Yaş, cinsiyet, eğitim ve deneyimlerin dental anksiyete üzerindeki rolü

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Introduction
Despite advancements in dentistry, anxiety and fear
are still major concerns in daily practice (1). Dental
anxiety is a very common dental health problem in
populations of many countries (2-4). Proposed factors
in etiology of dental anxiety are previous traumatic
experiences (excessive pain during previous dental
procedures, prolonged and exhausting treatments),
environmental factors (examination room, appearance and noise of equipments, bad odor), low pain
threshold, communicational issues (critisizing of patient for the oral hygiene, performing manipulations
without explanation, malpractices, distrust of patient
to the dentist), social interactions (unfavorable information by other persons or media) (5).
Dental anxiety is strongly associated with the oral
hygiene. It is a common behavior delaying or abandoning treatment because of dental anxiety which
may cause poor oral hygiene (6,7). It was reported that
poor periodontal hygiene, tooth caries and tooth losts
are more common in patients with high dental anxiety and number of restored teeth is higher compared
to patients with normal dental anxiety (8). Therefore
dental anxiety is a psychological disorder impairing
not only periodontal hygiene but also health quality.
Different researchers reported that the prevalence of
dental anxiety is 5-20% in populations, and females
are more anxious than males (9-11).
Attitudes of dentists or auxiliaries also have importance. Painful experiences in childhood strongly
causes dental anxiety (12). Although dental anxiety
can be observed in any age, onset is usually seen in
childhood or adolescence (13). Patients who had experienced dental anxiety during dental visits reported that the worst experiences had occurred earlier in
their lives (12-14). Therefore care should be exercised
and atraumatic procedures should be preferred when
treating children that may affect their future dental
attitudes.
* Dental Service, Turkish Army Land Forces
** Gulhane Military Medical Academy, Department of Conservative Dentistry
and Endodontics
Reprint request: Fulya Toksoy Topçu, Department of Conservative Dentistry
and Endodontics, Gulhane Military Medical Academy, Etlik-06018, Ankara,
Turkey
E-mail: fulyatoksoy@yahoo.com
Date submitted: May 28, 2009 • Date accepted: June 11, 2009146 • September 2009 • Gulhane Med J Oktay et al.
Questionnaires and scales are used for the assessment of dental anxiety (15,16). Corah’s dental anxiety scale (DAS) is commonly used for the assessment
of dental anxiety (17). Several studies previously
evaluated incidence and associated factors of dental
anxiety (18-20). Possible factors, which may influence dental attitude of patients, such as first dental
experience, complaints of admission and educational
level were investigated in the present study.
Material and Methods
The study was conducted at the Department of
Endodontics of Dental Sciences Center of Gulhane
Military Medical Academy. Patients anticipating endodontic treatment were approached by one clinician and asked to complete a questionnaire. The patients who refused to fill in the questionnaires were
excluded. The study samples included 400 patients
(215 males and 185 females). The average age of the
patients is 38.35±7.82 years. After the patients were
informed about the study, the patients filled in the
questionnaires.
The survey consisted of two sections. The first section requested sociodemographic and dental information of the patient including age, gender, education
and knowledge about the first and previous dental
treatments and visits. The second section comprised
of Corah’s Dental Anxiety Scale (DAS). The scale consisted of 4 questions and each had 5 answer alternatives. According to the answers the value of DAS
ranges from 4 (no anxiety) to 20 (highly anxious).
The data of the patients were collected according to
their age, gender, educational level and first dental
experiences. Data obtained from questionnaires were
assessed statistically by SPSS for Windows version 7.5.
Multivariety analysis of variance test was used. All
significance levels were set at 0.05.
Results
The means and standard error of dental anxiety for
the total population by age, gender, education and
the first dental experience are shown in Table I.
In this study, 215 male and 185 female patients
filled in the questionnaires. The average DAS value
of these patients was 8.30 ± 2.4. The results showed
that education had no significant effect on dental anxiety. Females tend to be more anxious than
males, but it has not reached statistical significance
(p>0.05). Although patients in their 3rd decades
(20-29 years) had showed the lowest DAS values, no
statistical difference was found (p>0.05) when they
were compared with the others in their 4th (30-39
years) and 5th (40-49 years). There is a striking statistical difference in respect to the patients’ first dental
experiences (p<0.05). The patients who had bad or
traumatic experiences in their childhood had significantly higher DAS values.
Discussion
Extreme dental fear and anxiety are the universal
problems affecting a large population. They lead to
avoidance of dental care and caries with a severe
adverse consequences to the patient’s oral health.
The results of our study showed that women demonstrate higher levels of dental anxiety than men.
Physicological emotions such as stress, depression,
fear, social phobia and panic are more prevalent in
females (21), and dental anxiety may correlate with
such emotions (22). Also this situation may depend
on the females’ easier expressions of their emotions
(23). Although Özdemir et al. found higher anxiety
scores of men than women (24), our finding is similar
to most previous reports that reported females tend
to be more anxious than males and showed higher
DAS values (25-30).
In our study, anxiety levels for age groups showed
no statistically significant difference for anxiety
scores. However, the individuals in the third decades
(20-29 years) had showed the lowest DAS values. This
was surprising to us and it was not in agreement with
previous studies. This finding is not inaccordance
with Stabholtz et al. (25), Thomson et al. (30), Brand
et al. (31) and Hagglin et al. (32) have reported that
as age increases the DAS values decrease and decrease
in DAS in aged individuals could be associated with
good experience or adaptation of dental procedures
and good relationship with dentists over years. Also
another explanation could be perception of patient
Table I. The means and standard deviations of dental anxiety
Feature n DAS score
(mean±standard
deviation)
Significance
Age (years) 20-29 159 7.92±2.30
30-39 149 8.61±2.50 0.056
≥40 92 8.38±2.49
Gender Female 185 8.52±2.50
0.077
Male 215 8.11±2.40
Education Primary 79 8.64±2.20
High 131 8.08±2.48 0.416
College 190 8.31±2.47
Experience Favorable 198 7.38±1.96
<0.001
Unfavorable 202 9.21±2.51Volume 51 • Issue 3 Dental anxiety • 147
to the pain in dental procedures which is less severe
compared to other medical experiences like major
surgery. In this study, the lower DAS values in earlier
periods may be associated with the unexperience of
patients for the dental procedures or better clinical
conditions depending on the developments in dentistry that provides the clinicians and patients more
uncomplicated procedures.
The increase in education level may provide a better oral health and hygiene and increased number of
periodical dental controls (28). Recent studies demonstrated that increase in education level results as
decreasing in dental anxiety (10,28). However, the results of our study showed that there was no relationship between the dental anxiety and various education levels. This result is in accordance with Özdemir
et al. (24) and Ay et al. (33).
Etiologically, dental anxiety is not a homogenous
group and appears from different factors (34). Some
of the factors are negative acknowledgement, experiences and being a witness to a traumatical or unpleasing dental procedure. Specially, previous negative experiences have an important effect on the appearance
of dental anxiety (35). The result of our study demonstrated that the patients who had negatively affected
in their first dental experiences and had traumatical
experiences in their childhood showed significantly
higher DAS values and during the oral investigations
we observed that these patients had obviously disqualified oral hygiene.
Within the limitations of this study, the first or the
past traumatical dental experiences are important facts
on affecting the dental anxiety of patients in the following years of their lifetime. According to our findings clinicians should pay attention to be not traumatic and painful and be more careful during the treatment procedures particularly in the childhood period.