GMJ
ORAL PROCEEDINGS
GULF MEDICAL JOURNAL
PREVALENCE OF DENTAL PHOBIA AMONG PATIENTS AT
DENTAL CLINICS IN UAE
Syeda Sheema1, Safa Khan1, Zaid Muayad1, Ali Thaier1, Meera Obaid1*, Hossam A. Eid2
1Level
10 Dental Students, College of Dentistry, 2PhD, Associate Professor, Periodontology Department, College of Dentistry,
Gulf Medical University. Ajman, UAE
*Presenting Author
ABSTRACT
Introduction: Dental phobia is a serious psychological condition with a multi-factorial etiology.
Most cases of dental phobia can be attributed to traumatic or painful dental experiences. Patients
with this phobia tend to avoid dental visits, which endangers their oral health.
Objective: The objective of the study was to assess the prevalence and possible causes of dental
phobia in dental patients in the UAE.
Materials & Methods: A random sample of 250 dental patients aged 12–37 years received
questionnaires that covered aspects such as sociodemographic factors, dental anxiety/phobia, and
related causes.
Results: The study indicated that dental phobia was more prevalent among females (22.8%) than
males (18.3%). When the association of dental procedures with dental phobia was evaluated, of 250
patients, 26.5% and 26.3% feared filling procedures and injections, respectively, followed by
extraction (24.8%), scaling (10.5%), and root canal treatments (4.8%). Nearly 23.9% of patients were
afraid of dental instruments, while 17.2% feared dentists themselves. Dental anxiety was more
prevalent in patients above 36 years (30.3%) than those in the age groups of 12–25 years (12.7%) and
26–35 years (22.9%). Caucasians were also observed to be more phobic (30%) than ethnicities such
as Arabs (22.4%), South Asians (20.5%), Filipinos (20%), and Africans (8%). Moreover, uneducated
people experienced greater dental fear (60%) than students from primary schools (33.3%), high
schools (23.6%), secondary schools (20.7%), and universities (17%).
Conclusion: The study showed that dental phobia among some UAE patients negatively affected
their oral health as they postpone routine dental care.
Keywords: Dental phobia, oral health, dental procedures, dental experiences, UAE
Citation: Sheema S, Khan S, Muayad Z, Thaier A, Obaid M, Eid HA. Prevalence of dental phobia
among patients at dental clinics in UAE. Gulf Medical Journal. 2016;5(S1):S136–S142.
INTRODUCTION
The word phobia, which has its roots in the
Greek language, refers to an intense,
unreasonable fear from a specific activity, object
or situation1–3. Dental phobia, which refers to
Correspondence: Dr. Hossam Abdelatty Eid
Abdelmagyd (BDS, MSc , PhD Oral Medicine
& Periodontology), Associate Dean and
Associate Professor, Periodontics, College of
Dentistry, Gulf Medical University, Ajman,
UAE.
Email:
[email protected],
[email protected]
136
fear related to the health and status of teeth, has
been observed in individuals with different
backgrounds, males and females. However, we
could differentiate based on age. Children
seemed more prone to dental phobia; those
aged 6–12 years harbored greater fear of going
for dental checkups and treatments1–3.
People with dental phobia endanger their
oral health by putting off routine dental care for
years or even decades2–4. Global statistics
regarding the prevalence of dental anxiety or
phobia are heterogeneous. Statistics indicate
that 5–15% of the world’s adult population
GMJ. 8th Annual Scientific Meeting Oral Proceedings 2016.
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GMJ. ASM 2016;5(S1):S136–S142
SYEDA SHEEMA, ET AL
suffers from dental phobia (odontophobia).
Dental phobia as a psychological barrier seems
to be prevalent in the UAE (47% males, 53%
females) as well as the entire GCC region.
Studies in Oman indicate that almost 50%
school children have some form of dental
phobia. In Dubai, a study of 5,000 school
students suggested that the dental anxiety rate is
48%4, 5.
Dentists’ apprehension about a treatment
can increase the patients’ fear regarding the
treatment. Therefore, dental practitioners
should ease anxiety among patients8–11. The aim
of this study is to assess the prevalence and
possible causes of dental phobia among patients
at dental clinics in the UAE.
Odontophobia has a multifactorial etiology;
most cases of dental phobia can be attributed to
traumatic or painful dental experiences1, 3, 4.
Patients with dental phobia tend to avoid dental
visits, resulting in less anxiety, which leads to
further avoidance; this is termed as operant
conditioning. Dental phobia could be acquired
indirectly through parental or vicarious
pathways. Several studies have found a
significant correlation between children’s fear
and maternal fear. Similarly, individuals may
develop anxiety by observing painful
procedures or hearing about them from others;
this is termed as vicarious learning1, 3.
A cross-sectional survey was conducted on a
random sample of 250 dental patients of
various nationalities aged 12–37 years at the Al
Qassimi Hospital, Abu Dhabi private clinics,
GMC clinics, and Abu Dhabi hospitals. All
subjects received adequate verbal and written
information about the purpose, procedure, and
benefit of the study. The study team obtained
consent from participants before administering
the
questionnaire,
and
maintained
confidentiality and anonymity. Consent from
guardians/parents was required for participants
aged 12–18 years. Subjects received structured
questionnaires,
including
questions
on
sociodemographic factors, dental anxiety, and
possible related causes. Subjects were informed
that participation was voluntary. Participants
were selected according to the following
inclusion criteria: age of participants ≥ 12 years
(with consent of parent/guardian for
participants aged 12–18 years). Patients with
mental or psychological disorders and subjects
refusing to provide consent were excluded from
the study. Permission to conduct the study was
obtained from the ethical research committee of
Gulf Medical University’s Centre for Advanced
Biomedical Research and Innovation (CABRI).
The study – which included data collection, data
entry, processing, coding, analysis, and report
preparation – was conducted over six months.
CABRI will store the collected data for three
years after completion of the study.
There
is
also
evidence
linking
socioeconomic status with dental anxiety, with
dental anxiety being more prevalent among
patients from a lower socioeconomic status3.
Moreover, a significant inverse relationship
exists between dental awareness and anxiety; the
lower the awareness and knowledge regarding
dental health, the higher the anxiety2. Sex seems
to be a determinant as well, with females
proven to experience greater dental anxiety than
males2, 3. Studies conducted on people aged 18–
65 years (average: 22.3 years) revealed that the
prevalence of dental anxiety is higher among
younger students and adults over the age of
452, 3. Waiting room time seems to be an
aggravating factor for dental anxiety, allowing
anxious patients to further process negative
experiences. Studies show that in a stressful
environment such as the waiting room of a
dental clinic, patients with a high level of dental
anxiety tend to recall more threatening words
than positive words1. This is termed as
cognitive bias and seems to be a common trait
among anxious patients3–7.
MATERIALS & METHODS
RESULTS
The collected data were statistically analyzed
with descriptive statistics and inference testing
using the Pearson chi-squared test (p ≤ 0.001).
All calculations were arrived at using SPSS
version 19.0 (IBM Corp, Armonk, NY, USA).
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PREVALENCE OF DENTAL PHOBIA AMONG PATIENTS AT
DENTAL CLINICS IN UAE
GMJ. ASM 2016;5(S1):S136–S142
Table 1. Association between participants’ sociodemographic characteristics and dental phobia (N = 250)
Dental phobia
Sociodemographic characteristics
Gender
Age
Ethnicity
Education
Yes
No
p value
No.
%
No.
%
Male
21
18.3
94
81.7
Female
31
22.8
105
77.2
12–25 years
13
12.7
89
87.3
26–35 years
19
22.9
64
77.1
>36 years
20
30.3
46
69.7
South Asian
18
20.5
70
79.5
Filipino
4
20.0
16
80.0
Arab
22
22.4
76
77.6
Caucasian
6
30.0
14
70.0
African
2
8.0
23
92.0
Primary school
5
33.3
10
66.7
Secondary school
6
20.7
23
79.3
High school
13
23.6
42
76.4
University
25
17.0
122
83.0
Others (illiterate)
3
60.0
2
40.0
0.38
(NS)
0.01
(p ≤ 0.001)
--
--
Figure 1. Sociodemographic factors
100%
90%
81.70%
80%
92.00%
87.30%
77.20%
79.50% 80.00% 77.60%
77.10%
70.00%
69.70%
70%
79.30% 76.40%
Non Phobic
66.70%
60.00%
60%
50%
40%
30%
20%
30.30%
18.30%
22.90%
22.80%
20.70% 23.60%
20.50% 20.00% 22.40%
12.70%
40.00%
33.30%
30.00%
Phobic
83.00%
17.00%
8.00%
10%
Gender
Age
Ethinicity
Of the 250 patients evaluated, 22.8%
females suffered from dental phobia compared
with 18.3% for males. Dental anxiety was
observed to be more prevalent among patients
above 36 years (30.3%) compared with younger
age groups (12–25 years: 12.7%, 26–35 years:
22.9%). Caucasians were observed to be more
138
Others (Illiterate)
University
High School
Secondary School
Primary School
Africans
Caucasian
Arab
Filipino
Indian Subcontinent
>36 years old
26-30 years old
12-25 years old
Female
Male
0%
Education
phobic than those of other ethnicities (Arabs:
22.4%, South Asians: 20.5%, Filipinos: 20%,
Africans: 8%). Moreover, dental anxiety was
more prevalent among uneducated people
(60%) than students in primary schools
(33.3%), high schools (23.6%), secondary
schools (20.7%), and universities (17%).
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GMJ. ASM 2016;5(S1):S136–S142
SYEDA SHEEMA, ET AL
Table 2. Association between dental procedures and dental phobia (N = 250)
Association between dental procedures and dental
phobia
What are you most
scared of at the dental
clinic?
When you are in the
dentist’s office for
your turn in the chair,
how do you feel?
How did you develop
this fear?
Which dental
procedure are you
most scared of?
How do you feel
about having your
teeth scraped and
polished?
How do you feel
about getting an
injection in the gum?
How do you feel
about getting a filling?
How do you feel
about getting a tooth
extracted?
How do you feel
about having sleep
induced for the
treatment?
Dentists
Injections
Dental instruments
Other
Relaxed
A little uneasy
Tense
Anxious
So anxious that I sometimes
break out in a sweat and almost
feel physically sick
A traumatic experience at the
dental clinic
A friend’s traumatic experience
at the dental clinic
Images/TV content/movies
Other
Extraction
Filling
Scaling
Other
Very bad
Bad
Okay
Good
Very good
Very bad
Bad
Okay
Good
Very good
Very bad
Bad
Okay
Good
Very good
Very bad
Bad
Okay
Good
Very good
Very bad
Bad
Okay
Good
Very good
When the association between dental
procedures and dental phobia was evaluated, of
Dental phobia
Yes
No
p value
No.
5
31
16
0
7
11
18
10
%
17.2
26.3
23.9
0.0
9.1
13.3
34.0
38.5
No.
24
87
51
14
70
72
35
16
%
82.8
73.7
76.1
100
90.9
86.7
66.0
61.5
6
85.7
1
14.3
27
33.3
54
66.7
11
21.6
40
78.4
7
5
36
13
2
1
4
7
18
18
5
0
5
9
17
21
2
3
11
17
19
1
8
5
11
27
1
11
11
11
18
17.1
13.2
24.8
26.5
10.5
4.8
6.9
7.7
28.6
62.1
50.0
0.0
9.3
15.0
25.0
56.8
6.7
4.5
19.0
29.3
51.4
4.0
16.0
10.2
19.3
38.6
3.0
15.3
14.9
33.3
47.4
34
33
109
36
17
20
54
84
45
11
5
32
49
51
51
16
28
64
47
41
18
24
42
44
46
43
32
61
63
22
20
82.9
86.8
75.2
73.5
89.5
95.2
93.1
92.3
71.4
37.9
50.0
100.0
90.7
85.0
75.0
43.2
93.3
95.5
81.0
70.7
48.6
96.0
84.0
89.8
80.7
61.4
97.0
84.7
85.1
66.7
52.6
--
--
0.05
--
0.00
(p ≤ 0.001)
0.00
(p ≤ 0.001)
0.00
(p ≤ 0.001)
0.00
(p ≤ 0.001)
the 250 patients, 26.5% and 26.3% feared filling
procedures and injections, respectively,
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139
PREVALENCE OF DENTAL PHOBIA AMONG PATIENTS AT
DENTAL CLINICS IN UAE
GMJ. ASM 2016;5(S1):S136–S142
followed by extraction (24.8%), scaling (10.5%),
and root canal treatment (4.8%). Nearly 23.9%
patients were afraid of dental instruments, while
only 17.2% feared dentists themselves. (Pearson
chi-squared test, p ≤ 0.001)
While in the waiting room, most patients
feel anxious and physically sick (85.7%), while
others feel tense (34%) or uneasy (13.3%). A
traumatic dental visit was the main cause for
dental phobia (33.3%) among evaluated
patients, followed by a friend’s traumatic
experience (21.6%), and images, TV content,
and movies (17.1%) (Pearson chi-squared test,
p ≤ 0.001).
A high percentage (42.4%) of the evaluated
patients revealed that dental fear deters them
from booking appointments even if they
needed them, while 45.7% felt a shiver in their
body when the dentist is ready to start the
procedure (Pearson chi-squared test, p ≤ 0.001).
Most (56.5%) phobic patients avoid dental
visits, and this interferes with their social
activities (36%).
When the patients were asked to rate their
level of dental fear, 57.9% reported extreme
dental fear and only 6.3% experienced mild
fear. Many participants (55.9%) complained
about feeling nervous or edgy about upcoming
dental visits (Pearson chi-squared test,
p ≤ 0.001), 58.8% often think about things that
may go wrong before going to the dentist, and
75.7% thought something bad would happen to
them during the procedure. (Pearson chisquared test, p ≤ 0.001)
Lastly, among the participants, 27.8% felt at
ease when they had a family member or a friend
by their side during the procedure, followed by
listening to music (23.3%), leniency from the
dentist (17.5%), and being explained the
procedure (15.8%).
140
Figure 2. Distribution of dental phobia among some
UAE patients
21%
n = 51
Phobic
Non-phobic
79%
n = 199
DISCUSSION
The results of the present study indicate that
dental phobia was more prevalent among
Caucasians (30%) than those of other
ethnicities (Arabs: 22.4%, South Asians: 20.5%,
Filipinos: 20%, and Africans: 8%). The study
shows that the prevalence of dental phobia was
higher among females (22.8%) than males
(18.3%). This result is similar to that from other
studies, which can be attributed to a difference
in pain thresholds between the genders12–14.
Our findings indicate that a dental anesthetic
injection was the procedure inducing anxiety
the most (26.3%), while a root canal treatment
had the least influence on anxiety (4.8%). These
findings are consistent with the results of
Humphris et al., who found that the dental
anesthetic injection was the most anxietyprovoking item, with a mean score of 2.45±1.23
across samples15. However, they reported that
scaling and polishing (1.90±1.35) was the least
anxiety-provoking
procedure,
which
is
inconsistent with our findings. Interestingly, in
our study, about 17.2% feared dentists
themselves, which can be attributed to
iatrogenic factors. This finding may be due to
some dentists exhibiting inadequate necessary
communication skills while interacting with
patients. This finding raises the issue of the
responsibility of the dental profession and/or
the practitioner. Basically, the aggravation of
dental anxiety in patients after a dental episode
due to lack of preventive measures could be
considered a result of the concerned
GMJ. 8th Annual Scientific Meeting Oral Proceedings 2016.
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SYEDA SHEEMA, ET AL
professional’s fault. Relevant education should,
hence, be provided to dental students and
professionals16.
The percentage of people with dental
anxiety in this study was 21%, higher than the
results from Western countries, such as the
United Kingdom (11%) and Northern Ireland
(19.5%), and close to findings from Turkey
(23.5%)17, 18. However, these results are lower
than that of a 2014 study among Saudis
(48.3%)19. Our study results indicate anxiety and
phobias increase with an increase in age, in line
with several other studies by Tunc et al. and
Thomson et al. 200017, 20. However, these
findings contradict other study results, which
found that the lowest anxiety scores were
recorded for those aged 50 years or older12, 18, 20,
21. The higher anxiety with increased age in the
current study may be attributed to bad dental
experiences, along with the absence of
appropriate dental education, leading to
permanent psychological damage. The current
study reported that 85.7% patients feel anxious
and physically sick, followed by tense (34%) or
uneasy (13.3%) while waiting at the dental
clinic. Many evaluated patients developed dental
phobia primarily due to a traumatic experience
in the dental office (33.3%), followed by a
friend’s traumatic experience (21.6%) or images,
TV content, and movies (17.1%). Our results
were similar to the findings of some other
studies22, 23. Some studies showed no significant
difference in dental anxiety scores among
participants based on their frequency of dental
visits and duration since the last dental visit24.
According to the present study, dental fear
was more prevalent among uneducated people
(60%) than students from primary schools
(33.3%), high schools (23.6%), secondary
schools (20.7%), and universities (17%). This
result indicates that the relationship between
dental anxiety and sociodemographic factors is
unclear despite some studies showing that
dental anxiety is most frequent in lower
socioeconomic status groups25, 26.
This study had some limitations. The
sample size is small, with significant variation in
GMJ. ASM 2016;5(S1):S136–S142
the number of individuals representing each
ethnic group, which could have negatively
affected the validity of the study results. This
limits the degree to which the results can be
assumed to apply to the overall UAE
population. A larger heterogeneous sample
would have improved the generalizability of the
results. Another limitation is that criterion
validity could not be established using standard
scales due to the non-availability of translated
and validated dental anxiety questionnaires in
the UAE. The main weakness of this study is
the use of a convenience sample.
CONCLUSION
The results of the study indicate dental phobia
among some UAE patients resulted in routine
dental care being postponed, negatively
affecting their oral health.
ACKNOWLEDGMENTS
The research team wants to thank the members
of the biostatistics department as well as the
staff members of the College of Dentistry, Gulf
Medical University, for helping with the
research. Moreover, the authors appreciate the
help of Al Qassimi Hospital (Sharjah), ADNOC
Hospital (Abu Dhabi), Talat Medical Centre
(Abu Dhabi), and Palmyra Dental Clinic (Abu
Dhabi).
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