ابعاد کنترل روانشناختی والدین: ارتباطات با پرخاشگری فیزیکی و رابطه پیش دبستانی در روسیه

Aims To compare the prevalence of high dental anxiety across a variety of past distressing experiences with a previously reported Dutch sample. Method University students from the UK (N = 1024) completed an online survey containing; the Modified Dental Anxiety Scale, and the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ). Adjusted odds ratios (OR) were calculated to assess the association of self-reported distressing experiences and dental anxiety. Results The percentage of respondents with high dental anxiety (HDA) (total MDAS score ≥ 19) was 11.2%. Significant prevalence of HDA across several distressing experiences was shown in both UK and Dutch samples notably: extreme helplessness during dental treatment, lack of understanding of the dentist and extreme embarrassment during dental treatment. There were little or no effects of non-dental trauma, with the exception of sexual abuse in the UK sample. Conclusions Trauma from various past experiences may be implicated in an increased risk of high dental anxiety.

Dental fear and anxiety are both widespread problems, with approximately 25% of UK adults and 20% of US adults reporting delays in visiting the dentist due to dental fear (Boyle et al., 2009 and Smith and Heaton, 2003). Similarly, there have been numerous studies that have reported high dental anxiety levels in approximately 10–20% of their participants (Locker et al., 1999a, Locker et al., 1999b, Humphris et al., 2009 and Sohn and Ismail, 2005). Dentally anxious individuals frequently experience negative thoughts, feelings and fears, the fright response, sleep disturbances, and impaired social functioning in work and personal life (Cohen, Fiske, & Newton, 2000). Such individuals often avoid dental treatment and suffer detrimental effects to their oral health (Berggren and Meynert, 1984 and Richard and Lauterbach, 2007). The role of previous dental experiences has been one of the major factors to explain dental anxiety. Such experiences have been linked to increased perception of pain and negative cognitions regarding dental treatment (De Jongh, Adair, & Meijerink-Anderson, 2005). Moreover, this group of authors confirmed individuals with high dental anxiety (HDA) reported significantly more traumatic past experiences (including those in the dental setting) than individuals with lower dental anxiety (73% vs. 21%) (De Jongh, Fransen, Oosterink-Wubbe, & Aartman, 2006). Distressing experiences in the dental setting were the most frequently reported traumatic event, and 41% of HDA individuals indicated suffering from at least one of the post-traumatic stress disorder (PTSD) symptom clusters (insomnia, avoidance, etc.). This demonstrates that dental trauma does not simply affect oral health through avoidance of treatment, but can also impact mental health negatively with the development of PTSD. Therefore, it appears that previous distressing experiences play a major role in the development of dental anxiety and consequently require serious consideration. Oosterink et al. reviewed a number of studies and concluded that distressing experiences that are linked to the dental setting should be categorized as: “…dental treatment-related-distressing experiences…” or “…distressing experiences which fulfill the DSM-IV-TR stressor criterion and are not related to the dental setting per se…” ( Oosterink, de Jongh, & Aartman, 2009, p. 451). They also suggest that exemplars from the first category may involve: invasive dental treatments (injection, root canal); pain; distress resulting from dentist behavior; emotional distress in response to dental treatment (e.g., feelings of loss of control); and distressing stories told by others who are regarded as important. Distressing experiences which are not related to the dental setting may include: sexual abuse; war trauma; severe traffic accidents; distressing medical experience; and physical assault ( Oosterink et al., 2009). Furthermore, the degree of exposure to a negative dental event should be investigated when examining the event's relation to subsequent anxiety. Hence Oosterink et al. developed the 23-item Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ). This was designed to assess an individual's degree of exposure for events occurring within and outside the dental setting ( Oosterink et al., 2009). At present the originators of this scale have only quoted data from their local Dutch population and investigated the relationship of the scale with their own preferred dental anxiety assessments. As previous experiences are confirmed to be a major antecedent factor in the development of dental anxiety it would be important to compare the findings presented by the Amsterdam group with a separate UK sample to improve generalizability. Hence the aim of this study was to compare levels of dental anxiety across distressing experiences taken from the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ) in a UK sample.

This UK study confirms that the development of dental anxiety is significantly linked with exposure to past distressing dental experiences (Oosterink et al., 2008). A novel finding was discovered that a non-dental experience (sexual assault) significantly increased the likelihood of subsequent dental anxiety.