The Psychological Cycle of Dental Anxiety

Dental anxiety is a common problem, potentially leading to avoidance which may have negative implications for oral health. Much published research is not underpinned by sound theoretical considerations and neglects consideration of fear development over the course of a treatment cycle. The current study aimed to explore cognitions and feelings of people preparing for and undergoing a course of dental care and the underlying psychological cycle. Special attention is paid to images in this context and their role in the onset and maintenance of fear.

Methods:

Theoretical models guiding this research are the Dynamic Well-being Model and the Elaborate Intrusion Theory.

A cross-sectional online survey assessed demographic details, participants’ dental anxiety, information concerning previous and planned dental treatment, and intrusive thoughts. Semi-structured interviews were utilized to explore these issues in further detail. Based on visual analogue scale ratings (0-10), the participants (n=306) were classified into groups having low and high dental anxiety.  

Results:

The data confirm the assumption of a psychological cycle with anxiety levels elevating the closer patients get to dental visits and reducing afterwards. Less anxious as well as highly anxious people pass through the same stages and both groups indicate treatment as being most fear provoking. However the intensity of dental anxiety differs between the groups significantly at all times.

In line with the theoretical framework, highly anxious participants also report significantly more vivid images (r_s=0.704; p<0.001), intrusive memories (OR=3.87; 95%CI 1.75, 8.54; p<0.001), avoidance behaviour (OR=59.99; 95%CI 14.36, 250.65; p<0.001), remembered pain (r_s=0.408; p<0.001) and expected pain (r_s=0.550; p<0.001).

Conclusions:

The study demonstrates that dental anxiety follows a clear cycle. Thus the potential importance of timing of the implementation of interventions is highlighted. This provides a theoretical basis for developing effective approaches to managing anxious patients.