|Year : 2014 | Volume
| Issue : 1 | Page : 14-20
Comparison of dental anxiety among patients visiting a dental college and private dental clinics in Thiruvallur district, India
R Ganesh1, Chandasmita Goswami2, Rumana Munshi2
1 Department of Public Health Dentistry; Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Pandur, Thiruvallur, India
2 Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Pandur, Thiruvallur, India
|Date of Web Publication||19-Mar-2014|
Priyadarshini Dental College and Hospital, No. 1 VGR Gardens, VGR Nagar, Pandur - 631 203, Thiruvallur, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: The objective of the study was to assess and compare the prevalence of dental anxiety based on age and gender distribution among the patients reporting at private dental clinics in Thiruvallur district and in private dental college, Thiruvallur. Materials and Methods: The sample comprised of 230 patients, out of which 115 patients randomly selected from the private dental clinics and other 115 patients from Priyadarshini Dental College and Hospital, Thiruvallur. Modified Dental Anxiety Scale (MDAS) was used to assess the anxiety level of the patients. Result: A total of 115 patients in dental college and 115 patients in dental clinics were questioned in the study. Out of these, 13% of patients in dental college and 20.90% of patients in dental clinics were severely anxious. A total of 4.30% of patients in dental college and 3.50% of patients in dental clinics were not anxious at all. The ratio of rate of anxiety of female patients was greater than males. Conclusion: The prevalence of dental anxiety among the patients in this study was high. This highlights the need for dentists to understand what patients feel about dental treatment procedures and aid dentist efforts to improve patients care.
Keywords: Dental anxiety, extraction, MDAS
|How to cite this article:|
Ganesh R, Goswami C, Munshi R. Comparison of dental anxiety among patients visiting a dental college and private dental clinics in Thiruvallur district, India. SRM J Res Dent Sci 2014;5:14-20
|How to cite this URL:|
Ganesh R, Goswami C, Munshi R. Comparison of dental anxiety among patients visiting a dental college and private dental clinics in Thiruvallur district, India. SRM J Res Dent Sci [serial online] 2014 [cited 2022 Oct 6];5:14-20. Available from: https://www.srmjrds.in/text.asp?2014/5/1/14/129060
| Introducion|| |
Anxiety is an emotion similar to fear arising without any objective source of danger. It is an emotional and physiological response to known or unknown causes that may range from a normal reaction to extreme dysfunction.
Dental anxiety is patient's psychological condition and reaction to the dental environment such as dental chair, instruments, and dentists with masks and gloves. It depends on the patient's way of imagination. Patient may get anxious while waiting for his appointment with dentist, lying down in dental chair, getting checked his/her oral cavity.
Anxiety mainly of two types:
- State anxiety−used to determine individual's present level of anxiety,
- Trait anxiety−used to describe individual's long-term anxiety level. Dental anxiety is described as state anxiety. 
Anxiety may originate from one's previous negative experience about treatment. Dentist's behavior and communication with patient and explanation about the procedure plays important role in patient's anxiety level. An unsupportive dentist with perceived lack of empathy and respect rated as a common source of increased dental anxiety.  Anxious patients feel more pain and treatment of longer duration than less anxious patient.  Severely anxious patients sometimes feel symptoms like - moist palm, hand tremor, shaky inside, and rapid heartbeat. These people are usually unco-operative toward the treatment.
Despite of technological advances in modern dentistry, anxiety associated with dentistry remains widespread.  It is the major reason for avoidance of dental care, resulting in deterioration of personal oral health care.
The onset of dental anxiety originates in childhood, peaks in early adulthood, and declines with age.  These conditions may occur in any age group of people and social status. Previous studies about anxiety describes distribution of dentally anxious population according to age of onset, etiological factors such as negative dental experiences, family history and general psychological status. 
Hence, the aim of the study was to assess and compare the prevalence of dental anxiety based on age and gender distribution among the patients reporting at private dental clinics in Thiruvallur District and in private dental college, Thiruvallur district.
| Materials and Methods|| |
The cross-sectional study was conducted among public and private dental out patients to assess the anxiety level. The age group ranges from 16 to 70 years. There are 28 dental colleges in Tamil Nadu, out of which a private dental college, Priyadarshini Dental College and Hospital was randomly chosen. And we randomly selected 10 private dental clinics in Thiruvallur district.
The sample size was estimated to be 230 based on severity of anxiety of previous studies done by Mehboob et al.,  and Nair et al.,  with 90% power and 5% alpha error. A closed-ended questionnaire was prepared.
Modified Dental Anxiety Scale (MDAS) was used to assess the dental anxiety level among dental patients. The MDAS consists of five questions. Each question scores ranging from 1 to 5. When values are summed together, produce total score ranging from 5 to 25; which determine patient ranging from not anxious to extremely anxious.
The questionnaire contained questions about all possible dental procedures. Some determining factors used were injecting local anesthesia, surgical extraction, drilling a tooth, tooth loss, probing the gum to assess disease, sound or vibration of a drill, X-ray, and so on.
A pilot study was done among 20 patients randomly selected from outpatient department of Priyadarshini Dental College and Hospital to validate the questionnaires.
The study was conducted in the month of July to August 2013.
The study was approved by the Institutional Review board of Priyadarshini Dental College and Hospital. The permission to conduct the survey was obtained from the Institutional Ethical Committee of Priyadarshini Dental College and Hospital.
The questionnaires were distributed among randomly selected out patients of the college and the private dental clinics. The patients were asked to select one option.
The data were entered in the Microsoft excel sheet and SPSS V 15.0 was used for the statistical analysis. Mean and percentage values were calculated.
| Result|| |
The sample consisted of 230 patients of age group 16-70 years. The mean age of the total sample was 35.63 (standard deviation 11.66).
[Figure 1] shows the distribution of study subjects based on gender.
[Figure 2] shows the anxiety from local anesthetic injection among dental college patients.
|Figure 2: Anxiety from local anesthetic injection among dental college patients|
Click here to view
[Figure 3] shows the anxiety from local anesthetic injection among dental clinic patients.
|Figure 3: Anxiety from local anesthetic injection among dental clinic patients|
Click here to view
[Figure 4] shows the anxiety observed among study subjects in dental clinic and dental college.
|Figure 4: Anxiety observed among study subjects in dental college and dental clinics|
Click here to view
[Table 1] shows the Anxiety observed among different age groups in dental college and dental clinics.
|Table 1: Anxiety observed in different age groups of dental college and dental clinics|
Click here to view
[Table 2] shows the Prevalence and comparison of dental anxiety among patients reporting at private dental college and private dental clinics, using Modified Dental Anxiety Scale.
|Table 2: Prevalence and comparison of dental anxiety among patients reporting at private dental college and private dental clinics, using Modified Dental Anxiety Scale|
Click here to view
[Table 3] shows the level of anxiety regarding various dental environment.
In the questions number 1 and 15, the probability value seems to be (P = 0.26 < 0.05) and (P = 0.05) which suggests significant difference seen in anxiety level of male and female out patients reporting at dental college. No significant difference is seen in anxiety level among male and female patients for other questions.
| Discussion|| |
Despite of advances in dentistry, fear of dental procedures and pain still persists globally and is a major obstacle to successful dental treatment. 
Although the patients were not representative of the whole outpatient population of dental college and dental clinics, information from this study sample would be valuable to carry out our study.
The data support the performance of MDAS as measure of dental anxiety. The advantage of MDAS is that there is evidence of a suitable cut-off that has been reported based on both clinical and scientific grounds.  The MDAS is the modification of the Corah's Dental Anxiety Scale, which includes about local anesthetic injection. Fear of local anesthetic injection was very high among patients in this study. Previous study done by Mehboob et al., showed that 27% of population had high fear from local anesthetic injection. In our study, 26.1% of patient in dental college and 22.6% of patient in dental clinics were noted to have high rate of anxiety which is lower than the study done by Mehboob et al. It may be due to better dental environment of dental college and dental clinic. Injection phobia has often been strongly correlated with dental anxiety.  Educated people usually have less anxiety for injection in the dental clinic than the uneducated. 
The sex difference in dental anxiety had been reported in several studies. Females are more anxious than male about the dental anxiety score.  Psychological studies indicate that women have a lower pain threshold than men and low tolerance for painful stimuli and this may be the reason for gender difference in dental anxiety.  In our study also, females (56.1%) were more anxious than males (43.9%) about the dental anxiety score.
Rachman (1977) has suggested that three types of conditioning may play a role in acquisition of fears. While many fears have their origin in direct experience, other may arise via modeling or exposure to threatening information. This theory helps explain why not all fearful individuals have been exposed to traumatic conditioning.  There is positive correlation of anxiety level with age. In the present study, the rate of dental anxiety was high (50.4%) among adults aged 16-33 years but decreased among older adults (12.2%) in dental college. And in dental clinics, 49.6% of dentally anxious population was adults and 13.9% were older adults. This suggests that dental anxiety onset in the childhood, which may be due to negative family history; peaks in young adulthood and declines with age. This is in agreement with the studies by Devapriya et al.,  , Locker and Liddell  , Mehboob et al.,  , Nair et al.  Liddell and Locker  suggested that the age-dependant decline in the dental anxiety might be due to general decline in anxiety with aging and greater exposure to other diseases and their treatment.
Similar study was conducted by Mehboob et al.,  among patients reporting to the department of oral and maxillofacial surgery, Khyber College of Dentistry in 2010.  The study shows 27% of the total population were dentally anxious. Severe anxiety was noted in 14.5% of patients, 19.5% were moderately anxious, and 11% were not anxious at all. Whereas in our study, rate of extremely anxious patients reported to either dental college or dental clinics was low.
Another study done by Nair et al.,  among the patients of Pacific Dental college, Rajasthan had shown that 27.6% of the population was slightly anxious, 45.4% were moderately anxious, 25.8% were found to be very anxious. Only 1.2% of the total study population was extremely anxious, which is lower than our study result.
It is an established fact that dental anxiety is strongly correlated with pain experience and people who over estimate their pain often end up suffering from dental anxiety.  The study showed that uneducated participants were more anxious than educated participants, this was in agreement with Nair et al.  A worry about tooth loss was seen more in uneducated people. 
There was a significant difference seen in the anxiety level among the patients visiting to dental college and dental clinics. Patients visiting the dental clinics were found to be more anxious toward the cost of dental treatment that may need compare to the outpatients of dental college. This may be due to the more advance dental setup and equipment in dental clinics.
Anxiety for treatment is much more strongly associated with putting off making a appointment due to fear than it is related to dental clinic attendance (time since last visit). , Anxiety could lead to some difficulties both patient and dentist during the dental procedures such as a missing appointment, increases in the treatment time, decreases in treatment quality, leading to missed diagnosis, and delayed treatment. Patients reporting to the dental college were found to be more conscious about the number of appointments that they may need and time that they may require for necessary dental treatment. Because in dental college, patients have to follow many procedures before undergoing treatment.
Devapriya et al.,  and Liddell and Locker  suggested that patients who had reported poor oral health were more anxious than those who perceived their oral health as excellent or good. Also in our study, patients were found anxious about the condition of their poor oral health.
It is possible that many patients are anxious about the pain they expect as result of dental hygienic procedures such as a scaling and root planning. , But there was no similarity with result of our study. Patients feel less anxious while getting their teeth scaled and polished and also from the scrapping sound or vibration of the drill.
Patient reporting to the dental college does not feel much free to ask any questions to the dentist regarding the dental procedure, while in dental clinics patients get much individual importance. Also they feel gagging in the environment of dental college as they may get anxious that students treating the patients in dental college may not manage proper dental procedures.
Levels of anxiety may change as a function of experience; may it be medical, dental or any life incident. As more and more percentage of patients have fear regarding their dental health and treatment needs, such actions lead to treatment delay and avoidance behavior toward oral care and health in general. Hence, assessment of anxiety levels and treatment needs may be very helpful for the provision of good-quality dental care, better management, and psychological uplifting of an individual. 
| Conclusion|| |
The MDAS showed high reliability and excellent completion of scale item. The frequency of anxiety from local anesthetic injection is high among patient. There were more respondents with high dental anxiety among the females and younger age group. Patients visiting dental college were also getting anxious especially about number of appointments and time that they may require, management of proper dental procedure by the students treating the patients in dental college. Patients reporting to dental clinics were seems to be more anxious about cost of the treatment.
Proper prior explanation about the procedure, behavior of the dentist toward the patient, a healthy communication between the dentist and the patient, decreases the anxiety level of the patient up to a certain extent. The dental students should maintain proper dental procedure while treating the patients.
An understanding of the presence of the anxiety can help dentists to understand what patients feel about dental treatment procedures and aid dentist efforts to improve patients care.
| Acknowledgment|| |
We are thankful to biostatician for calculating the sample size and for doing the statistic analysis. We would also like to thank the Chairman, Dean, Principal of Priyadarshini Dental College and Hospital for their support throughout the study.
| References|| |
|1.||Akarslan ZZ, Erten H, Uzun O, Iseri E, Topuz O. Relation between trait anxiety, dental anxiety and DMFT indexes of Turkish patients attending a dental school clinic. East Mediterr Health J 2010;16: 558-62. |
|2.||Levin L, Eli I, Ashkenzazi M. Dental anxiety among young Israeli male adults as related to treatment received during childhood. J Public Health Dent 2006;66:147-51. |
|3.||Arigbede AD, Ajayi DM, Adeyemi BF, Kolude B. Dental anxiety among patients visiting a university dental centre. Nigeria Dent J 2011;19:20-4. |
|4.||Elmasuri GM, Rashidah ES. Dental anxiety among adult patients attending the Libyan national health services. Indian J Community Dent 1995;1:3-10. |
|5.||Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999;78:790-6. |
|6.||Mehboob B, Khan E, Khan M. Dental anxiety scale in exodontias patients. J Khyber Coll Dent 2011;1:20-3. |
|7.||Nair MA, Shankarapillai R, Chouhan V. The dental anxiety levels associated with surgical extraction of tooth. Int J Dent Clin 2009;1:20-3. |
|8.||Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health 2009;9:20. |
|9.||Appukuttan D, Datchnamurthy M, Deborah PS, Hirudayaraj JG, Tadepalli A, Victor JD. Reliability and validity of tamil version of modified dental anxiety scale. J Oral Sci 2012;54:313-20. |
|10.||Liddell A, Locker D. Gender and age differences in attitude to dental pain and dental control. Community Dent Oral Epidemiol 1997;25:314-8. |
|11.||Syed S, Bilal S, Dawani N, Rizvi K. Dental anxiety among adult patients and its co-relation with self-assessed dental status and treatment needs. J Pak Med Assoc 2013;63:614-8. |
|12.||Munster AE, Haluani H, Bjornebekk G, Deci EL. Motivation and anxiety for dental treatment: Testing a self determination theory model of oral self-care behavior and dental clinic attendance. Motiv Emot 2010;34:15-33. |
|13.||Ay ZY, Gundogar D, Buyukozlurk S, Gadbury-Amyot C. Dental Hygiene Fear Survey: Reliability and validity of the Turkish version. J Dent Educ 2008;72:183-94. |
|14.||Abu-Ghazaleh SB, Rajab LD, Sonbol HN, Aljafar AK, Elkarmi RF, Humphris G. The Arabic version of modified dental anxiety scale. Psychometrics and normative data for 15-16 year olds. Saudi Med J 2011;32:725-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]