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Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 179-180
Prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending a dental institution in Vadodara city, Gujarat, India


1 Department of Public Health Dentistry, Narsinhbhai Patel Dental College & Hospital, Visnagar, Gujarat, India
2 Department of Public Health Dentistry, K.M. Shah Dental College & Hospital, Vadodara, Gujarat, India

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Date of Submission04-Sep-2010
Date of Decision13-Jan-2011
Date of Acceptance08-Feb-2011
Date of Web Publication25-Apr-2011
 

   Abstract 

Context: Anxiety is a subjective state of feelings. Dental anxiety is often reported as a cause of irregular dental attendance, delay in seeking dental care or even avoidance of dental care, resulting in poor oral health related quality of life.
Aim: To assess the prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending a dental institution in Vadodara, Gujarat.
Patients and Methods: A total of 150 adult patients waiting in the out-patient Department of Oral Diagnosis of K.M. Shah Dental College and Hospital were included in the study. Subjects were selected by convenience sampling. Dental anxiety was assessed by using Modified Dental Anxiety Scale (MDAS) and self-designed, semi-structured questionnaire incorporating various demographic variables, type and nature of dental treatment. Statistical analysis was done using SPSS version 16. Descriptive analysis, unpaired t-test, one-way analysis of variance (ANOVA) test and multiple logistic regression were applied for statistical analysis.
Results: 46% of the participants were dentally anxious. Females were found to be significantly more anxious than males. Subjects residing in villages had significantly more score than those residing in city. Relative influence of age, education, type of dental treatment, and previous dental visit were not significantly associated with dental anxiety. However, those subjects who had past negative dental experience were found to be significantly more anxious.
Conclusions: The study shows that dental anxiety was high among study subjects. It is recommended that this issue should be given due importance and addressed in a practical and meaningful manner.

Keywords: Dental anxiety, modified dental anxiety scale, socio-demographic data

How to cite this article:
Malvania EA, Ajithkrishnan C G. Prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending a dental institution in Vadodara city, Gujarat, India. Indian J Dent Res 2011;22:179-80

How to cite this URL:
Malvania EA, Ajithkrishnan C G. Prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending a dental institution in Vadodara city, Gujarat, India. Indian J Dent Res [serial online] 2011 [cited 2019 Nov 20];22:179-80. Available from: http://www.ijdr.in/text.asp?2011/22/1/179/79989
Anxiety is defined as apprehension of danger and dread, accompanied by restlessness, tension, tachycardia and dyspnea unattached to a clear unidentifiable stimulus. [1] Little is understood of the natural history of dental anxiety. [2] Weiner and Sheehan (1990) have suggested that dentally anxious people could be classified into two groups, exogenous and endogenous, with respect to the source of their anxiety. In the former, dental anxiety is the result of conditioning via traumatic dental experiences or vicarious learning, while in the latter, it has its origins in a constitutional vulnerability to anxiety disorders, as evidenced by general anxiety states, multiple severe fears, and disorders of mood. [3]

Dental anxiety is often reported as a cause of irregular dental attendance, delay in seeking dental care or even avoidance of dental care. [4]th Mehrstedt et al.[5] and Crofts-Barnes et al.[6] have reported that those experiencing high levels of dental anxiety are among those with the poorest oral health related quality of life. Dental anxiety varies in intensity from patient to patient. Several investigators have estimated the prevalence and determinants of dental anxiety but majority of the studies have been mainly confined to populations from industrialized countries. There is evidence that the prevalence as well as characteristics of dental anxiety are influenced by culture. [4] Hence, factors that have been identified as responsible for dental anxiety in populations from industrialized countries may not be the same for populations in the developing countries such as India. Moreover, no published data are available regarding the prevalence of dental anxiety and its associated socio-demographic variables for population residing in Vadodara city, Gujarat. If dentists are aware about the level of anxiety among their patients, they can anticipate patient's behavior and be better prepared to take measures to help alleviate anxiety. Hence, the present study has been carried out to assess the prevalence and socio-demographic correlates of dental anxiety among a group of adult patients at K.M. Shah Dental College and Hospital, Vadodara, Gujarat.


   Patients and Methods Top


Ethical approval for carrying out the study was obtained from Sumandeep Vidyapeeth University, Piparia, Vadodara. A total of 150 adult patients waiting in the out-patient Department of Oral Diagnosis were included in the study. Collected and analyzed data were subjected to power analysis to check the appropriateness of sample size. Power analysis of the present study revealed a power of more than 0.8. Thus, the sample size decided was considered as an appropriate one to suggest significant differences between the variables of interest. Subjects were selected by convenience sampling. First five adult patients on the specified three working days of a week were considered as study subjects. Informed consent was taken from the patients prior to the data collection. All the above specifications related to the number of patients and time duration for collection of data was so designed to minimize bias related to length of waiting period, diurnal variation, etc. Thus, designed data collection was scheduled from April 2008 to mid of June 2008. Patients who were not willing to participate in the study, those were contradicted for the study, pediatric and adolescent patients, and elderly patients (above 60 years) were excluded.

Survey instrument

The survey instrument consisted of two sections. The first section was socio-demographic and dental information of patient, e.g. age, sex, education qualification, residence, employment, past dental visit, past negative dental experience, etc. and the second section was an anxiety inventory by using Modified Dental Anxiety Scale (MDAS). [7] MDAS was used as an anxiety inventory to overcome the limitation of Corah's scale. In MDAS, there is an addition of item regarding respondent's feeling toward a local anesthetic injection, which was ranked almost as highly as the drill in terms of fear and anxiety. In addition, the responses for each question are kept uniform in contrast to different sets of answers for each question employed in Corah's scale. [7] English version of MDAS has been used in the present study for which very good reliability and validity have been already demonstrated in various situations [8] and in the Indian population. [9] The scale comprises five multiple choice items dealing with patient's subjective reaction to the dental situations mentioned below:

  • anticipating visit to dental clinic;
  • waiting in the dentist's office for treatment;
  • waiting in the dental chair for drilling of teeth;
  • waiting in the dental chair for scaling of teeth; and
  • waiting in the dental chair for receiving local anesthetic injection in upper back posterior teeth.
Five possible answers in ascending order from 1 to 5 were provided for each question. Entire questionnaire was filled up by the principal investigator to minimize misinterpretation. The case definition of dentally anxious individual and severity of dental anxiety was determined by converting interpretation of Corah's scale into MDAS scale using the formula 0.56 +(1.15 × DAS score). [10] The interpretation of MDAS scale based on this conversion is given in [Table 1].
Table 1: Interpretation of MDAS scale

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Statistical analysis

Student's t-test for unpaired sample was used to compare the differences between two means. To compare means of more than two groups, one-way analysis of variance (ANOVA) test was used. All independent variables showing significant associations with dependant variable - dental anxiety - at a significance level of <0.05 in the bivariate analysis were included in a logistic regression analysis. Analysis was done by using SPSS version 16.


   Results Top


Prevalence of dental anxiety among the study population was 46%. Based on severity of dental anxiety, 16% were found to be moderately anxious, 17.33% were reported as highly anxious and 12.67% were found to be extremely anxious. MDAS scale was found to be internally reliable with a Cronbach's alpha of 0.78 for the application of the scale in the Indian population.

Bivariate relationships between dental anxiety and some selected socio-demographic variables are shown in [Table 2]. Females, people residing in villages and those having past negative dental experience showed significant relationship with dental anxiety, while age, level of education, employment and past dental visit were not significantly associated with dental anxiety.
Table 2: Bivariate relationship between dental anxiety and some selected socio-demographic variables

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The logistic regression model explaining dental anxiety is shown in [Table 3]. Only three out of seven independent variables that were significantly associated with dental anxiety in the bivariate analysis were retained in the model. Out of the three variables, females and those having past negative dental experience were significantly associated with development of dental anxiety.
Table 3: Logistic regression analysis explaining dental anxiety

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   Discussion Top


The present study was carried out to assess the dental anxiety among the adult patients at K.M. Shah Dental College and Hospital, Vadodara. This dental college and hospital, can be a suitable setting to carry out anxiety related studies as all the dental treatments are provided under a single roof by different specialty departments and people from various socio-demographic backgrounds will be accessible under a single roof. Prevalence of dental anxiety in the present study was found to be 46%, which suggests that despite the technological advances made in modern dentistry, anxiety associated with dental treatment was widespread in the study population. Prevalence was higher than that reported in other studies [11],[12],[13],[14],[15],[16],[17],[18],[19] in which the prevalence rates ranging from 3 to 32% were observed in the patients attending dental clinics. This difference can be attributed partly to the methodological differences or geographical variation.

Anxiety levels for the age groups when compared for dental anxiety did not reveal statistically significant difference. Anxiety scores were higher for the subjects below 20 years of age. Almost similar results have been reported by Udoye et al., [12] while Thomson et al.[15] and Stabholz et al.[17] have reported that anxiety was higher among subjects in the age group 35-44 years. None of the studies showed statistically significant difference. The result obtained in the present study might be due to the well-accepted fact that dentally anxious individuals are not a homogenous group but differ in terms of origin and manifestation of their fears of dental treatment. [15]

Females were found to be significantly more anxious than their counterparts. Majority of the studies reviewed revealed similar results. [1],[11],[13],[14],[16],[18],[19],[20],[21],[22],[23],[24] The observed difference between males and females might be due to:

  • real difference in the anxiety levels between genders;
  • a greater readiness among females to acknowledge feelings or anxiety; and
  • both the factors acting in combination. [16],[19],[24]
In the present study, the anxiety scores when compared with the level of education were seen to have an inverse relationship with mean MDAS scores. Higher anxiety levels have been reported for those who have low level of education by several authors in their studies, [4],[18],[25],[26],[27],[28] while Akeel et al.[21] had reported that subjects with higher level of education were found to be more anxious. A plausible explanation for the observed trend could be that higher education provides the individual with better tools to cope with stressful situations like anxiety (e.g. rationalization of situation). [17],[18]

The subjects who were residing in villages showed significantly higher MDAS score than those residing in city. This result is similar to that reported by Nicolas et al.[29] Interaction of various factors like relatively lack of awareness about dental treatment, low level of education, low level of rationalization of situation, etc., might have resulted in increased dental anxiety among the study subjects.

In the present study, the type of employment did not show statistically significant association with dental anxiety. Retired subjects showed highest dental anxiety, followed by housewives and unemployed subjects than the employed or working study subjects. None of the studies reviewed has analyzed the relationship of employment with dental anxiety. The possible reasons behind such a result might be due to the interaction of various factors like low level of rationalization of the situation, stressful condition of the subjects, etc. Further reasons which account for the current results need to be explored.

Dental anxiety was higher among the subjects who had not received any dental treatment compared to those who had undergone some form of dental treatment. The result is in agreement with the studies reported by Ekanayake et al., [4] Woosung et al.[24] and Erten et al.[27] Non-utilization of dental service may be because of negative attitude toward dentist or dental treatment [16] due to various reasons or might be because of fear of unknown origin from dental treatment, and as fear and dental anxiety are positively correlated, dental anxiety might be high among subjects who have never received dental treatment.

Analysis of influence of past negative experience on dental anxiety showed that those subjects who had negative dental experience in the past demonstrated significantly higher mean MDAS scores. The result is in conformity with several other studies. [4],[23],[25],[28],[30],[31] Weiner and Sheehan (1990) have suggested that exogenous group of anxious individuals was the result of conditioning via traumatic dental experiences or vicarious learning. Thus, traumatic negative dental experience could be one of the major factors in the initiation of dental anxiety as well as to increase the vulnerability of fear related to dentistry, which can act synergistically and increase the dental anxiety among the study subjects. [3]

In conclusion, the findings of the study suggest that prevalence of dental anxiety was high among the study subjects. Amongst the various socio-demographic factors, gender, residence and past negative dental experience were significantly associated with dental anxiety. Although meticulous care has been taken to exclude the patients with psychological disorders which may influence assessment of anxiety, some patients might have been missed out as reliability was based on the response of patient. Other accepted limitation is the cross-sectional design of the survey which does not provide information on causality. As the exploration of literature review suggests that such a study to assess anxiety has not been carried out in Vadodara city, cross-sectional studies may provide a glimpse about the factors to be considered for the future studies to check causal relationship. Further studies are needed to address the dental anxiety levels in different populations, which will help dental care providers to better manage their patients. More information should emerge in this field since specialties in dentistry are becoming more available to the public, and except for pediatric dentistry, none has given adequate attention regarding patient management prior to and during specific dental treatments. The development of dental anxiety could be prevented with pain control, behavior management, and consideration of patient as a whole. The inclusion of behavior sciences in dental education and the integration of ethical considerations in the academic dental curriculum could help to improve the situation.


   Acknowledgments Top


Our sincere thanks to Dr. Ramesh Shrivastav, Prof & HOD, Department of Biostatistics, M.S. University, Vadodara, for helping us with statistical analysis, all the staff members of Department of Public Health Dentistry, K.M. Shah Dental College & Hospital, for their support, and all the subjects who participated in the study, without whose cooperation, this work would not have been successful.

 
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Correspondence Address:
Ekta A Malvania
Department of Public Health Dentistry, Narsinhbhai Patel Dental College & Hospital, Visnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.79989

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    Tables

  [Table 1], [Table 2], [Table 3]

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