Assessment of the Relationship between Dental Anxiety and Oral Health-Related Quality of Life.

BACKGROUND: Dental anxiety and fear are the frequently encountered entities among most of the patients. The present study was conducted to assess the relationship between dental anxiety and quality of life (QoL).
MATERIALS AND METHODS: This study comprised of 118 patients. Dental trait anxiety (dental anxiety scale [DAS] and short version of the dental anxiety inventory [S-DAI]), Oral Health Impact Profile (OHIP-14), Decayed, Missing, and Filled Teeth (DMFT) score, and global assessment of functioning were recorded before and after treatment.
RESULTS: Out of 118 patients, males were 52 and females were 56. There was a correlation between both oral health ratings and DMFT (P < 0.001). OHIP-14 total score was significantly associated with both dental anxiety measures. DMFT shows significant association with dental anxiety and oral health-related QoL (OH-QoL) (P < 0.05). The mean DAS score before treatment was 17.3 and after treatment was 12.60, S-DAI score was 40.1 and 31.5 before and after treatment respectively, oral health status (patient rating) was 38.4 and 74.20 before and after treatment respectively, oral health status (dentist rating) was 38.7 and 73.1 before and after treatment respectively and aesthetics (dentist rating) was 35.6 and 72.4 before and after treatment respectively. There was improvement of OH-QoL with dental anxiety reduction which was significantly significant (P < 0.05).
CONCLUSION: Authors found that there is correlation between dental anxiety and fear with the poor oral health-related oral hygiene. Copyright:

INTRODUCTION

Dental anxiety and fear are the frequently encountered entities among most of the patients. This is the main reason for failure to maintain good oral hygiene.[1] Dental anxiety and fear are commonly seen in both genders, however, the prevalence is more in females. Even though there have been great achievement and advancement in the field of dentistry to deal with such fearful dental situations where use of conscious sedation, local anesthesia, etc., may be helpful, still anxiety and fear cannot be completely eliminated among patients.[2] This has negative impact on oral hygiene as well as oral health-related quality of life (OH-QoL). It is evident that young adults have more dental anxiety and fear. Similarly, education level also plays an important role. Low education among subjects promotes high dental anxiety and fear. Married patients have less fear than unmarried.[3]

OH-QoL is affected by dental anxiety and fear. Oral health is the mirror of general body health.[4] Thus, there is a need to tackle it cautiously. Most of the dental treatment such as pulpectomy, endodontic treatment, dental tooth extraction, and periodontal surgeries requires use of local anesthesia. The insertion of needle is sufficient to provoke dental fear in few subjects. The relationship between dental anxiety and OH-QoL has been studied extensively.[5] Dental fear and anxiety greatly affect the oral health of individuals. The present study was conducted to assess relationship between dental anxiety and quality of life (QoL).

MATERIALS AND METHODS

This study comprised of 118 patients who reported to various dental centers of Najran requiring dental treatment of both genders who gave their written consent to participate in the study. Ethical approval from the Ethical committee of faculty of Dentistry, Najran University, was taken before the commencement of study.

All enrolled subjects were provided with questionnaires which determine dental anxiety, QoL, and oral health status. Demographic profile was also recorded in case history pro forma. A thorough oral examination was performed in all enrolled subjects. The assessment of dental caries was initiated with Decayed, Missing, and Filled Teeth (DMFT) index. Global assessment of functioning was also recorded. Patients requiring dental extractions, fillings, endodontic treatment were managed with behavioral management techniques.

Dental anxiety among patients was determined using Dutch version of the dental anxiety scale (DAS) and the Dutch short version of the dental anxiety inventory (S-DAI). The DAS measured four responses as not anxious which were given score on 0 and to extremely anxious which was given the score of 20.

The S-DAI recorded responses as 9–45 where 9 were set as no anxiety and 45 were designated to extremely anxious. Pain score was recorded using visual analog scale where 0 indicated no pain and 100 showed extremely painful situation. OH-QoL was assessed using the short version of the Oral Health Impact Profile (OHIP-14). Score 0 showed no impact and 56 showed severe impact. Dental anxiety-related QoL was calculated by social attributes of dental anxiety scale, a total score ranged from 12 (no impact at all) to 60 (severe impact). Results were statistically analyzed with P value labeled significant below 0.05.

RESULTS

Table 1 shows that out of 118 patients, males were 52 and females were 56.

Table 1

Distribution of patients

	n
Total	118
Gender
Males	52
Females	56

Table 2 shows that there was correlation between both oral health ratings and DMFT (P < 0.001). OHIP-14 total score was significantly associated with both dental anxiety measures. DMFT shows significant association with dental anxiety and OH-QoL (P < 0.05).

Table 2

Correlations between oral health-related quality of life, general quality of life, dental anxiety and Decayed, Missing, and Filled Teeth before treatment

OHIP-dimensions	OHIP-total	GAF	DAS	S-DAI	DMFT
Functional limitation	0.52	0.40	0.11	0.20	0.43
Physical pain	0.60	−0.01	0.41	0.26	0.37
Psychological discomfort	0.64	−0.28	0.64	0.50	0.54
Psychological disability	0.81	−0.32	0.40	0.41	0.55
Physical disability	0.65	−0.13	0.40	0.33	0.31
Social disability	0.78	−0.21	0.26	0.34	0.37
Handicap	0.78	0.25	0.38	0.41	0.32
OHIP-total	-	-0.23	0.55	0.50	0.58
GAF	−0.23	-	−0.18	−0.16	−0.02
DAS	0.55	−0.18	-	0.76	0.42
S-DAI	0.50	−0.16	0.76	-	0.40
DMFT	0.58	−0.02	0.42	0.40	-

OHIP: Oral health impact profile, GAF: Global assessment of functioning, DAS: Dental anxiety scale, S-DAI: Short version of the dental anxiety inventory, DMFT: Decayed, Missing, and Filled Teeth

Table 3 shows that mean DAS score before treatment was 17.3 and after treatment was 12.60, S-DAI score was 40.1 and 31.5 before and after treatment, respectively, oral health status (patient rating) was 38.4 and 74.20 before and after treatment, respectively, oral health status (dentist rating) was 38.7 and 73.1 before and after treatment respectively and esthetics (dentist rating) was 35.6 and 72.4 before and after treatment, respectively.

Table 3

Comparison of dental anxiety scale, short version of the dental anxiety inventory, oral health status, and esthetics before and after treatment

Scale	Mean		P
	Before	After
DAS	17.3	12.60	0.02
S-DAI	40.1	31.5	0.01
Oral health status (patient rating)	38.4	74.20	0.001
Oral health status (dentist rating)	38.7	73.1	0.01
Esthetics (dentist rating)	35.6	72.4	0.001

DAS: Dental anxiety scale, S-DAI: Short version of the dental anxiety inventory

Table 4 shows that there was improvement of OH-QoL with dental anxiety reduction which was significantly significant (P < 0.05).

Table 4

Oral health-related quality of life item-scores before and after treatment

OHIP-dimensions	Mean		P
	Before	After
Functional limitation	1.93	1.32	0.01
Physical pain	2.76	0.92	0.001
Psychological discomfort	3.06	1.72	0.02
Psychological disability	2.72	1.48	0.01
Physical disability	2.32	1.24	0.01
Social disability	2.30	1.10	0.04
Handicap	2.04	1.06	0.05
OHIP-total	32.1	18.8	0.001

OHIP: Oral health impact profile

DISCUSSION

Dental anxiety and QoL are considered to be important factors in dental care. Dental anxiety is regarded as major barrier to dental care. There are certain factors that lead to dental fear and anxiety such as low socio-economic status and younger age.[6] Other factors such as female gender and low education may also contribute to dental anxiety among subjects. Previous painful experience and experience of patients' known one play an important role in aggravating dental anxiety.[7] The present study was conducted to assess relationship between dental anxiety and QoL.

We enrolled 118 patients, of which males were 52 and females were 56. Yıldırım[8] assessed the correlation of dental anxiety and oral health status among 294 patients (154 males and 140 females). The level of dental fear was determined using dental fear survey (DFS) and the community periodontal index of treatment needs measured the periodontal status of subjects. There was a statistically significant difference between the DFS groups with regard to sociodemographic data. It was observed in this study that females, young patients and patients with low education levels and low socioeconomic status had high DFS scores as compared to males, old patients, high education level and high socioeconomic status. Patients with Periodontal status were better in groups that had scores in the low and moderate ranges compared to groups that had high scores on the DFS.

We found that there was correlation between both oral health ratings and DMFT (P < 0.001). OHIP-14 total score was significantly associated with both dental anxiety measures. DMFT shows significant associated with dental anxiety and OH-QoL (P < 0.05). Vermaire et al.; evaluated the association between dental anxiety and QoL in 35 highly anxious dental patients who were subjected to dental trait anxiety (DAS) and OH-QoL scales. It was found that lower OH-QoL as measured with OHIP-14 was lined with higher dental anxiety (r = 0.51–0.56, P < 0.01). There was magnificent improvement of oral health status, decrease in dental anxiety when treatment was given. Reduction of dental anxiety, rather than improved oral health, was found to predict enhanced OH-QoL.[9]

In this study, we found that mean DAS score before treatment was 17.3 and after treatment was 12.60, S-DAI score was 40.1 and 31.5 before and after treatment, respectively, oral health status (patient rating) was 38.4 and 74.20 before and after treatment, respectively, oral health status (dentist rating) was 38.7 and 73.1 before and after treatment respectively and esthetics (dentist rating) was 35.6 and 72.4 before and after treatment, respectively.

Studies have mentioned that serious dental anxiety with phobic avoidance of dental treatment procedures has harmful effect on dental health. It is seen that poor oral health is associated with dental anxiety and fear.[10] Subjects having high levels of dental fear are more like to have poorer oral function and a higher incidence of oral diseases. These subjects avoid visiting dentists and there are longer intervals between their dental visits. Schuller et al.[11] in their study found that subjects have more decayed and missing teeth who experience dental anxiety or dental fear and they prevent going to dental surgeons.

The removal of dental fear is very essential and should be treated based on patient-centered assessment. Such subjects should be well informed about the dental treatment procedure and a various modification technique such as tell show do and live demonstration should be performed in order to avoid rejection of dental treatment.[12] Patients with a high level of dental fear may be given psychiatric support for comfortable treatment procedure.

The shortcoming of the study is small sample size.

CONCLUSION

Authors found that there is correlation between dental anxiety and fear with the poor oral health related oral hygiene.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.