Measuring Cognitive and Behavioural Dimensions of Dental Anxiety

The majority of dental anxiety measures focus on the cognitive (fear) dimension of dental anxiety. Subjects who avoid dental treatment are largely understudied, and may have unattended dental disease which has implications for dental and general well-being. Objective: To assess the prevalence of and relationship between fear and avoidance in dental anxiety in a randomly selected general population sample. Methods: A two stage random start systematic sampling procedure identified adult subjects based on electoral districts. A two wave mail survey asked multiple questions related to dental anxiety including the Dental Fear and Avoidance Scale (DFAS). Results: The 34.3% response rate (n=1184) was representative of the target population based on comparisons with census data. The reliability and validity of the DFAS was previously confirmed, with fear and avoidance identified as related but separate entities (r=0.60). The DFAS categorized study subjects as 62.7% low fear/low avoidance (L/L); 14.4% high fear/low avoidance (H/L); 6.3% low fear/high avoidance (L/H); and 16.6% high fear/high avoidance (H/H). Significantly more females were found in the high fear groups with no significant difference between sexes in the low fear groups. The mean (sd) age of subjects was 52.9 (16.4) years (range: 18-92 years). Other significant differences (p<0.001) were found between fear/avoidance categories and frequency of dental visits, last dental visit and avoidance behaviour. No significant difference was found between fear/avoidance categories and age, age of onset of dental anxiety and family history. Avoiding the dentist for as long as possible was the most frequently confirmed avoidance behaviour reported in all subjects: 10.9% L/L, 25.0% H/L, 45.2% L/H, and 80.8% H/H. Conclusions: A greater proportion of dentally anxious subjects may be identified if multiple dimensions of anxiety are measured. Differences exist between subjects with clinically significant levels of fear and avoidance, which may be important considerations in planning treatment and management strategies.