Dental Fear in Adults

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Dental fear may originate at any stage in life and estimates for the prevalence of dental fear in adults range from 4.2% to more than 50%. Difference in the estimates may reflect different populations and measurement instruments so a global estimate would provide data on the size of the problem.

The aim of this review was to estimate the global prevalence of dental fear in adults.

Methods

Searches were conducted in the Embase, PubMed, Scopus, Virtual Health Library and Web of Science databases with no language restrictions.  Observational studies reporting or providing data that allowed the calculation of the dental fear in adults were considered. Eligible methods for evaluating dental fear included self-report, assessment using validated tools or single-item questions, or the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) criteria for specific dental phobia.  Dental fear was defined according to three categorizations: ‘Any dental fear’, ‘High dental fear’, and’ Extreme/severe dental fear and dental phobia’ . Two reviewers independently selected studies, extracted data and assessed study quality using the Joanna Briggs Critical Appraisal Checklist for Prevalence and Incidence studies. prevalence pooled estimates of dental fear were calculated using fixed- and random-effect models. Sensitivity and sub-group analysis were conducted.

Results

  • 31 studies involving a total of 72,577 patients age 18 or older were included.
  • 28 studies were considered to have a high risk of bias and 3 a low risk of bias.
  • 18 studies were conducted in Europe, 7 in North America, 5 in Oceania and 1 in Asia.
  • 24 out of 31 studies (77%) used validated scales of dental fear and anxiety (DFA).
  • The global estimated prevalence of any DFA = 15.3 % (95%CI; 10.23 to 21.15%)
    • high DFA = 12.4 % (95%CI; 9.61 to 15.57%)
    • severe DFA = 3.3 % (95%CI; 0.92 to 7.06%).
  • A higher prevalence of DFA was reported in women
Women Men
Any DFA 19.1% 10.5%
High DFA 18.6% 9.2%
Severe DFA 4.7% 3.3%

Conclusions

The authors concluded: –

Dental fear and high dental fear are prevalent in adults worldwide, being more prevalent among women.

Comments

The reviewers have searched a good range of databases with no language restrictions. The included studies were published between 1991 and 2020. However most (28 out of 31) were considered to be at high risk of bias. A wide range of tools was used to assess DFA (Dental Anxiety Scale (DAS), Modified-Dental Anxiety Scale (MDAS), Dental Anxiety Question (DAQ), Dental Fear Scale (DFS), Gatchel Fear Scale (Gatchel FS), Seattle Item Question, Single-item dental anxiety and fear (SIDAF), Phobia Checklist) and as the authors note there was a high degree of variability in the prevalence estimates.  Only 24 studies (77%) used one of the validated tools and it would have been interesting to see the impact on the estimates of only including those studies. So, while the review provided some indicative values for dental fear prevalence they should be viewed cautiously.

Links

Primary Paper

Silveira ER, Cademartori MG, Schuch HS, Armfield JA, Demarco FF. Estimated prevalence of dental fear in adults: A systematic review and meta-analysis. J Dent. 2021 Mar 9;108:103632. doi: 10.1016/j.jdent.2021.103632. Epub ahead of print. PMID: 33711405.

Other references

Dental Elf – 7th Oct 2020

Dental Anxiety: Prevalence in children and adolescents

Dental Elf – 12th Jun 2019

Dental fear and anxiety: Is it related to negative oral health beliefs?

 

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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