Home Current issue Instructions
About us Archives Login 
Editorial board Search articles Contact us
Home Print this page Email this page Users Online: 197

 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 2  |  Issue : 3  |  Page : 270-273

Dental anxiety: Prevalence and associated factors


1 College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
2 College of Dentistry, University of Sharjah, Sharjah, United Arab Emirates

Date of Web Publication5-Aug-2013

Correspondence Address:
Sana Hawamdeh
College of Health Sciences, University of Sharjah, Sharjah - 27272
United Arab Emirates
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9626.116022

Rights and Permissions
  Abstract 

Objectives: This study aimed to estimate the prevalence of dental anxiety and examine the socio-demographic associations of dental anxiety among a representative sample of UAE college populations. Materials and Methods: Four hundred and thirteen college students of Sharjah University in the UAE completed Modified Corah's Dental Anxiety Scale (MDAS) (47% males and 53% females). The survey also included questions in a yes/no format with which respondents rated attributions for their anxiety. Results: Prevalence of dental anxiety (MDAS score of 13 or more) was 36%, with overall severity represented by a mean score of 11.52 (SD: 4.88). Students who visited their dentist more than two years ago had significantly higher MDAS scores compared with those who visited their dentist less than two years ago (t-test, P=0.02). Compared with female students, a significantly higher proportion of males indicated that their last visit to the dentist was more than two years ago (17% vs. 30%, respectively, χ2 -test, P=0.002). In addition, more than half of the students (55%) perceived a need for a checkup and 54% indicated that they visited the dentist because of problems with their teeth. Conclusions: The findings of this study indicate that although dental anxiety was not associated with gender and frequency of dental visits, feeling of lack of control and pain anticipation were strong predictors of anxiety. These results highlight the important role that dental healthcare providers could play in counseling anxious patients to reduce the impact of these factors on seeking dental care.

Keywords: Anxiety, dental anxiety, university students, United Arab Emirates


How to cite this article:
Hawamdeh S, Awad M. Dental anxiety: Prevalence and associated factors. Eur J Gen Dent 2013;2:270-3

How to cite this URL:
Hawamdeh S, Awad M. Dental anxiety: Prevalence and associated factors. Eur J Gen Dent [serial online] 2013 [cited 2019 Jul 20];2:270-3. Available from: http://www.ejgd.org/text.asp?2013/2/3/270/116022


  Introduction Top


The utilization of any implemented healthcare program done effectively on a large extent is based on the ability of the population targeted in order to reach provided services with minimal restricting factors. However, in dentistry, there have been several reports showing dental anxiety is an important limiting factor that interferes or rather prevents the effective utilization of the services available. [1],[2],[3] For many patients, fear and anxiety is a real problem that can become a barrier to treatment in the long run. Moreover, there are some patients who avoid dentists altogether because of their extreme fears, [4],[5] even in cases of emergency such as toothache. [4] In addition, dentists may also become anxious when dealing with anxious patients, leading to management difficulties, which may cause the treatment time to prolong. The most common origins of dental anxiety happen to be a previously painful or negative experience during visits to a dentist. A patient's anxiety also poses major management problems for the dental team as more treatment time will be required for an anxious patient and is very likely to miss appointments.

In the UAE, health programs are provided through governmental and private institutions to the general population. Most importantly, it is dental services that are important components of such programs. Effective utilization of the services offered may have a great impact on the dental status of the individuals served. Dental anxiety has clearly shown to be associated with avoidance of regular dental care. [6],[7] Since there is evidence of adverse dental health, consequences of such avoidance means that estimation of the prevalence and severity of dental anxiety has become of great importance to the public health in the UAE. [8] A review of the literature indicated lack of information about the prevalence of dental anxiety among people in the Emirates. Moreover, recent evidence further highlight the need for more information on dental anxiety due to the substantial intercultural differences and the prevalence of dental anxiety. [9] The aims of the current study were to determine the prevalence of dental anxiety and to explore some possible etiologic factors in a sample of university students in UAE.


  Materials and Methods Top


Four hundred and thirteen male and female (195 males, 218 females) undergraduate college students at University of Sharjah were invited to participate in the study. All students were between the ages of 18 and 25 and the majority of the respondents were non-national Arabs (62%). Most participants indicated that their last visit to the dentist was less than 2 years ago and 58% indicated that the reason for visit was dental problems [Table 1].
Table 1: Frequency distribution of demographic and variables related to dentist visit

Click here to view


Dental anxiety was measured by Modified Corah's Dental Anxiety Scale (MDAS). [8] MDAS consists of five questions each of which has five scores, ranging from 'not anxious' to 'extremely anxious,' in ascending order from 1 to 5. Each question thus carries a possible maximum score of 5, with a total possible maximum score of 25 and a minimum score of 5 on the entire scale. A score of 13 or above is considered a case of dental anxiety. [8] This answering scheme is a simplified rating system in comparison with Corah's Dental Scale that was an early four-question measure of dental anxiety. MDAS includes an extra item about the respondent's anxiety to a local anesthetic injection, which is a major focus of anxiety for many. MDAS has been found to be reliable and valid in several samples from UK, Scotland, Wales, Ireland, Finland, Dubai, Brazil and Turkey. [5],[6],[7],[8],[9],[10],[11],[12] The survey also included questions in a yes/no format on which the respondents rated their attributions for their anxiety (such as anticipated pain, feeling out of control, unpleasant stories heard from others and negative experiences such as gagging). The study received ethical approval from the Ethics and Research Committee of University of Sharjah.

Descriptive statistics were used to assess the frequencies of responses to the questionnaire items. Independent t-test was used to compare MDAS scores by gender. In addition, multivariate logistic regression was used to assess the association between anxiety level (MDAS score >13 'anxious' vs. MDAS score <13 'not anxious') and participants' characteristics, anticipated pain, feeling out of control, unpleasant stories and afraid of chocking.


  Results Top


The prevalence of dental anxiety (MDAS score of 13 or more) in the sample was 36%, with overall severity represented by a mean score of 11.52 (SD: 4.88). Students who visited their dentist more than 2 years ago had significantly higher MDAS scores compared with those who visited their dentist less than 2 years ago (t-test, P = 0.02). Compared with female students, a significantly higher proportion of males indicated that their last visit to the dentist was more than 2 years ago (17% vs. 30%, respectively, χ2 -test, P = 0.002) [Table 2].
Table 2: Dental anxiety by gender, perceived need for dental checkup and contact with dental services

Click here to view


As shown in [Table 3], participants' responses on the five-item MDAS indicated that there were no significant sex differences and that the highest MDAS scores for both males and females were for local injection anxiety (mean = 2.85 (SD: 1.47) and 2.98 (SD: 1.35), respectively).
Table 3: Mean and SDs for responses to MDAS by sex

Click here to view


Multivariate logistic regression analysis [Table 4] revealed that respondents who indicated their cause of anxiety was to be anticipated pain were 2.89 times more likely (95% confidence interval: 1.81, 4.63, P = 0.00) to be anxious about dental visits compared with the other participants. In addition, the odds of being anxious was 3.34 time higher (95% confidence interval: 1.55, 7.22, P = 0.002) among participants who indicated that feeling out of control was their reason for anxiety than among those who did not. Although fear of chocking and hearing unpleasant stories did not reach statistical significance, there was a tendency for these two factors to be associated with dental anxiety levels (afraid of chocking: odds ratio = 2.03, 95% confidence interval: 0.99, 4.16, P = 0.05, and unpleasant stories: odds ratio = 1.97, 95% confidence interval: 0.96, 4.02, P = 0.06). Gender and time since last visit were not significant predictors of dental anxiety level.
Table 4: Logistic regression analysis for the association between dental anxiety, and reasons for anxiety and other participants' characteristics

Click here to view



  Discussion Top


The results clearly indicate that prevalence of dental anxiety, expressed by a mean MDAS score of 11.52, is in the lower reference range compared with those reported in other parts of the world. [11] These results could be attributed to the selected sample of university students. Similar results [13],[14],[15] were also reported by other researchers in which higher levels of education were associated with decline in anxiety levels. After much observation, the highest level of dental anxiety was shown among housewives and school students compared with those self-employed and professionals. [13] This finding may relate to the lack of independence and feeling of insecurity among these groups.

Noteworthy in this study is that the majority of the respondents had visited a dental clinical before. This finding may reflect the near-total literacy along with excellent penetration of dental care in the study area.

In addition, there is an enormous variation in prevalence estimates due to use of different instruments. This must be taken into account when assessing whether differences among populations are actual or operational in origin.

Consistent with previous findings by Thomson et al., [15] and Berggren and Carlsson, [7] our findings indicate that dental anxiety was not significantly different between females and males. However, unlike results obtained by others, [16],[17],[18],[19] ratings of dental anxiety were higher in females than males. Intercultural study findings indicate that the level of anxiety in females is more likely to have a constant value, whereas males provided a wide range of different responses in terms of their level of anxiety based on their cultural background. [20],[21] Cultural differences of the subjects may explain the findings.

Furthermore, Schuurs and Hoogstraten [13] suggested that the higher dental anxiety score of women in their study did not necessarily mean that women are more anxious than men, but that they express anxiety more readily than men do. In this study, it may be that both genders are likely to self-report and men were able to express their fears as openly as women. The levels of anxiety were higher in the needle injection situation. This result confirms the results of other studies that determined that the needle is still one of the main stimuli that invokes fear in connection with dental treatment. [18],[21],[22]

Anxious students attributed their nervousness mainly to anticipated pain and feeling out of control. Anticipation of pain during dental treatment and fear of the unknown or feeling of loss of control were frequently reported reasons for fear and dental anxiety. [10],[16],[17],[18],[23],[24] Replication of such a finding in this study underscores the need for well-trained supporting staff able to identify anxious patients. Furthermore, a patient can be reassured that everything will be done to make the procedure as pain-free as possible to the best of the clinician's ability, if the anxious patient thinks that the procedure is going to be painful. In addition, anxious clients who feel out of control can be reassured that the procedure is entitled to be stopped at any time.

Understanding the extent and reasons of dental anxiety in this population is important, as it relates to poor oral health. Accordingly, assessment of the level of patient anxiety could provide important information regarding patients' attitude toward different dental procedures. [25] Provision of suitable intervention could minimize adverse dental outcomes that may occur as a result of dental fear or anxiety.

Furthermore, the findings of this study and those in other countries [13],[19],[25],[26] underscore the importance of training dentists in the management of dental anxiety, which could reduce the difficulties of delivering successful treatment.

A limitation of this study is that all participants were university students, which could affect the generalizability of the findings for the entire UAE population. In addition, as participants' responses required recall of past dental experience from memory, the possibility of various biases cannot be ruled out, such as diminished or exaggerated traumatic events, and hence caution is required in interpreting these results.

In conclusion, the findings of this study indicate that although dental anxiety was not associated with gender and frequency of dental visits, feeling of lack of control and pain anticipation were strong predictors of anxiety. These results highlight the important role that dental healthcare providers could play in counseling anxious patients to reduce the impact of these factors on seeking dental care.


  Acknowledgment Top


The authors would like to acknowledge University of Sharjah for providing full funding for the study (grant # 060502).The authors would also like to thank the study participants.

 
  References Top

1.Okoro CA, Strine TW, Eke PI, Dhingra SS, Balluz LS. The association between depression and anxiety and use of oral health services and tooth loss. Community Dent Oral Epidemiol 2012;40:134-44.  Back to cited text no. 1
[PUBMED]    
2.Seckman CH. Dental anxiety: Maintaining control of problem patients. RDH 2011;31:24-30.  Back to cited text no. 2
    
3.Woodmansey KF. The prevalence of dental anxiety in patients of a university dental clinic. J Am Coll Health 2005;54:59-61.  Back to cited text no. 3
[PUBMED]    
4.Milgrom P, Weinstein P, Getz T (1995). Treating Fearful Dental Patients: A Patient Management Handbook (2 nd ed.). Seattle, Wash.: University of Washington, Continuing Dental Education. doi: 10.1111/j. 1600-0528.1996.tb00893.x  Back to cited text no. 4
    
5.Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: Exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 2007;7:1.  Back to cited text no. 5
[PUBMED]    
6.Locker D. Psychosocial consequences of dental fear and anxiety. Community Dent Oral Epidemiol 2003;31:144-51.  Back to cited text no. 6
[PUBMED]    
7.Berggren U, Carlsson SG. Psychometric measures of dental fear. Community Dent Oral Epidemiol 1984;12:319-24.  Back to cited text no. 7
[PUBMED]    
8.Humphris GM, Freeman R, Campbell J, Tuutti H, D'Souza V. Further evidence for the reliability and validity of the modified dental anxiety scale. Int Dent J 2000;50:367-70.  Back to cited text no. 8
[PUBMED]    
9.Acharya S. Factors affecting dental anxiety and beliefs in an Indian population. J Oral Rehabil 2008;35:259-67.  Back to cited text no. 9
[PUBMED]    
10.Humphris GM, Morrison T, Lindsay SJ. The modified dental anxiety scale: Validation and United Kingdom norms. Community Dent Health 1995;12:143-50.  Back to cited text no. 10
[PUBMED]    
11.Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health 2009;26:9-20.  Back to cited text no. 11
    
12.Tunc EP, Firat D, Onur OD, Sar V. Reliability and validity of the Modified Dental Anxiety Scale (MDAS) in a Turkish population. Community Dent Oral Epidemiol 2005;33:357-62.  Back to cited text no. 12
[PUBMED]    
13.Schuurs AH, Hoogstraten J. Appraisal of dental anxiety and fear questionnaires: A review. Community Dent Oral Epidemiol 1993;21:329-39.  Back to cited text no. 13
[PUBMED]    
14.Newton JT, Buck DJ. Anxiety and pain measures in dentistry: A guide to their quality and application. J Am Dent Assoc 2000;131:1449-57.  Back to cited text no. 14
[PUBMED]    
15.Kanegane K, Penha SS, Borsatti MA, Rocha RG. Dental anxiety in an emergency dental service. Rev Saúde Pública 2003;37:786-92.  Back to cited text no. 15
    
16.Arslan S, Ertaº ET, Ülker M. The relationship between dental fear and sociodemographic variables. Erciyes Med J 2011;33:295-300.  Back to cited text no. 16
    
17.Ray J, Boman UW, Bodin L, Berggren U, Lichtenstein P, Broberg AG. Heritability of dental fear. J Dent Res 2010;89:297-301.  Back to cited text no. 17
    
18.Oosterink FM, de Jongh A, Aartman IH. What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci 2008;116:44-51.  Back to cited text no. 18
    
19.Abrahamsson KH, Berggren U, Hakeberg M, Carlsson SG. The importance of dental beliefs for the outcome of dental-fear treatment. Eur J Oral Sci 2003;111:99-105.  Back to cited text no. 19
    
20.Fuks AB, Steinbock N, Zadik D. The influence of social and ethnic factors on dental care habits and dental anxiety: A study in Israel. Int J Paediatr Dent 1993;3:3-7.  Back to cited text no. 20
    
21.Schwarz E, Birn H. Dental anxiety in Danish and Chinese adults-A cross cultural perspective. Soc Sci Med 1995;41:123-30.  Back to cited text no. 21
    
22.Edmunds R, Buchanan H. Cognitive vulnerability and the aetiology and maintenance of dental anxiety. Community Dent Oral Epidemiol 2012;40:17-25.  Back to cited text no. 22
    
23.Peretz B, Mersel A. Non institutionalized elderly dental patients in Israel: Socio-demographics, health concerns and dental anxiety. Spec Care Dentist 2000;20:61-5.  Back to cited text no. 23
    
24.Singhal V. Pain control: Keep exploring resources that will reduce anxiety and pain. RDH. 2011;31:78-87.  Back to cited text no. 24
    
25.Al Omari WM, Al Omiri MK. Dental anxiety among university students and its correlation with their field of study. J Appl Oral Sci 2009;17:199-203.  Back to cited text no. 25
    
26.Thomson WM, Locker D, Poulton R. Incidence of dental anxiety in young adults in relation to dental treatment experience. Community Dent Oral Epidemiol 2000;28:289-94.  Back to cited text no. 26
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Prevalence of and factors associated with dental anxiety among medical and dental students of the Northern State Medical University, Arkhangelsk, North-West Russia
Sergei N. Drachev,Tormod Brenn,Tordis A. Trovik
International Journal of Circumpolar Health. 2018; 77(1): 1454786
[Pubmed] | [DOI]
2 Prevention and Optimal Management of Peri-Surgical Pain in Dentistry
Tara Renton
Dental Update. 2018; 45(10): 935
[Pubmed] | [DOI]
3 Dental anxiety in children aged 6-15 years
Ljiljana Markovic-Đuric,Anita Kos-Dragicevic,Marina Bektaševic
Scripta Medica. 2015; 46(1): 7
[Pubmed] | [DOI]
4 Changes induced by music therapy to physiologic parameters in patients with dental anxiety
Cynthia Mejía-Rubalcava,Jorge Alanís-Tavira,Hugo Mendieta-Zerón,Leonor Sánchez-Pérez
Complementary Therapies in Clinical Practice. 2015; 21(4): 282
[Pubmed] | [DOI]
5 An evaluation of the sociodemographic determinants of dental anxiety in patients scheduled for intra-alveolar extraction
Peter E. Egbor,Osagie Akpata
Libyan Journal of Medicine. 2014; 9(1): 25433
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Acknowledgment
References
Article Tables

 Article Access Statistics
    Viewed3042    
    Printed112    
    Emailed2    
    PDF Downloaded662    
    Comments [Add]    
    Cited by others 5    

Recommend this journal