Abstract
Background:
Dental anxiety is a prevalent issue among adolescents and often leads to the avoidance of dental care, exacerbating oral health problems during a critical stage of development.
Methods:
A cross-sectional study was conducted among 400 adolescents aged 13–18 years from four secondary schools in an urban area. The Modified Dental Anxiety Scale (MDAS) was used to assess dental anxiety. Oral health-seeking behavior was evaluated through a validated questionnaire assessing frequency of dental visits, reasons for avoidance, and symptom-based consultation patterns.
Results:
The mean MDAS score was 15.3 ± 4.2, indicating moderate anxiety levels. Among participants, 38.5% had high dental anxiety (MDAS ≥ 19), with significantly higher prevalence in females (45.8%) than males (31.2%, P = 0.003). Only 27.5% reported routine dental check-ups in the past year. High anxiety was significantly associated with infrequent dental visits (P < 0.001), symptom-driven visits (P = 0.002), and avoidance behavior due to fear (P < 0.001). Logistic regression revealed that adolescents with high dental anxiety were 3.6 times more likely to delay dental care.
Conclusion:
Dental anxiety significantly impairs oral health-seeking behavior in adolescents. Early identification and psychological interventions may promote regular dental visits and improve overall oral health outcomes in this age group.
KEYWORDS: Adolescents, dental anxiety, oral health
INTRODUCTION
Dental anxiety is a well-documented psychological phenomenon characterized by excessive fear or stress in dental settings, often resulting in avoidance behavior and poor oral health outcomes.[1] Adolescents, in particular, are vulnerable to developing dental anxiety due to heightened emotional sensitivity, peer influence, and limited prior exposure to dental environments.[2] The transition period of adolescence is crucial for establishing lifelong oral health habits and attitudes.[3]
Several studies have highlighted a strong inverse correlation between dental anxiety and the frequency of dental visits, as well as a positive correlation with untreated caries and gingival issues.[4] A systematic review found that high dental fear was associated with up to threefold increased odds of dental avoidance, reinforcing the need to explore this dynamic in adolescent populations.[5]
Despite increased awareness, the prevalence and implications of dental anxiety among adolescents remain underexplored, especially in developing countries where cultural and socio-economic factors influence healthcare utilization. Furthermore, limited studies have investigated the behavioral consequences of dental anxiety specifically in school-going adolescents, who may not have autonomous access to care.[6]
MATERIALS AND METHODS
A sample size of 400 was calculated using Cochran’s formula with an estimated 35% prevalence of dental anxiety, a 95% confidence level, and 5% margin of error. Stratified random sampling ensured proportional representation from each school.
Inclusion criteria were adolescents aged 13–18 years, enrolled in the selected schools, and willing to participate with parental consent. Exclusion criteria included ongoing psychiatric treatment, cognitive disability, or previous traumatic dental history requiring sedation.
Modified Dental Anxiety Scale (MDAS): A validated 5-item instrument assessing dental fear on a scale of 5–25. Scores ≥19 indicated high anxiety.
Oral Health-Seeking Behavior Questionnaire: A 10-item questionnaire assessing frequency of visits, reasons for consultation, avoidance behavior, and influencing factors.
Data collection procedure
Participants completed the questionnaires under supervision during school hours. A brief orientation was provided before administration.
Statistical snalysis
Data were analyzed using SPSS v26.
RESULTS
Demographics
Of 400 adolescents, 212 (53.0%) were female and 188 (47.0%) were male. The mean age was 15.6 ± 1.7 years.
Prevalence of dental anxiety
The mean MDAS score was 15.3 ± 4.2. High dental anxiety (MDAS ≥ 19) was reported by 154 participants (38.5%), with significantly higher prevalence among females (45.8%) than males (31.2%, P = 0.003) [Table 1].
Table 1.
Prevalence of high dental anxiety by gender
| Gender | High anxiety (%) | P | ||
|---|---|---|---|---|
| Male | 31.2% | |||
| Female | 45.8% | 0.003 |
Dental visit frequency and behavior
Only 110 adolescents (27.5%) reported at least one preventive dental visit in the last year. A total of 265 (66.2%) reported visiting the dentist only when in pain, while 25 (6.3%) had never visited a dentist.
Association between anxiety and behavior
High anxiety was significantly associated with:
Infrequent dental visits (once per year or less): 82.4% vs. 41.6%, P < 0.001
Symptom-driven consultations: 78.2% vs. 51.4%, P = 0.002
Reported fear-based avoidance: 72.0% vs. 29.7%, P < 0.001 [Table 2].
Table 2.
Association between dental anxiety and health-seeking behavior
| Behavior | High anxiety (%) | Low anxiety (%) | P | |||
|---|---|---|---|---|---|---|
| Preventive visit (past year) | 17.6% | 58.4% | <0.001 | |||
| Symptom-based visit | 78.2% | 51.4% | 0.002 | |||
| Avoidance due to fear | 72.0% | 29.7% | <0.001 |
Regression analysis
Logistic regression showed that high dental anxiety increased the odds of delaying dental visits by 3.6 times (OR = 3.6; 95% CI: 2.1–6.3; P < 0.001) after adjusting for age and gender.
DISCUSSION
This study highlights the significant burden of dental anxiety among adolescents and its detrimental effect on oral health-seeking behavior. The overall prevalence of high dental anxiety (38.5%) in this population is consistent with earlier reports from similar age groups across different regions.[7]
The observed gender disparity, with females reporting higher anxiety levels than males, aligns with previous studies suggesting that adolescent girls are more susceptible to anxiety-related disorders and exhibit greater anticipatory fear in clinical settings.[8,9] This may be influenced by heightened emotional expression and hormonal sensitivity during puberty.
Crucially, our findings establish a strong association between dental anxiety and negative health-seeking patterns. Adolescents with high MDAS scores were significantly more likely to avoid routine check-ups and seek care only when symptomatic—findings consistent with previous research by Crego et al., who observed similar behavior in Spanish adolescents.[1]
Avoidance behavior due to fear remains a critical barrier to preventive care. Fear of pain, embarrassment, and loss of control are commonly reported drivers of dental anxiety.[1] This maladaptive coping leads to a vicious cycle of neglect, progressive disease, and eventually traumatic emergency visits, further reinforcing fear—a pattern well documented by Armfield and colleagues.[2]
Importantly, logistic regression in our study showed that dental anxiety independently predicted delayed dental visits, even after adjusting for age and gender. This suggests that interventions targeting anxiety directly—through desensitization techniques, school-based education, or behavioral therapy—could be effective in enhancing oral healthcare utilization.[3,4]
Studies have also shown that parental anxiety, peer modeling, and negative previous dental experiences are potent contributors to adolescent dental fear.[5,6] Addressing these psychosocial dimensions through community awareness, parental engagement, and fear-reduction strategies in pediatric dentistry may significantly improve care-seeking behaviors.[7]
The findings underscore the importance of integrating psychological assessment into routine dental screening in schools and primary care. Identifying at-risk adolescents early could help tailor interventions to promote positive dental experiences and long-term oral health.[2,8,9]
CONCLUSION
Dental anxiety is a prevalent issue among adolescents and significantly hampers their willingness to seek timely dental care. Females are more affected, and those with high anxiety often avoid preventive visits, contributing to poorer oral health outcomes. Interventions addressing fear and promoting adolescent-friendly dental environments are essential to improve care utilization and oral health trajectories.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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