Abstract
BackgroundA vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM.Methods1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety.ResultsBased on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14–1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09–1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status.ConclusionsClarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.
Highlights
A vicious cycle exists between dental anxiety, oral health behaviors and oral health status
A 3-year cohort study has demonstrated the role of Decayed Missing Filled Teeth (DMFT) scores in the development of dental anxiety, which brings an idea to the mechanism of the vicious cycle [4]
The objectives of the study were (a) to identify psychological factors contributing to oral health and dental anxiety based on the Health Belief Model (HBM) and (b) to explore the direct and indirect associations of the HBM factors on oral health and dental anxiety via oral health behaviors among Hong Kong adolescents
Summary
A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Little is known about the relationship between HBM factors and dental anxiety of adolescents The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM. A vicious cycle of dental anxiety, oral health behavior and oral health status has been hypothesized [1]. Multifaceted socio-economical and psychosocial aspects are involved in the onset of dental anxiety [1] Psychological factors such as personality traits or attachment patterns are important in the development and persistence of dental anxiety [5, 6]. Signs of depression and anxiety in adolescents [6], as well as higher psychological distress [8], are highly correlated to dental anxiety
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