Fear of dental treatment--an underrecognized symptom in people with impaired mental health.
BACKGROUND
In industrialized countries, about 5% to 15% of all adults have a pathologically severe fear of dental treatment, and some 3% avoid going to the dentist altogether. The affected persons may, in turn, suffer from severe dental diseases and their psychosocial effects. Many people with dental phobia have other mental disorders as well. These facts motivated us to study the prevalence of fear of dental treatment in a group of patients being treated by our psychosomatic service.


METHODS
212 patients of our psychosomatic service and 95 healthy controls were studied with the Hierarchical Anxiety Questionnaire (HAQ) to determine the intensity of their fear of dental treatment. Mental disorders were diagnosed with structured clinical interviews according to DSM-IV.


RESULTS
Nearly one patient in three (30.5%, n = 64) suffered from pathologically severe fear of dental treatment; 24 of them (38.5%) had avoided visiting a dentist for longer than one year. Only 4 (4.2%) of the healthy controls were greatly afraid of dental treatment. Certain types of mental disorder were especially highly associated with fear of dental treatment: in particular, anxiety disorders (relative risk [RR] 7.44, 95% confidence interval [CI] 2.68-20.70) and depressive disorders (RR 4.92, 95% CI 1.73-14.05). Patients with post-traumatic stress disorder were affected most commonly: 34 (42%) of these patients were greatly afraid of dental treatment (RR 9.97, 95% CI 3.69-26.90). 75 of the 134 study participants who were afraid of dental treatment (56%) had cancelled a dental appointment, or failed to appear for a scheduled appointment, because of their fears.


CONCLUSIONS
Fear of dental treatment commonly accompanies certain types of mental disorder. Patients at high risk should be asked about such fears so that the problem can be recognized early and appropriately treated.
University Clinic Carl Gustav Carus Dresden Clinic and Polyclinic for Psychotherapy and Psychosomatic Medicine.
Maria
M
Lenk
Hendrik
H
Berth
Peter
P
Joraschky
Katja
K
Petrowski
Kerstin
K
Weidner
Christian
C
Hannig
D000328:Adult; D017677:Age Distribution; D001071:Appointments and Schedules; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D016854:Dental Anxiety / Q000453:epidemiology* / Q000523:psychology*; D003729:Dental Care / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008603:Mental Health; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution