Dental anxiety in a representative sample of residents of a large German city


In a demographic survey, 300 residents of a German city were questioned to determine the prevalence of dental anxiety. The correlation between the amount of dental anxiety and the age, sex, and education of the subjects was examined and the reasons for avoiding dentist’s appointments, the duration of this avoidance, and what the subjects desire from future dental treatment. The Hierarchical Anxiety Questionnaire (HAQ) was used to measure the amount of dental anxiety. The average level of anxiety was 28.8±10.1 according to the HAQ. Young people were more afraid than older people (p=0.007), and women were more anxious than men (p=0.004). Of the women, 72% go to the dentist regularly, but only 60% of the men do (p=0.020). A painful experience while receiving dental treatment was given by 67% as the main reason for their dental anxiety, followed by a fear of needles (35%). The people wished for the most accurate information available about the dental treatment they receive (69%), followed by a compassionate dentist (62%), and treatment that is free of pain (62%). Of the people, 11% [95% CI: (7.5%; 14.5%)] suffer from dental phobia. All dental phobics were able to state the cause of their fear and more urgently wished for help from the dentist in overcoming their anxiety than the non-phobics (p=0.030). To satisfy the needs of the phobic patients, it appears necessary to screen the phobics out of the group of all patients and then offer them adequate therapy, or refer these patients to specialised treatment centres.

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  1. 1.

    (1994) Diagnostic and statistical manual IV: diagnostic criteria from DSM-IV. American Psychiatric Association, Washington, D.C

  2. 2.

    Agras S, Sylvester D, Oliveau D (1969) The epidemiology of common fears and phobia. Compr Psychiatry 10:151–156

    PubMed  Article  Google Scholar 

  3. 3.

    Azrak B, Willershausen B, Keller G (1998) Befragung der Patienten zur Akzeptanz der zahnärztlichen Behandlung in der Universitätsklinik 6:171–186

    Google Scholar 

  4. 4.

    Barkowski D, Bartsch N, Bauch J (1996) Lebenslage, Salutogenese und erhöhtes Kariesrisiko. Prävention 19:103–106

    Google Scholar 

  5. 5.

    Berggren U (1984) Dental fear and avoidance. Thesis, University of Gotenburg, Sweden

  6. 6.

    Berggren U, Carlsson SG (1984) A psychological therapy for dental fear. Behav Res Ther 22:487–492

    PubMed  Article  Google Scholar 

  7. 7.

    Berggren U, Linde A (1984) Dental fear and avoidance: a comparison of two modes of treatment. J Dent Res 63:1223–1227

    PubMed  Google Scholar 

  8. 8.

    Corah NL (1969) Development of a dental anxiety scale. J Dent Res 48:596–602

    PubMed  Google Scholar 

  9. 9.

    Corah NL, Gale EN, Illig SJ (1978) Assesment of a dental anxiety scale. J Am Dent Assoc 97:816–819

    PubMed  Google Scholar 

  10. 10.

    De Jongh A, Muris P, Ter Horst G, Van Zuuren F, Schoenmakers N, Makkes P (1995) One-session treatment of dental phobia: preparing dental phobics for treatment by reconstructuring negative cognitions. Behav Res Ther 33:947–954

    PubMed  Article  Google Scholar 

  11. 11.

    Doerr PA, Lang WP, Nyquist LV, Ronis DL (1998) Factors associated with dental anxiety. J Am Dent Assoc 129:1111–1119

    PubMed  Google Scholar 

  12. 12.

    Duivenvoorden HJ, Schuurs AH, Thoden v, V, Verhage F, Makkes PC, Eijkman MA (1985) Influence of repression upon the measurement of dental anxiety. Community Dent Oral Epidemiol 13:315–318

    PubMed  Article  Google Scholar 

  13. 13.

    Fiset L, Milgrom P, Weinstein P, Melnick S (1989) Common fears and their relationship to dental fear and utilization of the dentist. Anesth Prog 36:258–264

    PubMed  Google Scholar 

  14. 14.

    Fuks AB, Steinbock N, Zadik D (1993) The influence of social and ethnic factors on dental care habits and dental anxiety: a study in Israel. Int J Paediatr Dent 3:3–7

    PubMed  Article  Google Scholar 

  15. 15.

    Gale EN (1972) Fears of the dental situation. J Dent Res 51:964–966

    PubMed  Google Scholar 

  16. 16.

    Gatchel RJ, Ingersoll BD, Bowman L, Robertson MC, Walker C (1983) The prevalence of dental fear and avoidance: a recent survey study. J Am Dent Assoc 107:609–610

    PubMed  Google Scholar 

  17. 17.

    Hakeberg M (1992) Dental anxiety and health. Thesis, University of Gotenburg, Sweden

  18. 18.

    Hakeberg M, Berggren U, Carlsson SG (1992) Prevalence of dental anxiety in an adult population in a major urban area in Sweden. Community Dent Oral Epidemiol 20:97–101

    PubMed  Article  Google Scholar 

  19. 19.

    Hakeberg M, Gustafsson JE, Berggren U, Carlsson SG (1995) Multivariate analysis of fears in dental phobic patients according to a reduced FSS-II scale. Eur J Oral Sci 103:339–344

    PubMed  Article  Google Scholar 

  20. 20.

    Jöhren P (1999) Validierung eines Fragebogens zur Erkennung von Zahnbehandlungsangst. Zahnärzteblatt 108:104–114

    Google Scholar 

  21. 21.

    Jöhren P, Enkling N, Sartory G (2005) Prädiktoren des Vermeidungsverhalten bei Zahnbehandlungsphobie. Dtsch Zahnärztl Z 60:161–165

    Google Scholar 

  22. 22.

    Jöhren P, Gängler P (1999) Die Diagnostik der Zahnbehandlungsangst und der Zahnbehandlungsphobie. Zahnärztl Welt 108:668–685

    Google Scholar 

  23. 23.

    Jöhren P, Margraf-Stiksrud J (2002) Zahnbehandlungsangst und Zahnbehandlungsphobie bei Erwachsenen. Stellungnahme der DGZMK. Deutsch Zahnärztl Z 57:9–10

    Google Scholar 

  24. 24.

    Kleinknecht RA, Klepac RK, Alexander DA (1973) Origins and characteristics of fear of dentistry. J Am Dent Assoc 86:842–847

    PubMed  Google Scholar 

  25. 25.

    Kunzelmann K-H, Dünninger P (1990) Dental fear and pain: effect on patient’s perception of the dentist. Community Dent Oral Epidemiol 18:264–266

    PubMed  Article  Google Scholar 

  26. 26.

    Lindsay SJE, Jackson C (1993) Fear of routine dental treatment in adults: its nature and management. Psychol Health 8:135–153

    Article  Google Scholar 

  27. 27.

    Malamed SF (1993) Pain and anxiety control in dentistry. J Calif Dent Assoc 21:35–39

    PubMed  Google Scholar 

  28. 28.

    McNally RJ (1987) Preparedness and phobias: a review. Psychol Bull 101:283–303

    PubMed  Article  Google Scholar 

  29. 29.

    Mehrstedt M, Tönnies S, Eisentraut I (2002) Zahnbehandlungsängste, Gesundheitszustand und Lebensqualität. Verhaltenstherapie und Verhaltensmedizin 23:329–340

    Google Scholar 

  30. 30.

    Micheelis W, Bauch J (1991) Mundgesundheitszustand und -verhalten in der BRD. Deutscher Ärzteverlag, Köln

    Google Scholar 

  31. 31.

    Milgrom P, Fiset L, Melnick S, Weinstein P (1988) The prevalence and practice management consequences of dental fear in a major US city. J Am Dent Assoc 116:641–647

    PubMed  Google Scholar 

  32. 32.

    Mineka S, Ohman A (2002) Phobias and preparedness: the selective, automatic, and encapsulated nature of fear. Biol Psychiatry 52:927–937

    PubMed  Article  Google Scholar 

  33. 33.

    Moore R, Birn H, Kirkegaard E, Brodsgaard I, Scheutz F (1993) Prevalence and characteristics of dental anxiety in Danish adults. Community Dent Oral Epidemiol 21:292–296

    PubMed  Article  Google Scholar 

  34. 34.

    Neverlien PO (1990) Normative data for Corah’s Dental Anxiety Scale (DAS) for the Norwegian adult population. Community Dent Oral Epidemiol 18:162

    PubMed  Article  Google Scholar 

  35. 35.

    Pierce KA, Kirkpatrick DR (1992) Do men lie on fear surveys? Behav Res Ther 30:415–418

    PubMed  Article  Google Scholar 

  36. 36.

    Ragnarsson E (1998) Dental fear and anxiety in an adult Icelandic population. Acta Odontol Scand 56:100–104

    PubMed  Article  Google Scholar 

  37. 37.

    Schwarz E, Birn H (1995) Dental anxiety in Danish and Chinese adults—a cross-cultural perspective. Soc Sci Med 41:123–130

    PubMed  Article  Google Scholar 

  38. 38.

    Slovin M (1997) Managing the anxious and phobic dental patient. N Y State Dent J 63:36–40

    PubMed  Google Scholar 

  39. 39.

    Stouthard ME, Hoogstraten J (1990) Prevalence of dental anxiety in The Netherlands. Community Dent Oral Epidemiol 18:139–142

    PubMed  Article  Google Scholar 

  40. 40.

    Strauss A, Fagerhough S, Suczek B, Wiener C (1980) Gefühlsarbeit. Ein Beitrag zur Arbeits- und Berufssoziologie. KZfSS 32:629–651

    Google Scholar 

  41. 41.

    Thomson WM, Stewart JF, Carter KD, Spencer AJ (1996) Dental anxiety among Australians. Int Dent J 46:320–324

    PubMed  Google Scholar 

  42. 42.

    Wetzel W-E, Hüge I, Ehret R (1984) Soziostrukturelle Einflüsse auf die Gebißgesundheit 13-14 jähriger Schulkinder. Dtsch Zahnärztl Z 39:456–460

    PubMed  Google Scholar 

  43. 43.

    Willershausen B, Azrak A, Wilms S (1999) Fear of dental treatment and its possible effects on oral health. Eur J Med Res 4:72–77

    PubMed  Google Scholar 

  44. 44.

    Zerfowski M, Koch MJ, Niekusch U, Staehle HJ (1997) Caries prevalence and treatment needs of 7- to 10-year-old schoolchildren in southwestern Germany. Community Dent Oral Epidemiol 25:348–351

    PubMed  Article  Google Scholar 

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Enkling, N., Marwinski, G. & Jöhren, P. Dental anxiety in a representative sample of residents of a large German city. Clin Oral Invest 10, 84–91 (2006).

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  • Dental anxiety/phobia
  • Prevalence
  • Hierarchical anxiety questionnaire