Avoidance of dental treatment: Reasons and behaviour

Traditionally the focus in dental anxiety has been on measuring its cognitive component (fear). Limited study exists on the behavioural component which involves actions such as avoidance or endurance of feared stimuli. Study Objective: (1) investigate the prevalence of avoidance as a component of dental anxiety within a general population sample; (2) investigate self-report reasons for avoidance and avoidance behaviour between fear/avoidance groups. Methods: A random sample of adults living in the City of Etobicoke (municipality in Greater Metropolitan Toronto) was identified using electoral listings (n=1242 subjects) and based on identified inclusion/exclusion criteria. A two-wave mailed questionnaire included 15 self-report questions asking if subjects would avoid dental treatment based on issues of communication, trust, control, personal experience or cost. Subjects were also asked to comment on 6 avoidance behaviours. Results: The prevalence of dental fear/avoidance was 62.7% low fear/low avoidance, 14.4% high fear/low avoidance, 6.3% low fear/high avoidance, and 16.6% high fear/high avoidance. The study population included an equal distribution of ages across fear/avoidance groups (18-92 years; mean=52.9, sd 16.4). ANOVA identified a statistically significant difference (p<0.001) between fear/avoidance groups and reasons for avoidance. High fear groups frequently identified control and experience issues as reasons for their avoidance, with high avoidance groups more frequently identifying communication and trust issues. High fear/high avoidance subjects indicated multiple reasons for avoidance in all conceptual categories. Chi Square analysis indicated a significant difference (p<0.001) between avoidance behaviour and fear/avoidance groups with high fear/high avoidance subjects citing most frequent avoidance behaviour (i.e. avoiding treatment for as long as possible or until in pain). Conclusion: Despite fear and avoidance being correlated components of dental anxiety, the investigation of avoidance behaviour and reasons provides valuable information to facilitate appropriate management and treatment of individuals with dental anxiety.