Dental anxiety in a Swedish city population of women. A cross-sectional and longitudinal study of prevalence, dental care utilisation and oral and mental health factors

Abstract

The aims of this thesis were to describe the level of dental anxiety and investigate the associations: to dental attendance, oral health, general health and socio-economic factors in a representative sample of middle-aged and elderly women in Göteborg, Sweden; to study variations in dental fear in a longitudinal perspective and its relation to mental health and personality factors; to explore the structural relationships between dental anxiety, general anxiety and mood factors among dental phobic patients. The cross-sectional study of more than 1000 women aged 38-84 years, showed that although the prevalence rates of dental anxiety were lower in higher age-groups, there was still a consid-erable proportion of elderly women who experienced negative feelings, ranging from discomfort to severe fear. Higher levels of dental anxiety predicted irregular dental visits. Among subjects high in dental fear a significantly poorer oral status was found for irregular dental attenders compared to regular attenders. The association between dental anxiety, socio-economic factors and general health factors seemed clear when using simple group comparison. However, multivariate logistic regression analyses indicated that these factors were of minor importance. The longitudinal analyses were based on 778 women investigated in a psychiatric study in 1968-69, and followed up after 6, 24 and 28 years. The prevalence of dental anxiety was lower in older age-groups and was found to be an age-effect rather than based on cohort fac-tors. A high level of dental fear at baseline and a greater number of fears/phobias at follow-up predicted high dental fear at follow-up. Over the study period, dental anxiety increased or decreased with number of other fears. Chronic dental fear was related to psychiatric impair-ment and neuroticism at baseline, while remission was related to extraversion. In a clinical study of 220 phobic patients, three dimensions (dental anxiety, general anxiety and mood) were hypothesised and measured indirectly by different psychometric scales. This explorative study used Structural Equation Modeling (SEM) and revealed a structural relationship between these areas. The mood dimensions associated with dental care showed a clear impact on level of dental anxiety. The study also revealed the advantages of using a SEM method in de-tecting and estimating the variance/covariance structures among multiple measurement models.