AIM: The overall aim of this thesis was to examine the associations between dental anxiety, experiences of dental care, psychosocial factors and oral health among 15-year-olds, and to analyse changes in the prevalence of dental anxiety over time.

MATERIALS AND METHODS: The thesis was based on two cross-sectional epidemiological studies in Jönköping, Sweden. Papers I, II, and III were based on a random sample of 15-year-old individuals. The total sample consisted of 221 individuals. Six questionnaires were used, one included items of background data, while the others were psychometric instruments measuring dental anxiety, temperament, general anxiety and depression, general fearfulness and attitudes to dental care. Paper IV was based on the Jönköping studies, a series of epidemiological studies from 1973, 1983, 1993, and 2003 in which random samples of 15-year-old individuals were included. The total sample consisted of 405 individuals. Questionnaires including background data and dental anxiety were used and clinical data were collected.

RESULTS: Of the 15-year-old individuals 6.5% were classified as dentally anxious with girls proportionally more fearful than boys (Papers I-III). Dental anxiety correlated significantly with three of the temperament dimensions; emotionality, activity and impulsivity. Reported pain or unpleasant experiences during dental care treatment were clear predictors concerning dental anxiety (Paper I). Both symptoms of general anxiety and depression were significantly correlated with dental anxiety after controlling for other potential risk factors (Paper II). Dental anxiety was associated with both general fearfulness and with attitudes to dental care, where the strongest predictor of dental anxiety was general fearfulness (Paper III). A trend analysis over the 30-year period showed a gradient of statistically significantly decreasing dental anxiety prevalence, from 38.1% in 1973 to 12.8% in 2003. Over the period the 15-year-old individuals with dental anxiety had significantly higher number of filled tooth-surfaces than those with no dental anxiety, and also more caries in 1973. There were no such differences concerning plaque and gingivitis (Paper IV).

CONCLUSIONS: Dental anxiety in 15-year-olds correlated with experiences of dental care, psychosocial factors as well as to oral health. Specifically, pain experiences related to dental care, attitudes to dental care and general fearfulness seem to have the strongest impact on dental anxiety. Dental anxiety showed a clear declining change over time. More girls than boys reported dental anxiety. The thesis shows that dental care providers need paying attention on providing a supportive dental care situation, in which the patients should not experience pain. One part may be adequate local anaesthesia during operative dentistry or similar dental treatments. Another part may be a good oral health to prevent negative experiences of dental care. There is a need for the understanding of psychological factors associated with dental care procedures.

Objectives: Dental anxiety has a major impact on oral health and general quality of life. Previously, some studies have shown an association between dental anxiety and temperament among children and adults. However, there is a lack of cohort studies which have investigated a possible relationship in adolescents. The aim of the present study was to analyse the prevalence of dental anxiety and its association with temperament (EASI - emotionality, activity, sociability, impulsivity), sociodemographic factors and previous painful and unpleasant experiences of dental care among 15-year old individuals.

Methods: The sample included 263 randomly selected 15-year old individuals living in the municipality of Jönköping, Sweden. The school, parental and adolescent consent was acquired. Because no sensitive nor clinical procedures were performed on the 15-year olds, no ethic approval was necessary. Three self-reported questionnaires were used, one included items of sociodemography, while the others dealt with dental anxiety assessed by the Dental Fear Survey (DFS) and temperament assessed by an adapted version of “The EAS Temperament Survey for Children” now composed of 25 items, which has been modified for adults, the EASI temperament survey. SPSS 16.0 was used for statistical analysis with T-test, Mann-Whitney U-test, Chi-square test, Fisher’s exact test, Pearson correlation and Hierarchical multiple regression.

Results: The results showed that 6.5 % of the adolescents were classified as dentally anxious and with girls proportionally more fearful than boys. The three temperaments activity, impulsivity and emotionality were significantly correlated with dental anxiety. A hierarchical multiple regression analysis showed that pain at the last dental appointment or previous pain experiences during dental care treatment were the strongest predictors regarding dental anxiety in 15-year olds. The temperament dimensions activity and impulsivity had also statistically significant correlations to dental anxiety in this regression analysis.

Conclusions: Although some of the temperament dimensions are correlated with dental anxiety, this study showed that previous pain experiences during dental care treatment is a strong predictor for high dental anxiety in 15-year olds.

Syfte: Syftet med föreliggande studie var att bland 15-åringar undersöka prevalens av tandvårdsrädsla och dess samband med temperament (EASI), bakgrundsfaktorer samt tidigare smärtsamma erfarenheter i tandvårdssituationen.

Metod: Urvalet bestod av 263 slumpmässigt utvalda 15-åringar boende i Jönköpings kommun. Tre självrapporterande frågeformulär användes varav ett gällande bakgrundsfaktorer. Grad av tandvårdsrädsla mättes med Dental Fear Survey (DFS) medan temperament mättes med hjälp av en bearbetad version av ”The EAS Temperament Survey for Children”, nu bestående av 25 delfrågor, vilken blivit modifierad för vuxna, EASI temperament survey.

Statistiska analyser: Data analyserades med SPSS 16,0 gällande frekvenser, medelvärden,  standardavvikelser, medianer, samband samt skillnader.

Resultat: Resultatet visade att 6,5 % av ungdomarna klassificerades som tandvårdsrädda med en övervägande andel flickor. De tre temperamenten aktivitet, impulsivitet och emotionalitet var signifikant korrelerade till tandvårdsrädsla. En hierarkisk multipel regression visade emellertid att smärta vid senaste tandläkarbesöket samt om det under uppväxten förekommit smärtsamma eller obehagliga tandbehandlingar var de tydligaste prediktorerna avseende tandvårdsrädsla hos 15-åriga ungdomar. Även dimensionerna aktivitet och impulsivitet i temperament korrelerade signifikant till tandvårdsrädsla i denna regressionsanalys.

Slutsats: Fastän några av dimensionerna i temperament korrelerar med tandvårdsrädsla, visade denna studie, att tidigare smärtsamma erfarenheter i tandvårdssituationen är en stark prediktor gällande hög nivå av tandvårdsrädsla bland 15-åringar.

Studien har inte genomförts med stöd eller forskningsanslag.

Objectives: To report the prevalence of dental anxiety in Swedish 15-year-olds over a 30-year period (1973-2003) and how dental anxiety relates to oral health. Basic research design: The study used a repeated cross-sectional design. Participants: In 1973, 1983, 1993, and 2003, random samples of 96 to 107 15-year-olds were selected from the city of Jönköping, Sweden, 405 overall. Main Outcome Measures: Dental anxiety (DA) and its association with oral health (caries, gingivitis, plaque, fillings) were analysed (α=0.05). Results: The proportions of dentally anxious during the period were 38% (n=37) in 1973, 26% (n=28) in 1983, 18% (n=15) in 1993 and 13% (n=12) in 2003 a clearly decreasing trend with time. The strongest predictor of DA was gender, with girls reporting higher levels of DA. In three of the four examination years, adolescents with DA had more filled permanent surfaces than those without DA. Those with DA had a greater caries experience only in 1973. No associations were found between DA and plaque or gingivitis. Multivariate logistic modelling confirmed that DA decreased over time and that girls had higher levels of DA. Conclusions: This study showed a clear decrease in DA in 15-year-olds over a 30-year period, with a greater proportion of girls being more dentally anxious. The results also indicate a relationship between DA and oral health; the dentally anxious having more filled surfaces and, only in 1973, more decayed tooth surfaces.

Objectives:  The objective of the study was to analyse the relationship between dental anxiety and symptoms of general anxiety and depression among 15-year-old individuals. Methods:  The sample analysed included 221 randomly selected 15-year-old individuals living in the city of Jönköping, Sweden. One questionnaire captured sociodemography and dental history, while dental anxiety was assessed by the Dental Fear Survey (DFS) and symptoms of general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Results:  About 6% of the adolescents were classified as dentally anxious. Symptoms of general anxiety and depression were significantly correlated with dental anxiety in both the bivariate and multivariate analyses. The latter analyses were adjusted for gender and previous painful experiences of dental care. Individuals with high dental anxiety showed general anxiety scores on a clinical level (mean = 9.8, SD = 4.3). Conclusions:  Symptoms of general anxiety and depression were shown to be significantly correlated with dental anxiety among 15-year-old individuals.

Objective: The aim of the present study was to analyse the prevalence of dental anxiety and its association with temperament, sociodemographic factors and previous painful and unpleasant experiences of dental care among 15-year old individuals. Material and methods: The sample included 263 randomly selected 15-year old individuals living in the municipality of Jönköping, Sweden. The school, parental and adolescent consent was acquired. Three self-reported questionnaires were used, one included items of sociodemography, while the others dealt with dental anxiety assessed by the Dental Fear Survey (DFS) and temperament assessed by an adapted version of The EAS Temperament Survey for Children modified for adults, the EASI temperament survey. Results: The results showed that 6.5 % of the  adolescents were classified as dentally anxious and with girls proportionally more fearful than boys. The three temperaments activity, impulsivity and emotionality were significantly correlated with dental anxiety. A hierarchical multiple linear regression analysis showed that pain at the last dental appointment or previous pain experiences during dental care treatment were the strongest predictors regarding dental anxiety in 15-year olds. The temperament dimensions activity and impulsivity were also significantly predictive of dental anxiety. Conclusions: Although some of the temperament dimensions are correlated with dental anxiety, which may emphasize an important finding with regard to personality, this study showed that previous pain experiences during dental care treatment is a strong predictor for high dental anxiety in 15-year olds.

The etiology of dental anxiety (DA) may involve a spectrum of factors related to past dental experiences, general and specific fears, and other personality factors, but is relatively unexplored in adolescents. The aim of this study was to examine how general fearfulness and attitudes to dental care/personnel were related to DA in 15-yr-old subjects. The sample included 263 randomly selected 15-yr-old adolescents living in the municipality of Jönköping in southern Sweden. Four questionnaires were used: one general questionnaire regarding background data and three psychometric instruments dealing with DA, general fearfulness, and dental beliefs. Of all participants, 6.5% were classified as having DA. Dental anxiety was moderately to strongly correlated both with attitudes to dental care/personnel and with general fearfulness and indicated the strongest impact for individuals with both high general fearfulness and high dental beliefs in relation to DA. The linear multiple regression analysis showed that the best predictors of DA were general fearfulness and dental beliefs. This suggests that both individual vulnerability in terms of generalized fear and apprehensions about dental staff, which is linked to experiences of dentistry, appear to be important factors for DA and may be considered as risk factors for DA in adolescents.