Dental Anxiety, Beliefs and Expectations among Disadvantaged Public Dental Service Users in Australia

Objectives: Little is known about dental anxiety among financially disadvantaged Australian adult users of public dental services or about how dental anxiety affects their service use or their beliefs and expectations.
Methods: A cross-sectional random sample of 517 adult public dental patients (mean age = 55.6, range 20-94) from South Australia completed a questionnaire assessing dental anxiety and visiting patterns, perceptions of behavioural control and self-efficacy in relation to visiting public dentists, and dental expectancies, attitudes and beliefs.
Results: Approximately 40% of participants indicated some level of dental anxiety, and 15.2% were ‘Quite’ or ‘Very’ afraid of going to the dentist. Only 10.4% of the public dental patients had private dental insurance and most usually visited the dentist when in discomfort/pain (56%) or when something needed to be fixed (66.3%). Higher dental anxiety was associated with less frequent dental visiting, poorer self-rated oral health, and increased perceived need for a dental visit. Higher dental anxiety was significantly associated with a range of negative dental visiting expectancies, including bad experiences, pain, long wait times, unnecessary treatment, and higher costs. People with greater dental anxiety also considered that ‘having to pay a gap’, ‘not having your choice of dentist’ and ‘having to pay for dental treatment regardless of the amount’ made visiting the dentist more difficult. Finally, there was a strong association between greater dental anxiety and negative beliefs about visiting the dentist.
Conclusions: In addition to the disadvantage already accompanying low-income public dental service users, those with dental anxiety were found to have poorer self-rated oral health, worse dental service usage and greater perceived treatment needs. Greater dental anxiety was related to more deleterious beliefs and expectations regarding future dental visits. Disadvantaged South Australian dental service users face a range of barriers in relation to receiving dental care, and these are both more extensive and more diverse among those with higher dental anxiety.