Dental anxiety is a widespread problem that affects countless people globally, causing them to avoid dental care and suffer from poor oral health. A study by the Department of Oral and Maxillofacial Surgery (OMFS), Faculty of Dentistry, University of Hong Kong (HKU) revealed both dental-related factors and non-dental factors: negative childhood experience, attributed dental anxiety.

By combining insights from two academic essaysOMFS researchers specifically examined dental-related and non-dental factors negative childhood experiences (ACE) (Definition according to the World Health Organization, 2020), which contributes to dental anxiety.

Clinical Professor of Oral and Maxillofacial Surgery Mike YY Leung, who led the project, said: “Our aim is to raise awareness of the importance of these factors in assessing and managing dental anxiety, inspire more research and promote interdisciplinary collaboration to help individuals overcome their fears and get the necessary dental care they need.”

Dental care-related factors that lead to dental anxiety

The first study by the OMFS research group, is published in December 2022 i International Journal of Environmental Research and Public Healthtitled “Qualitative Evaluation of YouTube Videos on Dental Fear, Anxiety, and Phobia,” analyzed 145 YouTube videos to assess their quality and content.

The study found that these videos, produced by various sources, covered many factors, symptoms and procedures but lacked information on defining or diagnosing dental fear, anxiety and phobia. Many videos had high view counts, including patient testimonials.

The etiology of dental fear, anxiety and phobia mentioned in the videos can be broadly categorized into two groups: cognitive and behavioral factors.

Cognitive factors, such as perceived lack of control, were evident in testimonies such as “The dentist made me feel powerless.” Behavioral factors, including direct trauma and conditioning through modeling and verbal instructions, contributed to dental anxiety with statements such as “My sister cried in the dentist’s chair” and “My parents told me my uncle died at the dentist.”

Negative childhood experience correlates with dental fear

While patient testimonials from the first study have been extensively documented in previous research, exploring the causes of dental anxiety requires going beyond dental-related factors. In the recent study “Adverse Childhood Experiences and Dental Anxiety Among Chinese Adults in Hong Kong: A Cross-sectional Study,” is published in Frontiers in Psychologyresearchers examined the correlation between adverse childhood experiences (ACE) and dental anxiety.

In this study, 171 participants completed online questionnaires (using the Adverse Childhood Experiences International Questionnaire—ACE—IQ) to assess their ACEs and dental anxiety levels (using the Modified Dental Anxiety scale—MDAS and Dental Fear Survey—DFS) .

Results revealed a significant relationship between ACEs and dental anxiety, with higher cumulative ACEs positively correlating with increased dental anxiety scores. Specific ACEs, such as emotional and physical neglect, sexual assaultand domestic abuse, were found to significantly influence the likelihood of experiencing elevated dental anxiety.

Implementation of comprehensive assessment and treatment

Dental fear, anxiety and phobia are common concerns that significantly affect individuals’ oral health and general well-being. The results of the two studies highlight the importance of considering both dental-related and non-dental factors when investigating the causes of dental anxiety. The analysis of YouTube videos revealed a need for accurate information and collaboration between dentists and mental health professionals to ensure reliable content is available to the public.

On the other hand, to address the significant associations between dental anxiety and adverse childhood experiences, it is important for dentists to consider early life experiences when investigating the causes of dental anxiety and adopt a more comprehensive approach to assessment and treatment, considering both dental care. -related and non-dental factors.

Additionally, working with mental health experts can facilitate the development of targeted interventions that address both dental and psychological aspects. Raising awareness and promoting education about dental anxiety, including its potential causes, is also critical.

Project co-investigator Ms Natalie Wong said: “Dental anxiety is a complex issue with many contributing factors. There are various ways to alleviate the causes of dental anxiety, even simple measures such as parents not scaring their children can be helpful.”

The research team encourages further research into the underlying mechanisms linking ACE to dental anxiety and evaluates the effectiveness of interventions that address both dental and non-dental factors. Taking these steps will help manage dental anxiety and improve patient care.