|Year : 2021 | Volume
| Issue : 2 | Page : 107-112
Exploring dental anxiety among male and female across adolescents, young adults, and middle adults
Samina Bano1, Syed Ansar Ahmad2, Kriti Vyas3
1 Department of Psychology, Jamia Millia Islamia, New Delhi, India
2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
3 Department of Psychology,Faculty of Humanities and Social Sciences, Vishwakarma University, Pune, Maharashtra,India, India
|Date of Submission||10-Oct-2020|
|Date of Acceptance||22-Feb-2021|
|Date of Web Publication||16-Jul-2021|
Department Counselling and Special Education, Manthan International School, Tellapur, Hyderabad, Department of Psychology,Faculty of Humanities and Social Sciences, Vishwakarma University, Pune, Maharashtra,India
Source of Support: None, Conflict of Interest: None
Introduction: Dental anxiety is a state of uneasiness and worry, making the patient feels that something terrible will happen to him regarding dental treatment and procedure. Research suggests that dental anxiety is a prominent factor in leading to avoidance of dental treatment by the patients. The intensity of dental anxiety varies individually and across gender. Research suggests that adopting healthy dental care habits encourages good oral health, contributing to the quality of life, whereas poor dental habits can lead to dental problems. Therefore, the present study attempts to explore the level of dental anxiety and dental care habits across age groups and gender. Methods: The sample consists of 150 patients from Delhi/National Capital Region. They were divided into three age groups – adolescence (n = 50), young adulthood (n = 50), and middle adulthood (n = 50). Modified Dental Anxiety Scale was used to assess dental anxiety and a semi-structured interview was taken to assess the level of dental hygiene among the patients. Results: there are statistically significant differences in dental anxiety scores between males and females. Our results also point that these gender differences persist across age groups – adolescence, young adulthood, and middle adulthood on dental anxiety. Conclusion: The findings reveal higher dental anxiety levels among adolescents, which gradually increase with age. Furthermore, females are more susceptible to have dental anxiety than males. Thus, dental professionals should provide age and gender-targeted counseling to avoid dental anxiety among their patients.
Keywords: Adolescence, dental anxiety, dental hygiene, middle adulthood, young adulthood
|How to cite this article:|
Bano S, Ahmad SA, Vyas K. Exploring dental anxiety among male and female across adolescents, young adults, and middle adults. J Dent Res Rev 2021;8:107-12
|How to cite this URL:|
Bano S, Ahmad SA, Vyas K. Exploring dental anxiety among male and female across adolescents, young adults, and middle adults. J Dent Res Rev [serial online] 2021 [cited 2021 Aug 1];8:107-12. Available from: https://www.jdrr.org/text.asp?2021/8/2/107/321526
| Introduction|| |
Dental problems are always acted as a burden on the people. They are often accompanied by pain, decreased social functioning, disturbance in daily routine, etc. There is an increase in the prevalence of dental diseases and one of the reasons is dental anxiety. Dental anxiety is a condition involving worry about dental treatment leading to the feeling of losing control. It is excessive or unreasonable anxiety toward dental procedures and treatment leading to a negative impact on one's daily life as well as avoidance of dental treatment. Researchers identified few behavioral symptoms in dental anxiety patients such as fidgeting, sitting on the edge of the chair, startled reaction to noise, and generalized muscle tensions.
Dental anxiety is the major concern for dental care professionals and is ranked fourth among common fears., Research suggests that only a few dental patients do not experience anxiety. Dental anxiety was also found high among dental patients in India. Studies suggest that dental anxiety can vary according to the age group. Dental anxiety increases from 11% to 13% in adolescence to 26% during young adulthood.
Studies show different reasons for this dental anxiety. One of the reasons is the clinical setup; for example, patients feel powerless while sitting on the patient chair in the reclined position and dentist checking the patients' mouth cavity and using drillers., Another reason for dental anxiety is the dental treatment and procedures such as use of injections, scrapping, and the sight of blood.
Patients with dental anxiety problems tend to avoid dental treatment and further aggravate the dental problem leading to poor oral health., Research suggests that it leads to a vicious cycle of dental fear or anxiety because avoidance leads to delay in treatment, this further deteriorates dental problem; as a result, the patients need to undergo specialized and complex treatment procedures. These treatments cause them pain thereby reinforcing their dental anxiety or fear. Therefore, dental professionals must deal with and ease the dental anxiety of the patients.
Another concern for dental health professionals is maintaining good dental hygiene by the patients. It has been established that following regular and proper dental care habits such as brushing at least twice a day, regular use of dental floss and mouthwash, and using fluoride-based toothpaste help in reducing the occurrence of dental caries and other dental problems.,
Apart from the aforementioned reasons, dental anxiety is also affected by a number of factors like age and gender of the patients. Regarding age, some studies suggest that dental anxiety starts in childhood and is at the peak in early adulthood and slowly tapers down with increasing age. In contrast, some studies have indicated that it originates in adolescents and young adulthood or maybe later life. A study conducted by a group of researchers provides evidence that dental anxiety was high among the age groups of 25–35 and 35–45 years and low for the age group of 55–65 years. On the contrary, another study found that the age group between 20 and 39 years was high on dental anxiety as compared to the younger and older population. Due to such mixed results, the present study explores the level of dental anxiety across three age groups – adolescents, young adults, and middle adults.
In addition to age, previous literatures have also suggested that dental anxiety varies according to gender, particularly females are prone to high dental anxiety as compared to males.,, However, again few recent studies found no significant gender difference on dental anxiety.,
To summarize, previous studies investigating dental anxiety across different age groups have shown an inconsistent finding. Studies have looked at dental anxiety either across gender or age, and their conclusion is focused either on age difference or gender difference. None of the studies so far have explored the age-related changes in dental anxiety with respect to gender. However, how dental anxiety changes among males and females as the age progresses is still an open question. Therefore, the present study investigates whether dental anxiety varies across the different age groups with respect to gender.
| Methods|| |
Dental patients were selected from Dental Hospital at Jamia Millia Islamia University, Delhi. One hundred and sixty-five patients were approached, those who gave the consent were included in the final sample. Few of the participants were dropped from the sample due to incomplete information. Hence, the final sample comprised 150 dental patients. The sample was divided into three age groups – adolescence (12–19 years), young adulthood (20–40 years), and middle adulthood (41–60 years). Each group consists of 50 patients.
The patients were asked to fill up a brief sociodemographic profile about their age, gender, religion, education qualification, profession, family type, family annual income, housing type, and housing space [Table 1].
Dental history and hygiene
The patients were asked to fill up details, such as frequency of brushing and tongue cleaning, methods of maintaining oral health, complaints of tooth sensitivity and gums' bleeding, reasons for a dental visit, and treatment sought by them.
Modified Dental Anxiety Scale (MDAS) developed by Humphris, Morrison, and Lindsay (1995) was used to measure dental anxiety. The scale was originally based on the Corah's Dental Anxiety Scale. The scale consists of 5 items and patients need to rate their responses from not anxious (1) to extremely anxious (5). The total score ranges from 5 to 25. A cutoff score of 19 and above denotes high dental anxiety or dental phobic. The Cronbach's alpha value of the Dental Anxiety Scale for the present study was 86.
The protocol involved in the present study was approved by the Institutional Ethics Committee for the Faculty of Social Sciences, Jamia Millia Islamia, New Delhi.
The Dental Hospital at Jamia Millia Islamia was contacted and permission was obtained from the authorities. The patients sitting in the waiting area of the out-patient department were approached. The patients were briefed about the study. They were assured about the confidentiality and anonymity of the information. After obtaining verbal consent from them, they were asked to fill up the demographic profile and gave details about the dental history and dental care habits. After that, they were asked to fill the MDAS to assess dental anxiety among patients. The patients were thanked for contributing to the research.
After the data collection, a statistical analysis was performed using JASP-0.12.2 software. To examine the differences in terms of age and gender on dental anxiety, we employed a two-way analysis of variance (ANOVA) along with the simple main effect analysis.
| Results|| |
Participants' responses were recorded and summarized in terms of mean and standard deviation across the age group and gender [Table 2].
|Table 2: The mean and standard deviation for males and females across the three different age groups|
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To investigate whether the dental anxiety scores differ across age and gender, we employed 2 (gender: male and female) ×3 (age: adolescents, young, and middle adults) ANOVA. The ANOVA results suggest that the dental anxiety scores were significantly different across three different age groups (F (2, 144) =10.31, P = 0.001 partial η2 = 0.11). Similarly, the results also indicate that the dental anxiety scores for males and females were also significantly different (F (1, 144) =27.07, P = 0.001, partial η2 = 0.14). However, age × gender interaction term was not statistically significant (F (2, 144) =1.26, P = 0.28, partial η2 = 0.01) [Table 3].
|Table 3: Analysis of variance result table showing the main effects of age, gender, and age×gender interaction|
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Since the main effect of age and gender was found significant, we motivated to do the simple main effect to test whether the dental anxiety scores differ for males and females across three age groups. Therefore, we conducted the simple main effect analysis, and the results suggest that the dental anxiety scores were significantly different for male and female in adolescents (F (1, 144) = 8.623, P = 0.004) and young adults (F (1, 144) =17.343, P = 0.001). However, the male and female dental anxiety scores in the middle adult group were partially significant (F (1, 144) =3.730, P = 0.055).
The overall analysis revealed that dental anxiety differs across different age groups. The adolescents experience the highest dental anxiety (13.52 ± 4.73), and middle adults (8.94 ± 4.69) experience the lowest dental anxiety. Similarly, the results also indicate that females (13.32 ± 5.21) exhibited more dental anxiety than males (9.12 ± 3.6).
| Discussion|| |
In the present study, we investigated the effect of age and gender on the dental anxiety. The results of the present study are in line with the previous literature suggesting that dental anxiety decreases with the age.,,,, Our findings are also in line with the previous study suggesting a similar pattern for general anxiety. For example, it has been noted that general anxiety decreases with increasing age, exposure to diseases, and medications. A few older patients of the present study also reported that they are already suffering from several other diseases such as thyroid, knee pain, skin diseases, and taking medical treatments. The exposure to continuous medical treatment makes them more habituated and enhanced their ability to cope up with medical treatments.,
Further, the item-wise inspection suggests that among all the items, adolescents were more extremely anxious from the use of local anesthetic injection and tooth drilling during the dental procedures. This is also consistent with previous studies., The potential explanation for such behavior could be that adolescents or younger population have relatively less exposure to these dental equipment as compared to older adults. This leads to the development of "fear of unknown." It has been argued that because of the feeling of such unknown fear, adolescents are more prone to anxiety toward the various dental procedures.
In regard to gender, current findings are in line with the previous studies, wherein females showed a higher level of dental anxiety as compared to males across the three age groups.,,,, This can be due to gender roles which makes female more acceptable of their anxiety and low tolerance toward pain. For males, it might be difficult to accept their anxiety about the conventional gender roles., Researchers have suggested the differential pain tolerance ability among males and females. For example, females were more likely to exhibit low pain tolerance compared to males.,, At the same time, it was also observed that women tend to remember their painful experience more vividly even after the treatment is over. These fundamental differences in tolerance level could also be another reason for the gender difference.
Further, it has also been suggested that maintaining dental hygiene is very important for optimal oral health and prevention of dental problems. Our data related to dental hygiene indicate that majority of patients were only using toothpaste and brush (87.3%) and only 1.3% of people used dental floss as the methods to maintain the dental hygiene. Ten percent of patients used mouthwash as well as toothpaste. This shows that there is a need of improvement in the methods used for implementing dental hygiene habits. It has been found that patients need to use dental floss and mouthwash rather than just toothpaste and brush. Research suggests that toothbrushing alone cannot take out the plaque formation from teeth; therefore, the use of mouthwash and floss is important. If plaque is not removed, then it could affect the gums leading to gum bleedings and this problem is present in 42% of patients in the present study. It was also found that 40% of the patients are brushing once in a day and 20% of patients never clean their tongue. The research found that if the tongue is not properly cleaned, then bacteria can be produced in the mouth leading to various problems like bad smell and oral diseases. It could also be seen that very few dental patients visited the dentist for a regular checkup (14.7%) and they visited mainly when there was tooth pain (80.7%). This is again pointing toward negligence by patients toward maintaining dental hygiene. They only get attentive to their oral health when there is unbearable pain. It is recommended by the dental professionals that regular dental health checkup is important for avoiding the dental caries and other diseases.
Limitations and future scope
The present study has a few limitations and implications for future research. First, the data collection was based on the opportunity sampling technique; hence, the possibility of sample selection bias could be there. Only one dental hospital in Delhi (Jamia Millia Islamia) was approached for the same, so findings could not be generalized. To avoid such bias, further research needs to be conducted in different parts of the country on the larger sample. Second, the current study only used quantitative data to explore the differences in the level of anxiety among different age groups and gender. However, the study did not use qualitative data to explore in-depth causes for dental anxiety and factors contributing to it. Hence, future researches can focus on using qualitative (i.e., interview) methods to gain more in-depth understanding of dental anxiety. Third, due to methodological limitations, the present study fails to explore any relationship between dental care habits and dental anxiety. Researchers can further explore more about dental care habits and then finding the relation between the uses of healthy or unhealthy dental habits with dental anxiety.
| Conclusion|| |
Oral health is an essential part of our life. However, it seemed to be neglected by many people. Therefore, it is essential for dental professionals to spread awareness about dental treatment and procedures as well as dental hygiene habits such as regular brushing, use of mouthwash and flossing, and regular dental checkups. Dental professionals can also set up free dental service camps so that people can get access to dental services and be aware. Increased awareness about dental procedures will help in relieving the patients' anxiety. It is imperative to identify patients' dental anxiety before starting the treatment. This will be helpful in generating awareness of dental hygiene with regular appointments, which further can reduce the level of anxiety among those patients. It is imperative for dental professionals to be sensitive and empathetic to patients' anxiety. As the results suggested that dental anxiety is more among adolescents, this means school and college authorities can play an important role in promoting awareness and the importance of dental hygiene. Further, in regard to gender, female patients can be counseled before any dental treatment and made aware of whole dental procedures. As per the findings, male dental patients might not be expressing their anxieties due to gender roles. Hence, dental care providers can provide the space to these patients so that they can freely share their feelings and thoughts. These steps will be helpful to improve patient–doctor relationship and patients' well-being.
The study was approved by the Institutional Ethical Committee for Social Sciences, Jamia Millia Islamia, New Delhi. An ethical clearance letter was issued on 07/01/2020.
The authors acknowledge Faculty of Dentistry, Jamia Millia Islamia, New Delhi, for the dental hospital and dental patients who have volunteered themselves for this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
McGrath C, Bedi R. The association between dental anxiety and oral health-related quality of life in Britain. Community Dent Oral Epidemiol 2004;32:67-72.
Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: A review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007;17:391-406.
Shim YS, Kim AH, Jeon EY, An SY. Dental fear & anxiety and dental pain in children and adolescents; A systemic review. J Dent Anesth Pain Med 2015;15:53-61.
Milgrom P, Weinstein P, Kleinknecht R, Getz T. Treating Fearful Dental Patients: A Clinical Handbook. New York: Appleton; 1985.
Appukuttan DP, Tadepalli A, Cholan PK, Subramanian S, Vinayagavel M. Prevalence of dental anxiety among patients attending a dental educational institution in Chennai, India – A questionnaire based study. Oral Health Dent Manag 2013;12:289-94.
Eitner S, Wichmann M, Paulsen A, Holst S. Dental anxiety – An epidemiological study on its clinical correlation and effects on oral health. J Oral Rehabil 2006;33:588-93.
Hmud RA, Walsh LJ. Dental anxiety: Causes, complications and management approaches. J Minim Interv Dent 2009;2:67-78.
Mohammed RB, Lalithamma T, Varma DM, Sudhakar KN, Srinivas B, Krishnamraju PV, et al
. 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.
Locker D, Thomson WM, Poulton R. Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood. J Dent Res 2001;80:1588-92.
Armfield JM, Slade GD, Spencer AJ. Cognitive vulnerability and dental fear. BMC Oral Health 2008;8:2.
Armfield JM. Towards a better understanding of dental anxiety and fear: Cognitions vs. experiences. Eur J Oral Sci 2010;118:259-64.
Milgrom P, Weinstein P, Heaton LJ. Treating Fearful Dental Patient: A Patient Management Handbook. 3rd
ed. Seattle: University of Washington; 2009.
Marya CM, Grover S, Jnaneshwar A, Pruthi N. Dental anxiety among patients visiting a dental institute in Faridabad, India. West Indian Med J 2012;61:187-90.
van Wijk AJ, Hoogstraten J. Experience with dental pain and fear of dental pain. J Dent Res 2005;84:947-50.
Pitts N, Duckworth RM, Marsh P, Mutti B, Parnell C, Zero D. Post-brushing rinsing for the control of dental caries: Exploration of the available evidence to establish what advice we should give our patients. Br Dent J 2012;212:315-20.
Acharya S. Factors affecting dental anxiety and beliefs in an Indian population. J Oral Rehabil 2008;35:259-67.
Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999;78:790-6
Appukuttan DP, Cholan PK, Tadepalli A, Subramanian S. Evaluation of dental anxiety and its influence on dental visiting pattern among young adults in India: A multicentre cross sectional study. Annals of Medical and Health Sciences Research 2017;7:393-400.
Hakeberg M, Berggren U, Carlsson SG. Prevalence of dental anxiety in an adult population in a major urban area in Sweden. Community Dent Oral Epidemiol 1992;20:97-101.
Farooq I, Ali S. A cross sectional study of gender differences in dental anxiety prevailing in the students of a Pakistani Dental College. Saudi J Dent Res 2015;6:21-5.
Natarajan S, Seenivasan M, Paturu R, Arul QA, Padmanabhan T. Dental fear and anxiety in different gender of Chennai population. Int J Epidemiology 2009;9.
Kirova DG. Dental anxiety among dental students. Journal of IMAB-Annual Proceeding 2011;17:137-9. DOI: 10.5272/jimab.2011172.137.
Giri J, Pokharel PR, Gyawali R, Bhattarai B. Translation and validation of modified dental anxiety scale: The Nepali version. Int Sch Res Notices 2017;2017:1-5.
Humphris GM, Morrison T, Lindsay SJ. The modified dental anxiety sale: Validation and United Kingdom norms. Commun Dent Health 1995;12:143-50.
Astrøm AN, Skaret E, Haugejorden O. Dental anxiety and dental attendance among 25-year-olds in Norway: Time trends from 1997 to 2007. BMC Oral Health 2011;11:10.
Svensson L, Hakeberg M, Boman UW. Dental anxiety, concomitant factors and change in prevalence over 50 years. Community Dent Health 2016;33:121-6.
Guentsch A, Stier C, Raschke GF, Peisker A, Fahmy MD, Kuepper H, et al
. Oral health and dental anxiety in a German practice-based sample. Clin Oral Investig 2017;21:1675-80.
Caltabiano ML, Croker F, Page L, Sklavos A, Spiteri J, Hanrahan L, et al
. Dental anxiety in patients attending a student dental clinic. BMC Oral Health 2018;18:48.
Appukuttan D, Datchnamurthy M, Deborah SP, Hirudayaraj GJ, Tadepalli A, Victor DJ. Reliability and validity of the Tamil version of Modified Dental Anxiety Scale. J Oral Sci 2012;54:313-20.
Locker D, Liddell AM. Correlates of dental anxiety among older adults. J Dent Res 1991;70:198-203.
Bhola R, Malhotra R. Dental procedures, oral practices, and associated anxiety: A study on late-teenagers. Osong Public Health Res Perspect 2014;5:219-32.
Gao X, Hamzah SH, Yiu CK, McGrath C, King NM. Dental fear and anxiety in children and adolescents: Qualitative study using YouTube. J Med Internet Res 2013;15:e29.
Appukuttan D, Subramanian S, Tadepalli A, Damodaran LK. Dental anxiety among adults: An epidemiological study in South India. N Am J Med Sci 2015;7:13-8.
Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of Dental Anxiety among Dental Patients in Saudi Arabia. J Int Soc Prev Community Dent 2017;7:100-4.
Kassem El Hajj H, Fares Y, Abou-Abbas L. Assessment of dental anxiety and dental phobia among adults in Lebanon. BMC Oral Health 2021;21:48.
Ogawa M, Sago T, Furukawa H. The reliability and validity of the Japanese version of the modified dental anxiety scale among dental outpatients. ScientificWorldJournal 2020;2020:8734946.
Pierce KA, Kirkpatrick DR. Do men lie on fear surveys? Behav Res Ther 1992;30:415-8.
Peretz B, Rosenblum A, Zadik D. Stress levels and related variables among dental students in Jerusalem, Israel. Eur J Dent Educ 1997;1:162-6.
Mogil JS, Bailey AL. Sex and gender differences in pain and analgesia. Prog Brain Res 2010;186:141-57.
Eltumi HG, Tashani OA. Effect of age, sex and gender on pain sensitivity: A narrative review. Open Pain J 2017;10:44-55.
Settineri S, Tati F, Fanara G. Gender differences in dental anxiety: Is the chair position important? J Contemp Dent Pract 2005;6:115-22.
Arora V, Tangade P, Ravishankar TL, Tirth A, Pal S, Tandon V. Efficacy of dental floss and chlorhexidine mouth rinse as an adjunct to tooth brushing in removing plaque and gingival inflammation – A three way cross over trial. J Clin Diagn Res 2014;8:ZC01.
Azodo CC, Ehizele AO, Umoh A, Ojehanon PI, Akhionbare O, Okechukwu R, et al
. Tooth brushing, tongue cleaning and snacking behaviour of dental technology and therapist students. Libyan J Med 2010;5:1,5208, DOI: 10.3402/ljm.v5i0.5208.
[Table 1], [Table 2], [Table 3]