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Dental Anxiety Prevalence and Associated Factors among Patients Attending the Academy Dental Teaching Hospital – Khartoum, Sudan

Aya Khalid El Faki, Elhadi Mohieldin Awooda*

Department of Restorative and Community Dentistry, Faculty of Dentistry, University of Medical Sciences and Technology, Khartoum, Sudan

Abstract: Aim: To assess the prevalence of dental anxiety and the possible associated factors among adult patients. Materials and Methods: A descriptive, Cross-sectional, hospital based study among 384 patients (age 18-65 year) attended the outpatient clinic at Academy dental teaching hospital from period of February 2015 to April 2015. Corah’s dental anxiety questionnaire was completed by the participants that included three sections: demographic data and factors that could be associated with dental anxiety, Part (A) score assessing dental anxiety before receiving the treatment and Part (B) score assessing dental anxiety during or after receiving dental treatment. Chi-square test was used for association with the level of significance set at P <0.05. Results: Dental anxiety prevalence before receiving dental treatment (DAS-R score of 13 or more) was 26.1%, while during or after receiving the treatment was 26.8%. Dental anxiety was found to be associated with age (P = 0.00), pervious dental experience and socioeconomic status (P = 0.15) in both part (A) and (B) scores while gender (P=0.015 with a part A and P=0.009 with part B), number of dental visits (P=0.003 with part (A) and 0.017 with part (B) score). Occupation, educational level and type of treatment were found to be associated with part (A) score only. Conclusion: Dental anxiety in its different levels was found to be prevalent among all participants involved in this study. Dental healthcare providers could play an important role in counseling anxious patients to reduce the impact of these factors when seeking dental care.

Keywords: dental anxiety, dental fear, anxiety before treatment, anxiety after treatment, Corah’s Dental Anxiety Scale

Citation: Aya Khalid El Faki, Elhadi Mohieldin Awooda, Dental Anxiety Prevalence and Associated Factors among Patients Attending the Academy Dental Teaching Hospital – Khartoum, Sudan. American Journal of Medical Sciences and Medicine, 4 (4). 82-86. January 2016. doi:10.12691/ajmsm-4-4-3

1. Introduction

Anxiety and fear towards dental treatment are common problems frequently experienced by patients worldwide. Despite the advances in dental materials technology and increased oral health awareness, significant percentages of people suffer from dental anxiety. Dental anxiety was described by Klingberg and Broberg as a state of apprehension that something dreadful is going to happen in relation to dental treatment or certain aspects of dental treatment [1] Dental anxiety is ranked fourth among common fears and ninth among intense fears [2].

For many patients, dental anxiety and fear is a real problem that can become a barrier to treatment in the long run. Moreover, there are some patients who avoid dentists altogether because of their extreme fears [3,4] even in cases of emergency such as toothache [3]. Dental anxiety has a significant influence on Oral health quality of life; people with high level of anxiety are more likely to present with poor OHQOL than those having low anxiety [5,6,7]. As well as it can affect the outcome of the treatment. In addition, dentists may also become anxious when dealing with anxious patients, leading to management difficulties; this may cause the treatment time to prolong or even cancelling dentist appointments [8].

Studies of the prevalence of dental anxiety among adults varies according to different population from low (2.6%) to high (29.9%) [9-16]. Most of their results reveal a higher prevalence among female than male and indicate; the anxiety decreases with increasing age.

Assessment of dental anxiety is an essential part of the treatment as to know what strategies should be taken while treating the patient. Sudan as one of the developing countries lacks dental services for all groups of people, while anxious patients avoid regular dental check up, who depend on self-treatment, application of emergency services and use of traditional medicine to alleviate pain [17], but when it becomes un tolerable, resulting in late seeking of dentist services, hence more burdens to facilities and dental health care providers. No previous data available about the prevalence of dental anxiety and associated factors among Sudanese adult dental patients. The objectives of this study were to assess the prevalence of dental anxiety and the possible associated factors among adult patients attending the outpatient clinic at the Academy Dental Teaching Hospital as well as to determine the association between age, gender, educational level, previous dental experience and dental anxiety level.

2. Materials and Methods

A descriptive, Cross-sectional hospital based study among 384 adults patients (males & females), age (18-65 year). Mentally disable patients and patients less than 18 years were excluded. The study was carried out at the outpatient clinic at Academy dental teaching hospital which belongs to university of medical sciences and technology and ministry of health-Khartoum state. It is located at El-imtidad area in Khartoum city, the study was conducted during the period from January2015-April 2015.

Non probability purposeful sampling technique was used to collect the data, the sample size was 384 participants obtained from the equation (n=z2*p*q/d). Closed ended self-administered questionnaire designed by Clarke & Rustvold [18], some modifications were added by asking questions regarding factors that could be associated with dental anxiety as age, gender, educational level, and occupation, frequency of dental visits, socioeconomic status and previous dental experiences.

The questionnaire included three sections:

Section 1: demographic data and factors that could be associated with dental anxiety.

Section 11: Part (A) score that assess dental anxiety before receiving the treatment.

Section 111: Part (B) score that assess dental anxiety during or after receiving dental treatment. To compare between part (A) and part (B) and different variables, 4 Likert’s scale was used (low, moderate, high and severe anxiety.

The questionnaire was translated to Arabic by an expert in Both English and Arabic language. Pilot study was conducted among 20 randomly selected patients to ensure comprehensibility, reliability, relevant and accuracy in the Sudan context. Cronbach’s alpha test showed the reliability coefficient of 0.85, which was found to be satisfactory for conducting the study. These 20 questionnaires were not included in the final data. The study was approved by Ethical Committee of the University of Medical Science and Technology and patients were requested to participate voluntary and signed informed written consent were obtained. Data were analyzed by SPSS statistical software package (SPSS for Windows, Rel.20.0. 2011. Chicago: SPSS Inc.). Chi-squire test was used to assess association of dental anxiety with different factors and the level of significance was set at P value ≤ 0.05.

3. Results

Demographic data of the 384 participants showed male to female percentages of 35.2% and 64.8%, respectively. Age distribution among the participants was displayed in Figure 1 with the percentage of 42.2% among those from 20-30 years.

Figure 1. Age distribution among the participants

Classification according to the level of education revealed that 214 (55%) were university graduates, 112 (29.2%) were secondary education, and 3.4 % were illiterate.

Classification of the participants according to the type of treatment, showed that 132(34.4%) came for more than one treatment, where as 76 (19.8%) came for extraction, 66 (17.2%) for fillings, 51(13.3%) for scaling, 46(12.0%) for root canal treatment and only 13(3.4%) for Prosthodontic treatment.

Participants’ number of dental visit showed majority 283 (73.7%) had more than one visit, as in Figure 2.

Figure 2. classification of the participants according to number of dental visits

Participants were asked about their previous dental experience either bad or good; the results revealed that more than half (57.3%) had good experience.

Classification of the participants according to the results of part (A) score that assess their anxiety level before receiving the treatment showed that (43.8%) were low, (30.2%) moderate, 10.2% high and 15.9% were in severe level of anxiety. When they were classified according to the results of part (B) scores which reflect their anxiety level during or after receiving the dental treatment, the result showed; 6,3% were low, 66.9% were moderate and 26.8% were in high level of anxiety.

Age, as an independent variable, was found to be associated with part (A) score (before receiving the treatment) and Part (B) score (during or after the treatment), Patients at the age group (20-30) years were more likely to develop anxiety than patients in the other age groups, mainly low anxiety with Part (A) score and moderate anxiety with part (B) score, P=0.000 which is highly significant as shown in Table 1.

Table 1. Association between participants’ age with number and percentage of part A (before receiving the treatment) and part B scores (during or after the treatment)

Gender was found to be associated with part (A) scores and part (B) scores. Females were more likely to develop dental anxiety than males and mainly low and moderate anxiety (P=0.015) with part (A) score and moderate anxiety with part (B) score (P=0.009) as displayed in Table 2.

Table 2. Association between gender with number and percentage of part A (before receiving the treatment) and part B scores (during or after the treatment)

Occupation was only found to be associated with part (A) score. Unemployed individuals were more likely to develop anxiety, mainly low anxiety P =0.009. Education level, as an independent variable was found to be associated with part (A) scores. Graduates were more likely to develop dental anxiety, mainly low anxiety. P =0.006. The type of treatment was only found to be associated with part (A) score (before receiving dental treatment. Those with more than one type of treatment were more likely to develop anxiety than others with different type of treatment, mainly low anxiety. P =0.000.

Number of visits to a dentist was found to be associated with part (A) scores and part (B) scores. Those who visited the dentist more than one time were more likely to develop dental anxiety, mainly low anxiety. P =0.003, and mainly moderate anxiety with part (B) score P =0.017 as shown in Table 3.

Table 3. shows the association between number of dental visits with part A scores (before receiving the treatment) and part B scores (during or after the treatment)

Experience of dental treatment was found to be associated with part (A) and part (B) scores. Those with good experience were more likely to develop low anxiety with part (A) and moderate anxiety with part (B) scores, P =0.000. Socioeconomic status in this study was determined and based on patient’s self-evaluation, the result revealed 238(62%) were middle socioeconomic status, whereas 107(27.9%) showed a lower socioeconomic status, Socioeconomic status was found to be associated with part (A) and part (B) scores, those with moderate socioeconomic status were more likely to develop dental anxiety, mainly low anxiety, P =0.000 with part A score and mainly moderate anxiety, P =0.000 with part B score.

4. Discussion

The study was descriptive cross-sectional that could reflect the level of dental anxiety without intervention while the fact that it didn’t show the incidence rate. Patients were related to certain areas that targeting individuals with low socioeconomic status because it was a public hospital and this may contributes to susceptibility of bias, at the same time it may reflect the reality as poverty is common in Sudan.

Low and moderate anxiety were found to be the most common types of anxiety prevalent among the participants, provided that none of the study subjects (n=384) was free of anxiety. Our results contradict the results done in Netherlands which showed highly anxious [19], this may be due to the differences in life style and the standard of health surfaces provided.

In our study strong association was found between dental anxiety and age as younger individuals develop higher anxiety than their older counterparts, similar results obtained by others [20,21,22] but Kumar et al., 2009 results showed older individuals have higher anxiety levels than their younger counterparts [5]. The above results contradict Saatchi et al., 2015, which revealed no correlation between age and dental anxiety [23].

Gender was found to be associated with both part (A) and part (B) scores, females were more anxious than males and this agreed with other results obtained by [5,23,24,25], but other showed no association as Hawamdeh.et al., 2013 [26], Duarte.et al., 2013 [27] and [28] This discrepancy may be related to differences in social and cultural believes between different societies as in some; it is shameful for men to show their fear or pain even if it is real and unbearable.

Socioeconomic status was found to be associated with dental anxiety as lower income individuals were more likely to develop dental anxiety with both part (A) and part (B) scores. In this concern, our study is similar to study conducted in India by Priya et al., 2013 [29] as the similarity in socioeconomic status between Sudan and India may have a role.

Experience of dental treatment was found to be associated with part (A) and part (B) scores. Those with good experience were more likely to develop low anxiety and this is similar to study done in India study [29] as it concluded that postponement of dental visit and past negative experience were associated with higher dental anxiety scores, also negative dental experience was found to be the main reason of high anxiety level [23,30,31].

In contradiction to the results by others [23,28]; level of education was found to be associated with dental anxiety level as highly educated people are more able to be more knowledgeable and understand the nature of the treatment. In Sudan this may not be the same due to the difference in cultural, educational and social level among those nations. In the developed countries they have been exposed early to dental treatment since childhood through a governmental program of Oral health care, repeated regular visits to the dentist make people having the same feeling whether educated or not.

5. Conclusion

Dental anxiety in its different levels was found to be prevalent among all participants involved in this study and the degree of anxiety varies from one individual to another. Dental health care providers could play an important role in counseling anxious patients to reduce the impact of these factors on seeking dental care. It is recommended that the level of dental anxiety should be assessed for each patient before starting any dental treatment or during different treatment procedures.

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