1. Levels of dental anxiety Dr Kirsty Hill University of Birmingham 1

2. Outline Barrier to dental care: Dental Anxiety Definition of dental anxiety Assessment Levels of dental anxiety Impact of Dental Anxiety on Patients Attendance Oral Health Conclusion 2

3. The Concept of Anxiety Fear – ‘individual’s emotional response to a perceived threat or danger…incorporates negative cognitive appraisals; physiological changes; behavioural cues’ (Milgrom et al., p5) (fight or flight) 3

4. Dental Anxiety Anxiety – ‘response to situations in which the source of threat to the individual is ill-defined, ambiguous, or not immediately present’’ (Milgrom et al., p5) Anticipatory anxiety 4

5. Dental Phobia ‘a marked and persistent fear of clearly discernible, circumscribed objects or situations. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response’ ‘….prolongation of the avoidance response resulting in significant distress or interferes with one’s social or role functioning ‘ (DSM IV critera, 1994) 5

6. Dental Phobia Dental phobia shares features of anxiety and fear. It shares features that are apparent with other well known phobias such as spider and rat phobias. These include: Avoidance Suffers unable to explain their reactions Embarrassment and shame 6

7. MDAS The MDAS asks patients to imagine themselves in 5 different dental situations and to rate how they would react on a 5-point scale. – Three scores can be calculated. All questions are added to give a “total” score (max. 25); questions 1-4 can be summed to give a “general dental anxiety” score (max. 20); and question 5 can be summed to give a “needle phobia” score (max.5). The cut-off for clinically significant dental anxiety is 19. 7

8. Prevalence of dental anxiety 51% who had attended the a dentist had an MDAS score between 5-9 (indicating low/no anxiety) 36% had an MDAS score between 10-18 (moderate anxiety) 12% had a score of 19 or more (extreme anxiety) 8

9. Social Variation Social variation: extreme dental anxiety 15% routine and manual occupations 12% intermediate occupations 10% professional Variation was across all dimensions for the MDAS scale. 9

10. Modified Dental Anxiety Scale: Prevalence against Gender 10

11. Percentage reporting very/extremely anxious by sex 11

12. Anxiety: Percentage with 19 or over against age 12

13. Modified dental anxiety scale by self-assessed general and dental health General Health Dental Health 13

14. Modified dental anxiety scale by reason for last visit to dentist 14

15. Dental Anxiety and Oral health status People with teeth are more anxious than those without! Oral health Fewer treatment experiences 15

16. Relationship with dentist at last visit 16

17. Conclusion Barriers – Confounding issues between: Access, Cost and anxiety Anxiety is a serious issue Prevalence is high – particularly in women Further Research – Age – Social variation – Gender 17

18. Adult Dental Health Survey 2009 The NHS Information Centre commissioned the survey, with funding provided by the Department of Health in England, the Welsh Assembly Government and the Department for Social Services and Public Safety in Northern Ireland. The Office for National Statistics (ONS) was the lead contractor working in partnership with the National Centre for Social Research, the Northern Ireland Statistic & Research Agency, and a team of academics from the Universities of Birmingham, Cardiff, Dundee, Newcastle and University College London 18