A multi-layered barrier to oral health: a mixed methods exploration of dental anxiety

BACKGROUND: Dental anxiety is a prevalent psychological barrier that prevents many individuals from seeking routine dental care. This study aimed to assess the prevalence and predictors of dental anxiety and to explore the experiences of adult patients in a public dental hospital, providing insight into dental anxiety and its impact on treatment behaviors and clinician interactions. METHODS: The study employed an explanatory sequential mixed-method design, beginning with a quantitative phase involving 415 participants assessed using the Dental Fear Scale, followed by a qualitative phase with 12 participants selected via purposive sampling. Quantitative data were analyzed employing t-tests, ANOVA, and multinomial logistic regression. Qualitative data were analyzed via interpretative phenomenological analysis. RESULTS: Quantitative findings revealed moderate dental anxiety levels (mean score: 42.48 ± 18.02), with higher anxiety associated with female gender, older age (≥ 56 years), lower education, irregular dental visit attitudes, a history of dental trauma and complications, and attending for reasons such as orthodontic, pain, or surgery. Qualitative analysis identified four key themes: (1) anticipatory anxiety and bodily reactions, (2) emotional experiences during treatment, (3) past traumatic experiences and psychological residue, (4) relational expectations and anxiety reducing factors. CONCLUSIONS: Dental anxiety is a multifaceted issue influenced by sociodemographic, behavioral, and psychological factors as well as by previous traumatic experiences. The study highlights the need for trauma-informed care, patient-centered communication, and individualized anxiety-reduction strategies in dental practice. Promoting regular preventive visits and addressing anxiety through empathetic, transparent interactions may improve oral health outcomes.