Associate Professor Jason Armfield set out to explain the origins of dental fear and to understand why fear of the dentist is a serious psychological problem for many Australians. He developed a ‘dental anxiety scale’ that will help to identify and treat the condition across the world, leading to more people visiting the dentist and better population level oral health.
This story is part of our 10 of the Best, 2015 edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects.
High dental fear affects about one in seven Australian adults making it one of the most prevalent anxiety disorders in the country.1
For most Australians a trip to the dentist is a straightforward, albeit mildly unpleasant, activity. However, for a sizeable minority of people a dental visit can elicit serious anxiety.
Associate Professor Jason Armfield aimed to understand why dental fear is a serious psychological problem for so many.
'Traditionally, it was assumed that dental fear was a simple response to bad experiences at the dentist.
'However, some people who have had bad experiences have no dental anxiety, while others who have had no negative experiences suffer considerable dental anxiety,' he explained.
He investigated numerous aspects of the fear, as well as how dentists can identify, manage and treat dental anxiety. He identified that managing dental anxiety is about managing how people perceive a visit to the dentist.
'Specifically, people are more likely to be afraid of going to the dentist if they consider it to be uncontrollable, unpredictable, dangerous and disgusting.'
Associate Professor Armfield successfully identified several strategies for tackling dental anxiety and fear. Notably, he developed an adult ‘dental anxiety scale’ to measure dental anxiety in adults, which allows for a safe and standardised way to identify anxiety.
'High levels of dental fear are associated with poorer oral health outcomes such as decayed and missing teeth.'
This tool has been translated into almost a dozen languages around the world. A children’s scale is currently being developed, which will help to identify and treat the condition in Australia and overseas. Associate Professor Armfield emphasised that dentists play an important role in identifying both the anxiety and its source. Patients must also take an active role in addressing their own issues.
This valuable research goes beyond understanding the psychological ramifications, but plays a critical role in improving oral health across the community.
'Tackling dental fear from a number of directions will hopefully help us reduce dental anxiety in the community.
'This will lead to more people visiting the dentist and better population level oral health,' he concluded.
Next steps
Having identified and developed robust strategies for adults, Associate Professor Armfield hopes to further explore the causes of dental fear and anxiety in children. Cognisant of aspects such as parental influence and varying child personality characteristics, he hopes to identify and alleviate the problem early. This will reduce the need for expensive, unnecessary and risky options, such as undergoing general anaesthesia for basic dental procedures.
Addressing dental anxiety
In Australia, almost one in three adults with high dental fear has not visited a dentist in 10 or more years. Treating dental anxiety is about managing how people feel about going to the dentist. According to Associate Professor Armfield, there are several elements to be tackled in this regard:
- Dentists are aware of dental anxiety and its various components. Armfield created a ‘dental anxiety scale’ to allow reliable and safe self-reporting of dental anxiety.
- Dentists know how to effectively identify and manage a patient’s anxiety, which requires appropriate training and knowledge.
- An individual understands their own fear and takes an active role to address their anxiety.
1 Armfield JM. The extent and nature of dental fear and phobia in Australia. Australian Dental Journal 2010;55:368-377.
