Dental professionals find it difficult to identify patients with severe dental anxiety. At the same time, patients are reluctant to talk about their fears and hope that the staff will understand anyway. This dilemma is described in a new thesis presented at the Department of Odontology at Karolinska Institutet.

The thesis includes four studies that highlight different aspects of dental anxiety. The first study involved 1,128 patients who, during a routine examination, rated their dental anxiety on a scale of one to one hundred. After the examination, dentists and dental hygienists assessed how anxious they thought the patient had been. The assessments were consistent at low levels of anxiety. However, the more anxious the patients were, the more the assessments differed. The staff were not very good at detecting severe dental anxiety.

‘We thought it would be the exact opposite – that staff would miss those who were slightly anxious but pick up on those who were highly anxious. But that was not the case,’ says Markus Höglund, senior dentist at the Centre for Orofacial Medicine in Linköping and PhD Student at the Department of Dental Medicine at Karolinska Institutet.

In interviews, dental staff described how they recognised dental anxiety based on how stressed the patients appeared to be. The staff found it difficult to believe that someone who did not appear stressed would be afraid of dental care, even if they said so. But when people with severe dental anxiety were interviewed, they described feeling great shame about their fear. The patients tried to hide their dental anxiety and did not want to talk about it, while at the same time hoping that the dentists would understand anyway.

This all points to a need for a tool that makes it easy to identify dental anxiety, according to Markus Höglund. In the latest study, he has translated and validated such an instrument, called the MDAS, to swedish. It contains five questions that provide an accurate assessment of dental anxiety. The researchers hope that the form can be placed in waiting rooms and filled out by patients along with other health declarations.

‘It can be a good basis for discussion before the examination. There are effective methods for managing dental anxiety, and dentists are well trained in this area. This could help dental staff identify patients who need more support, while also helping patients communicate their fears,’ says Markus Höglund.

Approximately 20 percent of Swedes feel very uncomfortable about visiting the dentist, and around 0.5 per cent have a severe phobia. The studies are funded by Folktandvården Östergötland.