Dental anxiety among different genders and education levels are shown in Table 3. The majority of the females than males felt anxious about visiting the dentist for treatment tomorrow [382(73.2%) vs. 139 (54.5%), p<0.001], waiting in a room for the treatment [373 (71.5%) vs. 153 (60.0%), p=0.001], about the tooth to be drilled [477 (91.4%) vs. 203(79.6%), p<0.001], about the teeth scaled and polished [477 (91.4%) vs. 203 (79.6%), p<0.001], and about getting local anesthetic injection [471(90.2%) vs. 202 (79.2%), p<0.001]. Similarly, the educational level of the study participants showed significant differences with regards to the dental anxiety while teeth scaled and polished (p<0.001) and about to have a local anesthetic injection (p=0.029).    

Figure 1: Distribution of Modified Dental anxiety scores

The distribution of the modified dental anxiety scores is shown in figure 1. The majority of the study participants were in the moderate (39.4%) category of dental anxiety, followed by mild (32.6%), severe (14.4%), and high (13.6%).

Figure 2: Comparison of mean Modified Dental Anxiety score between genders

Female patients showed a significantly higher score on the Modified Dental Anxiety Scale compared to the males (13.46±0.21 vs. 10.98±0.27, p<0.001) (Figure 2)

Figure 3: Comparison of mean score among different educational levels

Patients having university education showed a higher mean score (13.29±0.32), followed by middle school (12.75±.36), high school (12.11 ±.25), and elementary school (11.29±1.72). However, a comparison of the mean anxiety score did not yield any significant difference across the study participants' different education levels (p=0.053) (Figure 3).

Discussion

This study assessed the prevalence of dental anxiety levels in a sample of adolescent dental patients receiving dental care in private university dental clinics in Riyadh City, Saudi Arabia. An Arabic version of the modified dental anxiety scale with proven validity and reliability was utilized in this study. The prevalence of dental anxiety (score ≥ 10) was high (67.4%) among adolescent dental patients. Studies conducted from Saudi Arabia have reported a prevalence of dental anxiety varying from 27.5%-54.4%.^{17, 25} simultaneously, the prevalence of severe dental anxiety or dental phobia (score ≥ 19) among the adolescent study participants was found to be14.4%. Our study finding is lower than that reported by Al-Madi and Abdellatif ¹⁷ among female adolescents in Saudi Arabia, wherein the prevalence of high dental anxiety was observed in 29% of the study participants. However, the prevalence of high dental anxiety varied in Sweden (5.4%), ²⁶ Malaysia (3.5%) ²⁷ and India (3%).²¹

This reported disparity in the prevalence of severe dental anxiety may be clarified by differences in subject age groups in these studies, where participants were drawn from patients visiting dental clinics of various settings.²⁸ In our study, only adolescent dental patients aged between 13-19 years receiving dental treatment from the undergraduate dental students were assessed for their dental anxiety levels. Additionally, choosing a cut-off point to categorize dental anxiety levels can cause a difference in reporting dental anxiety prevalence.²⁸In this study a modified dental anxiety scale is divided into four categorize to report dental anxiety levels. Our study reported that many study participants were in moderate to mild categorize of dental anxiety scale. Another likely cause for a high level of anxiety observed in our study could be the high proportion of adolescent patients who are typically apprehensive.²⁹

The current literature suggests that females have a lower threshold of pain tolerance and typically experience higher anxiety levels.^{30, 31}Similar findings were observed in our study, which reported significantly higher dental anxiety levels among females than males. Similar results were reported in previous studies carried in different parts of the world. ^{21, 25, 28, 32} This finding could be because females tend to experience more negative emotional states (neuroticism) than males in whom anxiety is positively associated with emotional states.^{33, 34}

Although the mean dental anxiety scores varied across different educational levels, there was an increase in the dental anxiety scores with increasing education years. However, our results indicated that educational level had no significant effect on dental anxiety of the adolescents receiving care from dental students. This finding is in line with the study reported by Arsalan et al. ³⁵ in which no significant difference in the dental anxiety score was observed across various educational levels.

We have some limitations in this study. The data in our study focused on self-reporting, and their responses could be susceptible to prejudice. The study was conducted in a private dental university set-up. Hence, it may be difficult to apply to other dental settings, such as government schools or private dental clinics. The adolescent subjects' dental fear and anxiety were assessed, limiting the application of findings to other age groups. The cut-off points of modified dental anxiety scales considered in this study may be different from other studies. Only dental adolescent patients seeking care from dental students were considered in this study. Thus limiting the generalizability of the results of this study. Further large scale studies involving important age groups and various sociodemographic factors should be considered. 

Conclusions

The majority of adolescent patients treated by dental students at a private dental university showed moderate degrees of dental anxiety. Relatively large dental phobic (14.4%) adolescents have also been documented relative to other research. Females have a higher degree of dental anxiety than males, hence they should be thoroughly screened to develop dental anxiety prevention techniques. However, the level of education did not display any effect on dental anxiety among adolescents in this study.

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Corresponding Author

Dalal R AlAssadi

Dental Intern, College of Dentistry, Riyadh Elm University, P.O. Box 84891, Riyadh 11681, Kingdom of Saudi Arabia.