| Abstract|| |
Aim: To assess the association between Individual deprivation measure with dental anxiety and socioeconomic status among patients visiting dentists in Chennai city, Tamil Nadu. Methods: A cross-sectional study was conducted among 50 patients aged 18-70 years who visited a private dental institution. Data on socio-demographics and detailed history about dental visits were obtained. Dental anxiety was measured using Corah Dental Anxiety Scale along with Individual deprivation measure questionnaire. Data were analysed using SPSS package 20. Descriptive statistics and one-way ANOVA were used for statistical analysis. Results: A total of 50 patients were enrolled in the study, 38% belonged to 31-40 years of age, 56% were male, 16% postponed dental visit due to dental anxiety, 54% belonged to upper middle class and 64% of the subjects had moderate anxiety. In all, 71.9% of the subjects with moderate anxiety were not deprived and 88.9% of upper middle class subjects were not deprived. Significant association was found between socioeconomic status and dental anxiety with Individual deprivation measure with a P < 0.05. Increasing socioeconomic status was associated with more deprivation and dental anxiety was higher among less deprived patients. Conclusion: Individual deprivation measure was associated with dental anxiety. Less deprived and higher socioeconomic class population had a significant higher dental anxiety.
Keywords: Deprivation, dental anxiety, socioeconomic
|How to cite this article:|
Sindhu R, Rajaram S, Bharathwaj V V, Mohan R, Manipal S, Prabu D. Is Individual deprivation measures associated with dental anxiety and socioeconomic status of patients visiting dentists. Indian J Dent Res 2020;31:515-9
|How to cite this URL:|
Sindhu R, Rajaram S, Bharathwaj V V, Mohan R, Manipal S, Prabu D. Is Individual deprivation measures associated with dental anxiety and socioeconomic status of patients visiting dentists. Indian J Dent Res [serial online] 2020 [cited 2021 Jan 28];31:515-9. Available from: https://www.ijdr.in/text.asp?2020/31/4/515/298421
| Introduction|| |
Individual Deprivation Measure (IDM) is a new gender-sensitive, multidimensional global measure developed based on extant measures of poverty and gender equity in disparate ways. The IDM is capable of measuring deprivation at individual level rather than measuring at household level, which allows investigation of the deprivation distributed within the household and allowing for the construction of indices of gender equity that is based on individual achievement. The scores are organized in intervals to measure different levels of deprivation rather than binary scores. The IDM also assess poverty which is comparable over time and several contexts.
The IDM measures deprivation under 15 dimensions of human life, which includes food, water, shelter, sanitation, healthcare, education, energy/cooking fuel, sanitation, family relationships, clothing/personal care, violence, family planning, the environment, voice in the community, time-use, and respect and freedom from risk at work. The IDM mostly concentrates on the individual as a unit of analysis and is done usually among people who invariably experienced poverty. The IDM illuminates the difference between the extent and the nature of poverty of the particular individual irrespective of their gender differences.
Psychiatric disorders are as common in dentistry as they are in general medicine practice with some reports reporting one out of four patients visiting the physician have one mental health issue. The most commonly experienced issue worldwide among dental patients are dental anxiety and fear towards dental treatment. Dental anxiety was found to be ranked fourth among common fears, followed by ninth among intense fears. Despite the advanced technologies, awareness about dental materials and treatment, a significant percentage of people experience dental anxiety while visiting dentists.
Various studies have been conducted to assess the dental anxiety prevalence among different populations across various cultures from developed countries, which showed that patients with severe dental fear happened to avoid dental treatment, postpone their dental visit, seek emergency dental care and also have poor health quality of life., Dental anxiety is a substantial problem among many patients that acts as a barrier to dental treatment, which leads the patients to avoid visiting dentists altogether even during emergencies.
Studies measuring the association between dental anxiety and Sense of Coherence (SOC) as well as association between SOC and IDM have found a positive association., The mean SOC was higher among those subjects who were less deprived showing the capability of utilizing the resources at their disposal. This denotes the likely chance of an indirect association persisting between dental anxiety and IDM. IDM measure is an instrument that measures poverty, which could also be measured using socioeconomic status (SES) scale as it evaluates a person's economic profile. Hence, studies evoking the association between IDM with dental anxiety and SES are necessary to focus on the high-risk population in order to resolve the gap persisting among various populations in terms of deprivation.
Dental anxiety varies among individuals and is related to various factors such as age, gender, educational qualification, SES and culture. The crucial aspect of managing the outcome of the treatment is identifying dentally anxious patients. The most commonly used questionnaire to measure dental anxiety is Corah Dental Anxiety Scale (CDAS). The aim was to assess the association of individual deprivation score with dental anxiety and SES among adult patients visiting the dentists in Chennai city, Tamil Nadu.
| Methods|| |
A cross-sectional study was conducted among 50 patients who visited the outpatient department of a private dental college and hospital, Chennai. The study was conducted in the months of September and October 2017. The study was independently reviewed and ethical approval for the study was obtained from the Institutional Review Board of SRM Dental College and Hospital, Chennai. A pilot study was conducted and the Tamil version of the questionnaire was pretested for validity and reliability among a sample size of 10 randomly selected subjects, those questionnaires were not included in the final analysis. The sample size for the study was estimated using the data obtained in the pilot study. A power analysis was performed using G × power software inputting an effect size of 0.4, alpha error probability of 0.05 and a sample size of 50 was calculated. The samples for the study were selected by simple random sampling; five samples per day were selected randomly using lottery method from the outpatient records of SRM Dental College and Hospital, Chennai and the subjects were interviewed face-to-face in the respective departments. Collection of data was restricted to 5 per day, as the IDM questionnaire is comprehensive and takes time. The questionnaire was validated and the Cronbach's alpha test showed a reliability coefficient of 0.85, which was found to be satisfactory for conducting the study.
The study population consisted of patients aged 18-70 years, who visited the dentists. Patients who gave informed consent were included in the study; patients undergoing psychiatric therapy or suffering from generalized anxiety disorders were excluded from the study.
The assessment tools consisted demographic details of the patient, a questionnaire containing the IDM and CDAS, which was used to measure the level of dental anxiety and its association with IDM.
The demographic details consisted information on age, gender, educational qualification, occupation and income of the patient. The quantitative variables include age and income; the qualitative variables include gender, educational qualification and occupation of the patient. These variables were open-ended questions which were recorded to calculate the SES of the subjects. The dental history was obtained regarding previous dental visit experience, duration since last dental visit, postponement of the dental treatment due to dental anxiety and self-perceived oral health status of the patient were also included in the questionnaire. The previous dental visit experience was assessed as good or bad; the duration since last dental visit was categorized into within 6 months, 6-12 months, 1-2 years and >2 years; the postponement of the dental treatment due to dental anxiety was given options as yes or no; self-perceived oral health status was categorized as excellent, good, fair or poor. The IDM questionnaire comprises questions under 15 dimensions with the scores ranging from 0 to 100. The subjects were categorized as extremely deprived, very deprived, deprived, somewhat deprived and not deprived based on the scores <60, 60-69.9, 70-79.9, 80-89.9, 90-100, respectively.
The dental anxiety of the study participants were assessed using CDAS; it is a brief questionnaire containing multiple choice questions that deals with the subjective reaction about visiting the dentist, waiting for dental treatment in the dental clinic, apprehension to scaling, drilling and more commonly local anaesthetic injection. Each item has 1-4 responses that are ranged in an ascending order from “low” to “don't know” . The questionnaire is simple, easy and takes minimum time for completion. It helps in understanding the nervousness or anxious behaviour of the patient which helps in the betterment of treatment planning and also probes the factors that defer the treatment which modifies the traditional treatment planning. According to Kuppuswamy socioeconomic scale, SES was categorized as lower, upper lower, lower middle, upper middle and upper class. Upper middle class is made up of professionals esteemed by exceptionally high educational attainment as well as high economic security consists mostly of “white collar” professionals. Lower socioeconomic class is made up of individuals distinguished by absence of educational attainment as well as with little economic security consists mostly of “blue collar” workers.
The questionnaire was administered both in Tamil and English languages. Patients were made to fill out the forms in the waiting hall before the commencement of treatment procedure.
SPSS® Base 20.0 statistical package was used for data analysis. Descriptive statistics was used for frequency distribution and one-way ANOVA was used to determine the differences between dental anxiety and SES with IDM.
| Results|| |
The sample consisted of 50 participants aged 18-70 years. In all, 56% (n = 28) of the study participants were males and 38% (n = 19), majority of the study subjects belonged to the age group of 31-40 years; 82% (n = 41) of the subjects had a good past experience with the dentists; 36% (n = 18) had reported the duration since last dental visit was >2 years; 84% (n = 42), majority of the subjects reported that they did not postpone the dental visit due to dental anxiety and 36% (n = 18) of the study participants rated their oral health as fair. [Table 1] 64% (n = 32) of the subjects were found to be moderately anxious and a majority of 54% (n = 27) belonged to upper middle class [Figure 1]. In this study, 76% (n = 38) of the study participants were found to be not deprived [Figure 2].
|Figure 1: Distribution of study participants according to age, gender, SES and Dental anxiety|
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|Figure 2: Distribution of study participants based on Deprivation status|
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One-way ANOVA was used to test the differences between IDM among participants with various dental anxiety levels. The difference was statistically significant at P < 0.05. Participants with moderate and high dental anxiety had lower mean IDM compared to the participants with low dental anxiety [Table 2]. One-way ANOVA yielded significant results when comparing the differences between IDM among subjects with various SES at P < 0.05. Subjects belonging to upper middle class SES had the highest mean IDM compared to subjects belonging to other categories [Table 3].
|Table 2: One-way ANOVA comparing mean IDM among subjects with various dental anxiety|
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|Table 3: One-way ANOVA comparing mean IDM among subjects with different socioeconomic status|
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| Discussion|| |
This study was performed to assess the association between IDM with dental anxiety and SES among 18–70-year-old individuals. IDM measures the deprivation status of every individual as it divaricates among individual, as well the dental anxiety also varies with different individuals.
The study results showed a significant difference between IDM and dental anxiety of the patients visiting the dentists. Moderate and high anxiety were found to be the most common types of anxiety prevalent among the participants, provided that none of the subjects were found to be free of anxiety. This is in accordance with the previous studies.,, This finding is in contradiction to a study conducted by Faki et al. in Sudan, which showed higher prevalence of low and moderate anxiety among the study subjects; this may be due to the differences in the standard of health services provided to them along with their lifestyle.
The dental anxiety was found to be higher among the subjects who are less deprived; the possible reason could be the social and cultural factors among different population, another reason may be the higher tolerance and low level of apprehension among extremely deprived subjects. IDM was not associated with different age groups as the levels of deprivation were equally noticed in all age categories in our study. The present study shows no gender discrepancy with respect to deprivation nor anxiety which shows both males and females are equally deprived. Other studies that determined dental anxiety contradicts this finding, females were more anxious compared to males.,,
SES was found to be associated with deprivation as lower and middle class subjects were more deprived than the subjects who were in the upper middle and upper socioeconomic class. Those with moderate SES were more likely to be deprived. In the present study, the mean IDM score was 89.79, which was significantly higher than in Nepal and Fiji with the mean IDM scores 67.59 and 77.69, respectively, indicating greater deprivation among present study population. The present study showed no significant association with the gender and deprivation, in contrast to a study done in Philippines where males were more deprived than the females. Another study conducted in Nepal showed 24% of females falling under “extremely deprived” category compared to 16% of males.
The limitation of the study was that the study population contained an unequal proportion of subjects with different socioeconomic classes which could have led to selection bias. Responses to questions on educational qualification, occupation and income were self-reported and could be biased as the chances for patients to under or overestimate their responses. More number of subjects belonged to middle and upper middle classes as the subjects were recruited from a private dental institution. Future research should involve an equal proportion of various socioeconomic class individuals with larger population.
| Conclusion|| |
Individual deprivation was noticed at varied levels in all the subjects and the association of individual deprivation with dental anxiety and SES was proved significant in this study. Dental healthcare providers could play a vital role in measuring the deprivation status and anxiety level of the patients and provide counselling to reduce the impacts of such factors in seeking dental care as well improving their quality of life.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Bessell S. The individual deprivation measure: Measuring poverty as if gender and inequality matter. Gender & Development 2015;23:223-40.
Weiner A. The fearful dental patient: A Guide to Understanding and Managing. Ames, Iowa: Wiley-Blackwell; 2011.
Kvale G, Berg E, Raadal M. The ability of corah dental anxiety scale and Spielberger's state anxiety inventory to distinguish between fearful and regular Norwegian dental patients. Acta Odontologica Scand 1998;56:105-9.
Erten H, Akarslan ZZ, Bodrumlu E. Dental fear and anxiety levels of patients attending a dental clinic. Quintessence Int 2006;37:304-10.
Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: Exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 2007;7:1.
El Faki AK, Awooda EM. Dental anxiety prevalence and associated factors among patients attending the academy dental teaching Hospital–Khartoum, Sudan. Am J Med Sci 2016;4:82-6.
Viswanath D, Krishna AV. Correlation between dental anxiety, Sense of coherence (SOC) and dental caries in school children from Bangalore North: A cross-sectional study. J Indian Soc Pedod Prev Dent 2015;33:15-8.
] [Full text]
Aurlene N, Sindhu R, Sasikala M, Divyalalitha N, Prabu D. Does individual deprivation affect the sense of coherence and oral health status of individuals? J Clin Diagn Res 2019;13:ZC01-05.
Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-7.
Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc 1978;97:816-9.
Shaikh Z, Pathak R. Revised Kuppuswamy and BG Prasad socio-economic scales for 2016. Int J Community Med Public Health 2017;4:997-9.
Tarkhnishvili A, Tarkhnishvili L. Middle class: Definition, role and development. Global J Hum-Soc Sci Res 2014;13:21-31.
Jakopovich D. The Concept of Class. Cambridge: SSRG Publications; 2014.
Mohammed RB, Lalithamma T, Varma DM, Sudhakar KN, Srinivas B, Krishnamraju PV. Prevalence of dental anxiety and its relation to age and gender in coastal Andhra (Visakhapatnam) population, India. J Nat Sci Biol Med 2014;5:409-14.
Al-Omari WM, Al-Omiri MK. Dental anxiety among university students and its correlation with their field of study. J Appl Oral Sci 2009;17:199-203.
Halonen H, Salo T, Hakko H, Räsänen P. Association of dental anxiety to personality traits in a general population sample of Finnish University students. Acta Odontol Scand 2012;70:96-100.
Kumar S, Bhargav P, Patel A, Bhati M, Balasubramanyam G, Duraiswamy P, et al
. Does dental anxiety influence oral health-related quality of life? Observations from a cross-sectional study among adults in Udaipur district, India. J Oral Sci 2009;51:245-54.
Saatchi M, Abtahi M, Mohammadi G, Mirdamadi M, Binandeh ES. The prevalence of dental anxiety and fear in patients referred to Isfahan Dental School, Iran. J Dent Res 2015;12:248-53.
Wisor S, Bessell S, Castillo F, Crawford J, Donaghue K, Hunt J, et al
. The individual deprivation measure: A gender sensitive approach to poverty measurement. IWDA; 2014.
Dr. R Sindhu
Department of Public Health Dentistry, SRM Dental College, Bharathi Salai, Ramapuram, Chennai - 600 089, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]