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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 35-39

A cross-sectional study to assess the level of dental anxiety prevailing in undergraduate dental students in Riyadh Elm University


Department of Preparatory Health Studies, Riyadh Elm University, Riyadh, Saudi Arabia

Date of Submission15-Apr-2019
Date of Decision30-Jun-2019
Date of Acceptance16-Sep-2019
Date of Web Publication05-Feb-2020

Correspondence Address:
Dr. Umbreen Noor Muhammad
Riyadh Elm University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_32_19

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  Abstract 


Objective: This study was designed to evaluate dental anxiety (DA) level in undergraduate dental students in Riyadh Elm University and its relation with gender and to assess whether the level of DA changes over the whole course of study.
Materials and Methods: In this cross-sectional study, the self-reported Modified DA Scale (MDAS) questionnaire was used. The minimum and maximum scores, scored from MDAS, were 5 and 25, respectively. The level of DA was categorized into less anxious (5–11), moderately anxious (12–18), and severely anxious (≥19).
Results: The overall response rate was 86% (158 males and 274 females). The mean MDAS from all the participants was 12.06, with 4% of males and 7% of females being severely anxious and 53% of males and 60% of females being moderately anxious. The females were reported to be more anxious than males (P < 0.05). The level of anxiousness was significantly decreasing (P = 0.000) with each successive year of the study. The most anxious situation of all dental procedures was the injection of local anesthesia, followed by noise generated from dental instruments.
Conclusion: Female undergraduate dental students and preclinical students were more anxious when compared with males and students of the clinical years, respectively. There is a need for proper dental health education, exposure to clinics, and counseling therapy from the early years of dental training to reduce the level of anxiety.

Keywords: Dental anxiety, Riyadh, undergraduate dental students


How to cite this article:
Muhammad UN, Rajan JS. A cross-sectional study to assess the level of dental anxiety prevailing in undergraduate dental students in Riyadh Elm University. Saudi J Oral Sci 2020;7:35-9

How to cite this URL:
Muhammad UN, Rajan JS. A cross-sectional study to assess the level of dental anxiety prevailing in undergraduate dental students in Riyadh Elm University. Saudi J Oral Sci [serial online] 2020 [cited 2020 Feb 22];7:35-9. Available from: http://www.saudijos.org/text.asp?2020/7/1/35/272992




  Introduction Top


In general, anxiety is a feeling of nervousness or unease about something with an uncertain outcome. Dental anxiety (DA) refers to a patient's sense of uneasiness or stressful response of a patient toward dentist and dental treatment.[1] Individuals suffering from DA often delay their dental visits, which leads to more deterioration of oral health status but also affects their general health.[2] It remains as the main barrier between patient and dental care provider. Due to reduced cooperation, treating an anxious person is difficult and stressful for dentists than treating nonanxious person.[3] Eli demonstrated that severe DA resulted in misdiagnosis of endodontic pathology, thus rendering treatment more difficult.[4]

In the past few years, major advances in infection control procedures, technologies, and techniques in the field of dentistry have created more awareness about oral health, but still anxiety related to dental procedures remains a big issue and major cause for the patients to avoid dental visits.[5],[6] Individuals suffering from DA often delay their dental visits, which leads to more deterioration of oral health status.[7] There exists a negative correlation between DA and oral hygiene practices.[8] A higher level of DA can result in bad oral health with increased number of decayed teeth, missing tooth, higher calculus index, and poor periodontal status.[9]

Many scales have been developed to assess the level of DA, but the Modified DA Scale (MDAS) has been most widely used. It is a brief, relatively quick, easy to score, valid, and reliable answering system for assessing DA in both children and adults. It was modified from the original Corah's DA scale by Humphris et al.[10]

Many factors such as gender, age, occupation, education level, cultural differences, previous traumatic dental procedure, or hearing unpleasant experiences of family members and friends may influence DA.[11] The higher level of DA has been seen among females than males.[12]

People of almost all age groups suffer from some level of DA, but it is suggested that it is more common in 20–26-year-old adults.[8] As the dental students constitute a large part of this age group, so it is important to assess the level of their DA. It will help them to learn techniques to avoid or to decrease the level of anxiousness in their patients. Hence, the aim of this cross-sectional study was:

  1. To evaluate the level of DA prevailing in undergraduate dental students in Riyadh Elm University (REU)
  2. To assess whether the level DA changes over the whole course of study
  3. To compare the level of DA between male and female dental students.



  Materials and Methods Top


This cross-sectional study was conducted at REU, Riyadh, from February 2018 to June 2018. The purpose of this study was explained to all students who were willing to participate. The participants suffering from any medical disorder or undergoing any psychiatric therapy were excluded from this study.

The self-reported assessment questionnaire, MDAS [Appendix 1], was utilized for this study to assess the level of DA. The population included undergraduate dental students of all years of the study, which was divided into three groups: preparatory years (Level 1–4), preclinical years (Level 5–8), and clinical years (Level 9–12). The personal information regarding gender, age, and level of dentistry was also obtained. Any queries regarding the questionnaire were answered.

MDAS consisted of five questions related to different situations encountered in dental clinics. These include:

  1. How would you feel if you had to go for a dental checkup tomorrow?
  2. How would you feel while waiting in the dentist's office for your dental treatment?
  3. How would you feel with the noise generated from dental instruments during dental procedures?
  4. How would you feel when the scaler tip touches your teeth while scaling?
  5. How would you feel when you are about to get a local anesthetic injection for your dental treatment?


Five answers (a, b, c, d, and e) were available for each question, which assessed the anxiety scale ranging from nonanxious to extremely anxious. If the participants select option “a,” it was scored as 1, “b” scored as 2, “c” scored as 3, “d” scored as 4, and “e” scored as 5. The scores of each five items were summed to obtain the overall score for the level of DA. The minimum score was “5,” whereas the maximum score was “25.” The level of DA scored from MDAS was categorized into less anxious (5–11), moderately anxious (12–18), and severely anxious (≥19).[13]

Statistical analysis

The reliability of the questionnaire was assessed using Cronbach's alpha coefficient. The data were analyzed using SPSS software (Statistical Package for the Social Sciences, version 22.0, SPSS Inc., Chicago, IL, USA). Cross tabulation was also achieved using Chi-square tests to compare the study groups on the basis of gender and year of study. The statistical significance was set at P < 0.05.


  Results Top


Of 500 questionnaires that were distributed among dental students in REU, 432 were completed and returned, which accounts for the response rate of 86%. The Cronbach's coefficient alpha value for the current study was 0.737. The study sample consisted of 37% (n = 158) of males and 63% (n = 274) of females. The mean age of the participants was 21.64 ± 2.52, with a minimum of 18 and a maximum of 29. The mean MDAS from all the participants was 12.06 ± 0.381. [Table 1] presents the comparison of level of DA between male and female dental students, and the difference between the score is statistically significant with P < 0.05. The female students were more anxious than males.
Table 1: Comparison of level of dental anxiety on the basis of gender

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[Table 2] shows the year-wise distribution of the study sample on the basis of the level of DA. The analysis among the three groups showed that the level of DA is significantly decreasing (P = 0.000) with each successive year of the study.
Table 2: Year-wise distribution of study participants by the level of dental anxiety

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The female students were significantly more anxious than males concerning item related to going for dental checkup tomorrow (P = 0.001) and waiting in the dentist's sitting room (P = 0.02) [Table 3]. However, no significant difference was observed in gender variation in the items related to the noise generated from dental instruments or having teeth scaled or injection of local anesthesia.
Table 3: Comparison of mean Modified Dental Anxiety Scale questionnaire for each item according to gender

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The most anxious situation of all dental procedures was the injection of local anesthesia, followed by noise generated from dental instruments [Table 3]. Nearly 36% of the participants (250 participants) were extremely anxious about having a local anesthetic injection, whereas 27% (186 participants) were extremely anxious about noise generated from dental instruments.


  Discussion Top


Although technology has been revolutionized, the anxiety, fear, and pain related to dental treatment remain a widespread global concern that should be managed and treated to improve oral health and thus quality of life.[14] Therefore, the present study was conducted to assess the level of DA prevailing in undergraduate dental students in REU, Riyadh, using MDAS questionnaire.

The Cronbach's coefficient alpha value was 0.737, suggesting good internal consistency.[13] In the present study, we found high level of DA among dental students, with 53% of males and 60% of females being moderately anxious, whereas 4% of males and 9% of females being severely anxious. These results were in line with other studies conducted in Saudi Arabia by Sghaireen et al. and Alshammary et al., which observed the overall high prevalence of DA.[12],[15] Our results were different from the Kirova's study in which more participants were anxiety free.[16] High level of DA might be due to lack of proper dental education and oral hygiene behaviors,[17] which in turn is the main reason of high caries rate in all age groups in Saudi Arabia.[18]

The present study analyzed that females were more anxious than male students. Other studies also reported the similar findings.[12],[18],[19],[20],[21],[22] This might be due to the reason that females are more prone to get emotional and neurotic problems because of their metacognitive beliefs and thought control strategies.[23] One study conducted by Kirova[16] showed no gender variation. The reason may be the cultural differences.

The review of literature suggested that most anxious of all the dental situations is local anesthetic injection, followed by teeth drilling.[12],[15] This finding is in line with our study in which participants were extremely anxious about having a local anesthetic injection and the noise generated from dental instruments during dental procedures.

The findings from the present study analyzed that students of clinical years had less level of DA than junior students. These results are consistent with findings from other researchers, who reported a low level of DA in advanced years of the study.[12],[19],[24] This might be due to decreased level of general anxiety with aging or increased ability to cope based on experience.[25] This can be explained in another way that with each successive year of the study, the students gain more knowledge about dental education and professionally become more developed and acquainted to the clinic environment.[26]


  Conclusion Top


In general, undergraduate dental students at REU have a moderate level of anxiousness as measured by MDAS. Female undergraduate dental students and preclinical students were more anxious when compared with males and students of the clinical years, respectively. Public health and community services should be focused on giving proper dental health education, increasing awareness about prevention of dental disease and promoting healthy oral behaviors in young population of Riyadh. Exposure to clinics and counseling therapy from the early years of dental training can help to reduce the level of anxiety in dental students.

Acknowledgment

I would like to thank all the students of Riyadh Elm University, who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



Appendix 1:

Modified Dental Anxiety Scale Questionnaire



Gender: Male Female

Age: _____________________________________

Level: _____________________________________

1. How would you feel if you had to go for a dental checkup tomorrow?

  1. I would look forward to it as a reasonably enjoyable experience
  2. I wouldn't care one way or the other
  3. I would be a little uneasy about it
  4. I would be afraid that it would be unpleasant and painful
  5. I would be very frightened of what the dentist would do.


2. How would you feel while waiting in the dentist's office for your dental treatment?

  1. I would be relaxed
  2. I would be a little uneasy
  3. I would be tensed
  4. I would be anxious
  5. I would be so anxious that I sometimes break out in a sweat or almost feel physically sick.


3. How would you feel with the noise generated from dental instruments during dental procedures?

  1. I would be relaxed
  2. I would be a little uneasy
  3. I would be tensed
  4. I would be anxious
  5. I would be so anxious that I sometimes break out in a sweat or almost feel physically sick.


4. How would you feel when the scaler tip touches your teeth while scaling?

  1. I would be relaxed
  2. I would be a little uneasy
  3. I would be tensed
  4. I would be anxious
  5. I would be so anxious that I sometimes break out in a sweat or almost feel physically sick.


5. How would you feel when you are about to get a local anesthetic injection for your dental treatment?

  1. I would be relaxed
  2. I would be a little uneasy
  3. I would be tensed
  4. I would be anxious
  5. I would be so anxious that I sometimes break out in a sweat or almost feel physically sick.




 
  References Top

1.
Mohammed RB, Lalithamma T, Varma DM, Sudhakar KN, Srinivas B, Krishnamraju PV. Prevalence of dental anxiety and its relation to age and gender in coastal Andhra (Visakhapatnam) population, India. J Nat Sci Biol Med 2014;5:409-14.  Back to cited text no. 1
    
2.
Kanaffa-Kilijanska U, Kaczmarek U, Kilijanska B, Frydecka D. Oral health condition and hygiene habits among adult patients with respect to their level of dental anxiety. Oral Health Prev Dent 2014;12:233-9.  Back to cited text no. 2
    
3.
Brahm CO, Lundgren J, Carlsson SG, Nilsson P, Hultqvist J, Hägglin C, et al. Dentists' skills with fearful patients: Education and treatment. Eur J Oral Sci 2013;121:283-91.  Back to cited text no. 3
    
4.
Eli I. Dental anxiety: A cause for possible misdiagnosis of tooth vitality. Int Endod J 1993;26:251-3.  Back to cited text no. 4
    
5.
Wiederhold MD, Gao K, Wiederhold BK. Clinical use of virtual reality distraction system to reduce anxiety and pain in dental procedures. Cyberpsychol Behav Soc Netw 2014;17:359-65.  Back to cited text no. 5
    
6.
Armfield JM. What goes around comes around: Revisiting the hypothesized vicious cycle of dental fear and avoidance. Community Dent Oral Epidemiol 2013;41:279-87.  Back to cited text no. 6
    
7.
Yüzügüllü B, Gülşahi A, Celik C, Bulut S. Dental anxiety and fear: Relationship with oral health behavior in a Turkish population. Int J Prosthodont 2014;27:50-3.  Back to cited text no. 7
    
8.
Kirova DG, Atanasov DT, Lalabonova CK, Janevska S. Dental anxiety in adults in Bulgaria. Folia Med (Plovdiv) 2010;52:49-56.  Back to cited text no. 8
    
9.
Alkan A, Cakmak O, Yilmaz S, Cebi T, Gurgan C. Relationship between psychological factors and oral health status and behaviours. Oral Health Prev Dent 2015;13:331-9.  Back to cited text no. 9
    
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Humphris GM, Morrison T, Lindsay SJ. The modified dental anxiety scale: Validation and United Kingdom norms. Community Dent Health 1995;12:143-50.  Back to cited text no. 10
    
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Appukuttan D, Subramanian S, Tadepalli A, Damodaran LK. Dental anxiety among adults: An epidemiological study in South India. N Am J Med Sci 2015;7:13-8.  Back to cited text no. 11
    
12.
Sghaireen MG, Zwiri AM, Alzoubi IA, Qodceih SM, Al-Omiri MK. Anxiety due to dental treatment and procedures among university students and its correlation with their gender and field of study. Int J Dent 2013;2013:647436.  Back to cited text no. 12
    
13.
Gunjal S, Pateel DG, Parkar S. DA among medical and paramedical undergraduate students of Malaysia. Int J Dent 2017;2017:5.  Back to cited text no. 13
    
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Pohjola V, Rekola A, Kunttu K, Virtanen JI. Association between dental fear and oral health habits and treatment need among university students in Finland: A national study. BMC Oral Health 2016;16:26.  Back to cited text no. 14
    
15.
Alshammary MA, Alhumaid ME, Alnejeem GS, Osman MA. DA among medical field students in university of Hail, Saudi Arabia. Sch J Dent Sci 2017;4:291-6.  Back to cited text no. 15
    
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Kirova DG. DA among dental students. J IMAB Ann Proc Sci Pap 2011;17:137.  Back to cited text no. 16
    
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Alsubaie AS. Oral health related behaviors and dental pain among children in Saudi Arabia. J Int Oral Health 2019;11:1-7.  Back to cited text no. 17
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Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of dental anxiety among dental patients in Saudi Arabia. J Int Soc Prev Community Dent 2017;7:100-4.  Back to cited text no. 18
    
19.
Saatchi M, Abtahi M, Mohammadi G, Mirdamadi M, Binandeh ES. The prevalence of dental anxiety and fear in patients referred to Isfahan dental school, Iran. Dent Res J (Isfahan) 2015;12:248-53.  Back to cited text no. 19
    
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Al-Omari WM, Al-Omiri MK. Dental anxiety among university students and its correlation with their field of study. J Appl Oral Sci 2009;17:199-203.  Back to cited text no. 20
    
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Drachev SN, Brenn T, Trovik TA. Prevalence of and factors associated with dental anxiety among medical and dental students of the Northern state medical university, Arkhangelsk, North-West Russia. Int J Circumpolar Health 2018;77:1454786.  Back to cited text no. 21
    
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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