COVID-19 Phobia and Dental Anxiety Among Patients Applying to a University Faculty of Dentistry During The Pandemic Period

Abstract

Objective This study examined the sociodemographic characteristics, health behaviors, oral health perspectives, and dental service utilization of individuals who applied to a university faculty of dentistry during the controlled normalization period of the COVID-19 pandemic in Türkiye. COVID-19 phobia and dental anxiety levels were assessed, and the relationship between these two constructs was evaluated. Material and Method This study was carried out with 390 individuals who applied to a university faculty of dentistry for any reason between January 3 and March 31, 2021, a period corresponding to the controlled normalization phase of the COVID-19 pandemic in Turkey during which dental services were delivered under strict infection control measures. In addition to sociodemographic data, participants’ health-related behaviors; perspectives on oral and dental health; and contact, infection, and quarantine status during the pandemic were recorded. The Coronavirus Phobia Scale (C19P-S) was used to assess COVID-19 phobia, and the Modified Dental Anxiety Scale (MDAS) to evaluate dental anxiety. Data were analyzed using a statistical software package. Results COVID-19 phobia was higher in women (p < 0.001), in individuals with chronic diseases (p < 0.05), and in those without a history of COVID-19 infection (p < 0.01). Individuals who had recovered from COVID-19 showed lower phobia scores (p < 0.01). Dental anxiety was higher in women (p < 0.001) and showed a weak but significant positive correlation with COVID-19 phobia (r = 0.32, p < 0.001). Conclusion The weak but significant association between COVID-19 phobia and dental anxiety suggests that these psychological factors may be present together in some individuals. Taking such factors into account during clinical evaluations may contribute to a better understanding of patients’ approaches to seeking dental care.

Keywords

• COVID-19
• Dental Anxiety
• Dental Health Services/utilization
• Psychological Impact
• Health Behavior

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

Ethical Statement

Ethical Approval Approval was received from the Suleyman Demirel University Faculty of Medicine Clinical Research Ethics Committee with the decision number 27/390 on 08/12/2020. The study was carried out in accordance with the ‘World Medical Association Declaration of Helsinki’ updated in October 2013. Consent to Participate and Publish Written informed consent to participate and publish was obtained from all individual participants or legal guardians included in the study.

References

1. 1. Hui DS, I Azhar E, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health- The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-266.
2. 2. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-160.
3. 3. Zhang SX, Wang Y, Rauch A, Wei F. Unprecedented disruption of lives and work: Health, distress and life satisfaction of working adults in China one month into the COVID-19 outbreak. Psychiatry Res. 2020;288:112958.
4. 4. Harrel SK, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. J Am Dent Assoc. 2004;135(4):429-437.
5. 5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):496.
6. 6. Xiao C. A Novel Approach of Consultation on 2019 Novel Coronavirus (COVID-19)-Related Psychological and Mental Problems: Structured Letter Therapy. Psychiatry Investig. 2020;17(2):175-176.
7. 7. Pakpour AH, Griffiths MD. The fear of COVID-19 and its role in preventive behaviors. Journal of Concurrent Disorders. 2020;2(1):58–63.
8. 8. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2022;20(3):1537-1545.

9. 9. Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson GJG. Development and initial validation of the COVID Stress Scales. J Anxiety Disord. 2020;72:102232.
10. 10. Lee SA. Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Stud. 2020;44(7):393-401.
11. 11. Arpaci I, Karataş K, Baloğlu M. The development and initial tests for the psychometric properties of the COVID-19 Phobia Scale (C19P-S). Pers Individ Dif. 2020;164:110108.
12. 12. Samimi Ardestani SM, Khosravani V, Sharifi Bastan F, Baloğlu M. The Persian Version of the COVID-19 Phobia Scale (Persian- C19P-S) and the Differences in COVID-19-Related Phobic Reactions in Patients with Anxiety Disorders. Int J Ment Health Addict. 2022;20(4):2419-2435.
13. 13. Gatchel RJ, Ingersoll BD, Bowman L, Robertson MC, Walker C. The prevalence of dental fear and avoidance: a recent survey study. J Am Dent Assoc. 1983;107(4):609-610.
14. 14. Pohjola V, Lahti S, Vehkalahti MM, Tolvanen M, Hausen H. Association between dental fear and dental attendance among adults in Finland. Acta Odontol Scand. 2007;65(4):224-230.
15. 15. Bui FQ, Almeida-da-Silva CLC, Huynh B, et al. Association between periodontal pathogens and systemic disease. Biomed J. 2019;42(1):27-35.
16. 16. Corah NL. Development of a dental anxiety scale. J Dent Res. 1969;48(4):596.
17. 17. Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health. 1995;12(3):143-150.
18. 18. Armfield JM. How do we measure dental fear and what are we measuring anyway? Oral Health Prev Dent. 2010;8(2):107-115.
19. 19. Seth R, Madathil SA, Siqueira WL, McNally M, Quiñonez CR, Glogauer M, Allison PJ. Sensitivity to change of the COVID-19 anxiety syndrome scale among Canadian dentists. BMC Psychol. 2025;13(1):1133.
20. 20. Iqbal J, Imran M. The fear of COVID-19 with role of avoidance behavior and self-resilience. South Asian J Manag. 2022;16(1):126-138.
21. 21. Daltaban Ö, Aytekin Z. Fear and anxiety of COVID-19 in dental patients during the COVID-19 pandemic: a cross-sectional survey in Turkey. Dent Med Probl. 2022;59(3):343-350.
22. 22. Ilgüy D, Ilgüy M, Dinçer S, Bayirli G. Reliability and validity of the Modified Dental Anxiety Scale in Turkish patients. J Int Med Res. 2005;33(2):252-259.
23. 23. Alpar R. Applied Statistics and Validity-Reliability with Examples from Sports, Health and Education Sciences. 1st ed. Ankara: Detay Publishing; 2020
24. 24. Johnston R, Jones K, Manley D. Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour. Qual Quant.2018;52:1957–1976.
25. 25. Kardeş V. Mental and Behavioral Evaluation During and After the Pandemic. Turk J Diab Obes. 2020;2: 160-169.
26. 26. Delibaş L. COVID-19 phobia and anxiety and its severity, vocational college sample. Prehospital Journal. 2021;6(2):201-212.
27. 27. Haktanir A, Seki T, Dilmac B. Adaptation and evaluation of the Turkish version of the Fear of COVID-19 Scale. Death Stud. 2022;46(3):719–727.
28. 28. Curuk GN, Ozgul E, Karadag S. The effect of COVID-19 on fear, anxiety, and sleep in nursing students. Ir J Med Sci. 2023;192(6):3125–3131.
29. 29. Yingst JM, Krebs NM, Bordner CR, Hobkirk AL, Allen SI, Foulds J. Tobacco use changes and perceived health risks among current tobacco users during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(4):1795.
30. 30. Cichocka E, Maj-Podsiadlo A, Gumprecht J. The impact of the COVID-19 pandemic on the assessment of healthcare and anxiety disorders in patients with chronic diseases. Int J Environ Res Public Health. 2023;20(20):6956.
31. 31. Huang F, Ding H, Liu Z, Wu P, Zhu M, Li A, Zhu T. How fear and collectivism influence public’s preventive intention towards COVID- 19 infection: a study based on big data from social media. BMC Public Health. 2020;20(1):1707.
32. 32. Elachola H, Ebrahim SH, Gozzer E. COVID-19: Facemask use prevalence in international airports in Asia, Europe and the Americas, March 2020. Travel Med Infect Dis. 2020;35:101637.
33. 33. Roseman IJ, Dhawan N, Rettek SI, Naidu RK, Thapa K. Cultural differences and cross-cultural similarities in appraisals and emotional responses. J Cross Cult Psychol. 1995;26(1):23–38.
34. 34. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912–920.
35. 35. Bellah RN, Madsen R, Sullivan WM, Swidler A, Tipton SM. Habits of the Heart: Individualism and Commitment in American Life. Updated ed. Berkeley: University of California Press; 2007.
36. 36. Kowal M, Coll-Martín T, Ikizer G, Rasmussen J, Eichel K, Studzinska A, et al. Who is the most stressed during the COVID-19 pandemic? Data from 26 countries and areas. Appl Psychol Health Well Being. 2020;12(4):946–966.
37. 37. Burkova VN, Butovskaya ML, Randall AK, Fedenok JN, Ahmadi K, Alghraibeh AM, et al. Predictors of anxiety in the COVID-19 pandemic from a global perspective: data from 23 countries. Sustainability. 2021;13(7):4017.
38. 38. Cansel N, Ucuz İ, Arslan AK, et al. Prevalence and predictors of psychological response during immediate COVID-19 pandemic. Int J Clin Pract. 2021;75(5):e13996.
39. 39. Jacques-Aviñó C, López-Jiménez T, Medina-Perucha L, de Bont J, Gonçalves AQ, Duarte-Salles T, Berenguera A. Gender- based approach on the social impact and mental health in Spain during COVID-19 lockdown: a cross-sectional study. BMJ Open. 2020;10(11):e044617.
40. 40. Kalafatoğlu MR, Yam FC. Investigation of COVID-19 Fears of Individuals in Terms of Some Variables. Humanistic Perspective. 2021;3(2):306-323.
41. 41. Peloso RM, Pini NIP, Sundfeld Neto D, Mori AA, Oliveira RCG, Valarelli FP, Freitas KMS. How does the quarantine resulting from COVID-19 impact dental appointments and patient anxiety levels? Braz Oral Res. 2020;34:e84.
42. 42. Erdal A. Examination of individuals' attitudes towards dental procedures in terms of demographic variables during the COVID- 19 pandemic process. Bolu Abant İzzet Baysal University Faculty of Dentistry, Department of Oral, Dental and Maxillofacial Surgery Speciality Thesis. Bolu: Abant İzzet Baysal University; 2020
43. 43. Ovalıoğlu Z, Bozkurt DA, Akman M. Covid-19 Pandemi Sürecinde Endodonti Kliniğine Gelen Hasta Anksiyete Düzeyi. NEU Dent J. 2020;2(3):98-102.
44. 44. Aycicegi-Dinn A, Caldwell-Harris CL. Individualism–collectivism among Americans, Turks and Turkish immigrants to the US. Int J Intercult Relat. 2011;35(1):9–16.
45. 45. Akinli S. COVID-19 Pandemic as a Crisis: Adaptation Strategies of Middle-Class Working Parents in Türkiye [master’s thesis]. Ankara: Middle East Technical University; 2024.
46. 46. Cicek I, Yildirim M. Exploring the impact of family conflict on depression, anxiety and sleep problems in Turkish adolescents: the mediating effect of social connectedness. J Psychol Couns Sch. 2025;35(2):130–146.
47. 47. Yetkin Ay Z, Erdek Y, Öztürk M, Kılınç G, Bozkurt Y, Yılmaz R. Investigation of dental fear level in patients applying to Süleyman Demirel University Faculty of Dentistry. Cumhuriyet University Journal of Faculty of Dentistry. 2005; 8(1): 12-18.
48. 48. Armfield JM, Spencer AJ, Stewart JF. Dental fear in Australia: who's afraid of the dentist? Aust Dent J. 2006;51(1):78-85.
49. 49. Jalnapurkar I, Allen M, Pigott T. Sex differences in anxiety disorders: A review. J Psychiatry Depress Anxiety. 2018;4(12):3-16.
50. 50. Berberoğlu B, Koç N, Boyacioglu H, et al. Assessment of dental anxiety levels among dental emergency patients during the COVID 19 pandemic through the Modified Dental Anxiety Scale. Dent Med Probl. 2021;58(4):425-432.
51. 51. Huang WL, Liao SL, Huang HL, Tsai PJ, Huang HH, Lu CY, Ho WS. Impact of post-COVID-19 changes in outpatient chronic patients’ healthcare-seeking behaviors on medical utilization and health outcomes. Health Econ Rev. 2024;14(1):71.
52. 52. Sahakyan S, Muradyan D, Giloyan A, Harutyunyan T. Factors associated with delay or avoidance of medical care during the COVID-19 pandemic in Armenia: results from a nationwide survey. BMC Health Serv Res. 2024;24(1):20.