Comparing the categories of the Dental Anxiety Scale to patients at or above and below the age of 46 showed no statistical significance. These findings were strongly in contrast to those of similar studies [10, 12, 21,22,23,24] showing a decrease in the prevalence of dental anxiety in older populations compared to younger populations. An explanation could be the classification into only two age groups and a generalization of the words “young” and “old”. A flaw of the Dental Anxiety Scale is the non-inclusion of local anesthetics and a strong influence of a patients judgment of the treatment. Patients are most afraid of the pain and bodily harm done by the injection , even though 40% of younger age groups prefer a treatment with anesthesia . The Modified Dental Anxiety Scale (MDAS), modeled on the original anxiety scale by Corah, includes an additional question about anesthetics . Findings for the sample groups showed a connection between age groups and dental anxiety using the MDAS .
The Brief Symptom Inventory-18 was used to compare the same age groups. Findings indicated a higher presence of depression and anxiety in younger than in older patients. Increased experience, emotional control, and immunity to stressful experiences are possible factors supporting these results . The older patient might be not working anymore and therefore can recover and prepare better for stressful experiences. There are, however, indications that symptoms of anxiety and depression begin to increase again . Therefore, it is important not to assume an older patient to not be at risk for anxiety and depression symptoms. These results further emphasize the need for a comfortable and reliable dental anxiety screening method.
When comparing dental anxiety and the Global Severity Index with the gender of our sample, female patients were more susceptible to psychological distress regarding a dental treatment than male patients. This was a confirmation of earlier studies . Women have a higher chance of developing dental anxiety than male patients as we expected . An explanation for this might be higher levels of neuroticism in women than men and it being correlated to anxiety [30,31,32].
Correlations between psychological distress and dental anxiety might be an indicator that patients with a generally higher level of psychological symptoms (depression, somatisation, anxiety) are at a higher risk for the development of specific anxieties such as dental fear. A similar study, comparing 212 patients with psychosomatic service with 95 healthy controls, confirmed these results . The large sample size of this study was favorable in comparison to similar studies. Also, the use of a general population and not just patients with an existing diagnosis of anxiety allowed a non-biased view towards the results. However only patients voluntarily visiting a dentist were interviewed. Patients with a diagnosable dental anxiety and an aversion to dental visits could not be examined.
The BSI-18 and the DAS are scientifically reliable questionnaires and are frequently used for large sample sizes, as in this study. To improve the individual judgment of the patient’s well-being, the more detailed BSI with 53 items or even the SCL-90R with 90 items could be applied in a subsequent study. There are also several factors for which the Dental Anxiety Scale is often criticised, such as the answering scheme not being consistent across the questionnaire and, most importantly, not including a question about local anaesthetics. The Modified Dental Anxiety Scale, validated by Humphris, Morrison and Lindsay in 1995 , improved these flaws and can be an interesting alternative to Corah’s DAS.
All questionnaires were completed by the judgment of the patients themselves. It is therefore possible that some patients did not answer the questions truthfully and might have reduced the severity of their answers to avoid being singled out as a patient with dental anxiety. The treatment the patients were expecting after their survey was not captured on any questionnaire. Patients with acute pain might already be psychologically weakened, expecting more pain and therefore fearing the treatment more than someone waiting for a routine dental check-up.
Patients suffering from dental anxiety are restricted in their daily routine. Most of the time, these patients will only choose to make a dental appointment if the pain becomes too unbearable. If the dentist is unaware of the patient’s anxiety, the encounter can deteriorate. This should not be the experience first experience of an individual fearing dental treatment. Screening using the Dental Anxiety Scale is fast and easy and can prepare the dentist to handle the patient. This would, however, require that the dentist has been professionally prepared to treat a patient who fears his surroundings. Improvements can be made in preparing students during their training or given as a mandatory lecture. With the help of specialized practitioners and a fully prepared dentist, it may be possible to reduce dental anxiety in susceptible individuals.