Introduction
DA (dental anxiety) or odontophobia is a psychosomatic illness that leads to anxiety linked to distress or pain from a prior dental treatment. Drown et al. (2018) define DA as extreme anxiety or fear towards any dental stimuli. It is characterized by avoidant behaviour, distress and poor compliance towards consistent dental appointments, thus interfering with their dental and general physical health. The anxiety might also affect an individual’s maintenance and self-care, affecting their general health due to negative feelings and thoughts about themselves. This view of oneself can lead to recurrent sleep disturbances, depression, medication overuse, unexplained pain, and poor occupational and social functioning. People who also evade dental care have higher risks of systemic conditions such as heart disease and diabetes. According to a study by Witcraft et al., 2021, DA affects about fifteen to thirty per cent of people globally, with the same rates cutting across adults, college students, adolescents and children.
Index validity evaluation and triggers
The IDAF-4C+ phobia module had many participants reporting disruption in their daily life due to dental anxiety. The study on the subgroup of ninety-eight participants also revealed that 94.6% had a dental phobia, which had no difference from the other study sample. The study also reveals that the two main triggers of the dental anxiety state are pain/discomfort and the patient’s inability to control the whole process. The least of the triggers included anaesthesia and the cost of dental treatment. Other triggers included feelings of choking or disgust, especially among women, while others reported being handled by an unkind dentist. This measurement scale agreed with the other scales regarding reporting dental anxiety among adults. However, the IDAF-4C+ plus scale failed to perform well on adults with dental phobia, thus necessitating more research to be conducted on the same. Nevertheless, the measure provides more information to the researchers and clinicians than all the other measures.
Sensitivities that Matter
A study by Witcraft et al. (2021) suggests three possible sensitivity triggers that matter in developing dental anxiety disorders. One of the main sensitivity triggers is anxiety, which, according to Witcraft et al. (2021), refers to the fear of the experience and its consequences. The number two type is pain sensitivity, defined as the perception of being unable to handle general psychosomatic and physiologic-related pain. The third is disgust sensitivity, where an individual develops an emotional reaction to dental experiences, contributing to anxiety. Studies have revealed that the sensitivities are independent of each other in causing dental anxiety. Dentally anxious individuals showcase an increased anxiety sensitivity, dental-related pain and anxiety compared to individuals who are not dentally anxious. Studies have also shown that these sensitivities are exacerbated by psychological vulnerabilities, which amplify aversive properties and attention to dental procedures properties. Witcraft et al. (2021) continue to explain that pain and anxiety perpetuate aversive sensations, while disgust sensitivity exacerbates disease concerns related to dental procedures.
To confirm these prospects, Witcraft et al. (2021) conducted research among college students, a more vulnerable population, to dental anxiety. They included a sample of 717 students, 71.3% female students from a public university in the southeast of the US (United States). They enrolled students eighteen years and above on an online study concerning dental anxiety for one semester, and the participants received accreditation for participation. The results indicated that 61.2% of the participants reported mild to no dental anxieties, 26.8% had moderate anxiety, and 12.0% had high levels of mental anxiety. DA showcased a minor correlation with pain, anxiety and disgust psychological sensitivities. However, the pain did not significantly contribute to dental anxiety, thus underscoring the disgust emotion and fear of anxious arousal in dental anxiety experience. Transient dental anxiety development might explain why pain sensitivity did not contribute much to dental anxiety, but might contribute to the anxiety after subsequent exposures. Another study by Row (2005) found that these sensitivities and fear are more prominent among younger adults than older adults. As young people take more responsibility for their health, they may become more anxious and omit their dental care routines leading to more complications.
The impacts
In their study, Alenezi & Aldokhayel (2022) state that dental anxiety is often expected to negatively influence an individual’s dental health because the majority retaliate by avoiding dental care. The study reveals that according to a study conducted by Hagglin et al., many elderly and middle-aged women in Sweden, who have dental anxiety, have more missing teeth compared to women without dental phobia. These results thus necessitate further research on dental anxiety impacts due to the large number of people affected by this state. To gather more information on this matter, Alenezi & Aldokhayel (2022) conducted a study involving adult participants aged eighteen years and above in Saudi. They were given a short questionnaire that contained questions investigating the cause and effect of dental anxiety or fear. Of the total adult population sample, 52% were male, and 48% were female. There was an imperceptible difference in levels of dental fear among the female and male participants, with male prevalence being 35% and female prevalence being 41% (Alenezi & Aldokhayel, 2022).
The majority also reported that they overcome their fear and seek dental care when they experience some annoying pain, moderately on slight pain, and a small number seek care when they see a large lesion on their teeth. The researchers also identified that dental fear impacted the patient’s rate of dental health-seeking behaviours, which resulted in even more invasive procedures when the patients finally gathered the courage to seek dental and medical care. Most patients admitted that they only seek dental care in the presence of aggravated dental pain, which means severe dental conditions. The study also revealed that the pain could lead to poor quality of life and other general health issues that arise from the fear associated with anxiety. Some heart conditions, such as infective endocarditis, can also develop due to poor dental hygiene. Individuals who fail to seek consistent dental care may experience embarrassment and self-esteem issues while interacting with others. Therefore, the primary caregivers should be able to detect patients undergoing this stress because they could be at risk of other psychological and physical illnesses needing immediate intervention.
Conclusion
Generally, the evidence from the articles reviewed above clearly indicates that many people suffer from dental anxiety and fear, which impacts their dental and general health in different ways. Three sensitivities have been linked to the causes or triggers of dental anxiety, including pain, disgust and anxiety sensitivities. Researchers argue that these sensitivities can be perpetuated by other underlying mental or health conditions that cause patients to adopt an avoidant behaviour towards dental and medical care seeking. They, therefore, are faced with effects such as poor dental health, increased risk of cardiovascular diseases, poor self-image and embarrassment. Therefore, it is paramount for primary physicians to identify this state and respond appropriately to avoid serious long-term effects.
References
Alenezi, A. A., & Aldokhayel, H. S. (2022). The impact of dental fear on dental attendance behaviours: A retrospective study. Journal of Family Medicine and Primary Care, 11(10), 6444-6450.
Drown, D. A., Giblin-Scanlon, L. J., Vineyard, J., Smallidge, D., & Dominick, C. (2018). Dental Hygienists’ Knowledge, Attitudes and Practice for Patients with Dental Anxiety. American Dental Hygienists’ Association, 92(4), 35-42.
Rowe, M. M. (2005). Dental fear: Comparisons Between Younger and Older Adults. American Journal of Health Studies, 20.
Svensson, L., Hakeberg, M., & Wide, U. (2020). Evaluating the validity of the Index of Dental Anxiety and Fear (IDAF‐4C+) in adults with severe dental anxiety. European Journal of Oral Sciences, 128(5), 423-428.
Witcraft, S. M., Wickenhauser, M. E., Maack, D. J., & Dixon, L. J. (2021). What sensitivities matter in dental anxiety? Investigating sensitivity to anxiety, pain, and disgust. Psychology, Health & Medicine, 26(3), 313-321.
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