Dental Anxiety Scores Research Articles

Oral health and oral treatment needs in patients fulfilling the DSM-IV criteria for dental phobia: Possible influence on the outcome of cognitive behavioral therapy

Objective. To describe oral health and oral treatment needs in a group of dental phobic patients (DSM-IV) and to explore possible relationships between these factors and changes in self-reported dental anxiety before and after phobia treatment. Material and Methods. Forty patients (25 women) fulfilling the DSM-IV criteria for specific phobia were included in the study. Mean age of the group was 34.9 years (range 19–60) and mean dental avoidance was 11.2 years (range 3–30 years). They were treated with cognitive behavioral therapy (CBT) during either one session (3 h) or five sessions (1 h each). Oral health was evaluated by orthopantomogram and clinical examination. The outcome of the CBT was measured by the change in dental anxiety scores (DAS, DFS) and in positive and negative thoughts during a standardized dental behavior test from pretreatment to 1-year follow-up. Results. Mean (SD) DMFT was 16.5 (5.8), range 3–26; DT was 6.6 (4.2). Mean number of teeth with dental treatment need (restorative, periodontal, extractions, etc.) was 9.6 (6.9), range 1–28. There were statistically significant correlations between number of decayed teeth and decrease in negative thoughts (r=−0.39, p=0.048) and maximum anxiety (r=−0.65, p=0.001). The total number of teeth with treatment need correlated with an increase in positive thoughts (r=0.60, p=0.001) and decrease in maximum anxiety (r=0.50, p=0.015). Conclusions. There are large variations in oral health and treatment needs among patients fulfilling the DSM-IV criteria for dental phobia. Patients with the best dental health and lowest treatment needs experience the largest increase in positive cognitions during exposure to dental treatment at 1-year follow-up.

Attitude toward Death: Does It Influence Dental Fear?

The possible influence of fear of death and attitude toward death were studied related to dental anxiety in Hungarian elementary and secondary school subjects (n = 277; 114 males, 163 females; age between 8 and 18 years). Dental fear and anxiety scores were DAS: 10.8 +/- 3.6; DFS: 40.6 +/- 15.6; STAI-S: 38.0 +/- 11.0; STAI-T: 40.3 +/- 10.0. Lester's Attitude Toward Death Scale scores were 6.3 +/- 1.3. Girls scored higher on DAS, STAI-S, and STAI-T scales (P < or = 0.05). Age influenced STAI-S, STAI-T, and Lester's Scale scores (P < or = 0.05). Lester's Scale scores influenced the expectations of the subjects about the dental fear of their surrounding people (parents, brother, sister, friends) (P < or = 0.05). A percentage of 7.22 of the subjects indicated a rather strong connection between dental fear and fear of death. These subjects had significantly higher dental fear and anxiety scores as compared to others (P < or = 0.01). Death-related content was found in 4.3% of drawings and in 10.5% of free associations (couplings) related to teeth (in 12.6% either in drawings or in couplings). The appearance of death-related content was higher with higher age, and higher expected dental fear of surrounding people (P < or = 0.01). Our data indicate a detectable influence of fear of death on dental fear, especially in subjects with higher dental fear scores.

Atraumatic Restorative Treatment and Dental Anxiety in Outpatients Attending Public Oral Health Clinics in South Africa

This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios. The test group of dental operators (n = 9) was trained in ART The control group (n = 11) was not, and did not apply ART The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t-test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios. The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups. The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios.

Prevalence of Dental Anxiety among 5- to 8-Year-Old Taiwanese Children

Many people experience discomfort to a greater or lesser degree about the prospect of dental treatment. Dental treatment can be a terrible experience, especially for children with dental anxiety. This study estimated the prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City, Taiwan. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was translated into Chinese, and a receiver operating characteristic (ROC) curve was made based on criteria determined from pretest clinical observations of a sample population to set a cutoff score. Then, the parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5- to 8-year-old children at kindergartens and elementary schools in Kaohsiung City, Taiwan. Participants were selected by stratified random sampling. The stratification was done by geographic district, age group, and sex. A total of 3,597 valid questionnaires were collected. The Chinese version of the CFSS-DS had an optimal cutoff score of 38/39 (sensitivity was 0.857, specificity was 0.882) with an area under the ROC curve of 0.912. The estimated prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City was 20.6 percent. The dental anxiety score was found to decrease as age increased; primary school boys had significantly lower scores. The prevalence of dental anxiety was found to be high for 5- to 8-year-old Taiwanese children. The study's findings point to the urgent need for preventive health education and intervention programs in Taiwan to promote children's oral health and reduce dental anxiety.

Self‐Assessed Dental Status, Oral Behavior, DMF, and Dental Anxiety

The purpose of this study was to evaluate the relation between self-assessed dental status, oral behavior, dental anxiety, and DMF scores. The study was conducted among young army personnel (eighteen to twenty-one years old) who arrived at a single military dental clinic for dental screening. A questionnaire was used to collect the data anonymously. The questionnaire included self-assessment of dental status and behavior, as well as the Dental Anxiety Scale (DAS). Dental caries status was evaluated using the World Health Organization (WHO) caries diagnostic criteria for decayed, missing, and filled teeth (DMFT). A total of 393 young adults were examined (98.3 percent response rate). Approximately one-third brushed their teeth once a day or not at all. Of the participants, 10.7 percent assessed their dental status as "Poor" and 46.3 percent as "Fair." Furthermore, 25.5 percent assessed their dental treatment needs as high. The average DAS score was 7.14. The average DMF score was 6.2. There was a correlation between self-reported tooth status, participants' assessment of their dental treatment needs, and DMF score (p<0.0001). Anxious participants assessed their dental treatment needs as higher (p=0.05). The dental practitioner could ask patients to assess their dental status prior to treatment or appointment. These findings will help the practitioner to accomplish more effective time and patient management.

Factors influencing the use of behavioral management techniques during child management by dentists.

Dental anxiety develops from a vicious cycle of bodily arousal from dental stimuli, cognitive interpretation and ineffective coping all working in a runaway feedback loop. Behavioral management strategies (BMT) aim at cognitive reorientation, which results in better compliance with instruction. This paper therefore tried to find out possible factors that influence the effective use of BMT during child dental management during treatment by dental operators in Nigeria. The levels of anxiety pre and post treatment were assessed using the short form of the dental version of the Child Fear Survey Schedule. Also, the type of treatment given to the child, the types and number of behavioral strategies employed during dental management as well as the gender and age of the child were noted. The professional status of the attending dental operator was also noted. Prior to the commencement of the study, the five students in the final year, who were to attend to the children in this study received one week training on the psychological management of dental anxiety in children. Results obtained from the dental operators were compared. The type of treatment received by the child did not significantly affect the dental anxiety score. The number of techniques combined by house officers and senior registrars were significantly higher than would be expected by chance (chi2=16.030, P=0.0001 and chi2=9.000, P=0.0001 respectively). Combination of techniques was also more frequent during invasive procedures and when dental anxiety levels were high. Combining techniques also tended to decrease dental anxiety more significantly than otherwise. Training has a role to play in the basic and efficient use in the management of the child dental patient. The training of dentists should thus entail the full spectrum (content and instructional effectiveness) of all psychological techniques.

Fear of dental care: Are we making any progress?

Dental anxiety has been a well-studied phenomenon since the late 1960s. The purpose of this literature review was to compare self-reported levels of dental anxiety during the past 50 years. The authors reviewed more than 200 articles and examined 19 studies involving more than 10,000 adults to assess any trends in dental anxiety. They investigated mean anxiety scores for college students and general adult samples using four measures of dental anxiety. Comparisons were made across publication year and location of study. Analyses of variance suggest stability in dental anxiety scores over time and region within both types of study samples. Regardless of assessment length (single item or multi-item), the authors found no significant trends suggesting an increase or decrease in self-reported anxiety levels. These results suggest that despite an increase in general anxiety within the United States during the past 50 years, dental anxiety seems to have remained stable throughout the period. The authors discuss the stable trend of self-reported dental anxiety levels in the context of increasing general anxiety in the United States and the current structure of individual dental practices.

General self-efficacy, dental anxiety and multiple fears among 20-year-olds in Norway.

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.

The effect of psychological management on dental anxiety in children.

The aim of this study was to determine the effect of using of psychological management techniques on the level of anxiety in Nigerian children during dental management. The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending a suburban dental clinic for the first time. This schedule was re-administered again two weeks later when they came for a follow up visit. The age of the patients was recorded. The types as well as number of psychological techniques employed during treatment were also noted. The overall mean dental anxiety level of the children decrease from an average of 15.23 +/- 5.03 before treatment to 13.40 + 4.13 after treatment (p < 0.001). However, the mean dental anxiety score in children in whom no psychological technique was employed during treatment increased after treatment. On the other hand, there was also a statistically significant decrease in the mean dental anxiety level of children treated using either a single psychological technique or combined psychological techniques after treatment. Better results were obtained when combined psychological techniques where used than when only a single technique was used. It was concluded that psychological techniques used in the management of dental anxiety in children are highly effective in decreasing dental anxiety levels. Better results are obtained when a number of techniques are combined effectively.

The effect of sociodemographic factors on dental anxiety in children seen in a suburban Nigerian hospital.

This paper attempts to determine the sociodemographic factors that relate to dental anxiety in suburban African children. A short form of the Dental subscale of the Child Fear Survey schedule (DFSS_SF) was administered to 81 patients (first time attendees at the clinic) between the ages of eight and 13 years. The psychometric scale was used after determining its reliability and validity to ensure that it was culturally appropriate. Age, gender, sociodemographic status were also recorded. The dental anxiety score distribution, its threshold level as well as the relationship between the sociodemographic variables and patients' anxiety were determined. There was no statistically significant association between age (P = 0.856), gender (P = 0.124), socio-economic status of the children (P= 0.12) and level of dental anxiety. However, a statistically significant relationship did exist between the type of school the child attended and the anxiety level (P = 0.009). Also, 18 (14.8%) of the children were found to have high anxiety levels. Further studies involving larger non-clinic samples are needed to examine the issues raised by the findings of this study.

Trauma-related sequelae in individuals with a high level of dental anxiety. Does this interfere with treatment outcome?

This study assessed trauma-related sequelae of 56 highly anxious patients attending a dental fear clinic. It was also examined whether such symptomatology interferes with anxiety reduction in response to a cognitive-behavioral treatment approach. About 34 patients (59%) indicated that they had experienced one or more aversive dental events that could explain the onset of their dental anxiety. There was no difference between the dental anxiety scores of patients who reported such a background and those who did not. Severity of trauma-related symptomatology was indexed by the Impact of Event Scale (IES). The mean IES score of patients with a traumatically induced dental fear was remarkably high (33.0; SD=19.7). Furthermore, there was a strong direct relationship between severity of trauma-related symptomatology and severity of dental anxiety (shared variance was 38%). Two patients (10%) met all DSM-IV diagnostic criteria for Posttraumatic Stress Disorder (PTSD) on the basis of the Self-Rating Scale for PTSD. However, no evidence was found to suggest that either a traumatic background, or level of trauma-related symptomatology, has a negative effect on treatment outcome.

Factors affecting dental attendance following treatment for dental anxiety in primary dental care.

To explore factors affecting patients' dental attendance behaviour following referral from a dental anxiety clinic to a general dental practitioner. A four-year follow up of patients who completed a course of treatment for dental anxiety by conducting semi-structured interviews, face-to-face or by telephone, with confirmation of dental attendance from the dental records. Forty-one patients who had completed a course of treatment for dental anxiety, in a specially designed community clinic. Mean time since last dental visit before treatment was 7.8 years (range 0.5-29). Twenty-three patients were successfully followed up and 11 (47%) were receiving regular asymptomatic dental care. The dental anxiety scores of those who subsequently became asymptomatic attenders were significantly lower at follow-up than the patients who became symptomatic attenders (P = 0.01). Effective dentist-patient communication was a common theme of the interviews. At four-year follow-up, dental anxiety was substantially lower in those who subsequently became asymptomatic attenders than those who became symptomatic attenders. A positive dentist-patient relationship had developed with the asymptomatic attenders.

Dental anxiety among Israeli dental students: a 4-year longitudinal study.

The aims of the present study were (a) to evaluate students' estimation of their parents' dental anxiety; (b) to measure students' dental anxiety and to study their ranking of the most fear provoking stimuli in the dental situation during their pre-clinical and clinical years; (c) to investigate gender differences among students with regard to dental anxiety. 30 3rd-year students (15 male and 15 female) who completed a 4-section questionnaire which requested sociodemographic information, evaluation of parents' dental anxiety, dental anxiety scale (DAS) and dental fear scale (DFS), completed the DAS and DFS in their 5th and 6th years. Both male and female students estimated their mothers' dental anxiety as significantly higher than their fathers'. Female students ranked their parents higher than males. DAS scores were significantly higher among female students than among males in the 3rd year. However, DAS scores were reduced from the 3rd to the 6th year among the total class and significantly among females, while males' levels of anxiety remained within close range throughout the years. The dental anxiety scores of all students who experienced a dental procedure in the past were higher than the scores of the students who did not. The most fearful stimulus was 'feeling the needle'. Our findings may suggest that the change in the reported dental anxiety of the students during the years of dental studies in the present study may be explained by the increased professional education and clinical experience that the students acquire throughout their studies in the dental school. Being exposed to basic trivial dental procedures (such as local anaesthetic injection) may help students either to be habituated or to use rational coping strategies when dealing with personal dental experience.

Changes in self-reported dental anxiety in New Zealand adolescents from ages 15 to 18 years.

Little is understood of the natural history of dental anxiety. The aim of this study was to examine three-year changes in self-reported dental anxiety among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated at ages 15 and 18 by means of the Corah Dental Anxiety Scale (DAS). A DAS score of 13+ defined high dental anxiety. Participants were assigned to one of four dental-anxiety study groups (Chronic, Incident, Remitted, or Never) on the basis of changes in reported level of anxiety from ages 15 to 18. Results are reported for the 691 participants who completed the DAS at both ages. The sample's overall dental anxiety score decreased significantly from age 15 (mean, 8.79) to 18 (8.52) (paired t test, t = 2.37; P < 0.05). The Chronic and Never groups had small negative DAS increments, the Incident group showed a substantial positive increment, and the Remitted group recorded an even larger negative increment. Multivariate analysis showed that the DAS score at age 15 was the sole predictor of the change in DAS score for the Chronic and Remitted groups, and was a co-predictor for the Incident and Never groups. An episodic dental visiting pattern was a strong predictor of a positive change in DAS score for the Incident group; and for the Never group, a higher DMFS score at age 15 predicted a positive change in DAS score at 18, but being female was predictive of a decrement. This study indicates lower stability of dental anxiety in late adolescence than has been reported from other age groups.

Dental anxiety in Danish and Chinese adults—A cross-cultural perspective

The aim of this study was to correlate dental anxiety as reported by two different ethnic groups with socio-demographic factors, dental status, and dental behaviour. Two randomly selected populations aged 35-44 years and 65-74 years were interviewed. The populations comprised 214 and 99 Danes and 384 and 497 Hong Kong Chinese respectively. Dental anxiety was assessed by the Corah Dental Anxiety Score (DAS). Mean DAS scores were significantly higher in Chinese than in Danes (8.7-10.3 and 6.7-8.2, respectively) and higher in the younger than in the older groups. Moderate to phobic dental anxiety was reported by 15% of the Danes and 30% of the Chinese, the latter proportion far beyond what is usually reported in Western populations. Only in the Chinese group did women report more anxiety than men. Regression analysis indicated that only a few of the variables selected to explain anxiety determinants had significant explanatory value. Among Chinese, gender was the most predominant in both age groups followed by perceived condition of teeth in the younger age group. Among Danes, perceived condition of teeth had an explanatory value for both age groups and dental visit pattern was the strongest for the younger age group. In spite of statistical significance, all explanatory values were small and indicate that variables not included in this analysis may exert a greater influence on the variation in dental anxiety. DAS, seemingly, was able to highlight variations in dental anxiety in the populations in spite of their differences and made interpretations feasible with regard to contrasting dental care behaviour and dental status.(ABSTRACT TRUNCATED AT 250 WORDS)

Attendance pattern of anxiety‐treated dental patients: a pilot study

Ex-patients of a dental fear clinic were found to have significantly reduced, yet still high, dental anxiety scores in comparison with the pre-intervention scores. In spite of the intervention about one quarter of the ex-patients did not visit a dentist regularly. A positive relationship was found between dental anxiety, measured with Corah's DAS, and "dislike of drilling". A short duration of (self-reported) psychophysiologic anxiety reactions appeared to be associated with the intention to ask for treatment, e.g. if a cavity were present. However, regular dental attendance was not correlated with dental anxiety scores.

Dental fear and anxiety in an older adult population

A random sample of 580 people aged between 50 and 89 yr completed a questionnaire containing two measures of dental fear and anxiety. One of these was Corah's Dental Anxiety Scale (DAS) and the other a scale derived from the Structured Interview for Assessing Dental Fear (SIADF). The mean score on the DAS was 7.8, and 8.4% of subjects were classified as dentally anxious. There were no differences in mean DAS scores by sex but significant differences by age, with younger individuals having higher scores (P less than 0.0001). The edentulous had significantly higher scores than the dentate (P less than 0.001). Scores on the SIADF scale were higher among younger individuals (P less than 0.0001), the edentulous (P less than 0.01) and women (P less than 0.05). Older adults who were dentally anxious were less likely to report a regular source of dental care and a dental visit in the previous year and more likely to report having avoided or delayed dental treatment. Possible explanations of higher dental anxiety scores among younger persons and the edentulous are reviewed.

Correlates of dental anxiety in a university population.

The purpose of this study was to identify correlates of dental anxiety in university students. Dental anxiety was measured by means of the Corah Dental Anxiety Scale. Information about the students' dental attitudes, perceptions, and past dental experiences was collected by a written questionnaire administered to an approximately 13 percent random sample of all full-time students. The response rate was 27.3 percent (n = 846). The mean dental anxiety score for the entire study group was 8.77; mean scores for men (8.44) and women (9.10) were significantly different. Of the 18 independent variables studied, seven were found to be significantly associated with dental anxiety scores: sex, frequency of childhood visits to the dentist, childhood experience with dentists, frequency of mothers' visits to a dentist, perceived number of types of services required, symptoms as reason for last dental visit, and number of preventive actions taken prior day. As a group, the independent variables explained 22.8 percent of the observed variation in dental anxiety scores. When the amount of variation which was explained by each of the independent variables was considered separately four variables were found to be significant: childhood experience with dentists, gender, attitudes toward dentists, and number of preventive actions taken the prior day. Further studies are required to identify additional antecedents of dental anxiety in university students. These studies should focus on the ability of the antecedents to explain observed variation in anxiety levels.