Levels of dental anxiety

Dr Kirsty HillUniversity of Birmingham

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Outline

• Barrier to dental care: Dental Anxiety• Definition of dental anxiety

• Assessment

• Levels of dental anxiety

• Impact of Dental Anxiety on Patients• Attendance

• Oral Health

• Conclusion

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The Concept of Anxiety

Fear – ‘individual’s emotional response to a perceived threat or danger…incorporates

negative cognitive appraisals; physiological changes; behavioural cues’

(Milgrom et al., p5)

(fight or flight)

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Dental Anxiety

Anxiety – ‘response to situations in which the source of threat to the individual is ill-defined,

ambiguous, or not immediately present’’

(Milgrom et al., p5)

Anticipatory anxiety

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Dental Phobia

‘a marked and persistent fear of clearly discernible, circumscribed objects or situations. Exposure to the

phobic stimulus almost invariably provokes an immediate anxiety response’

‘….prolongation of the avoidance response resulting in significant distress or interferes with one’s social or

role functioning ‘

(DSM IV critera, 1994)

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Dental Phobia

Dental phobia shares features of anxiety and fear. It shares features that are apparent with other well known phobias such as spider and

rat phobias. These include:• Avoidance• Suffers unable to explain their reactions• Embarrassment and shame

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MDAS

• The MDAS asks patients to imagine themselves in 5 different dental situations and to rate how they would react on a 5-point scale. – Three scores can be calculated. All questions are

added to give a “total” score (max. 25); questions 1-4 can be summed to give a “general dental anxiety” score (max. 20); and question 5 can be summed to give a “needle phobia” score (max.5).

• The cut-off for clinically significant dental anxiety is 19.

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Prevalence of dental anxiety

• 51% who had attended the a dentist had an MDAS score between 5-9 (indicating low/no anxiety)

• 36% had an MDAS score between 10-18 (moderate anxiety)

• 12% had a score of 19 or more (extreme anxiety)

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Social Variation

• Social variation: extreme dental anxiety

• 15% routine and manual occupations• 12% intermediate occupations • 10% professional

• Variation was across all dimensions for the MDAS scale.

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Modified Dental Anxiety Scale: Prevalence against Gender

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0

5

10

15

20

25

30

35

40

Anxiety going for treatmenttomorrow

Anxiety in the waiting room Anxiety if tooth drilled Anxiety for scale andpolish

Anxiety for injection

MDAS Categories

Pe

rce

nta

ge

Men

Women

Percentage reporting very/extremely anxious by sex

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Anxiety: Percentage with 19 or over against age

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Modified dental anxiety scale by self-assessed general and dental health

• General Health • Dental Health

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Modified dental anxiety scale by reason for last visit to dentist

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Dental Anxiety and Oral health status

• People with teeth are more anxious than those without!

• Oral health• Fewer treatment experiences

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0 5 10 15 20 25

At least one issue reported

Was NOT involved as much as wanted indecisions about dental care or treatment

Was NOT given enough time to discuss oralhealth with dentist

Dentist DID NOT listen carefully to what had tosay about oral health

Dentist DID NOT explain reasons for dentalcare or treatment in a way that could be

understood

DID NOT have confidence and trust in dentist

DID NOT get answers to questions that couldbe understood

Was NOT treated with respect and dignity

Issu

e re

po

rted

Percentage

Relationship with dentist at last visit

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Conclusion

• Barriers – Confounding issues between: Access, Cost and

anxiety

• Anxiety is a serious issue• Prevalence is high – particularly in women• Further Research

– Age– Social variation – Gender

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Adult Dental Health Survey 2009

The NHS Information Centre commissioned the survey, with funding provided by the Department of Health in England, the Welsh Assembly Government and the Department for Social Services and Public Safety in Northern Ireland.

The Office for National Statistics (ONS) was the lead contractor working in partnership with the National Centre for Social Research, the Northern Ireland Statistic & Research Agency, and a team of academics from the Universities of Birmingham, Cardiff, Dundee, Newcastle and University College London

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