Study on the Dental Fear, Anxiety, Depression

Transcription

1 Original Article Int J Clin Prev Dent 2018;14(1):53-64 ㆍ ISSN (Print) ㆍ ISSN (Online) Study on the Dental Fear, Anxiety, Depression Eun-Joo Na 1, Mi-Hae Yun 1, Hee-Hong Min 1, Soo-Il Shin 2 1 Department of Dental Hygiene, Daejeon Health Institute of Technology, Daejeon, 2 Department of Advanced General Dentistry, School of Dentistry, Dankook University, Cheonan, Korea Objective: Study the psychological status of my fear, anxiety, depression, etc. of the patient to the dentist and we want to be used as a reference for the future care of patients in a dental clinics. Methods: We surveyed 276 patients who visited dental clinics and questionnaire about patient s fear and psychological condition at visit to dental clinic and analyzed statistically. Results: The degree of fear and anxiety in the dentist was higher in women than in men. There was no significant difference in fear and anxiety according to ages, and education and monthly income were not even in the most difference. Fear and instability felt when people were treated by the people around them were more severe than when they were treated by themselves. There was no difference in fear or anxiety according to the periodical dental visits. It was found that dental fear increased when there was no aura, depression, crying, sharp nerves, and it was found that the time to sit on the dental chair and the fear of dental smell were the highest. Conclusion: The fear that the patients feel is not high compared to the existing study and it is thought that the fear and anxiety that the patients continuously feel should be lowered through the publicity and education about the dental care of patients. Keywords: fear, anxiety, depression Introduction In modern society, many people visit hospitals as their interest in health increases [1,2]. The degree of visitation of dental clinics is influenced by social humanities, economic factors, Corresponding author Soo-Il Shin Department of Advanced General Dentistry, School of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: , Fax: , hanashin@daum.net Received March 6, 2018, Revised March 17, 2018, Accepted March 20, 2018 and dental diseases, etc. [1,3]. Recently, these factors and psychological factors, such as dental fear, have been newly emerged, and many hospitals are making a lot of effort in terms of technology and services, and many people are reluctant to visit due to psychological fear [3,4]. The types of negative reactions of patients who visited the dental clinic were resistance, fear, anxiety, timidity, It has been reported that a significant proportion of children and adults experience such negative emotions in dental care [5]. In order to investigate the psychological factors and psychological state of the patients who want to participate in the dentistry through the questionnaire [6,7]. All persons who are presently visiting the dentist or who have visited the dentist. When the subject visited the dentist, they wanted to know based on their experience. Copyright c Korean Academy of Preventive Dentistry. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 53

2 International Journal of Clinical Preventive Dentistry Materials and Methods 1. Subject The subject was a questionnaire survey of 276 persons who had dental care from the 20s to the 60s without disability (Table 1). 2. Method The questionnaire used in the study was as shown in Appendix 1, 2. And, this study was approved by the IRB of the Dankook University Dental Hospital (IRB: DUDH IRB ). The items included in the questionnaire included gender, age, education, monthly income, regular dental visits, visits to dentists for the past year, purpose of dental visits, number of brushings, past pain experience, degree of pain, self-diagnosis oral Table 2. General information of subjects Division Item Number % Gender Male Female Age (yr) 20s s Over Academic level High school graduation University graduation Graduate school graduation Income Less than 2 million won million won Over 4 million Table 3. Dental visit statistics Division Item Number % Table 1. Gender and age distribution of subjects Age (yr) Total Male Female Number % Number % Number % Tatal s s Over Regular visits Yes No Reason for dental visit Regular checkup Preventive care Dental caries treatment Pain treatment Oral prophylaxis Past pain experience When I am cured When other is cured Table 4. Statistical data about the fear of dental care Fear related questionnaire items Not at all Usually it is not Is average Usually it is It really is Number % Number % Number % Number % Number % 1. The dentist is afraid and has put off his promise My dentist was afraid to cancel my appointment I have felt muscle tension when I visited dental clinic I had a bad breath when I visited dental clinic I have a hard time sweating when I visit dental clinic The nausea of the dentist is feared My heart was crushed during my visit to the dentist I am afraid that the dental appointment is approaching I am afraid to get to the dentist I am afraid I am waiting for treatment in the waiting room I am afraid during the waiting time to sit on the treatment chair I am afraid to smell the dental smell I am afraid to see a dentist I am afraid to see needles I am afraid to poke my needle I am afraid to see a drill that heals I am afraid that the drill to be treated is going back I am afraid of feeling when teeth are removed I'm scared when I skate The overall feeling of dentistry is bad Vol. 14, No. 1, March 2018

3 Eun-Joo Na, et al:study on the Dental Fear, Anxiety, Depression Table 5. The statistics related to the physical and psychological status Physical and psychological state Related questionnaire Items Not at all Sometimes Often Always Number % Number % Number % Number % 1. I am depressed and depressed I feel best in the morning during the day I want to cry or cry I can not sleep well at night I eat as usual I still enjoy sex I feel weight loss I am suffering from constipation My heart jumps faster than before I got tired without any reason My spirit is as clear as before I handle things as easily as before I can not calm down because I am restless I think the future is hopeful I am more nervous than usual I have no difficulty making a decision I feel I'm useful and necessary My life is very full I will die when I die I still enjoy what I used to do Table 6. Fear of dental treatment according to gender Fear related questionnaire items Male (n=166) Female (n=110) p-value a 1. The dentist is afraid and has put off his promise. 2.10± ± My dentist was afraid to cancel my appointment. 1.85± ± I have felt muscle tension when I visited dental clinic. 2.57± ± I had a bad breath when I visited dental clinic. 2.01± ± I have a hard time sweating when I visit dental clinic. 2.14± ± The nausea of the dentist is feared. 1.82± ± My heart was crushed during my visit to the dentist. 2.16± ± I am afraid that the dental appointment is approaching. 2.14± ± I am afraid to get to the dentist. 2.13± ± I am afraid I am waiting for treatment in the waiting room. 2.10± ± I am afraid during the waiting time to sit on the treatment chair. 2.17± ± I am afraid to smell the dental smell. 2.11± ± I am afraid to see a dentist. 1.96± ± I am afraid to see needles. 2.48± ± I am afraid to poke my needle. 2.69± ± I am afraid to see a drill that heals. 2.75± ± I am afraid that the drill to be treated is going back. 2.81± ± I am afraid of feeling when teeth are removed. 2.58± ± I'm scared when I skate 2.36± ± The overall feeling of dentistry is bad. 2.36± ± Average of 20 items 2.26± ± Values are presented as mean±standard deviation. a p-value by 2-sample t-test. health status. Fear of feeling during treatment is a total of 20 questions, and the questionnaire is selected from 5 levels of totally not, generally not, normal, generally, and very agree. The questionnaire for the physical and psychological state was also asked to choose among the total of 20 questions, namely, Not 55

4 International Journal of Clinical Preventive Dentistry so, Sometimes, Often, and Always. The questionnaires were classified by gender, age, education, monthly income, by Excel, by Microsoft Office Excel 2013 (Microsoft, Redmond, WA, USA), followed by descriptive statistics through SPSS program (SPSS Inc., Chicago, IL, USA), and using a 2-sample t-test and a member disposed ANOVA was performed to verify significance. Results 1. General information of subjects Table 2 shows the generalities of the 276 participants. 2. Dental visit statistics Table 3 shows the dental visit statistics. 3. Statistics on fear of dental care Table 4 shows statistical data about the fear of dental care in the subject. 4. Statistics related to physical and psychological condition The statistics related to the physical and psychological status of the subject were as shown in Table Statistics on fear of dental practice by factor Table 6-11 show the statistical values of fear of each factor of subject. 6. Correlation between the degree of fear in dental care and the physical psychological state of the day Correlation between the degree of fear in dental care and the physical psychological state of the day was as shown in Table 12, 13. Discussion Our bodies do not accept the positive and negative aspects of stress differently. As a result, when the stress is applied to the body, the positive stress can be perceived as a pain to the body as well as the negative stress and can have a bad influence [8]. In the case of patients who come to the dentist, a certain degree of difference appears, but basically there is some sense of anxiety and fear. Fear, anxiety, and fear in dentist can also be a source of stress for receiving dental care [9]. Dental phobia is a problem that is difficult to solve for patients who need dental care. Patients with dental phobia are not only less cooperative in treatment, but also are often the biggest con- Table 7. Fear of dental treatment according to age Fear related questionnaire items 20s (yr) (n=83) 30s (yr) (n=100) Over 40 (yr) (n=93) p-value a 1. The dentist is afraid and has put off his promise. 1.84± ± ± My dentist was afraid to cancel my appointment. 1.80± ± ± I have felt muscle tension when I visited dental clinic. 2.40± ± ± I had a bad breath when I visited dental clinic. 1.84± ± ± I have a hard time sweating when I visit dental clinic. 2.00± ± ± The nausea of the dentist is feared. 1.66± ± ± My heart was crushed during my visit to the dentist. 2.18± ± ± I am afraid that the dental appointment is approaching. 2.16± ± ± I am afraid to get to the dentist. 2.13± ± ± I am afraid I am waiting for treatment in the waiting room. 2.13± ± ± I am afraid during the waiting time to sit on the treatment chair. 2.17± ± ± I am afraid to smell the dental smell. 2.06± ± ± I am afraid to see a dentist. 1.93± ± ± I am afraid to see needles. 2.61± ± ± I am afraid to poke my needle. 2.87± ± ± I am afraid to see a drill that heals. 2.84± ± ± I am afraid that the drill to be treated is going back. 2.99± ± ± I am afraid of feeling when teeth are removed. 2.60± ± ± I'm scared when I skate 2.24± ± ± The overall feeling of dentistry is bad. 2.35± ± ± Average of 20 items 2.24± ± ± Values are presented as mean±standard deviation. a p-value by one way ANOVA. 56 Vol. 14, No. 1, March 2018

5 Eun-Joo Na, et al:study on the Dental Fear, Anxiety, Depression Table 8. Fear of dental treatment according to academic level Fear related questionnaire items High school graduation (n=87) University graduation (n=167) Graduate school graduation (n=22) p-value a 1. The dentist is afraid and has put off his promise. 2.00± ± ± My dentist was afraid to cancel my appointment. 1.80± ± ± I have felt muscle tension when I visited dental clinic. 2.39± ± ± I had a bad breath when I visited dental clinic. 1.93± ± ± I have a hard time sweating when I visit dental clinic. 2.09± ± ± The nausea of the dentist is feared. 1.80± ± ± My heart was crushed during my visit to the dentist. 2.17± ± ± I am afraid that the dental appointment is approaching. 2.00± ± ± I am afraid to get to the dentist. 1.90± ± ± I am afraid I am waiting for treatment in the waiting room. 1.94± ± ± I am afraid during the waiting time to sit on the treatment chair. 2.09± ± ± I am afraid to smell the dental smell. 2.07± ± ± I am afraid to see a dentist. 1.95± ± ± I am afraid to see needles. 2.75± ± ± I am afraid to poke my needle. 2.99± ± ± I am afraid to see a drill that heals. 3.05± ± ± I am afraid that the drill to be treated is going back. 3.20± ± ± I am afraid of feeling when teeth are removed. 2.79± ± ± I'm scared when I skate 2.47± ± ± The overall feeling of dentistry is bad. 2.37± ± ± Average of 20 items 2.29± ± ± Values are presented as mean±standard deviation. a p-value by one way ANOVA. Table 9. Fear of dental treatment according to income Fear related questionnaire items Less than 2 million won (n=99) million won (n=100) Over 3 million (n=71) p-value a 1. The dentist is afraid and has put off his promise. 1.90± ± ± My dentist was afraid to cancel my appointment. 1.79± ± ± I have felt muscle tension when I visited dental clinic. 2.39± ± ± I had a bad breath when I visited dental clinic. 1.93± ± ± I have a hard time sweating when I visit dental clinic. 2.01± ± ± The nausea of the dentist is feared. 1.65± ± ± My heart was crushed during my visit to the dentist. 2.10± ± ± I am afraid that the dental appointment is approaching. 2.09± ± ± I am afraid to get to the dentist. 2.05± ± ± I am afraid I am waiting for treatment in the waiting room. 2.08± ± ± I am afraid during the waiting time to sit on the treatment chair. 2.14± ± ± I am afraid to smell the dental smell. 2.05± ± ± I am afraid to see a dentist. 1.97± ± ± I am afraid to see needles. 2.84± ± ± I am afraid to poke my needle. 3.13± ± ± I am afraid to see a drill that heals. 3.05± ± ± I am afraid that the drill to be treated is going back. 3.24± ± ± I am afraid of feeling when teeth are removed. 2.91± ± ± I'm scared when I skate 2.52± ± ± The overall feeling of dentistry is bad. 2.46± ± ± Average of 20 items 2.32± ± ± Values are presented as mean±standard deviation. a p-value by one way ANOVA. 57

6 International Journal of Clinical Preventive Dentistry Table 10. Fear of dental treatment according to past pain experience Fear related questionnaire items When I am cured (n=219) When other is cured (n=55) p-value a 1. The dentist is afraid and has put off his promise. 2.16± ± My dentist was afraid to cancel my appointment. 1.92± ± I have felt muscle tension when I visited dental clinic. 2.78± ± I had a bad breath when I visited dental clinic. 2.10± ± I have a hard time sweating when I visit dental clinic. 2.32± ± The nausea of the dentist is feared. 1.89± ± My heart was crushed during my visit to the dentist. 2.32± ± I am afraid that the dental appointment is approaching. 2.34± ± I am afraid to get to the dentist. 2.32± ± I am afraid I am waiting for treatment in the waiting room. 2.27± ± I am afraid during the waiting time to sit on the treatment chair. 2.38± ± I am afraid to smell the dental smell. 2.28± ± I am afraid to see a dentist. 2.15± ± I am afraid to see needles. 2.75± ± I am afraid to poke my needle. 3.05± ± I am afraid to see a drill that heals. 3.05± ± I am afraid that the drill to be treated is going back. 3.13± ± I am afraid of feeling when teeth are removed. 2.89± ± I'm scared when I skate 2.59± ± The overall feeling of dentistry is bad. 2.57± ± Average of 20 item 2.46± ± Values are presented as mean±standard deviation. a p-value by 2-sample t-test. Table 11. Fear of dental treatment according to regular visits Fear related questionnaire items Yes (n=71) No (n=205) p-value a 1. The dentist is afraid and has put off his promise. 2.15± ± My dentist was afraid to cancel my appointment. 2.04± ± I have felt muscle tension when I visited dental clinic. 2.73± ± I had a bad breath when I visited dental clinic. 2.13± ± I have a hard time sweating when I visit dental clinic. 2.32± ± The nausea of the dentist is feared. 2.01± ± My heart was crushed during my visit to the dentist. 2.32± ± I am afraid that the dental appointment is approaching. 2.30± ± I am afraid to get to the dentist. 2.24± ± I am afraid I am waiting for treatment in the waiting room. 2.28± ± I am afraid during the waiting time to sit on the treatment chair. 2.37± ± I am afraid to smell the dental smell. 2.21± ± I am afraid to see a dentist. 2.24± ± I am afraid to see needles. 2.72± ± I am afraid to poke my needle. 2.97± ± I am afraid to see a drill that heals. 2.93± ± I am afraid that the drill to be treated is going back. 2.93± ± I am afraid of feeling when teeth are removed. 2.87± ± I'm scared when I skate 2.45± ± The overall feeling of dentistry is bad. 2.45± ± Average of 20 items 2.43± ± Values are presented as mean±standard deviation. a p-value by 2-sample t-test. 58 Vol. 14, No. 1, March 2018

7 Eun-Joo Na, et al:study on the Dental Fear, Anxiety, Depression Table 12. Correlation between the degree of fear in dental care and the physical psychological state of the day (1) 1. I am depressed and depressed. 2. I feel best in the morning during the day. 3. I want to cry or cry. 4. I can not sleep well at night. 5. I eat as usual. 6. I still enjoy sex. 7. I feel weight loss. 8. I am suffering from constipation. 9. My heart jumps faster than before. 10. I got tired without any reason. 1. The dentist is afraid and has put off his promise. 2. My dentist was afraid to cancel my appointment. 3. I have felt muscle tension when I visited dental clinic. 4. I had a bad breath when I visited dental clinic. 5. I have a hard time sweating when I visit dental clinic. R P R P R P R P R P The nausea of the dentist is feared. R P My heart was crushed during my visit to the dentist. 8. I am afraid that the dental appointment is approaching. R P R P I am afraid to get to the dentist. R P I am afraid I am waiting for treatment in the waiting room. 11. I am afraid during the waiting time to sit on the treatment chair. R P R P I am afraid to smell the dental smell. R P I am afraid to see a dentist. R P I am afraid to see needles. R P I am afraid to poke my needle. R P I am afraid to see a drill that heals. R P I am afraid that the drill to be treated is going back. 18. I am afraid of feeling when teeth are removed. R P R P I'm scared when I skate R P The overall feeling of dentistry is bad. R P Average of 20 items R P R: Pearson correlation, P: p-value. 59

8 International Journal of Clinical Preventive Dentistry Table 13. Correlation between the degree of fear in dental care and the physical psychological state of the day (2) 11. My spirit is as clear as before. 12. I handle things as easily as before. 13. I can not calm down because I am restless. 14. I think the future is hopeful. 15. I am more nervous than usual. 16. I have no difficulty making a decision. 17. I feel I'm useful and necessary. 18. My life is very full. 19. I will die when I die. 20. I still enjoy what I used to do. 1. The dentist is afraid and has put off his promise. 2. My dentist was afraid to cancel my appointment. 3. I have felt muscle tension when I visited dental clinic. 4. I had a bad breath when I visited dental clinic. 5. I have a hard time sweating when I visit dental clinic. R P R P R P R P R P The nausea of the dentist is feared. R P My heart was crushed during my visit to the dentist. 8. I am afraid that the dental appointment is approaching. R P R P I am afraid to get to the dentist. R P I am afraid I am waiting for treatment in the waiting room. 11. I am afraid during the waiting time to sit on the treatment chair. R P R P I am afraid to smell the dental smell. R P I am afraid to see a dentist. R P I am afraid to see needles. R P I am afraid to poke my needle. R P I am afraid to see a drill that heals. R P I am afraid that the drill to be treated is going back. 18. I am afraid of feeling when teeth are removed. R P R P I'm scared when I skate R P The overall feeling of dentistry is bad. R P Average of 20 items R P R: Pearson correlation, P: p-value. 60 Vol. 14, No. 1, March 2018

9 Eun-Joo Na, et al:study on the Dental Fear, Anxiety, Depression tributors to the difficulty of managing patients in the dentist s mind by often delaying treatment or canceling and delaying appointments [5,10,11]. It is not easy to distinguish dental phobia from simply a patient s origin in a hospital called dentistry or some other factor related to dental care [5]. However, it is known that dental phobia usually begins to appear at a young age before adolescence, Locker et al. [12] reported that about half of all dental phobia occurred before adolescence and the remainder was expressed in adolescence and adulthood, with about 16% of all adults having dental phobia. In this study, we investigated the depression of an individual with dental care experience in relation to fear. In a previous study using Kleinknecht s dental fear survey (DFS), Holtzman et al. [13] reported that as age increases, fear and anxiety decrease, and women show more fear due to stimulation at dental care than men. Choi et al. [14] suggest that dental fear is related to gender, and Park and Han [15] are associated with an increase in age and an increase in dental fear in women. This study also showed that females had significantly higher dental fear in gender, and age and education level were not related to fear. However, there was a significant difference in fear items for postponement of dental appointment and scaling in age group, and it was found that fear was high in high age group. Many of our nationals visit dental clinics for treatment rather than prevention [16]. This increases the possibility of experiencing pain in dental care. This dental pain experience will be developed as dental fear in the future. In all studies, fear was high in the past when dental care experienced pain, and In this study, dental care was also correlated with pain experience and dental fear [17]. The results of correlations between depression and dental phobia in individuals show that dental fear increases when patients are sick, depressed, want to cry, nerves are sharp. Thus, if the desk staff or the staff who face the patient can feel such feelings in the patient s behavior or facial expression, it will be helpful to manage the patient. In addition, sitting on the dental chair, there was a high fear of waiting time and the smell of dental. Therefore, patients should be able to listen to music or movies while they are sitting on their chairs, and if they use dental specific odor materials, they should be ventilated more frequently than other days, and if aroma scent is used, the patient s fear can be alleviated. In this study the factors that caused the fear of the dental care, were analyzed only with respect to the depression of an individual. A case of selection of subjects studied only in adults visit the dentist experienced in Daejeon to generalize the results can be limited, and there were few adolescents, and the average age of the subjects was high, which did not reflect age differences. However, it is helpful to identify the factors related to the fear of dental care at present, The dental hygienist will be able to identify those patients in advance to prevent phenomenon that regular checkups and appointments decreased. Therefore, in future research, it is necessary to investigate the relationship between psychological factors and fears in various age groups such as adults, as well as children and adolescents. Conclusion To investigate the psychological state of fear, anxiety, depression, etc., a total of 276 patients who had visited or visited the dentist were enrolled in this study. A questionnaire survey was conducted based on the experience of visiting the dentist. The results were as follows. 1. The degree of fear and anxiety in dentistry was higher in women than in men. 2. Fear and anxiety according to age group showed almost no difference, and there was almost no difference in education and monthly income. 3. The fear and anxiety appeared more when the person was treated directly than the fear and anxiety felt by the person around them. 4. There was no difference in the level of fear and anxiety according to regular dental visits. 5. It was surveyed that dental fear increased when nervousness was sharp when there was no energy, depression, crying, and. The time spent sitting in the dental chair and the smell of dental were found to have the highest fears. References 1. Duncan RP, Gilbert GH, Peek CW, Heft MW. The dynamics of toothache pain and dental services utilization: 24-month incidence. J Public Health Dent 2003;63: Glasrud PH. Dentists characteristics and child behavior management techniques. ASDC J Dent Child 1984;51: Osterberg T, Lundgren M, Emilson CG, Sundh V, Birkhed D, Steen B. Utilization of dental services in relation to socioeconomic and health factors in the middle-aged and elderly Swedish population. Acta Odontol Scand 1998;56: Klages U, Kianifard S, Ulusoy O, Wehrbein H. Anxiety sensitivity as predictor of pain in patients undergoing restorative dental procedures. Community Dent Oral Epidemiol 2006;34: Kim DE. Management of adult dental phobic patients. J Korean Acad Pediatr Dent 2007;34: Schuurs AH, Hoogstraten J. Appraisal of dental anxiety and fear questionnaires: a review. Community Dent Oral Epidemiol 1993;21: Kleinknecht RA, Klepac RK, Alexander LD. Origins and char- 61

10 International Journal of Clinical Preventive Dentistry acteristics of fear of dentistry. J Am Dent Assoc 1973;86: Jung MH, Jun SH. Patients who visit to dental clinic utilization behavior, dental fear and oral and maxillofacial pain. J Dent Hyg Sci 2009;9: Korean Society for Promotion and Disease Prevention homepage [Internet]. Seoul: Korean Society for Promotion and Disease Prevention [cited 2018 Mar 5]. Available from: O Shea RM, Corah NL, Ayer WA. Sources of dentists stress. J Am Dent Assoc 1984;109: Corah NL, O Shea RM, Ayer WA. Dentists management of patients fear and anxiety. J Am Dent Assoc 1985;110: Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999;78: Holtzman JM, Berg RG, Mann J, Berkey DB. The relationship of age and gender to fear and anxiety in response to dental care. Spec Care Dentist 1997;17: Choi SS, Kim JY, Song KB, Lee SK. Analysis of the related factors of dental fear among teenagers in private dental clinics. J Korean Acad Dent Health 2004;28: Park MS, Han KS. A study on the fear, anxiety, depression and the stress symptoms in orofacial region in dental outpatients. J Wonkwang Dent Res Inst 2009;8: Ministry for Health Welfare and Family Affairs. National oral health research for Seoul: Ministry for health Welfare and family affairs; 2004: Jun SH, Jung MH. Relation between the degree of dental service on dental service provider and dental fear. J Korean Soc Dent Hyg 2007;7: Vol. 14, No. 1, March 2018

11 Eun-Joo Na, et al:study on the Dental Fear, Anxiety, Depression Appendix 1. Front of questionnaire. 63

12 International Journal of Clinical Preventive Dentistry Appendix 2. Back of questionnaire. 64 Vol. 14, No. 1, March 2018