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Year : 2019  |  Volume : 17  |  Issue : 3  |  Page : 230-234

Comparative assessment of dental anxiety among dental and pharmacy students in Paonta Sahib, Himachal Pradesh

1 Department of Public Health Dentistry, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
2 Department of Psychiatric Nursing, Himachal Institute of Nursing, Paonta Sahib, Himachal Pradesh, India

Date of Submission03-Sep-2018
Date of Acceptance11-Jun-2019
Date of Web Publication12-Sep-2019

Correspondence Address:
Dr. Sumeet Bhatt
Department of Public Health Dentistry, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_170_18

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Background: Dental anxiety is a recognized problem for both patients and dental professionals. The data on dental anxiety of professional students in India are limited. It has been suggested that repeated exposure to dental treatment environment could result in lowering of dental anxiety. Aim: The aim of this study was to compare the self-reported levels of dental anxiety among dental and pharmacy students at an Indian institute. Materials and Methods: A total of 437 students of dentistry and pharmacy participated in the study. Dental anxiety of the students was assessed using the Modified Dental Anxiety Scale. Data on demographic details and previous dental experience were also collected using a self-administered closed-ended questionnaire. Statistical Package for the Social Sciences (SPSS V.16) was used for statistical analysis. Kruskal–Wallis test and Mann–Whitney U-test were used to assess differences in dental anxiety between student groups. The level of significance was considered to be P < 0.05. Results: There were about 69% women and 31% men with the mean age of 21.01 ± 2.91 years. Senior dental students showed a significantly lower dental anxiety than pharmacy ( P < 0.001) and dental students in the early years ( P < 0.001). Women reported significantly higher dental anxiety than men ( P = 0.001). Dental anxiety was also associated with having no prior dental experience ( P < 0.001). The most fearful situation reported by the participants was local anesthetic injection. Conclusions: Dental anxiety was significantly associated with sex, level of study, and the past dental experience. Dental education and awareness might be a significant factor in reducing dental anxiety.

Keywords: Dental anxiety, dental education, dental students, pharmacy students

How to cite this article:
Bhatt S, Gaur A. Comparative assessment of dental anxiety among dental and pharmacy students in Paonta Sahib, Himachal Pradesh. J Indian Assoc Public Health Dent 2019;17:230-4

How to cite this URL:
Bhatt S, Gaur A. Comparative assessment of dental anxiety among dental and pharmacy students in Paonta Sahib, Himachal Pradesh. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2022 Aug 17];17:230-4. Available from: https://www.jiaphd.org/text.asp?2019/17/3/230/266753

  Introduction Top

Dentistry has advanced over the years with several improvements in technology and treatment procedures. Dental treatment has become more efficient and less painful. Yet, these advancements have failed to eliminate or substantially reduce dental fear and anxiety in dental patients. Dental anxiety is a common problem and a recognized barrier to accessing dental care.[1] It is not limited to a particular age group, religion, race, region, or population. Previous reports estimated that 5%–15% of the adult population of the world is afflicted with high anxiety from dental procedures, to the level of refraining from regular dental treatment.[2]

Dental anxiety is a stress that is created in response to dental treatment where the fear-inducing stimuli could range from a specific cause to something vague or even without a stimulus.[3] Various processes have been proposed to explain the etiology of dental anxiety and fear, such as a variety of genetic, behavioral, and cognitive factors.[4] People with dental anxiety tend to avoid or delay their treatment resulting in irregular dental attendance pattern.[5] Studies have shown that this type of avoidance behavior could result in poor oral health in dentally anxious individuals.[6],[7]

It has been observed that dental students have comparatively lower levels of dental anxiety than that in nondental students which might be due to lack of dental health education and awareness among nondental students.[8],[9] Some researchers have suggested that dental training is a type of exposure therapy that is advantageous to dental students in relation to dental anxiety. Repeated exposure to feared stimuli can result in a sort of “environmental habituation,” which can have positive effects on reducing dental anxiety among dental students.[10] Variations in dental anxiety levels among dental students have been seen as well. The dental students in the early years of their training have reported significantly higher dental anxiety levels than those in senior years.[10],[11] In a typical undergraduate dental program, the students spend the initial years studying basic sciences and preclinical work. The later years are devoted to clinical experiences in different areas of dentistry. Thus, it can be hypothesized that increasing clinical exposure decreases dental anxiety over the course of dental studies.

Only a few researchers have reported dental anxiety among Indian dental students,[12] and no study has been done to compare dental anxiety between dental and nondental students in India. Therefore, this study was conducted to assess and compare the self-reported levels of dental anxiety among dental and pharmacy students in Paonta Sahib, India.

  Materials and Methods Top

This cross-sectional study was conducted on 437 students (134 men and 303 women) of the Himachal Institute of Dental Sciences and Himachal Institute of Pharmacy using convenience sampling. Both the colleges are constituents of Himachal Group of Institutions and are situated in Paonta Sahib, India. Data collection for this study was done in February 2018.

Before the beginning of the study, ethical approval was obtained from the Institutional Ethics Committee of Himachal Institute of Dental Sciences, Paonta Sahib (Reference no. 9978A/01/02/2018). Permission for the study was obtained from the heads of the respective colleges and informed consent was obtained from the participants. The study was conducted among students from first to final years in classrooms at the end of their lectures. The dental interns and postgraduates were contacted in their respective departments. Students who had been admitted to hospital or suffered from major physical/mental health problems in the last year, students with known systemic illness, or students who are currently under treatment for known physical/mental health problems were excluded from the study. A voluntary, written informed consent was obtained from all the participants before the study. After the students consented to participate, they were given a brief explanation of the purpose of the study and that the investigation concerns the assessment of dental anxiety through the completion of a questionnaire. The students were given the opportunity to ask questions regarding the study. The questionnaires were completed by the students in the classrooms anonymously. The participation in the study was entirely at will of the students, though none of the students declined participation, giving a response rate of 100%.

Assessment of dental anxiety was done using the Modified Dental Anxiety Scale (MDAS) which is a modification of Corah's Dental Anxiety Scale (CDAS).[13] The CDAS does not inquire about the local anesthetic injection, which can be a focus for some patients' anxiety. The MDAS is a brief, five-item questionnaire which asks participants to rate their emotional reaction to the prospect of a dental visit the day previous, then when in the waiting room, receipt of drilling, scaling, and a local anesthetic injection. Precoded responses range from “not anxious” (Scoring 1) to “extremely anxious” (Scoring 5). It is summed together to construct a Likert scale with a minimum score of 5 and a maximum of 25. It has good psychometric properties, is relatively quick to complete and scoring is easy.[14] A score below 11 is considered normal, 11–18 represents moderate anxiety, and a score above 18 represents extreme anxiety.[15] Data were also collected on age, sex, level of course, and past dental visits.

Statistical analysis was done using SPSS software (Statistical Package for the Social Sciences, Version 16, SPSS Inc., Chicago, IL, USA). Mann–Whitney U-test was used to compare the dental anxiety in relation to gender and dental visits, and Kruskal–Wallis test was used to identify differences in dental anxiety among students based on their study course. Multiple comparisons were done using Mann–Whitney U-test to identify individual differences between different courses. The level of significance for the present study was set at P < 0.05.

  Results Top

The study was done on 437 students with a mean age of 21.01 ± 2.91 years (range 18–45 years). There were 134 (30.7%) men and 303 (69.3%) women. Normality testing using the Shapiro–Wilk test revealed that the data were skewed in relation to participants' gender ( P < 0.001). Therefore, nonparametric tests were used as tests of significance.

There were 78 pharmacy students and 359 dental students in the study. The dental students were subdivided based on exposure to the clinical environment. The students in 1st, 2nd, and 3rd years were included in one group (n = 204) and students in the final year, internship, and postgraduation formed the second group (n = 155). Out of the total sample of 437 students, 233 (53.3%) students had never visited a dentist prior to this study [Table 1].
Table 1: Distribution of participants based on sex, field of study, and dental visits

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On calculating the anxiety scores, 151 (34.6%) students were found to have no anxiety. Hence, the prevalence of anxiety in this population was 65.4%. Two hundred and fifty (57.2%) students reported moderate anxiety, whereas extreme anxiety was found in 36 (8.2%) students. The most anxious situation reported was injection of local anesthetic injection (24.7%) followed by drilling of tooth (13.7%). The situation which evoked least anxiety was scaling and polishing of teeth (38.4%) [Table 2].
Table 2: Distribution of participants according to responses to items in the Modified Dental Anxiety Scale (n=437)

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Comparison of dental anxiety between sexes showed that women had a significantly higher MDAS score compared to men ( P = 0.001). Women were found to be significantly more anxious about waiting in the dental office ( P = 0.005), having their tooth drilled ( P = 0.001), and injection of local anesthetic ( P = 0.001) [Table 3].
Table 3: Dental anxiety scores according to sex of the participants (n=437)

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Dental students in the senior year showed significantly lower dental anxiety scores compared to pharmacy students as well as dental students in 1st, 2nd, and 3rd years ( P < 0.001). Dental anxiety among pharmacy students did not differ significantly from that of dental students in their initial years [Table 4].
Table 4: Dental anxiety scores according to participant's study field

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On comparing the dental anxiety based on dental visits, it was found that students who had never visited a dentist before had significantly higher dental anxiety scores than those who had ( P < 0.001) [Table 5].
Table 5: Dental anxiety scores according to participant's past dental visit

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  Discussion Top

Data on dental anxiety of students in professional courses in India are sparse and restricted to dental students. To the best of our knowledge, this is the first study to compare dental anxiety among dental and pharmacy students in India.

The dental anxiety in women was significantly higher than that in men. Most studies on dental anxiety have shown similar findings.[3],[16] Possible causes suggested for this difference are higher levels of neuroticism in women which is positively associated with anxiety, possible lower tolerance to pain among women, real gender differences in anxiety, and a greater readiness among women to acknowledge their feelings and anxiety than men.[3],[8],[17],[18]

In this study, dental students in senior years showed significantly lower dental anxiety than those in the early years and pharmacy students. There was no difference in dental anxiety between pharmacy students and dental students in the initial years of study. These findings are in agreement with previous reports. Nondental students do not receive dental health education or awareness related to dentistry, and this lack of education and not being familiar with dental treatment procedures might contribute to increased fear and anxiety.[8],[11] Low dental anxiety in dental students could be explained by the fact that dental students are repeatedly exposed to dental treatment setting. This type of desensitization as a result of being subjected to repeated exposure of fear-inducing stimuli has been termed as “flooding.”[4] However, this repeated exposure is acquired only as the dental training program advances. In the initial years, no practical training is conducted, and thus, no behavioral therapeutic effects from clinical exposure can be expected.[10] This might explain the finding that there was no significant difference in the dental anxiety of dental students in initial years and that in the pharmacy students. This practical part of the dental education may be the key element in decreasing dental anxiety.

In this study, previous exposure to dental treatment seems to decrease the levels of dental anxiety. The students who had visited a dentist before had significantly lesser dental anxiety than those who had never undergone any dental treatment. This is in agreement with the previous studies which reported higher dental anxiety among patients who had no prior dental experience. A fear of unknown manifesting itself as dental anxiety has been implicated as a possible cause.[3],[19]

Injection of local anesthetic injection was the most fearful situation of all, followed by drilling of teeth. 24.7% of the students were extremely anxious about having local anesthetic injection and 13.7% of the students reported extreme anxiety about drilling of their teeth. These findings are similar to previous reports where injection of local anesthetic was the most anxiety-provoking stimulus.[8],[11]

The findings of this study have important clinical implications. The fact that dental anxiety of senior dental students was significantly lower than pharmacy and junior dental students shows that repeated exposure to fearful stimuli could significantly reduce anxiety levels over time. Clinically, this translates to the possibility that familiarity with dental treatment procedures through health education and awareness could result in reduced dental anxiety.

This study has some inherent limitations. It would be interesting to know whether the recommended health education measures could actually help reduce dental anxiety or not. The cross-sectional nature of this study restricts us from arriving at a firm conclusion on this hypothesis. Second, this study involves students from one dental and one pharmacy institute. More studies are recommended in this area to generalize these findings.

The findings of our study indicate that familiarity with dental treatment can reduce dental anxiety among individuals. In this regard, dental curriculum can be an important factor and should increasingly focus on interpersonal aspects of dental treatment situation. A gentle, supportive, professional, and more considerate approach should be followed when managing patients with dental anxiety to avoid increasing their anxiety and thus avoid their repulsion to the dental care.[8]

  Conclusions Top

Compared to senior dental students, the dental students in their initial years of study and pharmacy students reported significantly higher dental anxiety. Women reported higher dental anxiety levels than men. History of dental treatment was also associated with dental anxiety.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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