A qualitative study of patients’ views of techniques to reduce dental anxiety

Abstract

Objectives

To explore the fear/anxiety inducing triggers associated with dental treatment, and what dentally anxious adults would like from their dental encounter.

Methods

Two focus-groups and three interviews with fourteen dentally-anxious people were conducted in this qualitative study. All discussions were tape-recorded and transcribed verbatim. Content was categorised by common characteristics to identify underlying themes using thematic analysis.

Results

Four themes were identified to bring general meaning within the content: 1. Preparedness, 2. Teamwork, 3. Reinforced trust, 4. Tailored treatment plan.

Conclusions

Preparatory information may need to be tailored and comprehensive, yet dissociative and reassuring. Dentally-anxious people might want a sense of control and shared-decision making. They may not want dentists to understate the treatment procedures and risks to make them feel better temporarily.

Clinical significance

Dental anxiety affects between 10 and 60% of the population. Participants in this study suggested different ways the dental team could help their anxiety. Therefore, it is key for whole dental team to find out what could be done to help dentally anxious patients.

Introduction

Dental anxiety may directly affect the oral health and indirectly increase the burden of dental treatment. Several studies have reported a prevalence level relating to dental anxiety of 5–60% worldwide amongst adults . The variation seen in reported prevalence data could be due to the differing severity of dental anxiety. Mild dental anxiety may result in disruption to regular attendance whilst in a more severe form may result in patients having never visited a dentist . The literature shows the detrimental effect of this with worse oral health and oral hygiene in more dentally anxious patients . Also due to delays in seeking treatment, dental anxious patients often present with poorer oral health resulting in poorer prognosis for restoration which could mean more extractions. The worsening dental procedures may further aggravate their fear . Moreover, the cost of further restorative treatment for the extraction site may be higher, and such costs disincentivise patients further from seeking dental care and can also affect their overall confidence , and therefore the quality of life . Therefore, the impacts of dental anxiety are far reaching and of economic impact as well as a person’s well-being and this is a major public health problem.

Previous studies into the treatment of dental anxiety have neglected the role of patient in their design and with gaps identified between dentists’ and patients’ perceptions of fear . Hence, a focus on patients’ preferences is needed. To better explore the patient perspective a qualitative method is most appropriate to understand what factors contribute to dental anxiety. The aim of this qualitative study is therefore to explore with dentally anxious adults (i) what are the triggers that exacerbate the fear/anxiety associated with dental treatment, (ii) what could reduce these anxiety triggers towards dental treatment.

Methods

Recruitment of participants

A purposive sample of self-identifying dentally anxious adults was recruited from the University of Leeds either via a poster invitation or using snowballing. The Modified Dental Anxiety Scale (MDAS) was used to quantify the anxiety level of the participants and confirm those who might be dentally phobic were willing to participate discussion ( Table 1 ). Data analysis and collection was concurrent and so recruitment ceased after no additional information was generated and data saturation reached . Ethical approval was obtained from the University Dental Research Ethics Committee (DREC:110416/MCW/199).

Table 1
Demographic data of all participants.
Pseudonym Session Sex Age bracket Health Professional Regular dental visit Last visit RCT hx. MDAS score Anxiety level
1 Fiona FG 1, MC 1 F 18–29 Y Emergency 1–2 yrs ago N 21 High
2 Flo FG 1 F 30–39 Y Never Never N 19 High
3 Fatima FG 1 F 18–29 N Occasional 1–2 yrs ago N 20 High
4 Febe FG 1 F 18–29 N Occasional < 6 mos ago N 11 Moderate
5 Frederica FG 1 F 30–39 Y Emergency 1–2 yrs ago Y 14 Moderate
6 Fergal FG 1 M 40–49 N Regular < 6 mos ago Y 15 Moderate
7 Fifi FG 2, MC 2 F 18–29 N Regular < 6 mos ago N 16 Moderate
8 Frida FG 2 F 30–39 Y Occasional 6–12 mos ago Y 13 Moderate
9 Fanny FG 2 F 30–39 N Emergency 6–12 mos ago N 22 High
10 Farah FG 2 F 18–29 N Regular < 6 mos ago N 18 Moderate
11 Fabian FG 2 M 18–29 N Regular 6–12 mos ago N 15 Moderate
12 Ian I 1 M 18–29 N Emergency < 6 mos ago N 17 Moderate
13 Irena I 2 F 30–39 N Emergency < 6 mos ago N 14 Moderate
14 Iris I 3 F 30–39 N Regular 6–12 mos ago Y 21 High
FG for Focus Group; I for Interview; MC for Member Checking
F for female; M for male.
Y for yes; N for no.
The rules of the pseudonyms are: ‘F’ initial names for participants of focus groups. ‘I’ initial names for participants of interviews. ‘Fi’ initial names for participants of focus groups and member checking.
MDAS for the Modified Dental Anxiety Scale and anxiety level [11,12]. An MDAS score of between 5 and 9, indicating low dental anxiety. An MDAS score of between 10 and 18 indicating moderate dental anxiety, and a score of 19 or more which suggests high dental anxiety.

Tool development

A topic guide for the focus groups was developed based on a literature review and moderated by a clinical dentist with qualitative research training (MCW). As studies have shown that most dentally anxious people might be more afraid of root canal treatment (RCT) than other dental treatment we opted to include questions relating to RCT specifically. Additional resources such as pictures of RCT in cartoon, X-rays and pictures of real teeth were used in the focus groups as some participants may not have had RCT experience. The topic guide was piloted with six people who included an experienced qualitative researcher (KVC) to ensure the questions were clear and facilitated discussion.

Data collection

Two complementary qualitative research methods were adopted in this study. Combining focus group and interview data enabled a more diverse range of the participants’ thoughts to be arrived at . Focus groups are suitable to generate opportunities for participant-led content exploring issues related to anxiety and dental treatment these ideas may have not yet been addressed in the literature before . However, anxiety may make participants feel embarrassment or reluctant to engage in focus groups, and individual interviews may be suitable for such sensitive issues . Besides, participants who were hard to recruit in focus groups could be interviewed to include their ideas .

Two focus groups and three interviews were undertaken with fourteen dentally-anxious adults (11 Women and 3 Men aged 18–49 years) each was audio-recorded, anonymised and transcribed verbatim. Two focus groups took two hours each, and interviews were one hour each. The settings for focus groups and interviews were on university premises and non-clinical to minimize any potential for anxiety .

Data analysis

All focus group and interview transcripts were analysed using thematic analysis . The codes-to-theory model for qualitative inquiries was used to demonstrate the analysis process from codes to themes and presented as figures and mind maps. Analysis was undertaken in Microsoft Word. The coding was done by first author (MCW) and agreed with a second researcher (KVC). The themes were derived from the data and the synthesis of the thematic map was achieved by all four authors to reduce the interpreter bias from the first author (MCW) . Taking into account the possible bias introduced during analysis by the researchers themselves, member-checking was undertaken with one participant from each focus group. This was done with initial themes emerging from the data rather than the actual transcripts to increase the validity of the analyses .

Methods

Recruitment of participants

A purposive sample of self-identifying dentally anxious adults was recruited from the University of Leeds either via a poster invitation or using snowballing. The Modified Dental Anxiety Scale (MDAS) was used to quantify the anxiety level of the participants and confirm those who might be dentally phobic were willing to participate discussion ( Table 1 ). Data analysis and collection was concurrent and so recruitment ceased after no additional information was generated and data saturation reached . Ethical approval was obtained from the University Dental Research Ethics Committee (DREC:110416/MCW/199).

Table 1
Demographic data of all participants.
Pseudonym Session Sex Age bracket Health Professional Regular dental visit Last visit RCT hx. MDAS score Anxiety level
1 Fiona FG 1, MC 1 F 18–29 Y Emergency 1–2 yrs ago N 21 High
2 Flo FG 1 F 30–39 Y Never Never N 19 High
3 Fatima FG 1 F 18–29 N Occasional 1–2 yrs ago N 20 High
4 Febe FG 1 F 18–29 N Occasional < 6 mos ago N 11 Moderate
5 Frederica FG 1 F 30–39 Y Emergency 1–2 yrs ago Y 14 Moderate
6 Fergal FG 1 M 40–49 N Regular < 6 mos ago Y 15 Moderate
7 Fifi FG 2, MC 2 F 18–29 N Regular < 6 mos ago N 16 Moderate
8 Frida FG 2 F 30–39 Y Occasional 6–12 mos ago Y 13 Moderate
9 Fanny FG 2 F 30–39 N Emergency 6–12 mos ago N 22 High
10 Farah FG 2 F 18–29 N Regular < 6 mos ago N 18 Moderate
11 Fabian FG 2 M 18–29 N Regular 6–12 mos ago N 15 Moderate
12 Ian I 1 M 18–29 N Emergency < 6 mos ago N 17 Moderate
13 Irena I 2 F 30–39 N Emergency < 6 mos ago N 14 Moderate
14 Iris I 3 F 30–39 N Regular 6–12 mos ago Y 21 High
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Jun 17, 2018 | Posted by in General Dentistry | Comments Off on A qualitative study of patients’ views of techniques to reduce dental anxiety
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