**1. Introduction**

#### **1.1. Definition**

The terms dental anxiety, fear, and phobia, though often used mutually, differ depending on the situation within which they occur. Nevertheless, a distinction has been made between these terminologies. *Dental fear* is a reaction to a known danger, which involves a "fight-or-flight" response when confronted with a threatening stimulus. On the other hand, *dental anxiety* is a

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

reaction to an unknown danger, and *dental phobia* is basically the same as fear, only much stronger, whereby the "fight-or-flight" response occurs when just thinking about or being reminded of the threatening situation [1].

*1.3.4. Cultural issues*

score higher in their fears/anxiety [23].

**2. What is dental anxiety**

diagnosis, and management.

**2.1. Dental anxiety pathway**

individuals' future dental attendance.

tal events as told by other individuals.

is the mother who expresses intensified fearful behavior.

ary measure for misbehaving.

**2.2. Causes of dental anxiety**

*pathway* [24].

The role of culture and norms in modifying individual's perception of dental fear and anxiety is also of prime importance when explaining these phenomena. Culture has been reported to have influence on perceiving dental anxiety [21]. Studies have shown that dental anxiety expression significantly varied according to ethnicity as well as religion due to the engraved dental anxiety coping mechanisms and expression among different cultures [22]. Generally, it has been reported that societies with cultures that emphasize on greater self-control, emotional restraint, and compliance to social rule (such as some Asian and African countries) were more likely to

Dental Anxiety and Its Consequences to Oral Health Care Attendance and Delivery

http://dx.doi.org/10.5772/intechopen.82175

37

In order to understand the dental anxiety well, it is important to explain its pathway, causes,

Five theories are thought to better explain the pathways of dental anxiety: *Pavlovian cognitive conditioning, informative pathway, vicarious conditioning, verbal transmission/threat, and parental* 

*Pavlovian cognitive conditioning* is the most commonly utilized pathway of dental fear and anxiety used by the patients, whereby past painful dental experience may negatively impact an

*Informative pathway* is an indirect pathway to phobia that involves learning about fearful den-

*Vicarious conditioning* is another indirect pathway, whereby individuals may acquire dental phobia by learning indirectly through observing the responses of others attending a dentist. In *Verbal transmission/threat*, there is no direct observation of traumatic/fearful event, but through hearing or reading about dangerous or threatening information about a stimulus irrespective of an actual presence of the threating stimulus. In this pathway, dental visit is used as a disciplin-

*Parental pathway* refers to a situation where a fearful behavior displayed by a parent becomes a pathway of acquiring dental anxiety by a child. A stronger relationship is observed when it

Dental anxiety has a wide range of causes and hence it is considered complex and multifactorial [25]. The causes may be patient, provider, or environment related. The patient-related

Dental anxiety is extremely common, and most people experience some degree of the anxiety especially if they are about to have a certain dental procedure done which they have never experienced before. Moreover, someone with a dental phobia will avoid dental care at all costs until either a physical problem or the psychological burden of the phobia becomes overwhelming. In this chapter, the term dental anxiety is employed.
