|Year : 2018 | Volume
| Issue : 2 | Page : 33-36
Prevalence of dental anxiety among undergraduate students at Muhimbili University of Health and Allied Sciences, Tanzania
Paulo Joseph Laizer1, Tumaini Simon Ndekero2, Karpal Singh Sohal1
1 Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
2 Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
|Date of Web Publication||29-May-2019|
Dr. Karpal Singh Sohal
Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, PO Box: 65014, Dar es Salaam
Source of Support: None, Conflict of Interest: None
Background: Dental anxiety is one of the most common phobias and among the major problems in dentistry. Students in medical field are future health professionals who are supposed to provide a positive attitude toward dentistry to the society. However, if they have dental anxiety, their attitude toward dentistry is likely to be negative. Aim: The aim of this study was to determine the prevalence of dental anxiety among undergraduate students at Muhimbili University of Health and Allied Sciences (MUHAS). Methodology: This was a descriptive cross-sectional study involving undergraduate students at MUHAS. Data were collected using self-administered Modified Dental Anxiety Scale questionnaire with additional questions on demographic characteristics and a list of fear-provoking factors. Data were entered and analyzed using the Statistical Package for the Social Sciences computer software version 19.0 (2010; IBM Corp., Armonk, NY, USA). Chi-square test was used to assess the association between variables, and the significance level was set at P < 0.05. Results: This study enrolled 252 undergraduate students with an age range of 18–39 years. More than half (54.4%) were males. Most (55.2%) of the participants had some degree of dental anxiety. The prevalence of dental anxiety was relatively higher in females (70.4%). The association between dental anxiety and the degree courses was significant. Dental students had the lowest dental anxiety level compared to nondental students. Conclusion: The prevalence of dental anxiety among undergraduate students at MUHAS was high. Dental anxiety was significantly higher in female students. There was a significant relationship between dental anxiety and the degree course of the participants.
Keywords: Dental anxiety, prevalence, undergraduate students
|How to cite this article:|
Laizer PJ, Ndekero TS, Sohal KS. Prevalence of dental anxiety among undergraduate students at Muhimbili University of Health and Allied Sciences, Tanzania. Int J Soc Rehabil 2018;3:33-6
|How to cite this URL:|
Laizer PJ, Ndekero TS, Sohal KS. Prevalence of dental anxiety among undergraduate students at Muhimbili University of Health and Allied Sciences, Tanzania. Int J Soc Rehabil [serial online] 2018 [cited 2020 Aug 5];3:33-6. Available from: http://www.ijsocialrehab.com/text.asp?2018/3/2/33/259323
| Introduction|| |
Dental anxiety is defined as an intuitive, vague, unpleasant feeling that something undesirable is going to happen within a dental context. It is one of the most common phobias and strongly associated with intrusive re-experience. A number of studies have shown that dental anxiety is among the major causes of delay in seeking for dental care among patients.,, Moreover, the relationship between dental anxiety and irregularity of dental attendance has been reported in various studies worldwide.,,,
Dental anxiety is commonly caused by a painful, traumatic, and/or unpleasant dental experience., However, indirect experiences such as hearing other's traumatic experiences or negative views and negative portrayal of dentistry in mass media, films, and cartoons can contribute in its development. In their study, Malvania and Ajithkrishnan found that those patients who had past negative dental experiences were found to be significantly more anxious. Tooth drilling and local anesthetic injection were the most common causes of dental anxiety in studies from Tanzania, Jordan, and Saudi Arabia.
Since dental anxiety has been shown to affect dental health-seeking behavior, health professionals have a role to play in reducing it. Students in medical field are the future health professionals, as such they are the role model of the society. However, if they have dental anxiety, they may not positively portray dentistry to the society member; therefore, this study was undertaken with an aim of determining the prevalence of dental anxiety among undergraduate students at Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania.
| Methodology|| |
This was a cross-sectional descriptive study, conducted at MUHAS, which is a public health university located in Dar es Salaam, Tanzania. The university provides degree in the fields of Medicine (MD), Nursing (BScN), Dentistry (DDS), Pharmacy (BPharm), Environmental Health Science (BScEH), Science in Radiotherapy (BRTT), and Medical Laboratory Sciences (BMLS).
All undergraduate students at MUHAS were eligible to participate in this study. A stratified random sampling method was used to obtain the participants. The degree courses at MUHAS were used as strata, and the simple random sampling method was used for each course to attain the sample size required. There was a variation in number of undergraduate students in different courses at MUHAS. This variation was considered in sampling whereby medical students contributed 30% of the estimated sample size. The pharmacy and nursing students composed 15%, respectively, whereas students in courses of science in radiotherapy, dentistry, environmental health sciences, and medical laboratory sciences contributed 10% of the samples, respectively.
Data were collected using a self-administered Modified Dental Anxiety Scale (MDAS) questionnaire. MDAS contains five questions which are summed together to produce a total score ranging from 5 to 25. It has reasonable psychometric properties and low instrumental effects and can be integrated into everyday dental practice as a clinical aid and screen for dental anxiety. Further questions to obtain information on students' age, sex, degree course, and previous dental visit in the past 5 years were added. Those who responded to have had previous dental visit were required to select the most fear-provoking stimuli to them in a dental environment, from the list of provoking stimuli provided.
The collected information was entered in computer. Coding was done and data were analyzed using the Statistical Package for the Social Sciences (SPSS) computer software version 19.0 (2010; IBM Corp., Armonk, NY, USA).
Data were presented in the form of frequency distribution tables and graphs. Mean was computed in continuous variables. Association between the variables was determined using Chi-square test. P < 0.05 was considered to be statistically significant.
Ethical clearance was obtained from MUHAS Research and Ethical committee. For confidentiality reasons, all respondents registered in the study used serial numbers/alphabets rather than names. Written consent was obtained from the students through the informed consent form which was attached to the questionnaires. Participants were ensured that their information will only be used for scientific purposes and they were free to withdraw themselves at any stage of the study.
| Results|| |
This study included a total of 252 undergraduate students at MUHAS. Majority (137, 54.4%) of the participants were males. The age of the participants ranged from 18 to 39 years with a mean age of 22.87 ± 2.7 years standard deviation [Table 1].
|Table 1: The distribution of the Muhimbili University of Health and Allied Sciences undergraduate students participated in this study according to their sociodemographic details|
Click here to view
The prevalence of dental anxiety among undergraduate students at MUHAS was 55.2%, where 38.1% had moderately anxiety (MDAS score: 15–18) and 17.1% had severe dental anxiety (MDAS score: 19–25). There was a statistically significant relation between dental anxiety and the sex of the participants (P = 0.000), where 46.1% of females had moderate dental anxiety compared to 38.1% of males. The prevalence of severe dental anxiety was 24.3% for female and 17.1% for male students [Table 2].
|Table 2: Level of dental anxiety by sex of the Muhimbili University of Health and Allied Sciences undergraduates (P=0.000)|
Click here to view
The relationship between dental anxiety and the degree course of the undergraduates at MUHAS was statistically significant (P = 0.003). The prevalence of dental anxiety was higher (58%) in nondental students compared to that in dental students (31%), and the difference was statistically significant (P = 0.008) [Table 3]. The relation between dental anxiety and attendance for dental treatment within the past 5 years was found to be statistically insignificance (P = 0.116) [Table 4].
|Table 3: Level of dental anxiety by degree course of the Muhimbili University of Health and Allied Sciences undergraduates (P=0.003)|
Click here to view
|Table 4: Relation between attendance for dental treatment in the past 5 years and the anxiety level of the Muhimbili University of Health and Allied Sciences undergraduate students (P=0.116, statistically insignificant)|
Click here to view
Less than a half (94, 37.3%) of the study participants had dental visit in the past 5 years. Among them, the sound of drilling machines was the most common (51.1%) fear-provoking factor in the dental environment, followed by the screaming from patients who were being treated (39.4%). The smell of disinfectant solutions and the movement of dental chair were the least fear-provoking factors at the dental environment [Figure 1].
|Figure 1: Percentage distribution of respondents according to the common fear-provoking factors in dental environment|
Click here to view
| Discussion|| |
There are many studies done on the prevalence of dental anxiety among different populations across the world; however, few of them involved students in health and allied sciences universities. This was a cross-sectional study to evaluate the prevalence of dental anxiety among undergraduate students at MUHAS.
In this study, the prevalence of dental anxiety among undergraduates at MUHAS was quite high. In previous studies, among university students, the prevalence of dental anxiety was found to range from 10 to 40%., The study done by Al-Omari et al. at Jordan University of Science and Technology undergraduate students found a prevalence of 32%, and an another study done by Inamdar et al. to undergraduate students in Jazan University, Saudi Arabia, found the prevalence of dental anxiety at 37%. The higher prevalence in this study might be attributed to the lack of awareness and traumatic dental experience among the students, as most of them come from rural areas of Tanzania where dental services are not well established.
The relationship between dental anxiety and the sex of the individuals has some controversy. In this study, female undergraduates had a higher prevalence of dental anxiety compared to male undergraduates. The same findings were obtained in the study by Saatchi et al. done in Iran and the other one by Thomson et al. in Australia. In contrast, Settineri et al. found no significant gender difference in dental anxiety in term of dentist–patient relationship, but rather, the use of instruments such as handpiece and the back-tilted position of the dental chair contributed to the difference. The higher dental anxiety among female undergraduates may be attributed to physiological conditions such as panic, stress, and depression.
The present study found a significant relationship between dental anxiety and the field of study of the undergraduates. Nondental students (MD, BPharm, BMLS, BRTT, and BScN) had a higher prevalence of dental anxiety than dental students (DDS). These findings are supported by those found by Al-Omari et al. in Jordan. These results can be accounted by the fact that dental students are more exposed to dental environment and have better education and knowledge on dental procedures than their fellow counterpart. The exposure and knowledge might have helped them to develop the positive attitude toward dental treatment and thus reducing anxiety.
In the present study, the relationship between dental anxiety and the regularity of dental visit was found to be insignificant statistically (P = 0.116), concurring the findings of Malvania and Ajithkrishnan. To the contrary, Quteish Taani and Hawamdeh and Awad found a significant association between dental anxiety and the regularity of dental visits.
The current study depicts that the sound of the tooth drilling machines and patients' screaming while undergoing dental treatment were the most common fear-provoking factors in the dental environment. A study done in India by Muppa et al. found that noises produced by drilling machines in the dental clinic and having to wait in the reception area were the leading anxiety-provoking factors. Similar findings were obtained from the study by Yousuf et al. where noises from dental equipment such as high-speed turbine handpieces, high-velocity suction, ultrasonic instruments, and mixing devices such as amalgamators potentially increased the fear of patients.
| Conclusion|| |
Dental anxiety is highly prevalent in this population despite their medical knowledge and technological advancement in dentistry. This study found a higher prevalence of dental anxiety among female and nondental undergraduates. The relationship between dental anxiety and the frequency of dental visits for treatment was statistically insignificant. The current study also found that screaming by patients while being treated and noises from drilling machines in dental clinics were the most common anxious-provoking factors.
Further studies on dental anxiety and the associated factors have to be conducted in the general population with a varying level of education and socioeconomic status. The curriculum for nondental students in medical schools should incorporate clinical rotation in dental settings, so as to expose the students to dental environment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hakim H, Razak IA. Dental fear among medical and dental undergraduates. Scientific World Journal 2014;2014:747508.
Oosterink FM, de Jongh A, Hoogstraten J. Prevalence of dental fear and phobia relative to other fear and phobia subtypes. Eur J Oral Sci 2009;117:135-43.
Kusekwa M, Kikwilu EN. Reason for late seeking of dental care among dental patients attending dental clinic at school of dentistry MUHAS, Tanzania. Tanzan Dent J 2011;17:7-14.
Kikwilu EN, Frencken JE, Mulder J, Masalu JR. Barriers to restorative care as perceived by dental patients attending government hospitals in Tanzania. Community Dent Oral Epidemiol 2009;37:35-44.
Meng X, Heft MW, Bradley MM, Lang PJ. Effect of fear on dental utilization behaviors and oral health outcome. Community Dent Oral Epidemiol 2007;35:292-301.
Hawamdeh S, Awad M. Dental anxiety: Prevalence and associated factors. Eur J Gen Dent 2013;2:270. [Full text]
Quteish Taani DS. Dental anxiety and regularity of dental attendance in younger adults. J Oral Rehabil 2002;29:604-8.
Šstrøm AN, Skaret E, Haugejorden O. Dental anxiety and dental attendance among 25-year-olds in Norway: Time trends from 1997 to 2007. BMC Oral Health 2011;11:10.
Bracha S, Vega E, Vega C. Posttraumatic dental-care anxiety: Is” dental phobia” a misnomer? Hawaii Dent J 2006;37:17-9.
Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety. Community Dent Health 1996;13:86-92.
Malvania EA, Ajithkrishnan CG. Prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending a dental institution in Vadodara city, Gujarat, India. Indian J Dent Res 2011;22:179-80.
] [Full text]
Al-Omari WM, Al-Omiri MK. Dental anxiety among university students and its correlation with their field of study. J Appl Oral Sci 2009;17:199-203.
Inamdar A, Alwadaani MA, Asiri AE, Arishi AY, Quadri FA, Chokhandre M. Dental anxiety in medical and dental undergraduates at Jazan university. J Oral Health Res 2013;4:25-31.
Humphris GM, Morrison T, Lindsay SJ. The modified dental anxiety scale: Validation and United Kingdom norms. Community Dent Health 1995;12:143-50.
Owibingire SS, Salehe F, Sohal KS. Oral health-related knowledge of nursing school students in Zanzibar. J Oral Health Comm Dent 2017;11:55-60.
Saatchi M, Abtahi M, Mohammadi G, Mirdamadi M, Binandeh ES. The prevalence of dental anxiety and fear in patients referred to Isfahan dental school, Iran. Dent Res J (Isfahan) 2015;12:248-53.
Thomson WM, Stewart JF, Carter KD, Spencer AJ. Dental anxiety among Australians. Int Dent J 1996;46:320-4.
Settineri S, Tati F, Fanara G. Gender differences in dental anxiety: Is the chair position important? J Contemp Dent Pract 2005;6:115-22.
Arslan S, Ertaş ET, Ülker M. The relationship between dental fear and sociodemographic variables. Erciyes Med J 2011;33:295-300.
Muppa R, Bhupatiraju P, Duddu M, Penumatsa NV, Dandempally A, Panthula P, et al.
Comparison of anxiety levels associated with noise in the dental clinic among children of age group 6-15 years. Noise Health 2013;15:190-3.
] [Full text]
Yousuf A, Ganta S, Nagaraj A, Pareek S, Atri M, Singh K, et al.
Acoustic noise levels of dental equipments and its association with fear and annoyance levels among patients attending different dental clinic setups in Jaipur, India. J Clin Diagn Res 2014;8:ZC29-34.
[Table 1], [Table 2], [Table 3], [Table 4]