Dental fear among children and adolescents in a multicultural population--a cross-sectional study.

The aim of this study was to explore dental fear in a multicultural population of child and adolescent dental patients, with background, gender, age, and socioeconomic status taken into account. A specific aim was to investigate whether the level of DF differed between patients with a non- Swedish background and patients with a Swedish background. In conjunction with a routine visit to the dental clinic, 301 patients (8-19 years old) assessed their dental fear on the Children's Fear Survey Schedule - Dental Subscale, using self-ratings. Following an interview protocol, patients' and their parents' country of birth, and parents' education and occupation/employment were registered. An interpreter was present when needed. Self-rated dental fear was almost equal among patients coming from a non-Swedish background and patients with a Swedish background. Girls scored higher than boys and younger children scored slightly higher compared to older children, but the pattern of dental fear variation was inconsistent. Socioeconomic status differed between the groups with a non-Swedish vs. a Swedish background, but no impact on dental fear was revealed. When children and adolescents with a non-Swedish vs. a Swedish background were modelled separately, female gender and younger age had an impact on dental fear only in the group with a Swedish background. No differences in dental fear were found between children and adolescents from non-Swedish vs. Swedish backgrounds. Dental fear variations according to gender and age were more pronounced in the group with a Swedish background compared to the group with a non-Swedish background. No impact of socioeconomic status could be revealed.

Planning predicts dental service attendance and the effect is moderated by dental anxiety and educational status: findings from a one-year prospective study.

BACKGROUND: The aim of this study was to investigate whether planning a dental appointment is a predictor of actual dental visits over a one-year period when controlling for past attendance, demographic factors, and dental health beliefs. In addition, the planning-attendance association was explored to determine whether dental anxiety and educational status moderated this relationship. METHODS: A total of N = 1,422 adults with a mean age of M = 44.4 (SD = 11.0) years and resident in Iran participated in a prospective study over a one-year period. The primary outcome was self-reported dental appointment attendance at one-year follow-up, which was validated using clinical records. Action planning, coping planning, health beliefs, age, dental insurance, income, dental health status, dental anxiety, and years of education were assessed at baseline by self-report questionnaire. Data were analysed using multivariate logistic regression. RESULTS: Action planning and coping planning were significantly associated with dental appointment attendance at one-year follow-up. Planning a dental appointment was more predictive of dental appointment attendance for people with higher levels of education and lower dental anxiety. CONCLUSIONS: The findings of this study suggest that implementation of the behaviour change technique planning into routine dental practice may have the potential to increase dental appointment attendance rates.

Dental anxiety and oral health outcomes among rural older adults.

OBJECTIVES: The objective of this study is to determine the degree to which rural older adults are able to complete a measure of dental anxiety and to assess the prevalence, as well as the demographic and oral health characteristics, of individuals reporting high dental anxiety. METHODS: A population-based sample of 635 African American, American Indian and White older adults (age ≥ 60 years) completed an in-home survey, and 362 dentate participants completed an oral examination. Dental anxiety was measured using the four-item Corah's Dental Anxiety Scale (DAS). Gender, ethnicity, age, education, and oral health outcomes were compared between those who completed all four DAS questions (completers) and those who did not (noncompleters) as well as, among completers, those with high versus low DAS scores. RESULTS: There were 94 (14.8%) noncompleters. Noncompletion was associated with older age, lower education, being edentulous, and having gingival recession. 12.4% of DAS completers had high DAS scores, which was more common among those aged 60-70 years, women, and those with oral pain and sore or bleeding gums. In logistic regression analysis, only sore and bleeding gums had a significant association with a high DAS score (odds ratio = 2.40, 95% confidence interval 1.09-5.26). CONCLUSIONS: About one in eight rural older adults have high dental anxiety, which is associated with poor oral health outcomes. Identifying new approaches to measure dental anxiety among a population with limited interaction with dental care providers is needed.

Additional psychometric data for the Spanish Modified Dental Anxiety Scale, and psychometric data for a Spanish version of the Revised Dental Beliefs Survey.

BACKGROUND: Hispanics comprise the largest ethnic minority group in the United States. Previous work with the Spanish Modified Dental Anxiety Scale (MDAS) yielded good validity, but lower test-retest reliability. We report the performance of the Spanish MDAS in a new sample, as well as the performance of the Spanish Revised Dental Beliefs Survey (R-DBS). METHODS: One hundred sixty two Spanish-speaking adults attending Spanish-language church services or an Hispanic cultural festival completed questionnaires containing the Spanish MDAS, Spanish R-DBS, and dental attendance questions, and underwent a brief oral examination. Church attendees completed the questionnaire a second time, for test-retest purposes. RESULTS: The Spanish MDAS and R-DBS were completed by 156 and 136 adults, respectively. The test-retest reliability of the Spanish MDAS was 0.83 (95% CI = 0.60-0.92). The internal reliability of the Spanish R-DBS was 0.96 (95% CI = 0.94-0.97), and the test-retest reliability was 0.86 (95% CI = 0.64-0.94). The two measures were significantly correlated (Spearman's rho = 0.38, p < 0.001). Participants who do not currently go to a dentist had significantly higher MDAS scores (t = 3.40, df = 106, p = 0.003) as well as significantly higher R-DBS scores (t = 2.21, df = 131, p = 0.029). Participants whose most recent dental visit was for pain or a problem, rather than for a check-up, scored significantly higher on both the MDAS (t = 3.00, df = 106, p = 0.003) and the R-DBS (t = 2.85, df = 92, p = 0.005). Those with high dental fear (MDAS score 19 or greater) were significantly more likely to have severe caries (Chi square = 6.644, df = 2, p = 0.036). Higher scores on the R-DBS were significantly related to having more missing teeth (Spearman's rho = 0.23, p = 0.009). CONCLUSION: In this sample, the test-retest reliability of the Spanish MDAS was higher. The significant relationships between dental attendance and questionnaire scores, as well as the difference in caries severity seen in those with high fear, add to the evidence of this scale's construct validity in Hispanic samples. Our results also provide evidence for the internal and test-retest reliabilities, as well as the construct validity, of the Spanish R-DBS.

Revised dental beliefs survey: reliability and validity of a 22-item modified Turkish version.

The aim of this study is to create a Turkish version of the Revised Dental Beliefs Survey (DBS-R) and describe its psychometric properties. The participants were 420 general dental patients. The results of the exploratory factor analysis revealed that the DBS-R consisted of three factors consisting of 22 items. Confirmatory factor analysis results showed that the 22-item three-factor version fit the data better than the original 28-item English language four-factor structure model proposed in Odontol Scand (2004;62:21). The internal reliability of the Turkish version of the DBS-R was Cronbach alpha of 0.88. The correlation between the Turkish version of the DBS-R and the Modified Dental Anxiety Scale (MDAS) was 0.29. Scores on the 22-item version were higher for anxious participants (MDAS > or = 15) than those determined to be not anxious [59.4 +/- 15.5 vs. 51.1 +/- 17.2 (t = -4.38, P < 0.0001)]. In conclusion, a 22-item modified version of the DBS-R in Turkish appears reliable and valid.

What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting.

Relatively little is known about the anxiety-provoking capacity of the various objects and situations characteristic of the dental setting. The aims of the current study were to establish a hierarchy of anxiety-provoking capacities of a large set of dental stimuli and to determine the differences in relation to gender, age, ethnicity, and level of dental trait anxiety. An additional aim was to derive an estimate of the number of stimuli to be presented to anxious patients in order to obtain full coverage of their dental fears. A questionnaire describing 67 potentially anxiety-provoking stimuli was constructed and presented to 960 adults. The results indicated that invasive stimuli (e.g. surgical procedures) were rated as the most anxiety provoking and that non-invasive stimuli (e.g. the dentist as a person) were the least anxiety provoking. The fear-evoking capacity of the dental stimuli varied with gender, age, ethnicity, and level of dental trait anxiety, whereas the rank order of these stimuli appeared to be independent of these factors. Furthermore, it appeared that the top 25 most anxiety-provoking objects and situations found in the current study contained only eight (28%) stimuli, which had been taken into account in previous research. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli.

Cultural factors and children's oral health care: a qualitative study of carers of young children.

OBJECTIVE: This qualitative study sought to identify cultural beliefs, practices and experiences that influence access to preventive oral health care for young children from different racial and ethnic groups. METHODS: Four to six focus groups in each of the African-American, Chinese, Latino and Filipino communities in San Francisco, California were included in the study. Participants were carers of children aged 1-5 years. The 22 groups (n = 177 participants) were stratified by carer's age and, except in the African-American community, by whether US or non-US born. Sessions were conducted in different languages as needed. RESULTS: Lack of knowledge and beliefs about primary teeth created barriers to early preventive care in all groups. In Chinese groups more than others, health beliefs regarding disease causation and prevention influenced access to preventive dental care. In all groups, multiple family carers, especially elders, influenced access to preventive care. Dental fear, whether derived from prevailing community beliefs or personal negative dental experiences, greatly influenced attitudes regarding accessing preventive care. CONCLUSION: There are both similarities and differences between racial/ethnic groups in how cultural beliefs and experiences influence young children's access to dental care and how it might be improved.

A comparison of psychosocial factors related to dental anxiety among Turkish and Finnish pre-adolescents.

PURPOSE: To assess psychological, individual and maternal factors related to dental anxiety among pre-adolescents in the different cultural settings of Turkey and Finland. MATERIALS AND METHODS: A cross-sectional study of Finnish (n = 338) and Turkish (n = 611) pre-adolescents aged 10-12 years old by paired matching of questionnaires for the subjects and their mothers. These questionnaires, along with modified dental anxiety scales, were designed to collect data on the pre-adolescents' and their mothers' oral and dietary behaviours in relation to psychosocial factors. Multiple linear regression and factor analyses as well as descriptive and correlation statistics were applied. RESULTS: The Turkish pre-adolescents (TP) reported poorer dental health (50%) and more frequent gingival bleeding (26%) than did the Finnish pre-adolescents (FP) (26%, 0%), (p < 0.05). A similar trend occurred for reported toothache (70% and 17% for TP and FP respectively [p = 0.00]). Mean dental anxiety (DA) for TP and their mothers, and Finnish counterparts respectively were 9.64 +/- 6.01, 8.70 +/- 4.53 and 7.39 +/- 4.51, 6.02 +/- 5.50 (p < 0.05). Among TP, those with low DA reported high levels of toothbrushing and dietary self-efficacy (DSES) and self-esteem (p < 0.05); FP showed similar trends for DSES and self-esteem. Principal component analysis revealed that maternal DA and regular dental visits largely accounted for primary associations with DA among TP. CONCLUSIONS: Appreciating the impact of various psychosocial factors may provide a better understanding of DA among preadolescents, and thus may reduce dental avoidance and behavioural management problems for the overall improvement of young patients' oral health.

[Dental fear scores of 12-19-year-old school children of the Hungarian minority in Transylvania]. / Adatok a határon túli magyarság fogászati félelem értékeiro1 12-19 éves korcsoportban.

In this study 549 school children of the Hungarian minority in Transylvania were investigated (n=549, 342 female, 207 male, age between: 12-19 years). Mean dental fear scores were high: DAS: 12.6 +/- 3.3, DFS: 50.6 +/- 25.1. Girls scored significantly higher (p< or =0.01) in both scales. Scores increased between age of 12 and 16 confluently in both scales (DAS, DFS; p< or =0.05). There was a strong Pearson's correlation between DAS and DFS scales: (r= 0.70; p< or =0.01), and a somewhat lower correlation between these scales and the general anxiety scores. Mean DBS score (n = 203 only) was: 44.9 +/- 10.2.

Dental anxiety among patients undergoing various dental treatments in a Nigerian teaching hospital.

The aim of the present study is to evaluate the levels of dental anxiety among patients undergoing various dental treatments and to compare the anxiety levels with those of similar studies conducted with subjects from different socio-cultural backgrounds. Dental anxiety was evaluated by the administration of a questionnaire based on the Corah's Dental Anxiety Scale (DAS). Student t-test and analysis of variance (ANOVA) with Bonferoni correction was employed to compare the mean DAS scores. Females recorded higher total DAS scores than males (7.49 +/- 2.96 and 7.16 +/- 3.44, respectively). Patients in the 24-34 year age group showed the highest total DAS scores (8.25 +/- 3.20) followed by the <24 year age group. The total DAS scores for age groups 35-39 and >50 years differ significantly from those of age groups <24 and 24-34 years. The highest DAS score was recorded for root canal therapy (9.30 +/- 2.84) followed by extraction. The level of dental anxiety among this study population is lower than those reported elsewhere. The observed avoidance of dental treatment among Nigerians, despite the seemingly low mean DAS scores, may be related to dental anxiety. The authors are, however, of the opinion poor dental awareness may be a contributory factor.

The modulating effect of culture on the expression of dental anxiety in children: a literature review.

The experience of anxiety is a universal human phenomenon. Studies have shown a world-wide variation in the prevalence of dental anxiety with estimates ranging between 3% and 43%. The aetiology of dental anxiety is multifactorial, with factors acting in synergy to affect its expression. For children, age and gender play fundamental roles in its expression. However, these two factors are modulated by other variables such as culture which may influence the context in which anxiety is experienced, the interpretation of its meaning and responses to it. The modulating effect of culture in synergy with other variables may be one of the reasons why reports on dental anxiety have varied from region to region. This paper attempts to identify the interrelating roles of culture, age and gender, and how these relationships may affect variability in the expression and measurement of dental anxiety in children.

Dental anxiety in Fiji.

Despite the technological advances in dentistry, anxiety about dental treatment and the fear of pain associated with dentistry remains globally widespread and is considered a major barrier to dental treatment. This can have detrimental consequences to people's oral health and pose a serious epidemiological challenge to oral health care professionals. Dental anxiety is well described in the Western world however there is little literature on the situation in the developing world. The purpose of the study was to evaluate the levels of dental anxiety in Fijians using Corah's DentalAnxiety Scale (DAS). 120 adults, aged 18-45 years were randomly selected from the capital city of Suva until there were 60 Indigenous and 60 IndoFijians, with 30 males and 30 females from each group responding to questions from Corah's Dental Anxiety Scale. The average DAS for all the participants was 8.8. The average DAS for IndoFijians was 9.8 and was significantly higher than for Indigenous Fijians ie 78. IndoFijians only reported less anxiety with increasing age as the Indigenous Fijians generally displayed low levels of anxiety. There was no significant difference in DAS between the genders. A considerable proportion of IndoFijians (28%) were anxious with 13% being highly anxious. Young IndoFijian adults are more likely to possess dental anxiety and should be managed appropriately which may include behavioural and/or pharmacological therapy. This may require referral to dental specialists or involve a multidisciplinary approach to the management of these people.

Childhood dental fear in the Netherlands: prevalence and normative data.

OBJECTIVE: This study aimed to present normative data on dental fear for the Dutch child population, by identifying not only highly fearful children but also children at risk for developing this high dental fear. METHODS: Fear distribution of samples of high and low fearful children was studied, using the Dutch parent's version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Total fear scores were calculated for both samples, for different age levels and for boys and girls separately. To establish cut-off scores, mean CFSS-DS scores were associated with dentists' clinical fear ratings and, in addition, were transformed into stanines. RESULTS: Scores between 32 and 38 were found to represent a borderline area for dental fear, and scores of 39 and higher to represent high dental fear. CONCLUSION: The results have shown 6% of the Dutch child population to be highly fearful, while another 8% may be at risk to develop high dental fear. By providing extra attention for these children, the development of high dental fear or phobia may be prevented.

Characteristics of adult dentally fearful individuals. A cross-cultural study.

This cross-cultural study investigated adult dental fear patients in three countries. A joint intake interview questionnaire and a dental anxiety scale explored the level, background and concomitant factors of dental anxiety among patients at the Universities of Tel Aviv (Israel), Goteborg (Sweden), and Pittsburgh (USA). It was shown that patients at all three sites were quite similar with regard to age, sex, level of dental anxiety (DAS) and avoidance time. Negative emotions were common, with more negative everyday life effects among Swedish patients. Regardless of country, most patients stated that they had always been fearful, but environmental etiologic factors were frequently reported. Swedish patients more often reported both direct and indirect learning patterns than Israeli patients. Patients' motivation for treatment was high, while the belief in getting fear reduction was clearly lower. The most common reason for Israeli patients to seek treatment was a personal decision to try to cope with the situation, while for Swedish patients it was pain. Israeli and US patients preferred more 'active' modes of treatment such as behavioral management therapies, while Swedish patients equally preferred active and more 'passive' treatment approaches such as general anesthesia. Preference for dentist attributes were similar among groups and underlined the strong emphasis that fearful individuals place upon dentists' behaviors and their performance of dentistry.

Dental phobia among Saudis.

This study compares dental fear and phobias among patients attending: (1) primary care dental clinics, or (2) specialist dental clinics, or (3) nondental clinics. Of 853 patients, 539 from dental clinics and 314 from nondental clinics were interviewed in a structured interview. Patients from primary dental clinics and from specialist dental clinics did not differ. However, nondental clinic patients had more dental phobia and more avoidance of dental clinics. Dental clinic patients had more chronic dental problems than did nondental clinic attenders. Dental phobia was much more common among women, whose onset age was younger than in men, and the phobia interfered greatly with dental care. Dental phobics had fainted more often during dental treatment, had more chronic dental problems, more family history of dental phobia, and more blood and specific phobias. Most of the dental phobics reported dental trauma before the fear started.

Dental patients' perceptions in a multiethnic environment.

Ethnic relations in multicultural metropolitan areas such as Los Angeles are extremely complex and are probably reflected, at least in part, in the relations between dental providers and their patients. The goals of this study were to determine whether dental services provided by providers of a different ethnic group and whether there was a direct relation between the level of patient anxiety and the level of preference for providers of the same ethnicity. Patients at the University of Southern California School of Dentistry were surveyed using a 29-item questionnaire. The survey included questions concerning preference for their provider's ethnicity and gender, dental anxiety, dental satisfaction, dental health, and socioeconomic status. The study focused on the four most common groups of patients at USCSD: Asians, Blacks, Caucasians and Hispanics, and their perceptions with regard to the dental providers of five potential ethnic backgrounds: Asian, Black, Caucasians, Hispanics and Middle Eastern. The majority of patients in all ethnic groups reported no preference for the ethnicity of their provider listed their own ethnicity. Moreover, the recorded preference levels for providers of the own ethnicity in the Hispanic group were consistently higher in correlation with higher dental anxiety, lower satisfaction with dental treatment, and poorer dental health. Our study suggests that ethnic relations are a significant factor in the dental office in Southern California.

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)

The influence of social and ethnic factors on dental care habits and dental anxiety: a study in Israel.

The purpose of the present study was to assess the influence of social and ethnic factors on dental care habits and dental anxiety in a group of children resident in Jerusalem, Israel. Four hundred and fifty-six children completed a questionnaire that included 21 questions: nine referred to socio-demographic variables, three concerned the children's dental care habits, and the remaining nine concerned dental anxiety. Social level was determined by the father's occupation and their area of residence. Ethnic background was established according to the mother's or grandmother's country of origin. Chi-squared tests revealed no significant differences between social class or ethnic origin and dental care habits or dental anxiety. Analysis of variance, however, revealed a significant difference between the anxiety reported by boys of the two ethnic groups studied. Dental care habits were good in the majority of the children of all backgrounds, and the level of dental anxiety was low in all groups. It was concluded that ethnic origin had an influence on dental anxiety only in boys, whereas ethnic origin and social class had no influence on dental care habits.

Dental fear in Japan: Okayama Prefecture school study of adolescents and adults.

A total of 3,041 students and staff in middle school in Okayama Prefecture, Japan, were surveyed regarding dental fear. Over 88% reported fear, with 42.1% classified as having high fear. Almost 70% reported acquiring dental fear prior to junior high school. A majority reported being hurt at the last appointment. Delay of dental work was also reported for over 50% of the sample. Coping, pattern of physiological upset, nondental fears, and sex and age differences were also reported. Results suggest intervention is needed to address the major dental public health problems associated with dental fear.