Dental fear and oral health behavior. Studies on psychological and psychosocial factors

Abstract: The general aim of this thesis was to study psychological and psychosocial factors in relation to the development, maintenance and expression of dental fear, how individuals cope with their fear, and how dental fear may impact on health and daily life. The study samples consisted of adult dental fear patients seeking treatment at a specialized dental fear clinic. Both quantitative and qualitative research methods were used. The qualitative interview protocols were analyzed using the constant comparative method of grounded theory. It was found that dental fear patients with concomitant high general fear differ in several ways from patients with less frequent and wide-spread fear. These differences concern dental fear reactions and related emotions, as well as general psychological dimensions. The results indicated an overall more negative and complex situation for patients with high dental and general fear. Comparisons between severe dental fear patients reporting different attendance patterns showed a higher education level and more filled teeth among patients with a history of regular dental care, while patients with phobic dental avoidance behavior had more anticipatory dental anxiety, more missing teeth, and reported a stronger negative impact from dental fear/poor oral status on daily life. General fearfulness was not related to phobic dental avoidance. According to the qualitative interviews the onset of dental fear was commonly related to an individual vulnerability and to traumatic dental care experiences, where perceived negative dentist behavior played a significant role. The patient was caught in a "vicious circle" that was difficult to break, and fear and anxiety were maintained by negative expectations about treatment and about the patient's own ability to cope in dental care situations. The interviews brought out the patients' ambivalence in coping with dental fear. The ambivalence was between, on the one hand the tendency to avoid dental care, and on the other hand the need for dental care and their attempt to find active problem-solving strategies. This left patients in a state of conflict with negative consequences for self-respect and well-being. It was obvious that dental fear and deteriorated oral health status resulted for many patients in wide-spread negative life consequences. It was also obvious that several psychological and social factors interact in determining how individuals cope with their dental fear, and demonstrate how dental fear affects their daily lives. Finally, the importance of dental beliefs in dental fear treatment was investigated. The interpretation of the results suggests that the assessment of dental beliefs provides valuable information and that patients' subjective perceptions about how dentists communicate are important for treatment outcome. However, initial dental beliefs were not found to predict clinical treatment outcome, and dental beliefs are one of several factors interacting in dental fear treatment. The results emphasize the complexity of dental fear and oral health behavior, where personality characteristics and environmental factors interact. This further elucidates the need for a broad-spectrum approach in dentistry.