Assessment of Anxiety Associated with the Dental Treatments on the Quality of Life: An Original Research.

BACKGROUND: Patients around the world when attending the dental clinic are prone to undergo the feelings of fear and anxiety. This may impact the dental follow-up and prognosis. AIM: The aim of the study is to evaluate the dental anxiety in the patients attending for the dental treatment in a college, in India.
MATERIALS AND METHODS: A sample of 500 adults with ages 15-60 years was considered for the study. Modified dental anxiety questionnaire was used in the present study to assess the anxiety faced by the patients attending for the dental treatment. ANOVA and Chi-square test were used to test for the significance between the variables, and the correlation between these variables was assessed using the Spearman's correlation. Likert scale was used to know the cutoff for the severity of the dental anxiety.
RESULTS: Only in the 4% of the participants in the present study had dental anxiety. Gender, age, financial status, education impacted the dental anxiety and the regularity toward the appointments.
CONCLUSION: It can be concluded from our study that there was a low anxiety in the dental patients toward the dental treatment and also anxiety decreased with the age. However, regular dental visits are advised to prevent the overall impact of the oral health on the general health. Copyright:

INTRODUCTION

Patients around the world when attending the dental clinic are prone to undergo the feelings of fear and anxiety. Ever changing technology and the innovations in the dental practices have added a little to the evasion of the common fear of the patient when attending the clinic.[1] There are various classifications and subclassifications of the anxiety and fear.[2] The dentists are quite commonly faced with the patients being anxious and apprehensive of the dental treatments that are seen irrespective of age and socioeconomic class. However, the factors such as previous traumatic experiences and domestic climates are seen to impact the patient attending the dental treatment. It has been shown in few studies that this may lead to the irregular follow-ups in the dental patients.[34567] To have a good prognosis and the treatment success, the factors associated with the dental anxiety are to be explored and assessed. Dental anxious patients can be easily recognized as they often defer the regular visits and have typical signs like they sit at the edge of dental chair, are visibly apprehensive, look unrelaxed, and are easily startled. Similar behavior can be seen in the children that may hamper the dental and overall heath.[89101112] In this study, we evaluated the anxiety in the patients attending the dental treatment.

MATERIALS AND METHODS

Modified dental anxiety questionnaire was used in the present study to assess the anxiety faced by the patients attending for the dental treatment. After taking the ethical clearance, a total of 500 participants were selected between the ages 15 and 60 for the study that was conducted for 10 months from November 2019 to July 2020 in a dental college in India. Edentulous, uncooperative patients, and the individuals who did not give assent were exempted from the study. Information was gathered through the modified dental anxiety scale (MDAS) adjusted from Corah NL.[13] Sociodemographic variables such as age and sex, economic and education status, and previous dental experiences were collected. The survey was pretried and preapproved through a pilot study and its Cronbach's alpha worth was discovered to be 0.830. A moral leeway was appropriately gotten from the moral council of Dental Institution. Statistical analysis was done using IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp. ANOVA and Chi-square test were used to test for the significance between the variables, and the correlation between these variables was assessed using the Spearman's correlation.

RESULTS

Among the 500 participants, almost equal distribution of the male and female participants (50.3, 49.7) was seen. There was a significant difference noted in the age distribution with the majority in the group of 15–29 years (68.31). When the education levels, financial status, and visits to dentist were considered, no significant difference was noted. Significant difference in attitude was seen in those who had a previous dental visit and it can be noted to be a good experience [Table 1].

Table 1

Distribution of the sociodemographic variables in the present study

Variables	n=500, n (%)	Significance (P)
Age (years)
15-29	341 (68.31)	0.031*
30-49	114 (22.76)
>50	45 (9.00)
Gender
Female	244 (49.7)	>0.05
Male	256 (50.3)
Education
Educated	479 (96.9))	>0.05
Uneducated	21 (4.1)
Pay
≤15,000	193 (38.6)	>0.05
15,000-20,000	43 (8.63)
>20,000	36 (7.3)
Nil	226 (45.3)
Previous dental visits
Yes	330 (66.0)	>0.05
No	170 (34.0)
Experience from the previous dentist visit
Good	461 (92.3)	0.001*
Bad	39 (7.6)

*P<0.05

Majority (86.65%) of the participants in the present study were observed to be postponing their dental visits due to the anxiety and the fear and it was statistically significant (P = 0.001) [Table 2].

Table 2

Percentage of the patients having dental anxiety and hence postponing the treatments

Variable I would like to postpone my dental visit	n=500, n (%)	Significance (P)
No	87 (17.3)	0.001
Yes	413 (82.65

Few observations were made in our study when the various factors related to the patients, and the dental anxiety was correlated. It was noted that there was a significant impact of the gender on the dental anxiety. However, there was an inverse relation between the financial status and the age was seen. Deferment of the dental treatment directly affects dental anxiety [Table 3]. Based on the severity of the anxiousness five questions, each of five points on the Likert scale was given. For the total points of 25, 19 points were considered as the cutoff point that specified an extremely dentally anxious patient, possibly dentally phobic.[1314] In only 20 (4%) participants, dental anxiety was observed [Table 4].

Table 3

The correlation between anxiety scores and the variables in the study

Variables	Spearman’s correlation of the variables	Significance
Sex and mean total score	0.931	0.030*
Age and mean total score	−0.1423	0.0010*
Educational qualification and the mean total score	0.0441	0.330
Pay/month and the mean total score	−0.1301	0.0040*
Postponement of the dental visit and mean total score	0.1931	0.0000*

*P<0.05

Table 4

Distribution of the participants among the various scores

Score	Percentage
5.0-7.0	27.6
8.0-10.0	27
11.0-13.0	24.6
14.0-19.0	16.6
≥19	4

DISCUSSION

In the present study, we used the MADS, for the assessment of the dental anxiety as it had the Cronbach's alpha values 0.83 that was similar to Indian version 0.781.[15] We observed that very few participants showed dental anxiety (4%). Furthermore, it was observed that majority of the patients who had dental anxiety were in the habit of postponing the dental treatments. This could have been associated with a previous dental negative experience. Our observations in the study where we found that dental anxiety was seen more in less educated people and who had a negative previous experience with the dental treatment, were similar to the study of Acharya[15] and Yuan et al.[16] However, the present observations were in contradiction to the studies of Pavi et al.[17] and Stole et al.[18] In the study of Moore and Brødsgaard,[4] they studied the dental anxiety in Danish patients and concluded that the dental anxiety was related with the financial, educational, and professional backgrounds of the patients which is similar to the outcome observed in our study. In the study of Kumar et al.,[19] they attempted to find the role of the dental anxiety on the oral health-related quality of life. They observed that women were more anxious and that negatively influenced the overall health in women than men. Men were seen to be less anxious than women, but the differences were not seen to be significant. Similar findings were also reported in the study of Morse.[20] We observed that as the age progressed, the anxiety also decreased. Similar observations were seen in the study of Udoye et al.[21] among the Nigerian patients undergoing various dental treatments where they also noted a decrease in anxiety with the age. This observation was supported in the studies of Locker and Lindell[22] and Neverlien.[23] In the present study, the reason for the postponement of the dental visits was observed to be the dental anxiety. Similar observations were made by Hägglin et al.[24] However, in our study, we have taken care to avoid the bias such as selection and recall bias. Longitudinal studies are warranted to know over long-term impact of the dental anxiety.

CONCLUSION

The dental treatments include procedures which might look and sound fearful to some and may increase anxiety in the patients. It can be concluded from our study that there was a low anxiety in the dental patients toward the dental treatment and also anxiety decreased with the age. However, regular dental visits are advised to prevent the overall impact of the oral health on the general health. Efforts are to be made to cater to the various factors that create the anxiety in patients and improve the dental visits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.