JKAOH Journal of Korean Academy of Oral Health J Korean Acad Oral Health 1225-388X 2093-7784 Journal of Korean Academy of Oral Health 10.11149/jkaoh.2015.39.4.229 jkaoh-39-229 Original Article Review on dental fear and anxiety factors by DFS HongJin-Sil KimYoung-Sam LeeHae-Jin KimJu-Yeon ChangKee-Wan Department of Preventive and Community Dentistry, Institute of Oral-bio Science, School of Dentistry, Chonbuk National University, Jeonju, Korea Corresponding Author: Kee-Wan Chang Department of Preventive and Community Dentistry, Institute of Oral-bio Science, School of Dentistry, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea Tel: +82-63-270-4034 Fax: +82-63-270-4035 E-mail: prevdent@jbnu.ac.kr 122015 12122015 39 4 229 236 13082015 26102015 17112015 Copyright © 2015 Journal of Korean Academy of Oral Health 2015 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objectives

The study on dental fear has increased recently. Studies found that people with high dental fear and or anxiety were less likely to visit dentists. The aim of this study is to review the trend of study on dental fear and to analyse the major factors related to dental fear.

 Methods

Seventy four papers listed in Korea Citation Index and SCI(E) were assessed. Quality Assessment and Validity Tool for Correlation Studies (QAVTCS) and Dental Fear Study (DFS) were used in this study. SPSS 12.0 was employed to analyse the descriptive statistics, t-test and Multiple Linear Regression (MLR) with stepwise.

 Results

The total mean score of QAVTCS for international studies was significantly higher than domestic studies (P=.001). The mean scores of item, ‘Seeing the anesthetic needle’ and ‘Feeling the anesthetic needle’, were severe level (Means= 3.05, 3.14, severe>3.00). According to the MLR, the powerful predisposing factors (independent variable) on ‘Overall fear of dentistry (dependent variable)’ were ‘Hearing the drill’ (P<.01) and ‘Having teeth cleaned’ (P<.05).

 Conclusions

It was concluded that people had high dental fear in direct dental treatment environment such as contact with seeing anesthetic needle and hearing dental drill. Therefore, this study suggests the need to map out specific and multidirectional plan for decreasing dental fear.

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Flow diagram for data collection.

Percentage of the published dental fear articles over period.

Distribution of points of articles in domestic and internationa by Quality Assessment

Point No. of Domestic No. of International
4 0 3
5 1 2
6 1 6
7 6 7
8 12 13
9 17 7
10 1 0
11 1 0
Subtotal 39 38
Mean±SD 8.28±1.10 7.21±1.47

Quality Assessment distribution of articles studied accordin to the item of questionnaires

Questionnaire Number Domestic (%) International (%)
1 100.0 94.7
2 0.0 21.1
3 100.0 86.8
4 71.8 39.5
5 100.0 100.0
6 87.2 47.4
7 94.9 89.5
8 94.9 89.5
9 0.0 2.6
10 71.8 36.8
11 7.7 13.2
12 97.4 100.0
13 2.6 0.0

Questionnaire number was composed 13 items.

General characteristics of articles in this study

Characteristics Categories N (%)
Domestic Internationa
Sample size -199 3 (7.7) 13 (37.1)
200-399 19 (48.7) 2 (5.7)
400-599 6 (15.4) 5 (14.3)
600-799 6 (15.4) 3 (8.6)
800-999 1 (2.6) 0 (0.0)
1000- 4 (10.3) 12 (34.3)
Total 39 (100.0) 35 (100.0)
Sample site Dental clinic 8 (20.0) 15 (42.9)
School 21 (53.8) 6 (17.1)
Work place 2 (5.1) 0 (0.0)
National survey 0 (0.0) 9 (25.7)
Various 5 (12.8) 1 (2.9)
Unknown 3 (7.7) 4 (11.4)
Total 39 (100.0) 35 (100.0)

The mean score according to each DFS question on articles of Korea

Classification Division M SD
Evasion of dental care Put off appointment 2.15 0.29
Physiologic arousal 1.87 0.24
Mean 2.01 0.26
Physiologic arousal Muscle tenderness 2.35 0.29
Increasing breathing rate 2.15 0.28
Perspiration increase 2.13 0.27
Nausea 1.74 0.25
Heart rate increase 2.23 0.30
Mean 2.12 0.24
Fear of specific objects Making an appointment 2.17 0.27
or stimulations Approaching dental offic e 2.30 0.29
Sitting in waiting room 2.38 0.29
Sitting in dental chair 2.49 0.38
Smell of dental office 2.29 0.26
Seeing the dentist 2.15 0.27
Seeing anesthetic needle 3.05 0.41
Feeling anesthetic needle e 3.14 0.46
Seeing the drill 2.92 0.40
Hearing the drill 2.96 0.41
Feeling the drill 2.98 0.51
Having teeth cleaned 2.51 0.39
Mean 2.61 0.33
Overall (DFS 19) 2.42 0.29

Multiple linear regression analysis of dental fear factors and overall fear of dentistry

Variables B SE β R2 Ad R2 R2 change
Constant ―.322 .295
Hearing the drill 1.039 .101 .952** .906 .897 .906
Having teeth cleaned .378 .138 .339* .946 .935 .040

P<.05,

P<.01 determined from multiple linear regression analysis (Stepwise).

Summary of included Study characteristics except references cited

Author (year) Journal Study population Country/Study Site Age (mean) Measuring tools Reliability/Cronbach's α Analysis DFS* Quality Assessment
M SD
Choi et al. (2006) Korean J Health Edu 1607 Korea/ Schools 13-70 DFS, DBS, DHSS, - two-way ANOVA, Multiple regression 52.16 15.71 9
Promotion Church, Workplace (32.8) SODTD
Jeon et al. (2007) J korean Soc Den Hyg 281 Korea/ Schools, Church, Workplace 13-70 DFS, SODTD α=.95 t-test, ANOVA, χ2, Multiple regression 52.54 18.81 8
Choi et al. (2008) J Korean Acad Pediatr Dent 313 Korea/ Schools 13-18 DFS - χ2, Multiple regression 50.40 17.00 7
Kwon et al. (2010) Jour. of Kocon.a 420 Korea/ Schools 14- DFS α=.89-.97 frequency, ANOVA, Pearson correlation 2.66 1.23 10
Park et al. (2010) J korean Soc Den Hyg 622 Korea/ Schools 14-16 DFS, DAS - frequency, ANOVA, t-test 2.02 - 7
Hwang et al.(2010) J Dent Hyg Sci 540 Korea/ Schools 20- DFS, MDAS - t-test, ANOVA, correlation 2.35 0.82 7
Sim et al. (2011) J Korean Acad Pediatr Dent 614 Korea/ Schools 14-16 DFS - Mann-Whitney U, χ2 2.00 - 8
Hong et al. (2012) J Korean Soc Den Hyg 165 Korea/ Schools 17-19 DFS α=.76-.93 ANOVA, Multiple regression, t-test 1.40 0.53 8
Yoon et al. (2012) Jour. of Kocona 311 Korea/ clinics all DFS α=.96 frequency, t-test, ANOVA 50.4 16.5 8
Choi et al. (2013) The J KDA 304 Korea/ Schools 14-16 DFS - frequency, t-test, χ2 2.51 - 7
Joo et al. (2013) J Korean Soc Den Hyg 300 Korea/ Schools 20- DFS α=.96 frequency, ANOVA, t-test, Multiple regression 2.41 - 7
Jun et al. (2014) J Dent Hyg Sci 352 Korea/ Schools 19 DFS - frequenvy, t-test, ANOVA, Correlation, Multiple regression 2.36 0.96 8
Sim et al. (2014) KJOHSM 347 Korea/ Schools 14-16 DFS α=.95 frequency, t-test, ANOVA, Multiple regression 3.05 - 8
Mehrstedt et al. (2004) Anesth Prog 137 Germany/ clinics 16-72 DAS, DFS, SF-36 - t-test, Perason, χ2 2.88 - 6
Skaret et al. (2005) Community Dent Oral Epidemiol 666 Norway 23 DSQ, DFS, DBS, GFS, DMFT α=.77 ANOVA, Pearson, χ2, Muliple regression, Logistic regression 2.20 16.40 8
Vika et al. (2008) Int J Paediatr Dent 1385 Norway/ Schools 18 DFS, IPS-A, MQ - ANOVA, Pearsion, χ2, z-test, Muliple regression, Logistic regression, 2.21 17.60 8
Coolidge et al. (2008) BMC Oral Health 195 Greece/ clinics 18-76 MDAS, DFS α=.92-.96 t-test, Spearman, χ2 1.97 17.07 9
(40.3)
Ulla et al. (2012) BMC Oral Health 500 Sweden 38-50 SOC, DFS, OHPI-14 - t-test, ANOVA, χ2, Multiple regression 1.81 - 8
Spindler et al. (2014) J Public Health Dent 102 Denmark/ clinics (40.8) DAS, DFS α=.90-.95 t-test, ANOVA, χ2, Pearson correlation 3.56 13.42 9
Esa et al. (2014) BMC Oral Health 503 Island/ Schools 16 DFS, DMFT α=.70-90 Descriptive, t-test, Mann-whitney U 2.04 12.43 9

DFS, dental fear survey; DBS, dentist belief survey; SODTD, self-assessments of oral disease and tissue damage; DHSS, dental hygienist satisfaction survey; DAS, dental anxiety scale; MDAS, modified dental anxiety scale; SF-36, SF-36 health survey; DSQ, dental satisfaction questionnaire; GFS, geer fear scale; IPS-A, ingection phobia scale; MQ, mutilation questionnaire-blood ungury fear and phobia; SOC, sense of coherence; OHPI-14, oral health impact profile-14. *The Dental Fear Survey includes 20 items, each rated 1-5. The results ar presented as mean sum score of as mean sum score ±SD. The mean sum score value ranged from 4 to 20.