ORIGINAL ARTICLE Kanaffa-Kilijańska et al

Oral Health Condition and Hygiene Habits Among Adult Patients with Respect to Their Level of Dental Anxiety Urszula Kanaffa-Kilijańskaa/Urszula Kaczmarekb/Barbara Kilijańskac/ Dorota Frydeckad

Purpose: Dental anxiety is a common phenomenon influencing the relationship between a patient and a doctor as well as the course of treatment. The aim of the study was to assess the oral health status and hygiene habits among adult patients with respect to their level of dental anxiety. Materials and Methods: 117 consecutive adult patients referred to the Department of Conservative Dentistry and Paedodontics of Wroclaw Medical University were included in the study. There were 58 women (49.57%) and 59 men (50.43%). The mean age of the patients was 36.57 ± 16.76 years. The level of dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). To evaluate dental health status and oral hygiene, the following indices were used: total number of decayed, missing and filled teeth (DMF/T) as well as surfaces (DMF/S), approximal plaque index (API), oral hygiene index (OHI), debris index (DI) and calculus ondex (CI). Results: The study revealed that the patients with high MDAS presented a higher calculus index (CI). There was a negative correlation between a high level of dental anxiety measured by MDAS and the number of filled teeth (F/T) as well as the number of filled dental surfaces (F/S). There was no significant correlation between dental anxiety as measured with the MDAS and age, gender or level of education; however, smokers had a significantly higher anxiety level than non-smokers. Conclusions: Dental anxiety has a negative influence on oral health status; the higher the level of dental anxiety, the lower the number of filled teeth and the higher the calculus index. Poor dental and periodontal health may have many somatic as well as psychosocial consequences, both of which lower the quality of life of the patient. Key words: adult, dental anxiety, Modified Dental Anxiety Scale (MDAS), oral health, oral hygiene Oral Health Prev Dent 2014;12:233-239 doi: 10.3290/j.ohpd.a31668

T

he experience of anxiety is very common. It is a reaction to many stressful situations and should be understood as a warning signal. Fearful reactions differ from person to person and they depend on many internal and external factors. Dental anxiety develops due to direct negative experience with

a

MD, Dentist, Department of Conservative Dentistry and Paedodontics, Wroclaw Medical University, Wroclaw, Poland.

b

Professor, Department of Conservative Dentistry and Paedodontics, Wroclaw Medical University, Wroclaw, Poland.

c

PhD student, Institute of Journalism and Social Communication, Faculty of Philology, University of Wroclaw, Wroclaw, Poland.

d

Medical Doctor, Department of Psychiatry, Wroclaw Medical University, Wroclaw Poland.

Correspondence: Dr. Dorota Frydecka, Department of Psychiatry, Wroclaw Medical University, Pasteura 10, 50-367 Wroclaw, Poland. Tel. +48-66-787-4588, Fax: +48-71-784-1602. Email: dfrydecka@ gmail.com

Vol 12, No 3, 2014

Submitted for publication: 23.07.12; accepted for publication: 26.02.13

dental care; however, its intensity is also determined by internal factors related to a stable personality trait and is called endogenous anxiety (Weiner and Sheehan, 1990; Locker et al, 1996; Berggren et al, 1997; Locker et al, 1999; Carrillo-Diaz et al, 2012; Porritt et al, 2012). People with a high level of general anxiety are predisposed to dental anxiety (Hakeberg et al, 2001). First reports about dental anxiety are from the 1950s (Shoben and Borland, 1954) and since then, the overall level of dental anxiety in the general population has not changed significantly (Smith and Heaton, 2003; Heaton et al, 2007). Multiple instruments and methods have been developed to assess dental anxiety and various psychometric tests allow objective assessment of the level of dental anxiety. It has been shown that being a subject of such a test does not increase the level of dental anxiety (Humphris et al, 2006; Hum-

233

Kanaffa-Kilijańska et al

phris and Hull, 2007): on the contrary, it reduces it due to the engagement of the patient in the process of diagnosis and treatment (Dailey et al, 2002). The aim of this study was the assessment of oral health status and hygiene habits (toothbrushing, use of dental floss) among adult patients with respect to their level of dental anxiety.

MATERIALS AND METHODS One hundred seventeen consecutive patients referred to the Department of Conservative Dentistry and Paedodontics of Wroclaw Medical University were included in the study. They completed the questionnaire (see Appendix) and underwent the oral health examination conducted by a dentist. The oral health status assessment included dental and periodontal status, as well as oral hygiene status. Dental status was assessed according to WHO criteria by calculating the total number of decayed, missing and filled teeth (DMF/T) and surfaces (DMF/S) as well as their components (D/T, M/T, F/T and D/S, M/S, F/S respectively). Oral hygiene status was assessed using the oral hygiene index (OHI) (Green and Vermillion, 1957) as well as the approximal plaque index (API) (Lange et al, 1977). Periodontal status was evaluated with the modified sulcus bleeding index (mSBI) (Lange and Mutschelknauss, 1974). Additionally, participants filled out a sociodemographic questionnaire including questions about age, gender, educational level, smoking history, time and cause of the last dental visit, self-assessment of oral condition and treatment needs, dental floss use and the frequency of toothbrushing. The level of dental anxiety was assessed by psychometric testing with Corah’s Dental Anxiety Scale (DAS) and the Modified Dental Anxiety Scale (MDAS) (Corah, 1969; Humphris et al, 1995) (see Appendix 1). Corah’s Dental Anxiety Scale (DAS) consists of four questions assessing the level of anxiety on a 5-point scale in different situations of dental treatment (day before dental visit, in the waiting room, on the dental chair before maintenance therapy, on the dental chair before dental calculus removal) (Corah, 1969). The results range from 4 to 20 points while a score of 15 or above suggests dental phobia (Corah et al, 1978; Murray et al, 1989; Locker et al, 1991). The Modified Dental Anxiety Scale (MDAS) consists of the DAS scale modified by adding a fifth item about local anaesthetic injection, which is important due to its general use in dental treatment (Humphris et al, 1995).

234

The scores range from 5 to 25 points, and a score of 19 or above indicates dental phobia. The project was approved by the Bioethics Committee of Wroclaw Medical University (KB– 126/2008 and KB–472/2008). The patients were informed about the aim and the methods of the study and they provided written informed consent prior to their participation. The results were statistically analysed using ANOVA and Pearson’s correlation coefficient. The analysis was performed using StatSoft (Krakow, Poland).

RESULTS The patients were 18 to 77 years old; 58 were women (49.57%) and 59 were men (50.43%). The mean age of the patients was 36.57 ± 16.76 years. 62.39% of the patients were between 18 and 37 years old, 20.52% between 38 and 57 years old, and 17.09% of the patients were between 58 and 77 years old. Sixty-five study participants (55.56%) had a secondary education, 39 (33.33%) had higher education and 13 patients (11.11%) had a primary or vocational education. The frequency of decay among patients was 98.29% (115/117). The current caries process was described by the D/T (mean 6.26 ± 4.48 teeth) and the D/S component (mean 10.78 ± 10.25 teeth). The mean number of filled teeth (F/T) was 7.23 ± 5.00 and the mean number of teeth extracted due to caries (M/T) was 4.66 ± 6.79. The mean value of M/S was 23.38 ± 33.96, and the mean value of F/S was 17.68 ± 15.05. Overall, the mean value of DMF/T was 18.15 ± 6.89 and the average DMF/S was 51.74 ± 38.84. For the OHI index, assessing oral hygiene status, the mean was 1.07 ± 0.89, for the DI 0.79 ± 0.63 and for the CI 0.28 ± 0.40. The approximal plaque index (API) mean was high: 75.29% ± 27.77. Assessing periodontal status, the mean value of the modified sulcus bleeding index (mSBI) was 30.44% ± 28.19. 71.79% of the patients had their last dental visit within one year previously and 28.21% of the patients more than one year previously. 12.82% of patients’ dental visits were due to odontalgia, 72.65% did not report any symptoms and 14.53% of the patients came for a routine check-up. Only 16.24% assessed their oral condition as good, 47.86% as satisfactory and 35.9% as unsatisfactory. About 16.23% of the patients believed that their dental treatment would require 1 to 2 visits, 42.74% of the patients declared being in need of 3 to 5 visits, while 41.03%

Oral Health & Preventive Dentistry

Kanaffa-Kilijańska et al

of the patients defined their treatment needs as requiring more than 5 appointments. The majority of the patients (59.83%) declared that they brushed their teeth twice a day, 28.20% three times a day or more, while 11.97% of the patients admitted that they brushed their teeth once a day or less frequently. Only 35.04% of the patients used dental floss. In the studied group, 25.64% of the patients were smokers. The level of dental anxiety assessed with the MDAS was low among 41.03% of the patients, moderate in 41.88% and high only among 17.09% of the patients (Table 1). It has been shown that the higher the level of dental anxiety measured by MDAS was, the lower was the number of filled teeth (F/T) (r = -0.28; p = 0.002) and the number of filled dental surfaces (F/S) (r = -0.18; p = 0.049). Additionally, the higher the level of dental anxiety assessed by MDAS was, the higher was the calculus index (CI) (r = 0.20; p = 0.030) (Table 2). There was no significant difference between dental anxiety measured by MDAS and gender, level of education or the time of and the reason for the last dental visit (p > 0.05) (Table 3). However, a relationship between the level of dental anxiety and self-assessed dental health status (F = 7.65; p = 0.001) was found. Patients with a low self-assessed dental health status, had high dental anxiety (Table 3). It has been shown that smokers had a significantly higher anxiety level as measured by MDAS than did non-smokers (F = 8.20; p = 0.005) (Table 3).

DISCUSSION The body of research has shown that dental anxiety is high on the list of different types of anxieties experienced in a given population. According to Fiset et al (1989), dental anxiety is in first or second place on the list depending on the assessment method. Research on a Danish population (N = 1959) showed

Table 2

MDAS

MDAS

Table 1

Level of dental anxiety according to MDAS MDAS

Level of dental anxiety

n/N

%

Low (5–9 points)

48/117

41.03

7.70 ± 1.23

Moderate (10–14 points)

49/117

41.88

11.69 ± 1.35

High (15–25 points)

20/117

17.09

17.00 ± 1.86

Overall

117

100

39.29 ± 8.23

x ± CI

that dental anxiety ranks fourth among the ten most common anxiety disorders with a prevalence of 24.3% (Oosterink et al, 2009). Dental phobia (3.7%) is the most prevalent phobia, topping heights (3.1%) and snakes (2.7%). Fiset et al (1989) showed that more than 22% of patients with a high dental anxiety level additionally experience two or more different types of anxiety. It is difficult to accurately assess the level of dental anxiety in the population since different measures of assessment are used. In the Polish population, it has been estimated that 40% of patients experience dental anxiety (Cieszko-Bruk and Strużak-Wysokińska, 1995). In Sweden, almost half of the adult patients are afraid of dental visits, and 5% to 10% of population is characterised by high levels of dental anxiety (Berggren and Meynert, 1984). In a study performed in large cities in the United States, Milgrom et al (1988) noticed that the prevalence of dental anxiety was about 50% and dental phobia about 3%. In Europe, many authors have found that a high level of dental anxiety is observed in 8% to 11% of the general population (Kunzelmann and Dunninger, 1990; Stouthard and Hoogstraten, 1990; Neverlien, 1994). In Asia, dental anxiety was observed among 6% to 20% of the general population (Domoto et al, 1988; Teo et al, 1990; Lo, 1993). The most common tool used for the assessment of dental anxiety was Dental Anxiety Scale (DAS)

Relationship between the values of MDAS and selected oral health parameters D/T

M/T

F/T

DMF/T

D/S

M/S

F/S

r = 0.1455

r = 0.1143

r = -0.2836

r = 0.0012

r = 0.1371

r = 0.1143

r = -0.1827

p = 0.117

p = 0.220

p = 0.002

p = 0.989

p = 0.141

p = 0.220

p = 0.049

DMF/S

Dl

Cl

OHI

API

mSBI

r = 0.0653

r = 0.0522

r = 0.2009

r = 0.1267

r = 0.0625

r = 0.0218

p = 0.484

p = 0.577

p = 0.030

p = 0.173

p = 0.503

p = 0.815

Vol 12, No 3, 2014

235

Kanaffa-Kilijańska et al

Table 3 Relationship between MDAS score and sociodemographic data Dental anxiety

Sociodemographic data (x ± SD) Age (years)

MDAS

18–37

38–57 ≠

58–77

10.70 ± 3.71

11.54 ± 3.16

11.25 ± 3.65

F = 0.57; p = 0.566

Gender

MDAS

Female

Male

11.38 ± 3.73

10.56 ± 3.42

F = 1.54; p = 0.217

Education level

MDAS

primary/ vocational

secondary

higher

11.38 ± 1.85

10.97 ± 3.67

10.82 ± 3.91

F = 0.12; p = 0.888

Time of the last dental visit

MDAS

Less than one year ago

Over one year ago

10.69 ± 3.49

11.67 ± 3.77

F = 1.77; p = 0.186

Reason for the last dental visit

MDAS

Control visit

Treatment

Pain

10.53 ± 3.95

10.78 ± 3.27

12.53 ± 4.60

F = 1.70; p = 0.187

Self-assessed dental health status

MDAS

Good

Satisfactory

Not satisfactory

8.47 ± 2.29

10.93 ± 3.56

12.14 ± 3.57

F = 7.65; p = 0.001

Smoking status

MDAS

Non-smoking

Smoking

10.43 ± 3.19

12.53 ± 4.21

(Corah, 1969). Since its modification, after including the fear of local anaesthetic injection, most authors use the Modified Dental Anxiety Scale (MDAS) (Humphris et al, 1995). In our study, the mean level of dental anxiety measured by MDAS was 10.97 ± 3.58 and high dental anxiety was observed among 17.09% of patients. The mean level of dental anxiety is similar to that observed in the British population, 10.39 (Humphris et al, 1995), and 10.36 (Humphris et al, 2009), as well as to that found in the Greek population, 10.91 (Coolidge et al, 2008). The lowest level of dental anxiety was reported from North America (10.0) (Heaton et al, 2007), while the highest was found in China (11.69) (Yuan et al, 2008). A great body of research suggests a multifactorial genesis of dental anxiety. Some authors emphasise the significance of sociodemographic fac-

236

F = 8.20; p = 0.005

tors in the aetiology of dental anxiety, such as age, gender, level of education and socioeconomic status (Schuurs et al, 1985; Humphris et al, 2000; Heaton et al, 2007), while others state that the main factor playing a role in the development of dental anxiety is individual experience with dental health care services (Oosterink et al, 2009). In our study, we found no significant associations between age and the level of dental anxiety. However, in the studies conducted by Humphris et al (Humphris et al, 2000; Humphris et al, 2009) and Heaton et al (2007), it has been observed that the level of anxiety drops with age. The relationship between dental anxiety and gender is also not clear. Our results show no significant difference between men and women with respect to the level of dental anxiety measured by MDAS. In contrast, it has previously

Oral Health & Preventive Dentistry

Kanaffa-Kilijańska et al

been suggested that men have a significantly lower level of dental anxiety (Heaton et al, 2007; Yuan et al, 2008; Humphris et al, 2009; do Nascimento et al, 2011). According to some authors, however, the lower level of dental anxiety reported by men may be influenced by cultural norms of behaviour which do not allow men to admit fear (Corah et al, 1978), while women are more likely to share their emotional states (Stouthard and Hoogstraten, 1990). There are some reports indicating a negative correlation between the level of education and the level of anxiety assessed by MDAS (Tunc et al, 2005; Firat et al, 2006), but in our study we found no such correlation, similar to other studies (Hakeberg et al, 1992; Humphris et al, 2009; Ofori et al, 2009). The influence of dental anxiety on oral health status has been widely researched. This study found a negative correlation between the level of anxiety measured by MDAS and the number of filled teeth, which can be attributed to dental treatment avoidance. The same results were obtained by Samorodnitzky and Levin (2005) as well as Schuller et al (2003) and Ragnarsson (1998). Our results demonstrate a relation between dental anxiety level and calculus index (CI), suggesting that dental anxiety results in the lack of systematic professionally conducted scaling. The positive correlation between dental anxiety and gingivitis was reported by Armfield et al (2009), while Ng and Leung (2008) observed the relation between dental anxiety level and poorer dental and periodontal conditions. In the present study, patients accurately assessed their own oral health and treatment needs. Self-assessment of poor oral condition and high dental treatment needs was correlated with a higher number of teeth with caries and a smaller number of filled teeth, because these patients also presented a higher level of dental anxiety, which prevented them from seeking professional dental health care. Dental anxiety is known to be a reason for avoiding dental visits, thus contributing to worse oral health status (Armfield et al, 2007; Boman et al, 2010). Poor dental and periodontal health may have many somatic and psychosocial consequences, both of which lower the patients’ quality of life. On the one hand, it may result in an acute or chronic inflammation and digestive tract disorders, causing discomfort and pain. On the other hand, it influences aesthetic appearance and how comfortable the individual feels in social interactions. The problem has been emphasised by research showing a lower quality of life due to worse oral health status among patients with a high level of dental

Vol 12, No 3, 2014

anxiety (McGrath and Bedi, 2003; Mehrstedt et al, 2007). Such findings point to the need for developing psychosocial interventions which might help patients deal with their dental anxiety and thus may play an important role in improving general somatic well-being as well as alleviating the stigma associated with poor oral health.

CONCLUSIONS The majority of patients had a medium level of dental anxiety as assessed by MDAS. Dental anxiety has an unfavourable influence on oral health condition: the higher the level of dental anxiety, the lower is the number of filled teeth and the higher the calculus index. Diminishing the level of dental anxiety might result in meeting dental treatment needs, thus improving the patients’ quality of life.

REFERENCES 1. Armfield JM, Slade GD, Spencer AJ. Dental fear and adult oral health in Australia. Community Dent Oral Epidemiol 2009;37:220–230. 2. 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. 3. Berggren U, Carlsson SG, Hakeberg M, Hagglin C, Samsonowitz V. Assessment of patients with phobic dental anxiety. Acta Odontol Scand 1997;55:217–222. 4. Berggren U, Meynert G. Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc 1984;109:247–251. 5. Boman UW, Lundgren J, Berggren U, Carlsson SG. Psychosocial and dental factors in the maintenance of severe dental fear. Swed Dent J 2010;34:121–127. 6. Carrillo-Diaz M, Crego A, Armfield JM, Romero-Maroto M. Treatment experience, frequency of dental visits, and children‘s dental fear: a cognitive approach. Eur J Oral Sci 2012;120:75–81. 7. Cieszko-Bruk M, Strużak-Wysokińska M. Fear of dental treatment: a continuous problem. J Stoma 1995;48:168–173. 8. Coolidge T, Arapostathis KN, Emmanouil D, Dabarakis N, Patrikiou A, Economides N, Kotsanos N. Psychometric properties of Greek versions of the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey (DFS). BMC Oral Health 2008;8:29. 9. Corah NL. Development of a dental anxiety scale. J Dent Res 1969;48:596. 10. Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc 1978;97:816–819. 11. Dailey YM, Humphris GM, Lennon MA. Reducing patients‘ state anxiety in general dental practice: a randomized controlled trial. J Dent Res 2002;81:319–322. 12. do Nascimento DL, da Silva Araujo AC, Gusmao ES, Cimoes R. Anxiety and fear of dental treatment among users of public health services. Oral Health Prev Dent 2011;9:329–337.

237

Kanaffa-Kilijańska et al 13. Domoto PK, Weinstein P, Melnick S, Ohmura M, Uchida H, Ohmachi K, Hori M, Okazaki Y, Shimamoto T, Matsumura S, et al. Results of a dental fear survey in Japan: implications for dental public health in Asia. Community Dent Oral Epidemiol 1988;16:199–201. 14. Firat D, Tunc EP, Sar V. Dental anxiety among adults in Turkey. J Contemp Dent Pract 2006;7:75–82. 15. Fiset L, Milgrom P, Weinstein P, Melnick S. Common fears and their relationship to dental fear and utilization of the dentist. Anesth Prog 1989;36:258–264. 16. Greene JC, Vermillion JR. The oral hygiene index: A method for classifying oral hygiene status.J Am Dent Assoc 1960;61:29–35. 17. Hakeberg M, Berggren U, Carlsson SG. Prevalence of dental anxiety in an adult population in a major urban area in Sweden. Community Dent Oral Epidemiol 1992;20:97–101. 18. Hakeberg M, Hagglin C, Berggren U, Carlsson SG. Structural relationships of dental anxiety, mood, and general anxiety. Acta Odontol Scand 2001;59:99–103. 19. Heaton LJ, Carlson CR, Smith TA, Baer RA, de Leeuw R. Predicting anxiety during dental treatment using patients‘selfreports: less is more. J Am Dent Assoc 2007;138:188–195; quiz 248–189. 20. Humphris GM, Clarke HM, Freeman R. Does completing a dental anxiety questionnaire increase anxiety? A randomised controlled trial with adults in general dental practice. Br Dent J 2006;201:33–35. 21. 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;9:20. 22. 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;50:367–370. 23. Humphris GM, Hull P. Do dental anxiety questionnaires raise anxiety in dentally anxious adult patients? A twowave panel study. Prim Dent Care 2007;14:7–11. 24. Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health 1995;12:143–150. 25. Kunzelmann KH, Dunninger P. Dental fear and pain: effect on patient‘s perception of the dentist. Community Dent Oral Epidemiol 1990;18:264–266. 26. Lange DE, Mutschelknauss R. Aids for prevention of periodontal diseases [in German]. Quintessenz 1974;25:95–102. 27. Lange DE, Plagmann HC, Eenboom A, Promesberger A. Clinical methods for the objective evaluation of oral hygiene [in German]. Dtsch Zahnarztl Z 1977;32:44–47. 28. Lo GL. The use of dental services by adult Singaporeans. Singapore Dent J 1993;18:22–25. 29. Locker D, Liddell A, Burman D. Dental fear and anxiety in an older adult population. Community Dent Oral Epidemiol 1991;19:120–124. 30. Locker D, Liddell A, Shapiro D. Diagnostic categories of dental anxiety: a population-based study. Behav Res Ther 1999;37:25–37. 31. Locker D, Shapiro D, Liddell A. Who is dentally anxious? Concordance between measures of dental anxiety. Community Dent Oral Epidemiol 1996;24:346–350. 32. McGrath C, Bedi R. Dental services and perceived oral health: are patients better off going private? J Dent 2003;31:217–221.

238

33. Mehrstedt M, John MT, Tonnies S, Micheelis W. Oral health-related quality of life in patients with dental anxiety. Community Dent Oral Epidemiol 2007;35:357–363. 34. Milgrom P, Fiset L, Melnick S, Weinstein P. The prevalence and practice management consequences of dental fear in a major US city. J Am Dent Assoc 1988;116:641–647. 35. Murray P, Liddell A, Donohue J. A longitudinal study of the contribution of dental experience to dental anxiety in children between 9 and 12 years of age. J Behav Med 1989;12:309–320. 36. Neverlien PO. Dental anxiety, optimism-pessimism, and dental experience from childhood to adolescence. Community Dent Oral Epidemiol 1994;22:263–268. 37. Ng SK, Leung WK. A community study on the relationship of dental anxiety with oral health status and oral healthrelated quality of life. Community Dent Oral Epidemiol 2008;36:347–356. 38. Ofori MA, Adu-Ababio F, Nyako EA, Ndanu TA. Prevalence of dental fear and anxiety amongst patients in selected dental clinics in Ghana. Health Educ J 2009;86:130–139. 39. Oosterink FM, de Jongh A, Hoogstraten J. Prevalence of dental fear and phobia relative to other fear and phobia subtypes. Eur J Oral Sci 2009;117:135–143. 40. Porritt J, Marshman Z, Rodd HD. Understanding children‘s dental anxiety and psychological approaches to its reduction. Int J Paediatr Dent 2012;22:397-405. 41. Ragnarsson E. Dental fear and anxiety in an adult Icelandic population. Acta Odontol Scand 1998;56:100–104. 42. Samorodnitzky GR, Levin L. Self-assessed dental status, oral behavior, DMF, and dental anxiety. J Dent Educ 2005;69:1385–1389. 43. Schuller AA, Willumsen T, Holst D. Are there differences in oral health and oral health behavior between individuals with high and low dental fear? Community Dent Oral Epidemiol 2003;31:116–121. 44. Schuurs AH, Duivenvoorden HJ, Thoden van Velzen SK, Verhage F, Eijkman MA, Makkes PC. Sociodemographic correlates of dental anxiety. Community Dent Oral Epidemiol 1985;13:212–215. 45. Shoben EJ, Jr., Borland L. An empirical study of the etiology of dental fears. J Clin Psychol 1954;10:171–174. 46. Smith TA, Heaton LJ. Fear of dental care: are we making any progress? J Am Dent Assoc 2003;134:1101–1108. 47. Stouthard ME, Hoogstraten J. Prevalence of dental anxiety in The Netherlands. Community Dent Oral Epidemiol 1990;18:139–142. 48. Teo CS, Foong W, Lui HH, Vignehsa H, Elliott J, Milgrom P. Prevalence of dental fear in young adult Singaporeans. Int Dent J 1990;40:37–42. 49. 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: 357–362. 50. Weiner AA, Sheehan DV. Etiology of dental anxiety: psychological trauma or CNS chemical imbalance? Gen Dent 1990;38:39–43. 51. Yuan S, Freeman R, Lahti S, Lloyd-Williams F, Humphris G. Some psychometric properties of the Chinese version of the Modified Dental Anxiety Scale with cross validation. Health Qual Life Outcomes 2008;6:22.

Oral Health & Preventive Dentistry

Kanaffa-Kilijańska et al

APPENDIX 1. Modified Dental Anxiety Scale (MDAS) Can you tell us how anxious you are, if at all, about your dental visit? Please incated by marking the appropriate box with a ‘X’ If you went to your Dentist for TREATMENT TOMORROW, how would you feel? Not anxious F

Slightly anxious F

Fairly anxious F

Very anxious F

Extremely anxious F

If you were sitting in the WAITING ROOM (waiting for treatment), how would you feel? Not anxious F

Slightly anxious F

Fairly anxious F

Very anxious F

Extremely anxious F

If you were about to have a TOOTH DRILLED, how would you feel? Not anxious F

Slightly anxious F

Fairly anxious F

Very anxious F

Extremely anxious F

If you were about to have your TEETH SCALED AND POLISHED, how would you feel? Not anxious F

Slightly anxious F

Fairly anxious F

Very anxious F

Extremely anxious F

If you were about to have a LOCAL ANAESTHETIC INJECTION in your gum, above an upper back tooth, how would you feel? Not anxious F

Slightly anxious F

Fairly anxious F

Very anxious F

Extremely anxious F

INSTRUCTIONS FOR SCORING (REMOVE THIS SECTION BELOW BEFORE COPYING FOR USE WITH PATIENTS) The Modified Dental Anxiety Scale. Each item scored as follows: Not anxious

=1

Slightly anxious

=2

Fairly anxious

=3

Very anxious

=4

Extremely anxious

=5

Total score is a sum of all five items, range 5 to 25: Cutoff is 19 or above, which indicates a highly dentally anxious patient, possibly dentally phobic.

Vol 12, No 3, 2014

239

Oral health condition and hygiene habits among adult patients with respect to their level of dental anxiety.

Dental anxiety is a common phenomenon influencing the relationship between a patient and a doctor as well as the course of treatment. The aim of the s...
106KB Sizes 1 Downloads 3 Views