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

Media coverage of the paper by Davies and Read was emotive and damning in terms of the dangers of antidepressant medication.

Studies suggest that despite improvement in dental health the overall level of dental fear and anxiety in population has remained relatively consistent over recent decades.  The origins of dental fear and anxiety result from a combination of both cultural factors (traditions, myths and beliefs) as well as psychological factors. However less is known about the influence of oral health beliefs on feelings and behaviours related to health professional care, in particular dental fear and anxiety

This review aimed to critically appraise the evidence on the relationship of oral health beliefs with dental fear and anxiety in distinct patient groups.


Searches were conducted in the Cochrane, Embase, Portal BVS, Clinical Trials, Ovid, OpenGrey, PubMed, Scopus, and Web of Science databases. There were no limits on language or date of publication.  Case-control, cohort, and cross-sectional studies assessing the association between negative health beliefs and dental fear/anxiety were considered.

Two reviewers independently selected the studies, extracted data and assessed risk of bias. The Newcastle Ottawa Scale for the relevant study design was used to assess risk of bias. Random effects meta-analysis of mean differences of dental beliefs scores between dental fear/anxiety and control groups, and the correlation of dental beliefs with dental fear and anxiety measures were conducted for studies with low or unclear/moderate risk of bias.


  • 10 studies involving a total of 5257 patients were included.
  • 4 studies were considered to be at high risk of bias, 6 at unclear or moderate risk of bias.
  • 7 different dental fear and anxiety measures were used and 4 different methods to assess dental beliefs.
  • 6 studies contributed to the meta-analysis.
    • The standardised mean difference of dental beliefs effects was higher in patients with dental fear and anxiety compared to controls = 1.20 (95%CI; 0.27-2.14) [ 3 studies,1074 patients].
    • A moderate positive correlation was observed between dental beliefs and dental fear measures; r = 0.54 (95%CI; 0.47-0.60) P < 0.001.


 The authors concluded: –

Based on these results, the presence of negative health beliefs is directly related to the increase of dental fear and anxiety; however, these findings are supported in studies with unclear/moderate risk of bias.


The authors have searched a broad range of databases to identify relevant papers and used standard methodological approaches to assess risk of bias. However, none of the included studies were considered to be at low risk of bias, with most being considered to be at risk in relation to selection bias and exposure and outcome measurement. Consequently while the findings suggest that patients with negative health beliefs are more likely to suffer with dental fear and anxiety this should be interpreted cautiously.


Primary Paper

Strieder AP, Oliveira TM, Rios D, Cruvinel AFP, Cruvinel T. Is there a relationship of negative oral health beliefs with dental fear and anxiety regarding diverse dental patient groups? A systematic review and meta-analysis. Clin Oral Investig. 2019 Jan 5. doi: 10.1007/s00784-018-2786-2. [Epub ahead of print] PubMed PMID: 30612241.

Review protocol on PROSPERO

Other References

Dental Anxiety blogs from the Dental Elf





Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Profile photo of Derek Richards

Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

More posts - Website

Follow me here –