Factors influencing dental phobia and screening behavior of patients in oral surgery practice

doi:10.21203/rs.3.rs-3575473/v1

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Factors influencing dental phobia and screening behavior of patients in oral surgery practice

https://doi.org/10.21203/rs.3.rs-3575473/v1

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Background

Despite efforts by dentists and patients to establish trust, dental visits continue to be anxiety-inducing. The frequency of dental treatment sought is influenced by this fear, impacting long-term oral health. This study aimed to use the Dental Anxiety Scale (DAS) to identify fearful patients at a dental surgery clinic, exploring correlations with preventive behavior, gender, age, and education.

Methods

The study enrolled 102 consecutive outpatients at a private dental clinic in Sachsen, Germany, with participants aged 16 and above. Adolescents and parents provided written informed consent and assent. A meticulously crafted questionnaire, featuring numerous questions, aimed to evaluate dental patients' anxiety levels and their oral health behavior. Assessment of anxiety considered factors such as age, gender, educational qualification, fear of dental treatment, frequency of teeth brushing, instances of canceled or missed dental appointments due to anxiety, and the timing of the last dental visit.

Results

Comparing all scales according to low and high anxiety, the mean score of the whole group of DAS was with a high significance from somatization, depressiveness and anxiety.

Significantly more time had passed since the last dental visit for most patients. Patients who had a higher anxiety level based on the DAS categorization were also less likely to have tartar removed and to have professional dental cleaning performed.

Conclusion

Dental treatment anxiety has no influence on preventive behavior, except for the questions that are also related to dental treatment anxiety ("Are you afraid of dental treatment?").

Dental Anxiety

dental fear

dental survey

oral surgery

oral health

health behavior.

Dentophobia, or dental fear, is a common emotional response to specific threats in dental situations [1][2]. Dental anxiety involves apprehension about impending unpleasant experiences during dental treatment, often accompanied by a feeling of losing control [1]. Dental phobia is a more severe form, marked by persistent anxiety related to specific situations or objects in dentistry [1][3]. The term 'dental fear and anxiety' (DFA) is used broadly for strong negative feelings about dental treatment in people of all ages [3]. Dental phobia may lead individuals to avoid the dentist, neglect oral health, and eventually face painful dental issues, creating a cycle of fear [3]. Dental anxiety often begins in childhood and can strain relationships and impact employment [4]. A German study [5] shows that patients with dental anxiety have poorer oral hygiene than patients without dental anxiety. Therefore, it is very important and necessary to educate patients with dental anxiety about the possible consequences of their phobia. This is the only way to make them aware that caries prevention should not be underestimated and to prepare themselves for the right treatment at the right time. In another German study [6] found in 1549 patients that there is a correlation between dental relationship between dental anxiety and psychological stress.

Consistently, studies have shown that females tend to experience higher levels of dental anxiety compared to males [7]. About one in six individuals experience high anxiety related to dental treatment, with middle-aged women exhibiting higher rates than men [4].

Initial studies found a link between fear of dental procedures and past painful dental experiences or anticipation of trauma [8]. Procedures like subgingival scaling, deep probing, and extractions are linked to increased reported pain, particularly in individuals with elevated dental anxiety [9].

The objective of this study is to explore the factors (such as anxiety level, age, gender, education) that influence the oral health behavior (such as frequency of tooth brushing, frequency of professional teeth cleaning, frequency of dental visits) among oral surgery patients.

During the period from December 2019 to June 2020 were asked 150 patients to participated and only N = 102 patients have accepted and were included in the study. The survey began in the waiting room before their routine treatments, where they filled out a comprehensive questionnaire. The questionnaire included the Dental Anxiety Scale (DAS) [10] and a set of descriptive questions, collecting information about preventive behavior. The general conditions to take part in the survey were an adequate comprehension of spoken and written German and psychological inconspicuousness. A special screening for psychological problems was not part of this study. Dental phobia or a high level of dental anxiety were not exclusion criteria. All patients gave written informed consent, and only patients providing written informed consent were included as study participants.

Dental Anxiety Scale (DAS)

This widely used self-assessment questionnaire is a common tool for exploring dental anxiety, comprising four items related to a dental situation [10]. Patients rate their anxiety levels on a scale of 1 (low anxiety) to 5 (high anxiety). Corah et al. [11] reported a mean score of 9.1 in a population of 2103 subjects, with a cutoff score of 15 distinguishing those with dental anxiety from those mildly anxious (scoring 13 to 15) and those not anxious (scoring below 13). The DAS has demonstrated validity in numerous studies, with a retest reliability of rtt = 0.86 [10] and a Cronbach's alpha of 0.80. In this study, Cronbach's alpha was calculated as 0.871 (N = 102).

Oral health

Participants were requested to respond to inquiries concerning their evaluation of oral health, dental care, and other aspects of dental well-being. Subsequent questions included:

1) How often do you brush your teeth? (never, 1x daily, 2x daily, 3x daily, 4x daily, more often)

2) How often do you go to the dentist? (For example, for prophylaxis). (Never, 1x a year, 2x a year, 3x a year, 4 times a year, more often)

3) How often do you have tartar removed? (Never, 1x a year, 2x a year, 3x a year, 4x a year, more often)

4) How often do you have professional teeth cleaning? (Never, 1x a year, 2x a year, 3x a year, 4x a year, more often)

5) When you think about your teeth, what is the condition of your teeth? (poor, less good, satisfactory, good, very good)

6) Have you ever canceled or missed a dental appointment due to dental anxiety? (Yes, No)

7) How much can you do yourself to maintain or improve the health of your teeth? (Nothing at all, little, some, much, very much)

8) Are you afraid of dental treatment? (very strong fear, strong fear, neither/nor no fear, no fear at all)

9) When was your last visit to the dentist?

Statistical procedure

All questionnaires were analyzed using the statistical program "Statistical Package for the Social Sciences" (SPSS 27). The mean total values were calculated and then analyzed using an independent sample t-test. Chi-squared tests were used to determine significance between questionnaire categories and sample characteristics. P values equal or less than 0.05 were considered statistically significant. The G*power program [12] was used to calculate an appropriate sample size for the desired statistical analyses. Based on an effect size of d = .80, a significant level of p = .05 and power of 95% (1-ß = 0.95), a minimum sample size of N = 35 per subject group was required for independent sample t-test.

In the group with a higher DAS score, it was a quarter of respondents who answered this with a "no," so their anxiety was probably due to other causes. However, the statistical difference of p < 0.001 is well above the significance level. Patients in the higher DAS score group naturally also exhibit a higher fear of dental treatment with a score of 45.5 % than, for example, patients with a lower DAS score of 43.5 %. The result is significant according to the chi-square test with p < 0.001.

Table 1: Relationship between dental treatment anxiety (DAS categorization) and preventive care behavior/oral health status (gender-, age-, education-specific differences)

Lastly the frequency with which prophylaxis services such as "scaling" and "professional and professional dental cleaning, with approximately two-thirds of respondents with lower and higher levels of education/graduation reported having tartar removed once a year, while a quarter removed once a year, whereas a quarter of both groups (with a low degree 24.1 % and 17.4% with higher education) reported having a prophylactic service performed even twice a year. Tartar removal more than three times a year and more often was performed by 8.7 % of respondents with a high level of education, but also those with a low educational level. This result is significant according to the Chi-square test with p = 0.043.

When asked "When was your last visit to the dentist?" it was found that in some cases this went back a long way in male subjects. Thus proved a high significance of p = 0.029, while it corresponded to female subjects.

No differences were found between the different groups (dental anxiety, age, gender, education) on most of the oral health behaviour measures studied.

In the present study, however, the data were predominantly collected in the home environment using the paper-pencil method. Consequently, there is no temporal and spatial relationship to dental treatment. Similarly, the terminology "surgery", as already used by a recent 2015 [13] and 2001 [14], leads to potential incorrect answers, which cannot be checked by the attending Doctor, since the survey was conducted in the questioning took place in the home environment, so it could not be verified by the treating physician.

Another not insignificant aspect, which could have influenced the study results is that subjects were asked about their self-assessed condition by means of a standardized questionnaire. However, false statements on dental anxiety are possible, since men in particular tend to answer untruthfully instead of answer truthfully, they tend to give a socially desirable answer in accordance with their social role [15].

In the case of preventive care behavior and individual attitudes towards oral health, the subjects were asked about the time elapsed since their last visit to the dentist. It was found that men generally had a longer history of their last dental appointment than women, with a strongly significant (p = 0.029) increase in the time elapsed since their last dental visit. Accordingly, women are more concerned about their oral health than men. The preventive care behavior of the two education-specific patient groups was then compared. This revealed that patients with a low level of education had a significantly poorer index (p = 0.043) according to the Chi test, which is particularly evident in the case of tartar removal. However, the two groups of patients did not differ significantly in the frequency of visits to the dentist and the performance of professional dental cleaning. Nevertheless, it was found that 2% of the patients with low completion never have a dental cleaning performed. One reason for this could be that professional tooth cleaning in Germany is in most cases a private service that is not covered by the statutory health insurance. In the meantime, however, more and more statutory health insurers have recognized the importance of this prophylaxis service and already support the subsidy through bonus programs.

Nevertheless, patients should definitely be further educated about the importance of prophylactic treatments such as tooth cleaning. This is the only way to prevent periodontal disease and halt its progression. The development and progression of caries is also strongly dependent on individual behavior [16]. However, with appropriate prophylactic measures, caries can be prevented, and further progression can be halted [17]. In addition, it is possible to reduce caries by means of overall concepts, which are usually a combination of information, instruction, professional tooth cleaning and fluoride application. Participation in such programs is particularly recommended for patients with an increased caries risk [16]. In addition, the majority of both patient groups are convinced that one can do a lot or very much for the health and maintenance of one's own teeth. Therefore, preventive behavior and attitudes toward oral health were investigated for both patient groups in relation to dental anxiety (DAS categorization). Significant correlations were found between anxiety level and fear of dental treatment in the patient group. Individuals who had a higher anxiety level according to the DAS categorization also had strongly significant anxiety toward dental treatment (p = 0.000). The same is true for the dental appointment (p = 0.000). This is because there are correlations between missed or canceled appointments and patients' anxiety levels. 77% of patients with higher anxiety levels had already missed or canceled one or more appointments. Nevertheless, it was noticeable in the patient group that patients with a higher anxiety level go to the dentist more often than patients with a lower anxiety level, which gives cause for thought in this respect. It is possible that those affected try to avoid invasive treatments by visiting the dentist more frequently. A Study [18] also found that people with dental anxiety visit the dentist more regularly than people without dental anxiety. There was no significant relationship between oral health attitudes and dental treatment anxiety. No significant relationship was found between oral health attitudes and dental treatment anxiety even with age-specific differences.

In the present study, it was confirmed that people have higher levels of anxiety when asked about the dental environment and may also avoid visiting the dentist. Therefore, it is important for dentists to be sensitized to the problem of dental anxiety in order to treat patients with higher levels of anxiety.

DAS

Dental Anxiety Scale

Funding

No funding was obtained for this study.

Availability of data and materials

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neurosciences, Research Group Applied Medical Psychology and Medical Sociology, Fetscherstr. 74, 01307, Dresden, Germany

Rezart Qorri, Nertsa Cunoti, Laura Magerfleisch, Hendrik Berth

Contributions

HB constructed the study design. RQ had been involved in acquisition of data. RQ an NC wrote the first draft of the manuscript. RQ, NC, LM and HB contributed to statistical analysis, data interpretation, and manuscript drafting. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hendrik Berth.

Ethics declarations

Ethics approval and consent to participate

The present study was approved by the Ethics Committee of the Technische Universität Dresden, Germany (EK 63032013), and only individuals who provided written informed consent were included as study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Table 1 is available in the Supplementary Files section

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Table1RQ.doc

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Version 1

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Factors influencing dental phobia and screening behavior of patients in oral surgery practice

Status:

Version 1

Abstract

Background

Methods

Dental Anxiety Scale (DAS)

Oral health

Statistical procedure

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Table

Additional Declarations

Supplementary Files

Status:

Version 1