Although dental phobia is classified under the heading of blood–injury phobia, studies show differences between the two conditions in terms of frequency of fainting and gender distribution. Anxiety sensitivity (AS), which refers to discomfort and negative attributions to bodily anxiety sensations, was useful in differentiating panic anxiety from other phobic anxieties. No study has compared dental phobia with blood–injury phobia directly. We examined 61 subjects, working at a military aircraft factory, using measures on demographics, dental fears (MDAS – Modified Dental Anxiety Scale) and blood–injury fears (MBPI – Multidimensional Blood/Injury Phobia Inventory), in addition to Anxiety Sensitivity Index. Regression analyses revealed that dental phobia was predicted by ASI, whereas blood/injury phobia was not. Our results provide additional support for the proposed distinction between the two conditions.
Dental phobia is defined as unreasonable fear of going to the dentist or of dental procedures, which can be disabling if avoidance is severe. Although dental phobia is classified under blood–injury phobias in DSM 5 (American Psychiatric Association, 2013), accumulating evidence suggests that the two conditions may be two distinct clinical syndromes. Öst (1992), for example, has shown that only 8 out of 81 blood phobics, and 10 out of 59 injection phobics also have dental phobia. Similarly, Poulton, Thompson, Brown, and Silva (1998) have shown that out of 96 dental phobics only %10 had blood phobia. One of the main findings suggesting a distinction between the two conditions is the relative absence of fainting among dental phobics compared to blood phobics. In the study of De Jongh, Bongaarts, and Vermeule (1998), none of the participants with dental phobia fainted during dental treatment. The phobic stimulus also seem to be different for the two conditions: the most distressing stimuli for blood–injury phobics are reported to be the sight of blood, needles and wounds; whereas dental phobics list the sight and sound of the aerator and dental treatment settings as their top-feared situations (De Jongh et al., 1995, Kleinknecht et al., 1973, Roy-Byrne et al., 1994 and Stouthard and Hoogstraten, 1987). De Jongh, Bongaarts, and Vermeule (1998) showed that the typical phobic stimulus for blood phobics (i.e. sight of blood) was feared by only 8% of dental phobics. Gender distribution is also dissimilar in two fear groups: blood–injury phobia is more common in women, whereas no gender difference could be shown in dental phobics (Berggren et al., 1995, Fredrikson et al., 1996, Öst et al., 1984 and Thomson et al., 2000).
Although the limitations of this study, namely a small and predominantly male sample, require caution in interpreting the results, we believe that our findings provide further evidence that dental phobia may be a specific phobia in its own right, distinct from blood/injury phobias. Previous research has already shown the two conditions to differ in terms of gender distribution and frequency of fainting. Our study is significant, in that it is the first to show that the two conditions also differ in terms of anxiety sensitivity. Classifying dental phobia under specific phobias, distinct from blood–injury phobia, will benefit patients and researchers alike, increase collaboration between disciplines (i.e. dentistry/psychology) and may help create new treatment modalities.
