عوامل موثر بر ترس از دندانپزشکی زودهنگام در مقابل شروع دیر هنگام در یک مطالعه طولی اپیدمیولوژیک

A longitudinal investigation of risk factors for early- and late-onset dental fear was conducted. Early-onset dental fear was related to conditioning experiences (indexed via caries level and tooth loss), service use patterns, stress reactive personality and specific beliefs about health professionals. Late-onset dental fear was related to aversive conditioning experiences, irregular service use and an external locus of control. In contrast to recent findings for dental anxiety, personality factors were not strongly related to the onset of dental fear in young adulthood. The key role played by conditioning events in the development of both early- and late-onset dental fear was confirmed. Conditioning events appear to play a different role in the development of dental fear vs dental anxiety. This may reflect important, but largely ignored differences between these two closely-related constructs. Interventions for early-onset dental fear should aim to modify both the dental fear and the personality vulnerabilities that may contribute to the development of dental fear early in the life-course.

The commonly held view that dental fear arises in youth and results from traumatic dental experiences (Kleinknecht et al., 1973 and Lautch, 1971; Milgrom, Mancel, King & Weinstein, 1995; Shoben & Borland, 1954) may require revision (Locker, Liddell, Dempster & Shapiro, 1999). Locker et al. (1999) studied the closely-related construct of dental anxiety among a community study of adults (aged 18 years and over) and obtained data consistent with at least two alternate paths to dental anxiety (Weiner & Sheehan, 1990). The first pathway involved conditioning events and was associated with early onset of anxiety; a second pathway, typifying late-onset cases, was characterised by high levels of general fearfulness and trait anxiety and relatively few aversive conditioning events. Based on these findings, Locker and his colleagues suggested that the late onset anxiety group might be particularly difficult to treat as it comprises individuals with an apparent constitutional vulnerability to negative affective states. Similar findings regarding the relative redundancy of conditioning events in the development of late-onset dental anxiety have recently been reported from a longitudinal cohort study (Thomson, Locker & Poulton, 2000).