University of Oulu

Kankaala, T., Rajavaara, P., Kestilä, M., Väisänen, M., Vähänikkilä, H., Laitala, M.-L., & Anttonen, V. (2022). Methods helping dentists to detect dental fear. International Dental Journal, S0020653922001496.

Methods helping dentists to detect dental fear

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Author: Kankaala, Taina1,2; Rajavaara, Päivi1,2,3; Kestilä, Maria1;
Organizations: 1Department of Cariology, Endodontology, and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Finland
2Dental Teaching Unit, City of Oulu, Finland
3Medical Research Center, University of Oulu and Oulu University Hospital
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2023-01-19


Objectives: Dental fear is common and yet often remains unrecognised. COVID-19 has challenged health care since 2020. This study aimed to evaluate patients’ self-reported dental fear and detection of dental fear by the dentists. Another aim was to validate a colour code instrument for estimating dental fear. The influence of COVID-19 on fear and attendance was assessed.

Methods: A cross-sectional survey was conducted in the primary urgent dental care of Oulu, Finland, in spring 2020 and 2021 after the first (T1) and third waves (T2) of the pandemic. Data were obtained for analyses using the Modified Dental Anxiety Scale (MDAS), Facial Image Scale (FIS), and a new “traffic light” colour code for dental fear (CCF). The influence of COVID-19 on dental fear and attendance was assessed with structured and open-ended questions. The questionnaires were completed by 273 anonymous participants.

Results: Of the participants, 167 (61.2%) visited dental care during T1 and 106 (38.8%) during T2. Their mean age was 45.1 years. An MDAS score of 19 or above, indicating severe fear, was reported by 10.6% of the participants. Of those with severe dental fear, 87% chose the red colour in the CCF “traffic light” system. The association between dentists’ and participants’ estimation of dental fear was weak (P < .001) and agreement with the red code was nonexistent (Cohen’s kappa value = −0.035). MDAS scores of the younger participants were higher than those of the older ones after the first wave (T1) (P = .021). COVID-19 had the strongest influence on dental attendance and dental fear of those having the most severe self-reported dental fear as measured by the MDAS.

Conclusions: Colour-coded traffic lights seem valid for screening severe dental fear and are easy and quick to use. They could be useful tools especially since recognising dental fear seems difficult for dentists. The COVID-19 pandemic has complicated dental care for the most fearful individuals.

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Series: International dental journal
ISSN: 0020-6539
ISSN-E: 1875-595X
ISSN-L: 0020-6539
Volume: in press
Issue: in press
DOI: 10.1016/j.identj.2022.06.018
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: The work was partly supported by the University of Oulu, Finland, the Finnish Dental Society Apollonia, the North Ostrobothnia Regional Fund of the Finnish Cultural Foundation, and Regional Council of Oulu Region through Finnish Structural Fund Sustainable growth and work programme 2014-2020 of the European Regional Development Fund (ERDF) under Grant A76934.
Copyright information: © 2022 The Authors. This is an open access article under the CC BY-NC-ND license (