title: Predictors of dental avoidance among Australian adults with different levels of dental anxiety.
abstract: OBJECTIVE
  It has been proposed that avoidance of dental visits might be the main determinant of poor oral health outcomes in people with high dental anxiety (HDA). This study aimed to determine the predictors of dental avoidance among people with HDA and also whether these predictors differed from those found in people with lower dental anxiety (LDA).
  
  
  METHODS
  Study participants (n = 596; response rate = 41.1%) comprised a random cross-sectional sample of the Australian adult population who completed a mailed self-complete questionnaire containing items relating to the use and accessibility of dental services, trust in dental professionals, dental anxiety, dental experiences, self-perceived oral health, vulnerability-related perceptions of visiting the dentist, and psychological health. Multiple imputation was used to replace missing values and statistically significant variables in bivariate analyses were entered into a multivariable logistic generalized linear model.
  
  
  RESULTS
  More than two-thirds of participants with HDA were currently avoiding or delaying a dental visit. Among people with HDA, dental avoidance was independently and significantly predicted by difficulty paying a $300 dental bill, having no or only little trust in the last-visited dentist, perceived treatment need and dental anxiety. Among people with LDA, only perceived treatment need and dental anxiety predicted avoidance.
  
  
  CONCLUSIONS
  In addition to their high anxiety, a number of additional barriers to dental visiting were found for people with HDA. These barriers, especially cost and communication issues with dentists, need to be addressed to assist people with HDA obtain necessary, regular dental care.
authors.affiliation: Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Armfield
authors.affiliation: Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam.
authors.forename: Manon
authors.initials: M
authors.lastname: Ketting
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003430:Cross-Sectional Studies; D016854:Dental Anxiety / Q000523:psychology*; D003729:Dental Care / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult