Prevalence of dental anxiety and its associated factors among patients visiting tertiary care dental hospital in Kathmandu, Nepal: a cross-sectional study

Abstract

Background

Dental anxiety, affecting 15.3% of adults globally, is more common in younger people and women. It often leads to avoiding dental visits, which worsens oral health. In Nepal, limited studies have focused on specific populations, leaving a gap in understanding its prevalence and associated factors among general dental outpatients.

Objective

This study aims to explore the prevalence of dental anxiety along with associated factors among patients visiting a tertiary care dental hospital.

Design

A cross-sectional design.

Setting

This study was conducted among outpatients visiting a tertiary care dental hospital in Kathmandu, Nepal, from July to October 2024. Dental anxiety was assessed using the Modified Dental Anxiety Scale-Nepali and a self-designed, semi-structured questionnaire that incorporated various demographic variables and the nature of the past and current dental visits. Data were entered in a Microsoft Excel sheet and analysed using SPSS V.27. Both descriptive and inferential findings were drawn from the study.

Participants

A total of 276 adult patients (18–65 years) participated in the study. Participants who can read and write the Nepalese language were included. Individuals with cognitive impairments, a diagnosed general anxiety disorder or those taking anxiolytic medications were excluded.

Primary and secondary outcome measures

Modified Dental Anxiety Scale (MDAS) scores and factors associated with dental anxiety.

Results

Prevalence of dental anxiety in the present study was found to be 47.82% (41.80% to 53.90%, 95% CI), which includes 44.8% (n=124) with moderate anxiety and 2.9% (n=8) with severe anxiety. The overall mean dental anxiety score on MDAS was 9.69±3.74. Significant differences in mean MDAS scores were observed in younger participants (18–30 years; p=0.01) and females (p=0.001). Additionally, those with no dental history and specific reasons for their current dental visit also showed significant differences in mean MDAS scores (p=0.049 and p=0.043, respectively).

Conclusion

Slightly more than two-fifths of the participants experienced moderate dental anxiety, while a smaller yet significant proportion experienced severe anxiety. It was found to be associated with factors such as age, sex, dental history and reason for current dental visit. These findings highlight the importance of further conducting large national-level studies and the need for targeted interventions by relevant stakeholders and researchers to develop effective patient management strategies, raise awareness through education and guide policymaking.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This study was conducted in the capital city of Nepal, Kathmandu, thus ensuring assessment of dental anxiety among a diverse sample of patients visiting the tertiary care hospital.

• The use of the Modified Dental Anxiety Scale (MDAS), a widely validated and standardised tool, ensures reliable and comparable assessment of anxiety levels, supporting internal validity.

• The study was conducted at a single tertiary care hospital in Kathmandu using a convenience sampling technique, which may limit the generalisability of the findings to the entire country.

• The cross-sectional design limits the ability to infer causality.

Introduction

Anxiety is essentially the fear of the unknown.¹ Dental anxiety, specifically, refers to a patient’s specific reaction toward stress associated with dental treatment or the anticipation of an unpleasant happening during any dental procedure.² It is a common emotion experienced by people worldwide.³ In some cases, this stress can escalate into dental phobia, causing individuals to completely avoid perceived threats—in this case, dental treatment. As a result, it becomes a significant obstacle for patients in seeking oral healthcare.⁴ Dental anxiety is a significant concern for both dentists and patients, as it often causes individuals to delay, cancel or completely avoid dental appointments and treatments.^{5 6} Over time, the worsening of untreated oral health issues can lead to feelings of guilt, shame and inferiority in patients, further intensifying their anxiety and creating a vicious cycle.⁷ Dentists also face challenges when dealing with anxious patients, as they typically require more time and effort, and managing them during procedures can be difficult. Additionally, anxious patients are more likely to express dissatisfaction with their treatment outcomes.⁸ Many dentists report that such patients are a major source of stress, which can negatively impact their practice efficiency and clinical performance.⁹ Such patients react to anxiety in different ways. Some may become overly talkative, sharing excessive details as a way to cope with their fear and seek reassurance from the dentist, who provides them with a sense of safety and support. On the other hand, some patients may display aggressive or inappropriate behaviour that clashes with the calm and professional environment of the dental clinic.¹

Dental anxiety arises from various triggers, including past traumatic experiences, fear of dental tools, needles, blood or even imagined fears influenced by negative stories.⁴ Often acquired in childhood, it can persist into adulthood and be shaped by cultural and socioeconomic factors.³ Patient-related factors like age, gender, education and socioeconomic status contribute, with females, younger individuals and those from lower socioeconomic backgrounds being more affected.^{4 10} The dentist’s communication style, demeanour and potential treatment errors also impact anxiety levels. Environmental factors, such as clinic sights, sounds and smells, further heighten discomfort.¹¹ Previous negative experiences are the most common cause of initial dental fear, with pain being the most significant fear-inducing factor. Among dental treatments, extractions are reported as the most anxiety-provoking, followed by root canal procedures.²

Recognising these factors is essential for understanding and addressing anxiety related to dental treatment.¹²

Globally, dental anxiety affects approximately 15.3% of adults.³ However, this prevalence varies significantly across regions, with studies reporting moderate to high levels of dental anxiety in 83.1% of participants in China, 51.8% in India and 31.5% in Lebanon.¹¹ In Nepal, research on dental anxiety and phobia remains limited, with existing studies primarily focusing on specific populations such as school children, dental students, patients undergoing oral surgical procedures and periodontal therapy (eg, scaling).13,17 However, there is a significant gap in understanding its prevalence and associated factors among outpatients seeking general dental care. This study aims to determine the prevalence of dental anxiety and identify associated factors among patients visiting a tertiary care dental hospital in Kathmandu, Nepal.

Methods

Study design and sampling

This cross-sectional study was conducted from July to October 2024 at People’s Dental College and Hospital, a tertiary care dental hospital in Kathmandu, Nepal. Patients aged between 18 and 65 years, who were able to write and read the Nepalese language, were included using a convenience sampling technique. Individuals with cognitive impairments, those previously diagnosed with generalised anxiety disorder or taking anxiolytic medications, were excluded from the study, based on previous literature.^{12 13 18} Taking into account potential non-responders, 300 participants were estimated, out of which 276 completed the survey. Among the 24 excluded, 15 refused to participate, while 9 were diagnosed with anxiety-related disorders and reported being on medication (figure 1). Data collection was carried out in the outpatient department.

Figure 1. Strengthening the Reporting of Observational Studies in Epidemiology flow diagram.

Measurement scales and scoring

Modified Dental Anxiety Scale (MDAS) is a modification of Corah’s dental anxiety scale with an added question about local anaesthetic injection.¹³ It consists of five questions assessing anxiety in different dental situations, getting ready for a dental visit, waiting in the dentist’s office just before treatment, sitting in the chair for drilling, preparing for scaling and getting ready for local anaesthetic injection. It has been translated into Nepali and validated by Giri et al,¹⁴ making it a reliable tool for measuring dental anxiety in Nepali patients. The Cronbach’s alpha of the Nepali version of MDAS is found to be 0.775, which shows good internal consistency of the instrument.¹⁴ Demographic variables such as age, gender, marital status, education level, employment status and monthly income, along with the reason for past and current dental visits, were added to the Modified Dental Anxiety Scale-Nepali questionnaire. The responses range from ‘not anxious’ (1) to ‘extremely anxious’ (5), with total scores ranging from 5 to 25. Based on a previous study, the participants were categorised as less anxious (5–9 of total score), moderately anxious (10–18 of total score) and those with a total score of 19 or above were identified as extremely anxious or dental phobic.¹⁰ The mean total score was calculated by dividing the sum of all participants’ total scores by the number of participants. Higher scores indicate greater levels of dental anxiety. The prevalence of dental anxiety was calculated by dividing the total number of participants with an MDAS score greater than 10 (moderate to extreme anxiety) by the total number of participants.

The questionnaire was self-administered under the guidance of the data collectors, who provided necessary instructions and clarifications when required. On completion, each form was carefully reviewed to ensure that all questions were answered appropriately and completely, minimising the chances of missing or inconsistent responses. Pretesting was done on a small sample (n=20) to ensure clarity, relevance and cultural appropriateness of the questions.

Statistical analysis

Data entry was performed using Microsoft Excel, and statistical analysis was conducted using SPSS software, V.27. Descriptive statistics for continuous variables were reported as means and SD, while categorical variables were presented as frequencies and percentages. Inferential statistical analysis was performed using an independent t-test and one-way analysis of variance (ANOVA) to compare group means. Post-hoc Tukey’s test was applied to identify significant differences between the groups. A p value less than 0.05 represents statistical significance.

The required sample size was calculated using the formula:

$${\displaystyle \mathrm{n}={\mathrm{Z}}^2\times \mathrm{p}\times \mathrm{q}/{\mathrm{e}}^2}$$

Using a 95% CI (Z=1.96), a prevalence (p) of 23.47% and a 5% margin of error, the final sample size was calculated to be 276.

Results

The response rate for this study was 92%, with 276 participants out of an estimated 300 eligible individuals completing the survey. Most of the participants (42.4%) were in the age group 18–30, with a mean age of 36.1±13.1. The mean anxiety scores were highest among the 18–30 years age group, that is, 10.63±3.80, which was statistically significant (p=0.01). The scores were observed to decrease with increasing age, indicating that younger participants experienced higher levels of anxiety (p=0.01) compared with those in other age groups (table 1).

Table 1. Sociodemographic characteristics and Modified Dental Anxiety Scale score (mean±SD) among patients visiting tertiary care dental hospital in Kathmandu, Nepal (N=276).

Variable	N (%)	Mean total score	SD	Statistical test	Metric	P value
Age group (years)
18–30	117 (42.4)	10.63	3.806	ANOVA F=6.724 df=2	η2=0.047	0.001*
31–50	110 (39.8)	9.11	3.487
>50	49 (17.8)	8.77	3.720
Sex
Male	139 (50.4)	8.94	3.337	t=3.450 df=274	Cohen’s d=3.67	0.001*
Female	137 (49.6)	10.46	3.979
Marital status
Married	180 (65.2)	9.38	3.589	t=1.930 df=274	Cohen’s d=3.72425	0.055
Unmarried	96 (34.7)	10.29	3.965
Education level
Bachelor’s and above	129 (46.6)	9.59	3.313	ANOVA F=1.165 df=4	η2=0.017	0.327
Grade 11–12	62 (22.4)	9.95	3.650
Grade 6–10	51 (18.4)	10.23	4.684
Grade 0–5	14 (5.1)	7.92	3.361
No formal education	20 (7.2)	9.45	4.135
Occupation
Employed	147 (53.1)	9.63	3.617	ANOVA F=1.452 df=4	η2=0.021	0.217
Unemployed	91 (32.9)	9.82	4.143
Student	28 (10.1)	10.50	3.109
Retired	9 (3.2)	7.11	2.619
Others	1 (0.4)	9.00	3.617
Monthly income (in NRs)
<10 000	127 (45.8)	9.89	4.041	ANOVA F=1.270 df=4	η2=0.018	0.282
10 000–20 000	32 (11.6)	10.28	3.735
20 000–30 000	33 (11.9)	9.81	3.786
30 000–50 000	47 (17)	9.63	2.892
>50 000	37 (13.4)	8.48	3.524

^*Represents statistical significance.

ANOVA, analysis of variance; NRs, Nepalese rupees.

Nearly equal proportions of males and females were present in the study. Female participants exhibited significantly higher levels of anxiety compared with their male counterparts (p=0.001). More than half of the participants (65.2%) were married, and it was found that the unmarried participants were more anxious towards dental procedures than the married ones, with a mean MDAS score of 10.29, which was not statistically significant (p=0.05). The majority of them (46.6%) held a bachelor’s degree or above. Participants who had their education between grades 6 and 10 were seen to be most anxious, with the mean MDAS score of 10.23, compared with other categories, which demonstrated similar mean scores. Half of the participants (53.1%) were employed, but only 13.7% of them had a monthly income of more than Nepalese rupees 50 000 and were found to be the least anxious of all. Students were seen to have more dental anxiety, with a mean score of 10.5, while the retired participants were seen to be the least anxious (table 1).

Post-hoc analysis using Tukey’s Honestly Significant Difference (HSD) revealed that the 18–30 age group had significantly different mean scores compared with the 31–50 (p=0.006) and >50 (p=0.009) age groups (table 2).

Table 2. Post hoc test results (Tukey HSD) for mean total score across age groups.

Comparison	Mean difference	P value
18–30 years vs 31–50 years	1.514	0.006*
31–50 years vs >50 years	0.342	0.85
18–30 years vs >50 years	1.856	0.009*

^*Represents statistical significance.

HSD, Honestly Significant Difference.

Most of the participants (66.4%) had a dental history. Participants who reported that they did not have any dental history were found to be more anxious towards the dental procedures, with a mean MDAS score of 10.32. On applying an independent t-test, it was found that there was a significant difference in the mean anxiety score of the dental history (p=0.04) (table 3).

Table 3. Findings related to past and current dental visits.

Variable	N (%)	Mean total score	SD	Statistical test	Metric	P value
Dental history
Yes	184 (66.4)	9.38	3.578	t=1.978	Cohen’s d=3.722	0.049*
No	92 (33.2)	10.32	3.997
Reasons for past dental visit
Drilling/RCT	77 (27.8)	9.81	3.545	ANOVA F=1.104 df=6	η2=0.024	0.360
Extraction/LA	57 (20.6)	8.89	3.653
No previous dental visits	87 (31.4)	10.25	3.897
Orthodontic treatment	5 (1.8)	9.60	4.560
Others	5 (1.8)	11.60	5.899
Prosthodontic treatment	7 (2.5)	9.00	4.123
Scaling	38 (13.7)	9.28	3.392
Reason for current dental visit
Extraction/LA	68 (24.5)	9.11	3.810	ANOVA F=2.20 df=9	η2=0.057	0.043*
Drilling/RCT	95 (34.3)	10.30	3.806
Orthodontic treatment	3 (1.1)	10.33	3.511
Pain	25 (9)	11.08	3.463
Prosthodontic treatment	10 (3.6)	10.80	4.685
Scaling	72 (26)	8.87	3.402
General check-up	3 (1.1)	7.66	1.527

^*Represents statistical significance.

ANOVA, analysis of variance; LA, local anaesthesia; RCT, root canal treatment.

One-fourth of the participants (24.5%) currently had a dental visit for extraction/local anaesthesia. People who visited the hospital with pain were found to be more anxious (mean MDAS score=11.08), while people who just visited the hospital for a general check-up were found to be least anxious (mean MDAS score=7.67) towards dental procedures. One-way ANOVA showed significant differences between the MDAS score and the reason for the current visit (p=0.04) (table 3).

Although ANOVA was performed and a significant association was seen for the reason for the current dental visit in table 3, there were no significant group differences in mean scores between the groups (online supplemental table 1).

The mean total dental anxiety score on MDAS was 9.69 with an SD of 3.74. Based on the MDAS score, 52% of the participants were identified to be less anxious (5–9 of total score), 44.8% were moderately anxious (10–18 of total score) and participants with a total score of 19 or above (2.9%) were identified as extremely anxious or dental phobic. It was observed that more than half of the participants (59.9%) would not be anxious about visiting the dentist for treatment, even while sitting in the waiting room (57.8%). About one-fifth (19.9%) of them would be fairly anxious when they were getting their tooth drilled. 27.8% of the participants would be slightly anxious when it came to teeth scaling and polishing, while 5.4% would be extremely anxious if they had to receive a local anaesthetic injection in their gums (table 4).

Table 4. Summary of anxiety-provoking stimuli and responses.

How would you feel	Not anxious n (%)	Slightly anxious n (%)	Fairly anxious n (%)	Very anxious n (%)	Extremely anxious n (%)	Mean	SD
If you went to your dentist for treatment tomorrow, how would you feel?	166 (59.9)	61 (22)	26 (9.4)	18 (6.5)	5 (1.8)	1.68	1.010
If you were sitting in the waiting room (waiting for treatment), how would you feel?	160 (57.8)	70 (25.3)	30 (10.8)	15 (5.4)	1 (0.4)	1.65	0.904
If you were about to have a tooth drilled, how would you feel?	109 (39.4)	62 (22.4)	55 (19.90)	42 (15.2)	8 (2.9)	2.20	1.196
If you were about to have your teeth scaled and polished, how would you feel?	152 (54.9)	77 (27.8)	30 (10.8)	16 (5.8)	1 (0.4)	1.68	0.910
If you were about to have a local anaesthetic injection in your gum, about an upper back tooth, how would you feel?	80 (28.9)	67 (24.2)	57 (20.6)	57 (20.6)	15 (5.4)	2.49	1.255

Multivariate analysis of individual influencing factors depicted that gender and age group were significant predictors of dental anxiety. It was found that males were less likely to have higher dental anxiety scores in comparison to females (β=−0.221, p=0.001), with the CI (−2.66 to –0.65) suggesting a robust negative association. Age group also showed a statistically significant association with dental anxiety (β=−0.190, p=0.020), indicating that younger individuals had a higher level of anxiety compared with the older ones, and the CI reinforces the strength of the relationship (table 5).

Table 5. Multiple linear regression predicting dental anxiety.

Predictor	Standardised coefficient (β)	P value	CI
			Lower	Upper
Gender (ref=female (0))	−0.22	0.001*	−2.66	−0.65
Age group	0.19	0.002*	−1.78	−0.15
Dental history	0.10	0.09	−0.15	−0.64
Reason for current dental visit	0.072	0.22	−0.350	−0.645

^*Represents statistical significance.

Discussion

The present study found that the prevalence of dental anxiety was 47.82%, including both 44.8% (n=124) with moderate anxiety and 2.9% (n=8) with severe anxiety. Dental anxiety was significantly higher among females and younger age groups. Here, gender remains a significant predictor of dental anxiety, which is consistent with the previous studies^{19 20} often signifying increased anxiety, help-seeking tendencies and behavioural differences among females. Likewise, a higher level of anxiety among the younger population was attributed to a lack of health education or limited exposure to dental services, which aligns with similar studies.¹⁹

Participants with no dental history exhibited greater anxiety, while those visiting for general check-ups were the least anxious. The highest anxiety levels were observed among patients seeking extractions/local anaesthesia or those visiting due to pain.

In this study, participants in the 18–30 years of age group had the highest mean anxiety scores, which is similar to studies conducted by Humphris et al¹⁹ and do Nascimento et al.²¹ These studies reported that age was strongly associated with dental anxiety, and younger subjects were more anxious than older ones. A study conducted by Locker et al suggested that the decline in dental anxiety with age could be due to factors like age-related changes in the brain, gradual reduction or extinction of fear responses, better coping skills and greater exposure to health conditions and medical treatments.²² Numerous studies consistently show that females experience higher levels of dental anxiety than males. Our study supports this finding, with female participants displaying significantly greater anxiety than their male counterparts.23,28 However, some studies showed no difference in dental fear and anxiety among males and females.29,31 Females are more expressive about their feelings and may have a relatively lower tolerance for pain than men. They readily admit their fears, whereas males may not be open about their emotions because of social stigma.^{10 12}

A study conducted by Ullah et al also showed that the married patients stated to have a relaxed mind throughout the procedure, while the unmarried ones displayed signs of uneasiness and stress¹² while in our study, no such inferences were to be found. Previous studies have indicated that higher education may reduce dental anxiety levels.^{19 21} However, in our study, educational level did not affect dental anxiety, consistent with findings by Arslan et al³² and Kanegane et al.³³ In contrast, other studies suggested that highly educated individuals may experience more dental anxiety than those with lower education levels.^{12 34}

Our study revealed that students were more likely to have dental anxiety, while the retired participants were seen to be the least anxious. This finding aligns with the study of Acharya, where students showed the highest levels of dental anxiety in contrast to the professionals and the self-employed.³⁴ The possible reason for this could be due to lower autonomy and coping mechanisms yet to develop through experience. In our study, those earning more than Nepalese rupees 50 000 per month had the lowest mean MDAS score and were found to be less anxious than other categories, which was similar to a study in India by Deogade and Suresan (MDAS score: 9.88).¹⁰ Most of the time, it may be due to the high cost of dental treatment, which is often considered expensive, making it unaffordable for some people.⁴

The majority of the participants (66.4%) had visited a dentist before, which reflects the level of awareness regarding the importance of dental care in the study area. Further, participants without a history of dental visits were found to be more anxious about dental procedures. An independent t-test showed a significant difference in mean anxiety scores based on dental history, which is supported by previous studies that have shown an inverse relationship between frequency of dental attendance and anxiety.^{5 8} Majority of the participants visited the hospital for extraction/local anaesthesia, while people who visited the hospital because of pain were found to be more anxious than other categories. The possible reason for this could be an anticipation of pain and feeling out of control. Literature related to this finding was quite limited.

The prevalence rate in the present study was similar to the findings of the studies done by Malvania and Ajithkrishnan³⁵ (46%). It was found to be more than the study conducted by Do Nascimento et al²¹ (23%), while less than that of the study done by Madfa et al³⁶ (63%). These differences could be partly due to methodological differences or due to geographical variation. The mean MDAS score of all the participants was 9.69±3.742, relevant to the study performed by Bhat et al, that is, 9.64±3.6.³⁷ Based on the MDAS scores, 52% of participants were classified as less anxious, 44.8% as moderately anxious and 2.9% indicating extreme anxiety or dental phobia. It aligns with the findings of Bhattarai et al,¹³ that is, 3.54%, Deogade and Suresan,¹⁰ that is, 5% and White et al³⁸ with 6.82% of patients experiencing extreme dental anxiety.

The prevalence of dental anxiety has been shown to range from 2% to 30% globally, depending on the assessment methods, study populations and cut-off scores used.³⁹ A systematic review and meta-analysis by Silveira et al³ reported a global prevalence of 15.3%, based on studies published between 1991 and 2020, most of which were conducted in high-income countries, particularly in Europe (18 out of 31 studies), with minimal representation from Asia. This limited geographic diversity affects the generalisability of global findings to low- and middle-income countries like Nepal. In our study, the prevalence of dental anxiety was notably higher (47.82%). This disparity may be explained by several contextual factors unique to Nepal, such as widespread poverty, limited access to mental and oral healthcare, and lingering psychological trauma from events like the 1996–2006 civil war and the 2015 earthquake. Additionally, cultural stigma surrounding mental health often discourages individuals from seeking professional help, driving them instead toward faith healers.40,44 These factors highlight the need for more region-specific studies.

In our study, participants were found to be more anxious the day before their appointment than while waiting on the appointment day, consistent with the findings of Bhattarai et al.¹³ However, Inamdar et al⁴⁵ reported higher anxiety levels while waiting for dental treatment on the appointment day compared with the day before, with approximately 10% of individuals experiencing increased anxiety. The levels of anxiety exhibited during waiting in the waiting room before proceeding to dental treatment demonstrate the need for well-trained supporting staff to be aware of anxious patients.⁸ The majority of participants reported no anxiety in reference to the given five MDAS indicators. However, dental phobia was highest for local anaesthesia and tooth drilling. Similarly, a study on students reported that they were most anxious about tooth drilling and local anaesthesia, followed by anticipation of dental treatment the next day, sitting in the waiting room, and undergoing scaling and polishing.¹³

This study provides valuable insights into the prevalence and factors associated with dental anxiety and phobia among general dental outpatients in Kathmandu. The findings can help inform the development of tailored interventions and management strategies for patients experiencing dental anxiety in tertiary care settings. However, this is a single-centred study with a small sample size, thereby failing to reflect all areas of Nepal. The cross-sectional design limits causality. Additionally, the MDAS, being a brief screening tool, may not capture the full spectrum of dental anxiety. No objective clinical data on dental health were collected, and only a limited range of influencing factors was assessed—important psychosocial determinants such as psychological stress, social support, past dental experiences and coping mechanisms were not assessed, which may have provided a more comprehensive understanding of the factors influencing anxiety or avoidance behaviours. Furthermore, the sample had a disproportionately high percentage (46%) of participants with a bachelor’s degree, and the overall mean age was relatively young, making it less comparable to populations in Western countries like those in North America or Europe.

The high prevalence of dental anxiety observed in this study may be linked to past traumatic dental experiences, fear of pain and lack of awareness about modern, pain-free procedures, along with cultural misconceptions.^{10 12} Although dental history and reasons for current dental visit were not seen to be significant predictors of dental anxiety in our study, previous studies indicate them to be a valuable predictor of future treatment needs, as they might have active dental issues to deal with⁴⁶ and frequent dental visits ensure better oral health.⁴⁷ Clinicians should adopt anxiety-reducing strategies such as patient education, behavioural interventions and improved communication to enhance patient comfort.⁴⁸ Policymakers can integrate mental health support within dental care, promote community awareness and implement training for dental professionals. Future research should explore the long-term impact of dental anxiety on oral health outcomes, assess intervention effectiveness and investigate regional variations across Nepal.

Conclusion

This study found that 47.82% of patients visiting a tertiary care dental hospital in Kathmandu, Nepal, experienced dental anxiety, with the majority reporting moderate anxiety (44.8%) and a smaller proportion experiencing severe anxiety (2.9%). Notably, younger individuals, females and those with no prior dental experience exhibited significantly higher anxiety levels. Also, patients visiting for extractions or experiencing pain reported the most severe anxiety. These findings not only contribute to the limited literature on dental anxiety in Nepal but also provide a foundation for future research and the development of anxiety-reduction strategies in dental care settings. While a majority experienced only mild symptoms, the presence of moderate to severe anxiety in a considerable subset indicates a need for targeted interventions. To effectively address this issue, training programmes for dentists should be introduced to help them recognise and manage dental anxiety through simple behavioural techniques such as ‘Tell-Show-Do’ and calm, reassuring communication. School-based oral health awareness programmes can help reduce fear early by familiarising children with dental care environments. Additionally, dental hospitals can establish patient counselling corners where trained staff or interns provide brief guidance and anxiety-reduction techniques before treatment. The use of visual aids and short audio or video instructions in the Nepali language can help patients better understand procedures, making them feel more at ease. Furthermore, community outreach through local radio or street drama campaigns can raise awareness, reduce stigma and encourage positive attitudes toward seeking dental care. These strategies are low-cost, sustainable and well-suited to the healthcare infrastructure of Nepal.

To generalise the results of such studies among the Nepalese population, future studies should be carried out using larger random samples. A longitudinal study could help establish causal relationships and provide deeper insights into its progression over time.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.