Dental anxiety – conditions, models, therapy




dental anxiety, discomfort, therapy


Dental anxiety is a condition suffered by many dental patients. It causes psychological discomfort and avoidance of dental appointments, which in turn may lead to oral health issues. Dental anxiety has not yet been fully explored and seems to be still posing challenge to both dentists and psychologists. The aim of this article is to review dental anxiety studies, paying particular attention to the conditions, social, demographic and psychological correlations, as well as the ramifications of this type of anxiety. The article presents the most common psychological models of dental anxiety, methods to measure this type of anxiety and therapy techniques used with patients suffering from dental anxiety.


Download data is not yet available.


Lin CS, Wu SY, Yi CA. Association between anxiety and pain in dental treatment: A systematic review and meta‑analysis. Journal of Dental Research. 2016;1–10.

Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: time for a sense of proportion? British Dental Journal. 2012;213(6):271–274.

Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. Journal of American Dental Association. 1978;97(5):816–819.

McNeil DW, Berryman M.N. Components of dental fear in adults? Behaviour Research and Therapy. 1990;27:233–236.

Carlsson V, Hakeberg M, Wide Boman U. Associations between dental anxiety, sense of coherence, oral health‑related quality of life and health behavior – a national swedish cross‑sectional survey. BMC Oral Health. 2015;15:100.

Armfield JM. Cognitive vulnerability: a model of the etiology of fear. Clinical Psychological Review. 2006;26:746–768.

Sohn W, Ismail AI. Regular dental visits and dental anxiety in an adult dentate population. Journal of American Dental Association. 2005;136(1):58–66.

Tellez M, Kinner DG, Heimberg RG, Lim S, Ismail AI. Prevalence and correlates of dental anxiety in patients seeking dental care. Community Dentistry and Oral Epidemiology. 2015a;43(2):135–142.

Kvale G, Berggren U, Milgrom P. Dental fear in adults: a meta‑analysis of behavioral interventions. Community Dentistry and Oral Epidemiology. 2004;32(4);250–264.

Vassend O. Anxiety, pain and discomfort associated with dental treatment. Behaviour Research and Therapy. 1993;31:659–66.

Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J. The adult dental health survey. London, UK: HMSO; 1998.

Armfield JM, Ketting M. Predictors of dental avoidance among australian adults with different levels of dental anxiety. Health Psychology. 2015;34(9):929–940.

Hakeberg M, Berggren U, Gröndahl HG. A radiographic study of dental health in adult patients with dental anxiety. Community Dentistry and Oral Epidemiology. 1993;21:27–30.

Locker D. Psychosocial consequences of dental fear and anxiety. Community Dentistry and Oral Epidemiology. 2003;31:144–151.

McGrath C, Bedi R. The association between dental anxiety and oral health‑related quality of life in Britain. Community Dentistry and Oral Epidemiology. 2004;31:67–72.

Crofts‑Barnes NP, Rough E, Wilson KE, Beddis AJ, Girdler NM. Anxiety and quality of life in phobic dental patients. Journal of Dental Research. 2010;89(3);302–306.

Oosterink FM, de Jongh A, Aartman IH. Negative events and their potential risk of precipitating pathological forms of dental anxiety. Journal of Anxiety Disorders. 2009;23(4):451–457.

van Wijk AJ, Hoogstraten J. The Fear of Dental Pain questionnaire: construction and validity. European Journal of Oral Science. 2003;111:12–18.

De Jongh A, Aartman I, Brand N. Trauma‑related phenomena in anxious patients. Community Dentistry and Oral Epidemiology. 2003;31:52–58.

Armfield JM. Development and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4C+). Psychological Assessment. 2010;22:279–287.

Berggren U, Meynert G. Dental fear and avoidance – causes, symptoms and consequences. Journal of the American Dental Association. 1984;109:247–251.

Thomson WM, Locker D, Poulton R. Incidence of dental anxiety in young adults in relation to dental treatment experience. Community Dentistry and Oral Epidemiology. 2000;28:289–294.

Hagglin C, Berggren U, Hakeberg M, HaIlstrom T, Bengtsson C. Variations in dental anxiety among middleaged and elderly women in Sweden: A longitudinal study between 1968 and 1996. Journal of Dental Research. 1990;78(10):1655–1661.

Hittner JB, Hemmo R. Psychosocial Predictors of Dental Anxiety. Journal of Health Psychology. 2009;14(1):53–59.

Moore R, Abrahamsen R, Brodsgaard I. Hypnosis compared with group therapy and individual desensitization for dental anxiety. European Journal of Oral Science. 1996;104:612–618.

Economou G. Dental anxiety and personality: Investigating the relationship between dental anxiety and self‑consciousness. Journal of Dental Education. 2003;67:970–980.

De Jongh A, Van Den Oord HJM, Ten Broeke E. Efficacy of eye movement desensitization and reprocessing in the treatment of specific phobias: four single case studies on dental phobia. Journal of Clinical Psychology. 2002;58:1489–1503.

Cohen S, Fiske J, Newton JT. The impact of dental anxiety on daily living. British Dental Journal. 2000;189:385–390.

Kent G. Effects of pre‑treatment inquiries on dental patients postappointment ratings of pain. British Journal of Medical Psychology. 1986;59:97–99.

Kyle BN, McNeil DW, Weaver B, Wilson T. Recall of dental pain and anxiety in a cohort of oral surgery patients. Journal of Dental Research. 2016; 1–6.

Arntz A, Van Eck M, Heijmans M. Predictions of dental pain: the fear of any expected evil is worse than the evil itself. Behaviour Research Therapy. 1990;28(1):29–41.

Eli I, Schwartz‑Arad D, Baht R, Ben‑Tuvim H. Effect of anxiety on the experience of pain in implant insertion. Clinical Oral Implants Research. 2003;14(1):115–118.

Klages U, Ulusoy O, Kianifard S, Wehrbein H. Dental trait anxiety and pain sensitivity as predictors of expected and experienced pain in stressful dental procedures. European Journal of Oral Science. 2004;112(6):477–483.

Locker D, Liddell A, Shapiro D. Diagnostic categories of dental anxiety: a population based study. Behaviour Research and Therapy. 1999;37(1):25–37.

Pohjola V, Mattila AK, Joukamaa M, Lahti S. Anxiety and depressive disorders and dental fear among adults in Finland. European Journal of Oral Science. 2011;119:55–60.

Rachaman S. The conditioning theory of fear‑acquisition: a critical examination. Behaviour Research and Therapy. 1977;15:375–387.

Litt MD. A model of pain and anxiety associated with acute stressors: distress in dental procedures. Behaviour Research and Therapy. 1996;34:459–476.

Senejko A. Obrona psychologiczna jako narzędzie rozwoju (Psychological defense as a tool of development). Warszawa, PWN; 2010.

Milgrom P, Weinstein P. Dental fears in general practice: new guidelines for assessment and treatment. International Dental Journal. 1993;43:288–293.

Kaczmarek U, Kanaffa‑Kilijańska U, Frydecka D. Metody oceny lęku stomatologicznego u dorosłych [Methods of assessing dental anxiety in adults]. Dental Medical Problems. 2010;47:97–100.

Krueger TH, Heller HW, Hauffa BP, Haake P, Exton MS, Schedlowski M. The dental anxiety scale and effects of dental fear on salivary cortisol. Perceptual and Motor Skills. 2005;100:109–117.

Corah NL. Development of a dental anxiety scale. Journal of Dental Research. 1969;48:596.

Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dental Health. 1995;12:143–150.

Gatchel RJ. The prevalence of dental fear and avoidance: expanded adult and recent adolescent surveys. Journal of American Dental Association. 1989;118:591–593.

Gadbury‑Amyot CC, Williams KB. Dental hygiene fear: gender and age differences. Journal of Contemporary Dental Practise. 2000;15:42–59.

Stouthard ME, Hoogstraten J. Prevalence of dental anxiety in the Netherlands. Community Dentistry and Oral Epidemiology. 1990;18:139–42.

Stouthard ME, De Jongh A, Hoogstraten J. Sex differences in dental anxiety. Nederlands Tijdschrift Voor Tandheelkunde. 1991;98(4):156–157.

Kleinknecht RA, Klepac RK, Alexander LD. Origins and characteristics of fear of dentistry. Journal of American Dental Association. 1973;86:842–848.

Gale EN. Fears of the dental situation. Journal of Dental Research. 1972;51:964–966.

Dailey YM, Humphris GM, Lennon MA. Dental anxiety: the use of dental anxiety questionnaires: a survey of a group of UK dental practitioners. British Dental Journal. 2001;190:450–453.

Carlsen A, Humphris GM, Lee GTR, Birch RH. The effect of pretreatment enquiries on child patients post‑treatment ratings of pain and anxiety. Psychology and Health. 1993;8:165–174.

Wolpe J. The practice of behavior therapy. 3rd ed. New York; Pergamon Press; 1982.

Hammarstrand G, Berggren U, Hakeberg M. Psychophysiological therapy vs. hypnotherapy in the treatment of patients with dental phobia. European Journal of Oral Science. 1995;103:399–404.

Tellez M, Potter CM, Kinner DG, Jensen D, Waldron E, Heimberg RG, Myers Virtue S, Zhao H, Ismail A.I. Computerized Tool to Manage Dental Anxiety: A Randomized Clinical Trial. Journal of Dental Research. 2015b;20:1S-7S.

Doering S, Ohlmeier MC, de Jongh A, Hofmann A, Bisping V. Efficacy of a traumafocused treatment approach for dental phobia: a randomized clinical trial. European Journal of Oral Science. 2013;121:584–593.

Van Etten M, Taylor S. Comparative efficacy of treatments for posttraumatic stress disorder: a meta‑analysis. Clinical Psychology and Psychotherapy. 1998;5:126–144.

De Jong R, Schutjes M, Aartman IH. A test of Berggren’s model of dental fear and anxiety. European Journal of Oral Science. 2011;119:361–365.

Janis LI. Psychological Stress: Psychoanalytic and behavioral studies of surgical patients. New York: John Wiley & Sons, 1958.

How to Cite

Sobol-Kwapińska M, Senejko A, Jaśkiewicz L, Kwiatkowska A. Dental anxiety – conditions, models, therapy. JMS [Internet]. 2018 Dec. 30 [cited 2023 Jun. 1];87(4):209-17. Available from:



Review Papers
Received 2018-11-18
Published 2018-12-30