Dental anxiety trajectories in a birth cohort

Objective: To identify trajectories of dental anxiety in a longitudinal study of young New Zealanders.

Methods: Prospective cohort study of a complete birth cohort born in 1972/73 in Dunedin, New Zealand, with dental anxiety scale (DAS) scores determined at ages 15, 18, 26, and 32, and dental examinations conducted at age 32. Group-based trajectory analysis was used to identify dental anxiety trajectories.

Results: DAS scores from at least three assessments were available for 828 participants. Six DAS score trajectories were observed: the stable nonanxious low trajectory (39.6%); the stable nonanxious medium trajectory (37.9%); the recovery trajectory (1.6%); the adult-onset anxious trajectory (7.7%); the stable anxious trajectory (7.2%); and the adolescent-onset anxious trajectory (5.9%). Females predominated in all but the stable nonanxious low trajectory group. The groups differed in their oral health and disease experience up to age 32. Cumulative caries experience (represented by DMFS scores) increased with age in all six groups, but the stable nonanxious low trajectory group had the lowest mean DMFS scores at each age. By age 32, their mean DMFS was more than five surfaces lower than the next lowest. The prevalence of caries-associated tooth loss showed the greatest increase in the adolescent-onset anxious, adult-onset anxious and stable anxious trajectory groups, and the least in the recovery and stable nonanxious low trajectory groups. The mean number of untreated, decayed surfaces at age 32 was lowest in the stable nonanxious low trajectory group, and highest in the adult-onset anxious and recovery trajectory groups. The poorest self-reported oral health was seen in the adult-onset anxious, stable anxious and adolescent-onset anxious trajectory groups.

Conclusion: The existence of six distinct trajectories of dental anxiety has been confirmed, and these appear to be clinically important. Funded by the NZ HRC, and by the National Institute of Dental and Craniofacial Research, grant DE015260.