An examination of constructs associated with dental anxiety and avoidance among adults seeking dental care

Abstract

Dental anxiety and the avoidance of dental treatment serve as substantial barriers to dental care and are associated with a range of maladaptive behaviors and outcomes. However, many important psychological constructs that may increase our understanding of anxiety and avoidance in relation to dental care and hence our ability to properly intervene have been poorly examined or neglected in the literature. The present study examined the prevalence of dental anxiety, specific phobia of dental procedures, and avoidance of dental care among dental patients presenting for routine (n = 78) and emergency (n = 42) care using self-report questionnaires, clinician-administered interview, and 6-month follow-up dental appointment data. We investigated correlates of dental anxiety, dental phobia, avoidance of dental care, and oral-health related quality of life (OHRQoL). It was expected that emergency patients would exhibit significantly greater impairment that regular care patients across several variables, with a similar pattern expected for patients with a specific phobia relative to those without the diagnosis. Further, it was hypothesized that emotion regulation, distress tolerance, experiential avoidance, and mindfulness would moderate the anxiety-avoidance and anxiety-OHRQoL relationships. Additional models tested the moderating roles of pain, optimism, and re-experiencing symptoms related to a prior traumatic dental event on the relationship between social appearance anxiety and avoidance of dental care. Dental anxiety, severity of phobia, and OHRQoL correlated with social appearance anxiety, pain experienced at the last dental appointment, re-experiencing symptoms, and blood-injection-injury fears, among other variables; however, there was no evidence that they were related to emotion regulation, and limited relationships emerged with experiential avoidance, distress tolerance, and mindfulness. Avoidance of dental care was unrelated to dental anxiety, other forms of anxiety, OHRQoL, pain, pessimism, and several other constructs related to emotion dysregulation, and difficulties with mindfulness. Our hypotheses that emergency patients would have a higher prevalence of dental phobia, longer avoidance, and greater pain at the last dental appointment than regular care patients was supported, although the groups did not differ on dental anxiety or remaining variables. As expected, patients with specific phobia (n = 26) scored higher than those without a diagnosis (n = 94) on dental anxiety, OHRQoL, social appearance anxiety, re-experiencing symptoms, and pain, but these groups did not differ on avoidance or other constructs. Our moderation hypotheses had minimal support: Dental anxiety was most strongly associated with avoidance of a dental appointment among those reporting the greatest experiential avoidance and the least mindful awareness, and dental anxiety was most strongly associated with OHRQoL among those demonstrating the greatest mindful observing. Implications of these findings are addressed, followed by a discussion of study limitations and directions for future research.