Interactive Role of Anxiety Sensitivity and Pain Expectancy in Dental Anxiety

Abstract

Dental anxiety is a major public health problem that leads to underutilization of dental care and poor oral health. Much research has demonstrated an association between the expectation of pain during dental treatment and dental anxiety; however, not all patients with high pain expectancy develop dental anxiety, suggesting that other factors may impact the degree to which pain expectancy increases dental anxiety. The present study examined whether anxiety sensitivity (AS; the fear of negative consequences of anxiety-related symptoms and sensations) increases the strength of the relationship between pain expectancy and dental anxiety. Participants were 104 adult patients of Temple University Kornberg School of Dentistry clinics. Baseline levels of AS and pain expectancy were assessed using self-report questionnaires. Baseline dental anxiety was assessed using self-report questionnaires and measures of psychological/physiological stress reactivity to films of dental procedures. Participants also underwent a pain expectancy induction, and all indices of dental anxiety were re-assessed following the pain expectancy induction. Linear regression analyses revealed that, in contrast to expectations, AS did not strengthen the relationship between self-reported or laboratory-induced pain expectancy and any indicators of dental anxiety. On the contrary, there was limited evidence that AS may weaken the pain expectancy-dental anxiety relationship. Consistent with previous studies, there was a strong pattern of findings supporting a direct association between pain expectancy and dental anxiety, but limited evidence of a direct association between AS and dental anxiety. AS may not be a strong risk candidate for dental anxiety, and future studies examining other theoretically-relevant vulnerability factors are needed to elucidate pathways through which pain expectancy leads to greater dental anxiety.