This study found 41.7% prevalence of low dental anxiety, but 54.2% prevalence of moderate to extreme dental anxiety. Thus, prevalence of 95.8% showed varying degrees of dental anxiety among adult patients visiting the University of Ghana Dental School Clinic. This result is in accordance with previous studies done in Ghana on dental anxiety including one by Ofori et al., 9 where the prevalence of 47.3% was recorded and a study by Okang et al., 13 which had a prevalence of 75.3%. The rise in the prevalence of dental anxiety is clearly seen from these studies, which calls for some interventions.
A number of causative stimuli have been proposed to cause dental anxiety. In this study, the most commonly reported causes of dental anxiety were from the sound and feel of the drill/handpiece (38.6%), followed by injection (36.8%) and the dental chair (14.0%). Others included the appearance of dental teams (5.3%), the environment and smell of the dental clinic (5.3%). In a comparative study by Armfield and Milgrom 14, they stated that one of the most commonly reported concerns with respect to dental anxiety was receiving the injection. This in turn caused dentists and patients to often avoid difficult injections, hence, resulting in poor pain control. The daunting visual stimulus of a sharp needle to be injected into the body is known to cause intense apprehension among patients 14.
Though not a prominent cause of dental anxiety among participants in this study, it was interesting to find that Settineri et al 15 found that key sources of dental anxiety in their study were from the (tilted-back) dental chair position and various sensory stimulants linked with dental treatment. According to Settineri et al 15, the tilting back of the dental chair caused patients to lose control and feel vulnerable as they were not seated upright 15.
It is also interesting to note, Gadbury-Amyot and Williams 16 stated that dental anxiety could result in longer intervals between dental visits, poorer oral function, esthetics and higher frequency of oral symptoms. These results suggest the need for proper counseling of patients on dental procedures. This could possibly calm patients’ nerves, reducing the harboring of anxiety 16.
In this study, there was a significant association between sex and dental anxiety as well as experience with dental care and dental anxiety. More females experienced high to extreme levels of anxiety, while males experienced low to moderate levels of dental anxiety. These results are similar to studies done by Farooq & Ali 17 and Gadbury-Amyot et al 16, where females reported higher levels of dental anxiety compared to their male counterparts. Similarly, in a study by Heidari et al 18 analyzing ‘Oral health status of non-phobic and dentally phobic individuals,’ they found that participants reporting dental anxiety were mostly women 19. Ghanaian studies by Ofori et al., 9 and Okang et al. 13, had similar results with females also reporting higher levels of dental anxiety and fear than men. But these findings may be true mostly because women are more likely to seek treatment and utilize healthcare services than men. In a study by Thompson et al.,19 they concluded that women reported that they would visit a family physician in response to both physical and mental health concerns to a greater extent than men did 19. Similarly, Farooq and Ali 17 noted that females tend to be more anxious in difficult situations than men, hence the reason for high dental anxiety among them. Furthermore, studies carried out by Milgrom et al 20 indicated that women are more likely to admit their fears and anxieties than men.
In this study, majority of participants (71.9%) reported satisfactory experiences from their previous visits to dental clinics while 10.6% of participants reported that their previous experiences at dental clinics were fearful. It was found that there was significant association between patients who had previous dental experience and dental anxiety. In this study 84.2% participants with previous experience with dental care had low to moderate levels of dental anxiety, while 50% of those without experience with dental care had high to extreme levels of dental anxiety. The differences seen can be attributed to better knowledge on the importance of oral care and possible previous pleasant experiences among returning patients. But in a study by Locker et al 21, results showed that the relationship between previous dental experiences and high dental anxiety was strong. In their study, those who experienced dental anxiety had previous painful experiences (71%), frightening (23%) and embarrassing experiences (9%). These anxiety-inducing experiences manifested in feeling faint, fainting or having a panic attack while at the dental clinic 21.
These varying perspectives according to the studies referenced above show the importance of clinicians to ensure all patients’ experiences– with or without previous dental care, are as pleasant as possible.
In conclusion, the study found great levels of dental anxiety among respondents visiting the University of Ghana Dental School Clinic. There was 41.7% prevalence of low dental anxiety, but 54.2% prevalence of moderate to extreme dental anxiety, resulting in the cumulative prevalence of dental anxiety to be 95.8%. The most commonly reported causes of dental anxiety were from the sound and feel of the drill/handpiece, followed by injection. With respect to factors influencing dental anxiety, there was significant association between sex and dental anxiety as well as experience with dental care and dental anxiety. Findings from this study may provide useful information for the dental team at the University of Ghana Dental School Clinic and provide insight into dental anxiety that may be experienced by patients.