dental anxiety among patients attending public and … · dental anxiety before going for dental...

INTRODUCTION

nxiety can be defined as a condition ofunidentified concern, discomfort aboutsomething with a vague outcome1. Dental

anxiety is one of the utmost commonest anxieties amongseveral other types of anxieties that have been widelystudied worldwide2,3. According to a one study, 73% to79% of patients were undergoing through some kind ofdental anxiety before going for dental procedure3, whichwas resulted into unsuccessful treatment, and so

dissatisfied patient that further might prevent futurevisits to a dentist3. The recent advancement in the qualityof oral health care has resulted in better and satisfiedpatient care4. Previous researches on dental anxiety indeveloped countries have shown that people usuallyavoid dental treatment because of dental fear results inpoor oral health5,6.

It has been observed that large proportion numberof patient visit their dentist only when they have anyemergency7 or alternate treatment become less orineffective for their particular problem, which mayfurther worsen their oral health8. Literature was unableto divulge the exact cause of dental anxiety; howeverpossible factors of dental anxiety were mentioned insome studies as gender, age, objects and situations3. Ithas also been observed in previous studies that dentalinstruments could be one of the reasons for dental

JPDA Vol. 24 No. 01 Jan-Mar 2015 46

DENTAL ANXIETY AMONG PATIENTS ATTENDING PUBLICAND PRIVATE DENTAL HOSPITALS OF KARACHI

OBJECTIVE: To assess and compare the frequency of dental anxiety among patients visiting the public and privatedental hospitals of Karachi, Pakistan.METHODOLOGY: This cross sectional study was conducted in 2014 among patients at public and private dentalhospitals of Karachi. Sample size of 400 patients was selected from the Outpatient Department (OPD) of hospitalsthrough non probability convenience sampling technique. Data was collected by interviewing the study participantvia structured questionnaire using Modified Dental Anxiety Scale (MDAS). Data was entered and analyzed usingSPSS version 20.RESULTS: Total 400 patients were studied of which 184 (46%) were males and 216 (54%) were females. Toothextraction and filling were identified as the most common reason to visit dental OPD as answered by 111 (27.8%)and 100 (25%) patients respectively. Among them 276 (69.5%) had positive experience and were satisfied whiletreated in dental OPD. Using MDAS, dental anxiety was found in 12 (3%) patients at private as compared to nonein public dental hospital (p=0.001).CONCLUSION: On the basis of MDAS score dental anxiety was found more among patients from private dentalhospital as compare to patients from public dental hospitals.KEY WORDS: Dental Anxiety, Public, and Private Dental Hospitals.HOW TO CITE: Faisal S, Zehra N, Hussain M, Jaliawala HA, Faisal A . Dental anxiety among patients attendingpublic and Private Dental Hospitals of Karachi. J Pak Dent Assoc 2015; 24(1):46-51.

1. Department of Health and Hospital Management, Institute of Business Management,Karachi.2. Department of Community Health Sciences, Ziauddin University, Karachi.3. Department of Community Health Sciences, Ziauddin University, Karachi.4. Department of Community Health Sciences, Ziauddin University, Karachi.5. Department of Health and Hospital Management, Institute of Business Management,Karachi.Corresponding author: “Dr Nosheen Zehra ” < [email protected] >

Shanila Faisal1

Nosheen Zehra2

Mujtaba Hussain3

Huzaifa Ali Jaliawala4

A

Asima Faisal5

ORIGINAL ARTICLE

JPDA Vol. 24 No. 01 Jan-Mar 201547

anxiety, as when it is placed in a mouth results in gagreflex and confrontation in breath9 thus patient who aresensitive to these things may face greater probability ofhaving dental anxiety. Kirova et al. found that 25-26-year-old age group tends to experience higher dentalanxiety than other people9.

The seriousness of problem can be understood byits worldwide ranking. Dental anxiety is ranked 4thamong the common fears and 9th among intense fears1.Understanding the frequency and seriousness of aproblem many treatment modalities for dental anxietyhas been suggested by various researches10. In most ofthe developing countries the access to dental treatmentis limited due to treatment cost ignorance aboutimportance of oral hygiene11. When compared this todeveloped countries thus chances of dental anxiety ismore due to less exposure and little awareness. Dealingwith a patient suffering from dental anxiety is usuallyfound to be a difficult task for the dentists to diagnoseand manage12-15. In country like United States of America,10-19% of population faces dental anxiety16-17. However,data on this topic is scarce in Pakistan.

The aim of this study therefore was to compare thepresence of dental anxiety among the patients attendingPublic and Private dental hospital of Karachi, and toalso compare the presence of dental anxiety amongdifferent demographics of patients visiting dentalhospitals of Karachi, Pakistan.

METHODOLOGY

This study was a cross sectional study and it wasconducted at one Public and one Private Dental hospitalsof Karachi. It was conducted in year 2014 and completedover a period of four months. The target population wasincluded of patients from age 18-70 years of bothgenders. Sample size was calculated by WHO samplesize estimation calculator. For sample size calculationanticipated population proportion of anxiety was takenas 50%, at 95% confidence level and keeping 0.05margin of error. The minimum number of participantsrequired for inclusion in the sample was calculated as385 but to avoid data wastage 400 participants wereincluded in the study. Patients who visited dental OPD(outpatient department) for routine check-up, scaling,extraction, filling and root canal were consented toparticipate in the study. Patients with impactions,extensive periodontal treatment and edentulous ridges

were excluded, furthermore those who were undergoingpsychiatric therapy or were suffering from generalizedanxiety disorders were also excluded from the studyafter taking detailed history from patients. Nonprobability purposive sampling technique was used toinduct patients in the study.

The data collection questionnaire was comprisingof four parts, the first part contains information aboutthe study and a request for a consent for participation,the second part includes demographic details whichproceed with the third part where questions regardingprevious dental experience, reason for last dental visitand the facility where dental procedure took place(Public, Private hospital or by unskilled person) wereasked, fourth part contain Modified Dental AnxietyScale (MDAS) Proforma which has an online openaccess which is used for measuring patient anxiety level.The MDAS consist of five items which have been codedfrom 1 to 5 (not anxious to extremely anxiousrespectively). The items that were included in MDASare;. If you went to your dentist for treatment tomorrow,how would you feel?. If you were sitting in the waiting room (waiting fortreatment), how would you feel?. If you were about to have a tooth drilled, how wouldyou feel?. If you were about to have your teeth scaled andpolished, how would you feel?. If you were about to have a local anesthetic injectionin your gum, above an upper back tooth, how wouldyou feel?

Maximum and minimum scores that can be obtainedare 25 and 5, moreover it also has cut-off value 19.Therefore those who score at or above this score wouldbe considered as 'very dentally anxious'. The studyparticipate were approached in the OPD waiting area ofpublic and private hospitals and face to face interviewwas conducted. The study was reviewed and approvedby Research Ethical Committee of Institute of BusinessManagement (IOBM) Karachi, Pakistan.

Standard procedure of informed consents was appliedand confidentiality of patients was well maintained anddata collected was only used for this study. Thequestionnaire was completed on the spot by theresearcher. Data was analyzed by using SPSS version20 software. All qualitative variables were presented aspercentages and frequencies and all quantitative variables

Dental Anxiety among Patients attending PublicFaisal S / Zehra N / Hussain M /Jaliawala HA / Faisal A


were presented as mean and standard deviation.Independent t- test and ANOVA was used for quantitativevariables with two and more than two categories ofindependent variables respectively. While Chi squarewas used for qualitative data while p value less than0.05 was considered significant.

RESULTS

In this study total 400 patients participated with 200each from public and private dental hospitals. Of them184 (46%) were males and 216 (54%) were females.Age of the study participants was distributed as 183(45.8%), 98 (24.5%), 76 (19%) and 43 (10.8%) in agegroups of 18-30, 31-45, 46-60 and more than 60. In ourstudy population 100 (25%) patients were illiterate while136 (34%) had primary and high school education, 127(31.8%) had graduation and 37 (9.3%) ha post graduation.Patients were inquired about the reason for their visitat dental OPD and their previous dental visit experience,

the details are provided in table 1.Dental anxiety score was calculated from Modified

Dental Anxiety Scale (MDAS) that comprised of 5 items.Mean score obtained by study participants was 10.24 ±4.7 with 0 and 25 as minimum and maximum score.MDAS score for various demographic factors ispresented in table 2, where mean MDAS score wasdifferent between type of hospital, past dental visitexperience and reasons for dental visit with statisticallysignificant p- value.

MDAS scores further transformed according to thesuggested cut off value of 19 into two groups as

No Dental Anxiety (score <19) and Dental Anxiety(score > 19). Among 400 study sample dental anxietywas found in 12 (3%) patients. Association of Dental

Anxiety with demographic factors was also analyzedand illustrated in table 3.

DISCUSSION

Oral health is not only essential in term of appearanceand oral wellbeing but it has connection with your wholebody. If not properly taken care off might result inserious conditions like cavities and gum diseases whichmay contribute to diabetes and respiratory diseases18.Research showed that one of the common reasons forimpediment in health care utilization was dental fearwhich usually let people delay their dental visit or evencancellation of appointments16,19,20. From the results ofthis study we analyzed the frequency of dental anxiety


Frequency of Dental Anxiety among Patients attendingPublic and Private Dental Hospitals of Karachi

Tables

Table 2: MDAS Score for various Demographic Factors

Table 3: Association of Dental Anxiety with various Demographic Factors

Table 1: Details of visit of patients from dental OPD of Private and PublicHospitals


among the patients visiting public and private dentalhospital of Karachi and dental anxiety was found moreamong the patient visiting private hospital.

The literature shows that women have a lower levelof pain threshold which results in higher number ofdental anxiety21-22. However in this study, no significantassociation was found between dental fear and gender,which has also been supported by some previousstudies23. Similarly, regarding dental anxiety and agerelation, it has been observed from the previous studiesthat dental anxiety found less in older patient then young. This might be because of increase in pain threshold ofadult as time passes19,24. Alike our study where dentalanxiety is found most among the patient age grouped18-30, one study also found that 20-30-year-olds thattend to experience higher dental anxiety than otherpeople3.

The attitude of dentist has a great role in developingdental anxiety, if the dentist is caring and spendsappropriate time in informing and relaxing the patientsabout the dental procedures, the people do not developdental fear even if they experience painful procedures23,25.Usually it has been observed and also literature supportsthat previous positive dental experience reduces futuredental anxiety26 but in this study patient with previouspositive experience faced more dental anxiety. Furtherincidence of dental anxiety can be prevented with paincontrol and considering patient as whole and behaviormanagement27 and creating awareness of dentalprocedures among common people.

Literature shows that patient with higher level ofeducation has awareness about oral health28 and visitdentists on regular basis thus exhibit low dental anxietybut in our study two extreme group patient with noeducation and patient with higher education exhibitlesser dental anxiety when compare to middle leveleducation. In one more study conducted in Lahore,Pakistan found that educated group of and people injobs were more dental phobic (55%) which followed bystudents(21%)22. In this study high socioeconomic groupfaces more dental anxiety then low socioeconomic groupalike few of the studies in relationship29,30. However,other studies do not found such relationship31,32.Our study also exhibited that postponement of dentalvisit was significantly associated with anxiety level,similar results were found in the study conducted inIndia Chenai28.

This study was conducted in Karachi, Pakistan which

is one of the developing countries where majority ofpopulation belong to low and middle socioeconomicstatus and most of them are catered by public healthfacilities. A study conducted in Australia stated thatpeople from lower socio-economic backgrounds hasreduced access to resources29 and have less optionsavailable for dental treatment thus showed less dentalanxiety. Similar finding was found in our study thatshows no dental anxiety among patient visited publichospital. However, one study also states that no matterhow much experienced dentist is, patients fear ofexperiencing pain during dental visit exist in patientmind31-3 which can make pain as one of the cause fordental fear among patients.

The MDAs score of this study shows that patientsvisited for dental filling exhibit most dental fear followedby patients came for extraction. These result correspondto the literature which states that procedures dealingwith drill and needle injections are the most provokingstimuli for dental anxiety34-6.

At the cut off value of > 19 for MDAS score, 3% ofthe patients had extremely high level of dental anxiety;this was similar to the findings of Acharya et al. (2.2%)among Indian population33. The percentage of peoplewith dental anxiety was less when compared withWestern countries like UK (11%)34, Northern Ireland(19.5%)35, Turkey (23.5%)36 and Finland (3%)34.

CONCLUSION

It was concluded from the results of this study thatMean MDAS Score was high among patients attendingprivate dental hospitals.

REFERENCES

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