Oral Health Literacy and Dental Anxiety in High-Risk/HIV-Positive Dental Patients

Objectives: To assess, in a sample of high-risk/HIV-positive dental patients, a) levels of dental anxiety (DA) and oral health literacy (OHL), b) the relationship between DA and OHL, c) the association of DA and OHL, respectively, with demographic and health care-seeking variables.
Methods: Using a structured questionnaire, 100 English-speaking adult patients attending Harlem United Community AIDS Center (HU) in Central Harlem, New York City were surveyed (response rate = 79%). DA was measured with Short-Dental Anxiety Inventory (S-DAI) and OHL with Rapid Estimate of Adult Literacy in Dentistry (REALD-30). Statistical significance was set at p<0.1 in this exploratory study.
Results: DA did not have significant statistical association with OHL, controlling for age, gender, educational attainment, time since last dental visit, and time since last medical visit (r=0.11, p=0.31). DA (mean S-DAI, 21.3±9.3) was categorized as low (0-12; 22%), average (13-30; 55%), and high (31-45; 23%). OHL scores (mean REALD-30, 18.3±6.1) were categorized as low (0-20; 51%) and high (21-30; 49%). Cross-tabular analyses demonstrated that OHL scores were associated with educational level (p=0.002), time since medical visit (p=0.076), and time since dental visit (p=0.077). DA levels were associated with gender (p=0.018) and race/ethnicity (p=0.024). Participants with high DA were 70% male and 67% Black or African American.
Conclusions: In this high HIV prevalence patient pool, low OHL is a common challenge faced by 51% of all participants and 38% of participants with college-level education. These individuals are likely to struggle with most patient education material and less likely to seek routine medical and dental care. While DA does not have a relationship with OHL, its association with gender and race/ethnicity suggests that DA levels are likely affected by socio-cultural beliefs. These findings underscore an important role for health providers, policymakers, and public health experts in addressing these invisible barriers to improved oral health outcomes.