troubled Asian youths the most.

CLINICAL RELEVANCE

DFA is a common problem among Asian youths, and understanding its extent, nature, and triggers is central for effective interventions.

Psychometric evaluation of the Lebanese Arabic version of the Dental Fear Survey: a cross-sectional study

BACKGROUND

Dental fear is a prevalent problem that can lead to poor dental health. The Kleinknecht's Dental Fear Survey (DFS) is one of the used scales to assess dental fear. The present study aims to evaluate the psychometric properties of the Lebanese Arabic version of the DFS (DFS-A) and to determine the optimal cut-off to identify dental fear as well as the correlates of dental fear in a group of Lebanese adults dental patients.

METHODS

A cross-sectional study was conducted among a group of 442 dental patients (18-65 years) recruited at 29 dental clinics from March to June 2019. Patients completed a questionnaire including questions about demographic characteristics, previous bad dental experience, trauma's experience period, the sensation of nausea during dental treatment, the DFS-A scale, the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A), and a general question about dental fear.

RESULTS

DFS-A revealed evidence of adequate psychometric properties. DFS-A scale demonstrated high internal consistency (cronbach's alpha = 0.93). Test-retest reliability assessment demonstrated strong reproducibility of the DFS-A scale score (ICC = 0.92 with 95% CI (0.83-0.96), p value < 0.0001 (N = 30). Confirmatory factor analysis revealed a three-factor structure of the DFS-A reflecting fear associated with specific dental stimuli and procedures, patterns of dental avoidance and anticipatory anxiety, and physiologic arousal during dental treatment. A significant correlation was found between DFS-A and the MDAS-A indicating a good convergent validity. The optimal cut-off point to identify patients with and without dental fear is 41. Considering this cut-off score, the prevalence of dental fear in our sample was reported at 33.8%. Multivariable analysis showed that having previous scary and painful dental experiences, a sensation of nausea during treatment, and having dental anxiety were identified as predictors of dental fear.

CONCLUSION

The adapted Arabic version of the DFS (DFS-A) is a valid tool to evaluate dental fear among Lebanese adult patients.

Translation and validation of modified dental anxiety scale based on adult Taiwan population

Background

Dental anxiety is associated with negative experiences of dental treatment and dental-visiting behavior. The Modified Dental Anxiety Scale (MDAS) is widely used for assessing dental anxiety. The study aims to establish the psychometric properties of a Chinese version of the MDAS based on the Taiwan sample (i.e., T-MDAS).

Methods

The T-MDAS and dental-visiting behavior and experience were assessed for 402 adult subjects recruited from community and clinical sites. The following psychometric properties were assessed: (a) internal consistency, (b) temporal stability, (c) criterion-related validity (i.e., the association with the score of Index of Dental Anxiety and Fear, IDAF-4C), (d) discrimination validity (i.e., the difference in scores between the subjects with and without a habit of a regular dental visit, and (e) the construct validity from a confirmatory factor analysis (CFA). Results. The T-MDAS showed good internal consistency (Cronbach’s α = 0.88) and temporal stability (ρ = 0.69, p < 0.001). The score was significantly correlated with the score of the IDAF-4C (ρ = 0.76, p < 0.001) and differed between subjects who regularly visited a dentist or not, supporting good criterion-related validity and discrimination validity. Results from CFA supports good construct validity. Furthermore, higher dental anxiety was related to the lack of a regular dental visit, feeling pain during treatment, and feeling insufficient skills and empathy of dentists. A higher proportion of high-dental anxiety subjects in female subjects (8.5%), compared to male subjects (5.0%), was noted.

Conclusions

The T-MDAS is a valid tool for assessing adult dental anxiety. The score is highly associated with dental-visiting behavior and experience of dental patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-02017-w.

Translation and Validation of Italian Version of Index of Dental Anxiety and Fear (IDAF-4C+): A Cross-Sectional Study

Dental anxiety (DA) is defined as unreasonable apprehension toward dental procedures. About 4–20% of the worldwide adult population presents DA, with peaks of 30% in the younger population. Managing patients with dental anxiety and fear with a reliable and valid instrument is necessary to understand the multidimensional dimensions of dental fear. This work aimed to validate the Index of Dental Anxiety and Fear (IDAF-4C+) into Italian. Two hundred and eighty dental students attending an Italian university were enrolled. The IDAF-4C+ was translated by experts and a native English translator, blinded to the original version. The Modified Dental Anxiety Scale (MDAS) was used to assess the validity of IDAF-4C+. Spearman correlation coefficients and Exploratory Factorial Analysis (EFA) were used. Reliability was evaluated by Cronbach’s alpha. The reliability of the Italian version of IDAF-4C+ was good (Cronbach’s alpha = 0.88). Correlation between IDAF-4C+ and MDAS ranged between 0.42 to 0.68. From EFA, one factor explained 58.76% of the common variance. Women showed a higher level of dental fear. The Italian IDAF-4C+ is a valid and reliable tool to assess DA in any clinical context. This instrument allows for a proper understanding and management of DA, and therefore a better patient oral health-related quality of life and compliance with the dentist’s instructions.

Dentist-administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in primary dental care

The study aimed to test the effectiveness of cognitive behavioural therapy (CBT) administered by a general dental practitioner (GDP) in a general dental practice. In a two-arm parallel randomised controlled trial, the experimental group received a short dentist-administered CBT-intervention (D-CBT). A best-practice control group (FHM) received dental treatment during sedation with midazolam combined with an evidence-based communication model (The Four Habits Model). Ninety-six patients with self-reported dental anxiety were allocated to the treatment arms at a 1:1 ratio. Modified Dental Anxiety Scale (MDAS) scores spanned from 12 to 25, and 82 patients (85%) had a score of 19 or more, indicating severe dental anxiety. In both treatment arms, scores on MDAS and Index of Dental Anxiety and Fear (IDAF-4C) decreased significantly, but no differences were found between treatment arms. Mean reductions were: MDAS scores: -6.6 (SD = 0.5); IDAF-4C scores: -1.0 (SD = 1.1). In conclusion, local GDPs in general dental practices with proper competence have the ability for early detection of dental anxiety and, with the use of a manual-based D-CBT or FHM treatment, GDPs could offer efficient first-line treatment suitable for dental anxiety of varying severities.

Patients' multifaceted views of dental fear in a diagnostic interview

OBJECTIVES

The aim was to examine how patients describe and perceive their dental fear (DF) in diagnostic interviews.

MATERIAL AND METHODS

The sample consisted of dentally anxious patients according to the Modified Dental Anxiety Scale (MDAS), who had problems coping with conventional dental treatment. The voluntary participants (n = 7, aged 31-62 years) attended a diagnostic interview aiming to map their DF before dental treatment. The data were analysed by theory-driven qualitative content analysis. The themes consisted of the four components of DF: emotional, behavioural, cognitional, and physiological, derived from the Index of Dental Anxiety and Fear.

RESULTS

Within these four themes, treated as the main categories, 27 additional categories related to the patients' interpretations of DF were identified in three contexts: before, during and after dental treatment. 10 categories depicted difficult, uncontrollable, or ambivalent emotions; nine depicted behavioural patterns, strategies, or means; five depicted disturbing, strong, or long-lasting physiological reactions, including panic and anxiety symptoms. The remaining three categories related to cognitive components.

CONCLUSIONS

The results indicate that dental care professionals may gain comprehensive information about their patients' DF by means of four component-based diagnostic interviews. This helps them to better identify and encounter patients in need of fear-sensitive dental care.

TRIAL REGISTRATION NUMBER

NCT02919241.

Psychometric Assessment of the Urdu Version of the Index of Dental Anxiety and Fear

Background

The objective of the current study was to adapt the Index of Dental Anxiety and Fear (IDAF-4C) in the Urdu language and measure its validity and reliability.

Methods

Original English questionnaire of IDAF-4C was translated into Urdu language by a panel of dentists and language experts (Urdu and English) followed by critical evaluation, modification and back translation into English language. A final Urdu questionnaire was distributed among 250 patients visiting the Endodontics section at Margalla Institute of Health Sciences (MIHS), Rawalpindi, Pakistan. Cronbach’s alpha was used to determine the reliability of the Index whereas validity was assessed by exploratory factor analysis (EFA). Mean rank scores of IDAF-4C for male and female participants were evaluated using Mann-Whitney U tests (P < 0.05).

Results

Of 250 questionnaires, 209 were returned with a response rate of 84%. Cronbach’s alpha for the Urdu version of IDAF-4C was 0.88. Exploratory factor analysis of the IDAF-4C revealed one factor explaining 55.55% of the common variance (Eigenvalue = 4.5). The mean rank scores of all eight items of IDAF-4C were greater for female participants as compared to male participants with a statistically significant association (P < 0.05).

Conclusion

The psychometric analysis of the Urdu version of IDAF-4C showed good reliability and consistency compared to the original version as well as other translated versions.