Dental Students’ Anxiety Level, Awareness of Dental Anxiety, and Attitudes in Treating Patients with Dental Anxiety

Abstract

Background: Successful treatment of patients with dental anxiety requires particular attitudes and knowledge. Dentists who have severe stress, inadequate knowledge, or less sensitivity to anxious patients may affect the success of the treatment. The aim of this study was to evaluate the general anxiety level and occupational perceptions of the final-year dental students and their attitudes to and knowledge level about anxious patients.
Methods: The anxiety levels of the dental students were assessed by the Beck Anxiety Inventory. A questionnaire that evaluated professional perceptions, dental anxiety awareness, attitude, and knowledge level was conducted. The answers between the groups were compared, and differences were assessed statistically.
Results: One hundred fifty-nine final-year dental students answered the questionnaire. No statistical difference was found between the anxiety levels of the students. 69,2% of students agreed that patients evaluate dentists with their style or behavior rather than their perceived technical competence. Female students and the students with adverse patient experiences perceived dentistry as a more stressful profession (respectively p=0,001, p=0,003). 39,6% of students had never taken a course related to dental anxiety. 25,8% of students thought that there is a relationship between dental anxiety and wound healing, and 37,1% of students thought that dental anxiety aggravates the inflammatory disease.
Conclusion: The final-year dental students need more training in managing their stress and increasing their knowledge about anxious patients. There is a need for further studies involving dental anxiety management strategies with a higher number of dental students or dentists.

Keywords

• Dental Anxiety
• Dental Student
• Dental Education

Dental Anksiyetesi Olan Hastaların Tedavisinde Diş Hekimliği Öğrencilerinin Anksiyete Düzeyi, Dental Anksiyete Farkındalığı ve Tutumunun Değerlendirilmesi

Abstract

Amaç Dental anksiyetesi olan hastaların tedavi başarısı, özel tutum ve bilgi gerektirmektedir. Diş hekimlerinin aşırı stresli olması, anksiyetesi olan hastalara karşı bilgisinin yetersiz ve duyarlılığının az olması, tedavilerinin başarısını etkileyebilmektedir. Bu çalışmanın amacı; diş hekimliği son sınıf öğrencilerinin genel anksiyete düzeylerini, mesleki algılarını ve dental anksiyetesi olan hastalara yönelik tutum ve bilgi düzeylerini değerlendirmektir. Gereç ve Yöntemler Diş hekimliği öğrencilerinin kaygı düzeyleri Beck Anksiyete Ölçeği ile değerlendirildi. Öğrencilere ayrıca mesleki algılarını, dental anksiyete farkındalığını, tutumunu ve bilgi düzeyini değerlendiren bir anket uygulandı. Gruplar arasındaki cevaplar karşılaştırıldı ve farklılıklar istatistiksel olarak değerlendirildi. Bulgular 159 diş hekimliği son sınıf öğrencisi anketi yanıtladı. Öğrencilerin anksiyete düzeyleri arasında istatistiksel bir farklılık bulunmadı. Öğrencilerin %69,2'si, hastaların diş hekimlerini algılanan teknik yeterliliklerinden ziyade tarzları veya davranışlarıyla değerlendirdiğini belirtti. Diş hekimliğini kız öğrenciler ve olumsuz hasta deneyimi yaşayan öğrenciler daha stresli bir meslek olarak algıladı (p=0,001, p=0,003). Öğrencilerin %39,6'sı diş kaygısı ile ilgili hiç ders almadığını bildirdi. Öğrencilerin %25,8'i dental anksiyete ile yara iyileşmesi arasında bir ilişki olduğunu düşünürken, %37,1'i dental anksiyetenin enflamatuar hastalığı ağırlaştırdığını belirtti. Sonuçlar Son sınıf diş hekimliği öğrencilerinin kendi streslerini yönetme ve Dental anksiyetesi olan hastalar hakkındaki bilgilerini artırma konusunda daha fazla eğitime ihtiyaçları vardır. Diş hekimliği öğrencisi veya diş hekimi sayısının daha fazla olduğu dental anksiyete yönetim stratejilerini içeren daha ileri çalışmalara ihtiyaç vardır. Anahtar kelimeler: dental anksiyete, diş hekimliği öğrencisi, diş hekimliği eğitimi

Keywords

• dental anksiyete
• diş hekimliği öğrencisi
• diş hekimliği eğitimi

References

1. 1. Firestein SK. Patient anxiety and dental practice. J Am Dent Assoc 1976;93:1180-1187.
2. 2. O'Shea RM, Corah NL, Ayer WA. Sources of dentists' stress. J Am Dent Assoc 1984;109:48-51.
3. 3. Abrahamsson KH, Berggren U, Hallberg LR, et al. Ambivalence in coping with dental fear and avoidance: A qualitative study. J Health Psychol 2002;7:653–664.
4. 4. Boran A, Shawaheen M, Khader Y, Amarin Z, Hill Rice V. Work related stress among health professionals in northern Jordan. Occup Med 2012;62:145-147.
5. 5. Brahm CO, Lundgren J, Carlsson SG, Nilsson P, Corbeil J, et al. Dentists views on fearful patients. Problems and promises. Swed Dent J 2012;36:79‐89. 6. Moore R, Brødsgaard I. Dentists' perceived stress and its relation to perceptions about anxious patients. Community Dent Oral Epidemiol 2001;29:73-80.
6. 7. Corah NL, O’Shea RM, Ayer WA. Dentists’ management of patients’ fear and anxiety. J Am Dent Assoc 1985;110:734–736.
7. 8. Weiner AA, Weinstein P. Dentists' knowledge, attitudes, and assessment practices in relation to fearful dental patients: a pilot study. Gen Dent 1995;43:164-168.
8. 9. Moore R, Brødsgaard I. Differential diagnosis of odontophobic patients using the DSM-IV. Eur J Oral Sci 1995;103:121-126.

9. 10. Moore R, Brødsgaard I, Mao TK, Kwan HW, Shiau YY, Knudsen R. Fear of injections and report of negative dentist behavior among Caucasian American and Taiwanese adults from dental school clinics. Community Dent Oral Epidemiol 1996;24:292-295.
10. 11. Korpela I, Vaununmaa K, Tolvanen M, Suominen A, Freeman R, et al. Dental students’ and patients’ perceived importance and knowledge of dental anxiety. Eur J Dent Educ 2019;23:515–521.
11. 12. Tay KM, Winn W, Milgrom P, Hann J, Smith T, et al. The effect of instruction on dentists’ motivation to manage fearful patients. J Dent Educ 1993;57:444‐448.
12. 13. Beck AT, Epstein N, Brown G, Steer RA. An inventory formea suring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893-897.
13. 14. Ulusoy M, Şahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother 1998;12:163- 172.
14. 15. Bellini M, Maltoni O, Gatto MR, Pelliccioni G, Checchi V, et al. Dental phobia in dentistry patients. Minerva Stomatol 2008;57:485-95. 16. Newton JT, Buck DJ. Anxiety and pain measures in dentistry: a guide to their quality and application. J Am Dent Assoc 2000;131:1449-1457.
15. 17. Acharya S. Factors affecting dental anxiety and beliefs in an Indian population. J Oral Rehabil 2008;35:259-67.
16. 18. Rønneberg A, Strøm K, Skaare AB, Willumsen T, Espelid I. Dentists' self-perceived stress and difficulties when performing restorative treatment in children. Eur Arch Paediatr Dent 2015;16:341-347.
17. 19. Benassi GF, Mariotto LGS, Botelho AL, Valente MLDC, Reis ACD. Relationship between temporomandibular dysfunctions, sleep disorders, and anxiety among dentistry students. Cranio 2020;5:1-4.
18. 20. Tinastepe N, Iscan I. Relationship between bruxism and smartphone overuse in young adults. Cranio 2021;31:1-8.
19. 21. Halonen H, Salo T, Hakko H, Räsänen P. The association between dental anxiety, general clinical anxiety and depression among Finnish university students. Oral Health Dent Manag 2014;13:320-3255.
20. 22. Diercke K, Burger GD, Bermejo JL, et al. The management of dental anxiety and impact of psychological factors on dentistry: is recent scientific research translated into German dental practices? J Health Psychol 2013;18:1519-1528.
21. 23. Milgrom P, Fiset L, Melnick S, Weinstein P. The prevalence and practice management consequences of dental fear in a major US city. J Am Dent Assoc 1988;116:641-647.
22. 24. Reed MJ, Corry AM, Liu YW. The role of women in dental education: monitoring the pipeline to leadership. J Dent Educ 2012;76:1427-1436.
23. 25. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA 2002;288:756-764.
24. 26. Roter DL, Hall JA. Physician gender and patient-centered communication: a critical review of empirical research. Annu Rev Public Health 2004;25:497-519.
25. 27. Inglehart MR. Interactions between patients and dental care providers: does gender matter? Dent Clin North Am 2013;57:357-70.
26. 28. Brahm CO, Lundgren J, Carlsson SG, Nilsson P, Hultqvist J, Hägglin C. Dentists' skills with fearful patients: education and treatment. Eur J Oral Sci 2013;121:283-291.
27. 29. K. Strøm A. Rønneberg A. B. Skaare I. Espelid T. Willumsen Dentists’ use of behavioural management techniques and their attitudes towards treating paediatric patients with dental anxiety. Eur Arch Paediatr Dent 2015;16:349–355.
28. 30. Hill KB, Hainsworth JM, Burke F, Fairbrother KJ. Evaluation of dentists’perceived needs regarding treatment of the anxious patient. Br Dent J 2008;204:442-443.
29. 31. Kloostra PW, Eber RM, Wang HL, Inglehart MR. Surgical versus non-surgical periodontal treatment: psychosocial factors and treatment outcomes. J Periodontol 2006;77:1253-60.
30. 32. Armfield JM, Spencer AJ, Stewart JF. Dental fear in Australia: who’s afraid of the dentist? Aust Dent J 2006;51:78–85.
31. 33. Yüzügüllü B, Gülşahi A, Celik C, Bulut S. Dental anxiety and fear: relationship with oral health behavior in a Turkish population. Int J Prosthodont 2014;27:50-53. 34. Thomson WM, Stewart JF, Carter KD, Spencer J. Dental anxiety among Australians. Int Dent J 1996;46:320-324.
32. 35. Doerr PA, Lang WP, Nyquist LV, Ronis DL. Factors associated with dental anxiety. J Am Dent Assoc 1998:129:1111-1119.
33. 36. Eitner S, Wichmann M, Paulsen A, Holst S. Dentalanxiety - an epidemiological study on its clinical correlation and effects on oral health. J Oral Rehabil 2006;33:588-593.
34. 37. Locker D. Psychosocial consequences of dental fear and anxiety. Community Dent Oral Epidemiol 2003;31:144-151.
35. 38. Woolgrove J, Cumberbatch G. Dental anxiety and regularity of dental attendance. J Dent 1986;14:209-213.
36. 39. Kanzigg L, Phillips CL, Stein MB, Hunt LC, Wilder RS. Dental Hygienists' Knowledge, Attitudes, and Comfort Level in Treating Patients with Dental Anxiety. J Dent Hyg 2018;92:30-37.
37. 40. Croog SH, Baume RM and Nalbandian J. Pain response after psychological prearation for repeated periodontal surgery. J Am Dent Assoc 1994;125:1353–1360.
38. 41. Kloostra PW, Eber RM, Inglehart MR. Anxiety, stress, depression, and patients' responses to periodontal treatment: periodontists' knowledge and Professional behavior. J Periodontol 2007;78:64-71.
39. 42. Maggirias J, Locker D. Psychological factors and perceptions of pain associated with dental treatment. Community Dent Oral Epidemiol 2002;30:151–159.
40. 43. Cole-King A, Harding KG Psychological factors and delayed healing in chronic wounds. Psychosomatic Medicine 2001; 63: 216–220.
41. 44. Marucha PT, Kiecolt-Glaser JK, Favagehi M. Mucosal wound healing is impaired by examination stress. Psychosom Med 1998;60:362–365.
42. 45. George JM, Scott DS, Turner SP, et al. The effects of psychological factors and physical trauma on recovery from oral surgery. J Behav Med 1980;3:291–310.
43. 46. Croog SH, Baume RM and Nalbandian J. Presurgery psychological characteristics, pain response and activities impairment in female patients with repeated periodontal surgery. J Psychosom Res 1995;39:39–51.
44. 47. Takada T, Yoshinari N, Sugiishi S, et al. Effect of restraint stress on the progression of experimental periodontitis in rats. J Periodontol 2004;75:306–315.
45. 48. Wimmer G, Köhldorfer G, Mischak I, Lorenzoni M, Kallus KW. Coping with stress: its influence on periodontal therapy. J Periodontol 2005;76:90-98.