Trust, shame, communication and dental anxiety across the social divide

Communication between the dentist and patient is vital in maintaining an appropriate clinical relationship. Social rank theory would suggest that a sense of shame, communication and anxiety have distinct associations that vary according to social status of the participants. Dentists and their patients provide a unique opportunity to examine how they relate and result in the patient becoming dentally anxious. Aim: To test ability of patient trust and dentist communicative behaviour to predict patient dental anxiety controlling for embarrassment of dental condition, past dental visiting and the moderating effect of social class. Methods: Cross-sectional representative survey using a two-stage cluster sample of adults including England, Wales and Northern Ireland (Adult Dental Health Survey 2009). Data drawn from structured interview. Path analysis of proposed model subjected to structural equation modelling following measurement development and confirmation of reliable constructs. Results: The overall model including all three major occupational groups demonstrated a high level of fit (chi-square=487.6, df=118, CFI=0.996, TLI=0.995; RMSEA=0.018 (95%CI: 0.016, 0.020). Trust in dentists strongly predicted lowered dental anxiety (stand. beta=-0.31) whereas reports of dentist communication behaviours was positively related (0.20). Patient's shame of dental status and visiting behaviour were associated to dental anxiety as hypothesised (0.22 and -0.18 respectively). Both trust and communication effects were moderated somewhat by social occupational status. Manual classes in particular were most sensitised to the communication approaches assessed and how they related to dental anxiety (e.g. parameter range = 0.09 to 0.35). The interaction between the dentist and patient did not show consistent effects across the social divide. The dentist should act to encourage trust and this is most easily operationalized by employing basic listening skills to reduce dental anxiety. Conclusions: Some support for the proposed model was found especially when social class was introduced as a moderator.