Dental fear: comparisons between younger and older adults

American Journal of Health Studies,  Summer-Fall, 2005  by M. Michelle Rowe

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Abstract: This study explored differences between 107 adults (ages 26-79) and 134 young adults (ages 18-23) on fear of dental treatment. Subjects completed scales measuring general dental anxiety (DAS-R) and negative perception of dental stimuli (DFAS). A relationship between negative perceptions and anxiety levels was found in both samples (adult r=.67, p<.001; young adult r=.74, p<.001). However, dental fear scores were significantly higher [t(239)=5.28, p<.001] in the young adult group (M=12.71, SD=5.71) than the adult group (M=9.31, SD=3.98). If health educators, psychologists and dental health providers are to manage this epidemic, identification and treatment of dental fear in young adults is necessary.

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Anxiety related to fear of dental treatment is often a significant barrier to proper dental health. This anxiety, or dental fear, often originates early in life through childhood experiences with dental treatment, and may lead to the lifelong fear of dentistry. Dental fear is disconcerting for both the patient and the entire dental team. It is especially problematic for hygienists, because they are frequently the first members of the dental team to treat the patient.

Patients who suffer from dental fear require a third more office time than those who experience either no fear or mild fear (King, 1991). Fearful individuals often avoid care despite extensive dental needs, and will tolerate pain for on average of 17.3 days before seeking treatment (King). These individual often self-medicate and avoid the inevitable dental visit as long as possible, increasing the likelihood of further complications.

Dental fear has reached an epidemic level affecting almost 50 million people in the United States. Of this number, twenty-five million often refuse treatment because of frightening childhood experiences. Dental fear has been ranked fifth among the most common fears (DeJongh, Morris, Schoemakers, & Ter Horst, 1995). Many fearful individuals never even consider going to the dentist while others schedule dental appointments and then break them. Consequently, there exists a large population of fearful individuals who do not seek treatment and are compromising their dental health (Kent & Blinkhorn, 1991). Dental fear can prevent an otherwise intelligent, reasonable person from optimizing and maintaining his or her oral health. While most people feel slightly anxious when visiting the dentist, those who suffer from dental fear often fail to go for routine care. Small, preventable problems later grow to require major intervention. Patients who are very fearful of routine dental treatment have poorer oral health than those who are less anxious, The extremely fearful patient will tolerate pain, inflammation, and even an abscessed tooth before talking steps to visit a dentist.

Dental fear perpetuates a vicious cycle (Ronis, Hansen, & Anton, 1995). The fear and anxiety result in avoidance, which furthers the deterioration of the teeth, leaving the person with feelings of guilt, shame, and inferiority (Moore, Brodsgaaurd & Birn, 1991). This fear is reinforced when avoidance behaviors result in the need for emergency care, which enhances the negative self perceptions, thereby reinforcing avoidance behavior. Dental fear leads to a self-perpetuating cycle, whereby fear leads to avoidance, avoidance leads to emergency treatment, and emergency treatment reinforces the fear (Gradbury-Amyot, Overman, Carter-Hanson, & Mayberry, 1995). There are also serious consequences for the provider, such as low utilization of services, failed appointments, increased emergency situations, and greater difficulty in rendering treatment (Gadbury-Amyot, 1996).

Previous studies addressing dental fear, anxiety, and phobia have reported that the primary reason people avoid dental treatment is fear of pain. The sensation of the anesthetic injection, the sight of the syringe, and the sight, sound, and sensation of the drill were most frequently identified as painful and producing fear (Ingersoll, 1982). Approximately 50% of patients who described themselves as fearful reported that the reason for their fear is the pain involved with treatment procedures. Of note, pain from dental treatment is generally rated milder than pain from other types of medical treatment. Most individuals rate dental pain somewhere between no pain and somewhat painful (Ingersoll). However, it should be noted that memories of pain are reconstructed and heightened over time, and match the existing level of dental fear for most fearful patients.

Dental fear has many causes (Berggren, 1992; Liddell, DiFazio, Blackwood, & Ackerman, 1994). The main categories include direct negative experiences reported by family, friends, or the media; general anxiety disorders, and individual personality characteristics (Bernstein, Kleinknecht, & Alexander, 1989; Moore et al., 1991). The literature also notes several sociodemographic correlates of dental anxiety. Specifically, women reported having dental anxiety more frequently than men, while men more commonly experienced severe dental fear and phobia (Berggren; Doebling & Rowe, 2000; Doerr, Lang, Nyguist, & Ronis, 1998; Locker, Shapior, & Liddell, 1996; Rowe & Moore, 1998; Schuurs, Duivenvooreen, Van Velzen, Verhage, Eijkman, & Makkes, 1985). There is conflicting evidence in the literature concerning the effect of educational level on dental anxiety; however, recent studies report that those with more education are less fearful (Doerr et al.).