Abstract

The aim of this study is to be small version of under preparing study that will determine the prevalence of dental anxiety among Qassim population, comparing between age group, educational level and gender predilection. This pilot study was conducted to determine the prevalence of dental anxiety among patients attending King Saud Hospital (KSH), comparing between different educational levels and gender as factors, structured questionnaire was distributed to 40 patients in dental center of KSH, 31 questionnaires were returned and analyzed.

1. Introduction

Generally fear is defined as an individual’s response to a real threatening event or dangerous situation to protect his or her life. Three different terms have been used concerning apprehension in dentistry in the literature: dental fear, dental anxiety, and dental phobia. Dental fear is considered to be aroused by a real, immediately present, specific stimulus (e.g. needles, drilling), whereas in the case of anxiety, the source of the threat is unclear, ambiguous, or not immediately present ¹ dental Phobia is Persistent, unrealistic and intense fear of specific stimulus, leading to the avoidance of the perceived danger ².

Elements of fear can be divided into two categories: subjective (including emotions and cognitions) and objective (including behavior and physiological reactions). The patient’s subjective experience of dental treatment is the most important channel for his or her later behavior (e.g. avoiding or not) with relation to dentistry. Thus, knowledge of a patient’s subjective dental fear is more relevant than knowledge of his or her objective dental fear when considering the development of dental health services ¹.

The response of fear is composed of three related components: (A) Unpleasant cognitive state (feeling that something terrible is going to happen); (B) Physiological changes including activation of the sympathetic branch of the automatic nervous system (tachycardia, profuse respiration, hyperventilation, muscle tension, gastrointestinal upset, and other physiological signs of emotional arousal); and (C) Overt behavioral movements (shakes, pacing, jitteriness, and attempts to escape or avoid the perceived threat). ^{2, 5, 10}

Dental fear is a normal emotional reaction to specific threatening stimuli in the dental situation ^{2, 5}. Because the fear consider as normal feeling, but when it is go beyond this level it is consider as dental anxiety. Dental anxiety is considered one of the main reasons for avoidance of dental care and the resultant deteriorating oral health. Patients with dental anxiety, in general, have a substantially deteriorated dental health compared to ordinary patients ³. Dental anxiety is a frequent problem among dental patients. The presence of dental anxiety is not a dilemma for patients only but also for the dental professionals themselves; and sometimes it renders the treatment more complicated to be accomplished successfully ⁴. Phobia represent a serve type of anxiety ⁵, thus dental phobia psychologically consider beyond the anxiety level.

According to American Psychiatric Association the criteria for a diagnosis of specific phobia are: (A) Marked and persistent fear that is excessive and unreasonable; (B) Exposure to the phobic stimuli almost invariably provokes an immediate anxiety response; (C) The person recognizes that the fear is excessive or unreasonable; (D) The phobic situation is avoided or else endured with intense anxiety or distress ⁵.

Dental anxiety and phobia can also be distinguished by looking at the quantity or intensity of the anxiety experience and the patient's capacity to cope with it. Patients who have dental anxiety can cope with the intensity of their anxiety and receive dental treatment. Patients who have dental phobia cannot cope with the intensity of their anxiety and thus avoid treatment ⁵.

The etiology of dental fear is more complicated than just a painful or unpleasant dental visit. It has been suggested that dental fear has endogenous and/or exogenous components. Endogenous components refer to dental fear as part of a more generalized anxiety disorder. Exogenous components refer to dental fear acquired as a function of direct or vicarious experiences to which people have been exposed. ⁵ The prevalence of dental anxiety ranged from 5-20% in various countries ³. Several studies reported significantly higher levels of dental anxiety among females ⁴.

There are several techniques and methods available that can help manage dental anxiety. The techniques employed should be those that are most appropriate in each case. Some examples of dental anxiety management techniques include:-

A. Conscious sedation - inhalation, intravenous, oral.

B. General anesthesia.

C. Psychological techniques/therapy.

D. Communication, rapport and trust building skills.

E. Behavioural techniques.

F. Relaxation techniques.

G. Cognitive behavioural therapy.

Clinical techniques and skills: eg pain management techniques, local anesthetic techniques. ².

2. Materials and Methods

This pilot study was conducted using a structured questionnaire. The structured questionnaire consisted of four parts. First part is demographic features of the respondent include age, gender, city and educational level. The second part is two questions that focusing in visiting the dentist and its importance. The third part is consists of three questions which determine the patient is suffering from dental anxiety or dental phobia. The fourth part in consist of three questions that focusing in causes of dental anxiety either as clinic related factors, dentist related factors and procedures related factors. 40 questionnaires were distributed among patients in dental center in KSH, 31 filled questionnaires were returned giving a response rate of 77.5%. The data was analyzed using SPSS 20 program for descriptive statistics.

3. Results

A total 31 questionnaires were included in the analysis. The majority of the respondents who responded to the questionnaire were male (18 in numbering, 58.1%) and for female the rate was 41.9 %. Regarding to the educational level of the respondents, primary education was 0%, intermittent education was 9.7%, secondary education was 35.5 %, and 54.8 % for carrier of bachelor degree, no response for post- graduate degrees.

The respondents most likely to show significant level of anxiety. 29% of the respondents were anxious. See Table 4 and related bar chart. Most of the respondents show aware that it's important to visit dentist regularly (93.5 %). see Table 3. The percentage of anxious respondents are 29%. Female show higher percentage than male (30.8% for female and 27.8 for male). Chi-square test was done, see Table 5.

According American Psychiatric Association dental phobia is specific type of phobia, and the difference between dental anxiety and phobia was phobic patient can stop his or her treatment, on the other hand anxious patient will complete the treatment plan, ² and in this study we ask the respondents about this point (did you stop your treatment due to anxiety?) and we found 12.9 % were phobic patients, female show higher percentage than male (23.1% for female and 5.6 % for male), chi-square test was done.

In this study , people with intermediate level education show the highest percentage of anxiety and secondary level of education show lower percentage than those with bachelor degree carrier chi-square test was done, see Table 9.

4. Discussion

Dental fear is commonly suggested to be multifactorial and multidimensional, consisting of behavioral, physiological factors ⁹. Anthore paper that suggest the dental fear is normal emotion ^{2, 5}. Dental anxiety can cause either by endogenous or exogenous factors ⁵. Once the anxiety become in severe form it is called phobia. The prevalence of dental anxiety ranged from 5-20% in various countries ³. In Finland there was a study that show 9.5% of the respondents were very afraid and 27.1% were somewhat afraid of visiting a dentist ⁵. A study in Holland reported that only 14% of the Dutch population experienced no apprehension or anxiety when visiting a dentist, whilst almost 40% experienced anxiety, and 22% were “highly anxious. In Australia, published data from 1996 reveal that some 14.9 % of adults could be classified as “high dentally anxious” ^{6, 10}. In this study, the respondents most likely to show significant level of anxiety, 29% of the respondents were anxious, see Table 4 and related bar chart, previous studies that show highly significance between them, Females have higher percentage than males. ^{2, 3, 9} some authors they said that percentage is 1:1.6 male to female ratio. In this study, the percentage of anxious respondents are 29%, female show higher percentage than male (30.8% for female and 27.8 for male).

Regarding to the relationship between dental anxiety and educational level, studies have shown people with basic until secondary level of education show higher level of anxiety than bachelor degree carrier ^{4, 9, 11}. In this study, people with intermediate level of education show the highest percentage of anxiety and secondary level of education show lower percentage than those with bachelor degree carrier .chi-square test was done, see Table 9 and Table 10.

5. Conclusion

This pilot study is the first step of under processing cross-sectional study. This pilot study show significant increasing in the prevalence of the dental anxiety comparing to anther countries, and show gender predication, females show higher percentage than males also show different percentage regarding to the educational level.

Acknowledgements

The author would like to acknowledge the deanship of scientific research in Qassim University for their unlimited effort and support.

References