|Year : 2020 | Volume
| Issue : 1 | Page : 24-28
Prevalence of dental fear among male students studying in National Guard schools in Riyadh: A cross-sectional study
Abed Al-Hadi Hamasha1, Rakan B Aldosari2, Ziyad M Osamie2, Mohammed M Aldosari2, Abdulaziz H Fakih2, Abdullah M Alonazi2
1 Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia; Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
2 Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
|Date of Submission||13-Jan-2019|
|Date of Decision||17-Jun-2019|
|Date of Acceptance||16-Sep-2019|
|Date of Web Publication||05-Feb-2020|
Prof. Abed Al-Hadi Hamasha
Department of Preventive Dentistry, Jordan University of Science and Technology, Irbid 22110
Source of Support: None, Conflict of Interest: None
Aims: The aim of the study is to measure the prevalence and factors associated with dental fear among National Guard male middle schools students.
Subjects and Methods: A cross-sectional analytical study was conducted among 468 students aged 10–17 years. The assessment tool of this study was a self-reported questionnaire filled by students or their legal guardians. The questionnaire included 33 questions; including students' demographics and experience in dental fear. Furthermore, questions related to the most frightening factors as well as factors that make students feel better in dental clinics.
Data analysis was conducted using SPSS software. Frequency distributions with numbers and percentages of demographics, frightening factors, and comforting factors were conducted.
Results: The response rate was 87%. Dental fear was reported by 29.1% of the sample. Tooth extraction was feared the most (49%) followed by root canal treatment (16%). The main sources of fear were related to dental procedures and noise from drilling teeth. The fear was originated from children own experience (41%) and only 13% relate their fear to what they heard from other people's experience. Variables reduced fear were female dentists (73%), the good reputation of the dentist (55%), and elegance and cleanness of the clinic (47%). The good appearance and neatness of the dentist, attitude of the receptionist, and decreased waiting time were not major factors in reducing dental fear.
Conclusion: Dental fear was present in 29% of schoolchildren and was mostly related to tooth extractions and drilling noise. Dentist's explanation of the dental procedure and her attitudes were reported as helping factors in reducing dental fear.
Keywords: Dental, fear, guards, national, prevalence, students
|How to cite this article:|
Hamasha AA, Aldosari RB, Osamie ZM, Aldosari MM, Fakih AH, Alonazi AM. Prevalence of dental fear among male students studying in National Guard schools in Riyadh: A cross-sectional study. Saudi J Oral Sci 2020;7:24-8
|How to cite this URL:|
Hamasha AA, Aldosari RB, Osamie ZM, Aldosari MM, Fakih AH, Alonazi AM. Prevalence of dental fear among male students studying in National Guard schools in Riyadh: A cross-sectional study. Saudi J Oral Sci [serial online] 2020 [cited 2020 Apr 2];7:24-8. Available from: http://www.saudijos.org/text.asp?2020/7/1/24/272991
| Introduction|| |
Dental fear is a normal emotional reaction to one or more specific threatening stimuli in the dental situation., However, when the fear is much stronger, it is called dental phobia. This fear is often related to fear of pain, treatment plan, dental instrument, clinic setting, traumatic experience, the negative attitude in the family, or even to dental staff.
Several variables were investigated as initiators of dental fear. In general, a traumatic experience from a previous dental visit can lead to fear of all future dentists.,, However, others found that variables related to the past dental experience had a limited influence on dental fear and anxiety. Dental needle injections are a common initiating factor for fear., The sight and sensation of injections were feared most., In an attempt to answer the question of why people are afraid of dentists, revealed reasons to be either exogenous or endogenous. Exogenous factors included direct learning from traumatic experiences or indirect learning through family members and the media. Endogenous factors are those related to inheritance and personality traits. Women were more likely to have dental fear and fear of dental pain than men.,,
Reviewing the published dental literature dealing with dental fear among Saudi school children revealed a lack of such studies. A noteworthy study was newly published dealing with dental fear among young children in Jeddah, Saudi Arabia. Younger children, girls, and public-school students were significantly more fearful than older children, boys, and private school children. In another Saudi study among dental patients, fear from dental procedures, personnel, and medical aspect of treatment were the most feared situations. The total fear scores among the Saudi population was reported to be between 23 and 26 out of a maximum of 75 scores.,
Dental fear among National Guard male middle school that received dental treatment has not been assessed as far known. The aim of the present study is to measure the prevalence of dental fear among National Guard male middle schools students in Riyadh and to explore the characteristics and factors associated with dental fear among them.
| Subjects and Methods|| |
The present cross-sectional analytical study was conducted among junior high schools for students from sixth grade and above sponsored by the National Guard in Riyadh. The sample frame of this study included male Saudi students aged 10–17 years old whom parents were affiliated with the National Guard.
The assessment tool of this study was a self-reported questionnaire in the Arabic language to be filled by students or their legal guardians. This project was approved by the Institutional Review Board of King Abdullah International Medical Research Center (SP17-303-R) permission to conduct the study was obtained from the administration of National Guard schools.
All students in the selected Riyadh junior high National Guard schools were invited to participate in this study by filling the questionnaires. Copies of the questionnaires along with consent forms to be signed by their legal guardians were sent with the students' home. Only those with signed consents forms were included in the analysis of this study.
The originally prepared English questionnaire was translated into the Arabic language by an official translator so that they can be understood by parents. A comparison of the two questionnaires (Arabic and English) was made, and any ambiguity was cleared and clarified in the Arabic version. The questionnaire was designed to include 33 questions. The first portion of the questionnaire was related to students' demographics, parent's occupation, and income. The second part was related to students' experience in dental clinics including frequency and reasons for dental visits, the gender of the dentist, and their feelings during dental visits. The rest of the questions were designed to assess students' opinions about the most frightening factors of dental clinics including place, instruments, needles, smell, anticipating pain, and dentists. Factors that make students feel better in the dental visits including satisfaction of dentists, the appearance of dentists, and the design of the dental clinic were also examined.
Data analysis was conducted using the statistical program SPSS (versions 22) (IBM Inc. NY, USA). The statistical tests used in this study were frequency distributed with numbers and percentages of demographics, frightening factors, and comforting factors in the dental clinics.
| Results|| |
Questionnaires were distributed to 546 students, of whom 491 questionnaires were returned, with a response rate of 87%. Of those, 23 questionnaires were eliminated because of more than half of the questions were unanswered. The total numbers of students who accepted participation in the study and had their consents forms signed by their legal guardians were 468 students.
[Table 1] presented the demographic characteristics of the study sample. The mean age of the sample was 14.24 (standard deviation = 0.92) years. Eighty-one percent of students' fathers were in active military services, 87% of their mothers were homemakers and three-quarters of students' incomes were low-to-medium income. Children had the highest fear if their fathers were teachers and their mothers were homemakers. The dental fear was higher in children with income below SR 5000/month.
Associated with dental fear and its related characteristics among the study sample are presented in [Table 2]. In general, dental fear was reported by 29.1% of the sample. Although satisfaction with the current dentists was reported among 88.5% of students, only 11.5% were strongly not satisfied. As far as dental procedure is concerned, tooth extraction was feared the most (49%) followed by root canal treatment (16%). Fear from restorations, dentures or scaling and polishing were feared by only 9% of the students. When participants were asked about their fear from sitting on the dental chair, 60% were answered because of needle injections, 6% from the chair itself, and 33.7 were not having fear from a dental chair sitting. In regard to the causes of dental fear from inside the dental clinic, 38% of students reported that the dental procedure is their source of fear, followed by the noise from drilling teeth (36%), and then the smell of medicaments and disinfectants (17%) and the least fearful source was the dentist himself (9%). When the students were asked the origin of their fear, 41% reported that their fear originated from their own previous painful experience and 23% had previous suffering from annoying but not painful dental. Only 13% of students relate their fear to what they heard of relatives or other people's experience.
|Table 2: Present data associated with dental fear and its related characteristics among the study sample|
Click here to view
[Table 3] presented factors that might be associated with reducing dental fear among students. Sixty-nine percent of students reported that dentists' explanation of the dental procedure to the patients will reduce their fear considerably. Of those who were affected by the good attitude of dental staff to reduce their fear in the clinic, 84% were influenced by the dentist, while 16% were influenced by the good attitude of the dental nurse.
Of the variables that played an important role in reducing the feeling of fear in the dental clinic were female dentists (73%), the good reputation of the dentist (55%), and elegance and cleanness of the clinic (47%). The good appearance and neatness of the dentist, the proper attitude of the receptionist, and decrease waiting time were not major factors in reducing dental fear.
| Discussion|| |
One of the limitations of this study was the fact that it was conducted only in National Guard middle schools and tested only male students. Approaching female schools was not possible for all male gender research team due to cultural reasons. Therefore, the results of this study are to better represent only male students and only for those joining National Guard schools. Generalizations of the outcome of this study other Saud children should be considered with caution.
The present study was aiming at exploring factors associated with dental fears in addition to factors that help to reduce the dental fear among students. This research paper is part of a research course administered by the College of Dentistry. Part of the duties of students is to compile factors related to dental fear presented in the literature in one questionnaire and not to use readymade questionnaire since it will not fit the mission of course.
The present study has demonstrated the existence of dental fears among Saudi students with a tangible percentage. However, this fear was not related to the satisfaction of their current dentists but rather to the nature of the profession of dentistry. Two types of dental treatment (extraction and root canal treatment) comprised 65% of the whole fear suffered. The procedure used to prepare the patient for their dental treatment and the setup of the treatment procedure was the main cause of fear from inside the clinic. If we can eliminate the noise of drilling of teeth during dental treatment, we can eliminate the fear in 36% of participants. Most of the fears suffered were based on personal experience of the sufferers, while one-third was based on heard experience from others. The present study had demonstrated that alleviating fear among dental patients cannot be achieved by reducing waiting time in the clinic, good behavior of receptionists, and good appearance of the dentist.
The present study comprised one of the first studies to assess dental fear in Saudi Arabian school children. The prevalence and characteristics of dental fear according to students' demographics and socioeconomic status in addition to the initiating and preventing factors were first addressed in the present study. No statistically significant relationship between dental fear and parents' education and income was found; however, there is an increased tendency of dental fear among low-income children and children of teachers. The reasons for this variation worth investigations.
The study was concerned with exploring dental fears among students in the ages of 11 and 17 years. This is an important time in the children lives, as they might develop fear from different sources including dental treatment experience. Dental practitioners need to pay extreme attention to this group of the population and try to avoid any traumatic procedure to eliminate fear from them in years to come.
Comparison of the prevalence of dental fears of our study (29.3%) with the two Saudi studies conducted in Jeddah, Saudi Arabia, revealed comparable results. Alshoraim et al. (2018) reported the mean dental fear of 23 out of 75, from 11 to 15 years age group. Similarly, El-Housseiny et al. (2014) reported dental fear score of 23 out of 75 but among dental patients of younger age group. Direct comparison of these results with ours is not practicable because the dental fear questionnaire used in these studies were not similar. The most fearful procedure in our study was tooth extraction, while tooth drilling was feared most in El-Housseiny et al. (2014).
The prevalence of dental fear in Saudi children was lower than that of India (42%), Hong Kong (33.1%), and higher than that of Brazil (24.6%). The difference might be attributed to differences in genetics, education, and previous bad experiences.
The causes of dental fear from inside the dental clinic, the most fearful dental procedures, and factors that help to reduce the dental fear were collectively studied and presented in our study. Some of these factors were also addressed separately in some studies. The effect of waiting for time and the gender of the dentist were first time introduced as factors related to dental fear. Female dentists were less feared than male dentists. However, reducing the waiting time does have an effect on reducing fear.
| Conclusion|| |
Dental fear was present in 29.1% of schoolchildren of the National Guard schools. The most fearful dental procedure was tooth extractions. The procedure of dental treatment and the drilling noise were feared most from inside the clinic. The students fear was originated from their previous painful and annoying experiences. Explanation of the dental procedure by the dentist, dentist's attitudes, and female gender of a dentist were reported as helping factors in reducing dental fear.
Finanacial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Seligman LD, Hovey JD, Chacon K, Ollendick TH. Dental anxiety: An understudied problem in youth. Clin Psychol Rev 2017;55:25-40.
Asl AN, Shokravi M, Jamali Z, Shirazi S. Barriers and drawbacks of the assessment of dental fear, dental anxiety and dental phobia in children: A critical literature review. J Clin Pediatr Dent 2017;41:399-423.
Erten H, Akarslan ZZ, Bodrumlu E. Dental fear and anxiety levels of patients attending a dental clinic. Quintessence Int 2006;37:304-10.
Alshoraim MA, El-Housseiny AA, Farsi NM, Felemban OM, Alamoudi NM, Alandejani AA. Effects of child characteristics and dental history on dental fear: Cross-sectional study. BMC Oral Health 2018;18:33.
Kakkar M, Wahi A, Thakkar R, Vohra I, Shukla AK. Prevalence of dental anxiety in 10-14 years old children and its implications. J Dent Anesth Pain Med 2016;16:199-202.
Brignardello-Petersen R. Previous bad experience, propensity to anxiety, and pain expectations may be associated with fear and anxiety when undergoing tooth extractions. J Am Dent Assoc 2017;148:e4.
Ekanayake L, Dharmawardena D. Dental anxiety in patients seeking care at the university dental hospital in Sri Lanka. Community Dent Health 2003;20:112-6.
Mungara J, Injeti M, Joseph E, Elangovan A, Sakthivel R, Selvaraju G. Child's dental fear: Cause related factors and the influence of audiovisual modeling. J Indian Soc Pedod Prev Dent 2013;31:215-20.
] [Full text]
McLenon J, Rogers MAM. The fear of needles: A systematic review and meta-analysis. J Adv Nurs 2019;75:30-42.
Heft MW, Meng X, Bradley MM, Lang PJ. Gender differences in reported dental fear and fear of dental pain. Community Dent Oral Epidemiol 2007;35:421-8.
Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract 2014;23:295-301.
Yahyaoglu O, Baygin O, Yahyaoglu G, Tuzuner T. Effect of dentists' appearance related with dental fear and caries aStatus in 6-12 years old children. J Clin Pediatr Dent 2018;42:262-8.
El-Housseiny AA, Alamoudi NM, Farsi NM, El Derwi DA. Characteristics of dental fear among Arabic-speaking children: A descriptive study. BMC Oral Health 2014;14:118.
Wu L, Gao X. Children's dental fear and anxiety: Exploring family related factors. BMC Oral Health 2018;18:100.
Silveira ER, Goettems ML, Demarco FF, Azevedo MS. Clinical and individual variables in children's dental fear: A school-based investigation. Braz Dent J 2017;28:398-404.
[Table 1], [Table 2], [Table 3]