- Email: [email protected]
Dental anxiety and regularity of dental attendance
J. Dent.
1986;
14: 209-213
Printed
Dental anxiety attendance
in Great Britain
209
and regularity
of dental
J. Woolgrove Department
of Community
Dental Health, King’s College School of Medicine and Dentistry, London
G. Cumberbatch Applied Psychology Division, Aston University, Birmingham J. Dent. 1986;
14: 209-213
(Received
14 April 1986;
accepted
9 June
1986)
ABSTRACT The relationship between dental anxiety and regularity of dental attendance was investigated by means of a questionnaire study of 248 dentate adults. The results confirmed that anxiety was a major barrier to seeking dental care. High levels of dental anxiety were associated with a history of painful dental treatment, unpleasant dental experiences and the expectation that future dental treatment would be painful. The findings support a classical conditioning model of dental anxiety, and highlight the importance of good patient management with children to avoid damaging experiences.
INTRODUCTION Regular dental visits have been generally recommended by the dental profession (Levine, 1985), although their frequency has been the subject of some debate (Sheiham, 1977; Elderton, 1985). However, self-reported dental attendance behaviour has suggested that only about half the British population visit the dentist for regular check-
ups (Todd et al., 1982). A recent study by Eddie (1984) suggested that actual attendance behaviour is even less frequent. The dental profession’s concern over ‘missing patients’ led to the formation of a General Dental Services Working Party whose remit was “to study methods of encouraging the very large group of the population which rarely visits the dentist to seek more dental care” (Anonymous, 1984). Green and Green (1984) have stated that there is a paucity of sound data on adults’ attitudes to dental treatment, but there is considerable evidence to suggest that anxiety is a barrier to dental care (Lindsay and Woolgrove, 1982; Schuurs et al., 1984). The aim of this study was to investigate the relationship between dental anxiety and dental attendance amongst dentate adults.
METHOD The survey was carried out by means of a standardized questionnaire. Questions covered dental attendance behaviour, dental experiences and expectations, and
dental attitudes. The Corah Dental Anxiety Scale (Corah, 1969) was included to yield a measure of anxiety on a scale from 4 to 20 from responses to the following four questions: 1. If you had to go to the dentist tomorrow, how would you feel about it? a, I would look forward to it as a reasonably enjoyable experience (score 1). b, I wouldn’t care about it one way or the other (score 2). c, I would be a little uneasy about it (score 3). d, I would be afraid it would be unpleasant and painful (score 4). e, I would be very frightened of what the dentist might do (score 5 ). 2. feel? a, b, c, d, e, almost
You are in the dentist’s waiting room, how do you Relaxed (score 1). A little uneasy (score 2). Tense (score 3). Anxious (score 4). So anxious that I sometimes break out in a sweat or feel physically sick (score 5).
3. When you are in the dentist’s chair waiting while he gets his drill ready to begin working on your teeth, how do you feel? Same responses as in question 2.
210
4.
J. Dent.
1986; 14: No. 5
You are in the dentists chair to have your teeth
cleaned. While you are waiting and the dentist is getting out the instruments which he will use to scrape your teeth around the gums, how do you feel? Same responses as in question 2.
“How often do you usually visit the dentist?”
every 6 months 6 months to 1 year l-3 years less than every 3 years
%
n
Anxiety score
29 16 24 31
70 40 58 75
8.9 10.3 10.2 11.4
243
Total SAMPLE A sample of 386 casual patients (i.e., patients without an appointment) awaiting examination at Birmingham Dental Hospital was asked to complete the questionnaire. This sample produced 333 questionnaires and 53 refusals. Many of the people who refused to complete the questionnaire had a poor command of the English language. Ten of the questionnaires were completed by people outside the study population-seven wore full dentures and three were under 16 years of age. A further 73 questionnaires were not fully completed (because patients were summoned for treatment before they had time to complete the questionnaire) and two questionnaires were spoiled. Thus the eligible sample was 303, which provided 248 questionnaires for analysis, representing an 82 per cent response rate. However, some questionnaires had one or two questions unanswered, and consequently not all the results are based on a sample size of 248. The age of the respondents (59 per cent male and 41 per cent female) ranged from 16 to 65 years with a mean of 30.
The Corah Dental Anxiety Scale produced a mean score of 10.2 for the total sample with the expected sex and age differences: males had a lower score (9.3) than females (11*4), and respondents over 30 years old had a lower score (9.6) than younger subjects (10.7). The following list of questions shows the number of people giving each response and the mean Corah anxiety score for each group: “Do you normally visit the dentist for?”
Total
“How often do you think that people should visit the dentist?”
every 6 months 6 months to 1 year l-3 years more than 3 years
%
n
Anxiety score
71 21 5 3
173 52 13 7
10.5 9.6 9.9 9.3
245
Total
Here 92 per cent of the sample thought that they should visit once a year or more. In order to investigate the discrepancy between the above results and people’s actual attendance patterns, we asked: “If you go to the dentist less often than you think you should, please say why”. Table I offers a classification of the 164 spontaneously mentioned reasons produced by 15 1 respondents. While anxiety predominates as the most frequent reason given, some ofthe other explanations (e.g., only go when in pain) may disguise anxiety-related reasons. In order to explore anxiety directly we asked: “Have you ever avoided or delayed a dental visit because of fear?”
RESULTS
a regular check-up occasional check-up when teeth give trouble
A significant minority (3 1 per cent) attended less often than once in 3 years, but ignorance of the need for regular check-ups was not the main reason for this:
%
n
Anxiety score
35 16 50
85 39 122
9.1 9.6 11.3
246
Those who normally visited the dentist only when they were having trouble with their teeth showed higher anxiety scores and were the majority in this sample. This is not surprising in a sample of casual patients.
never rarely sometimes often Total
%
n
Anxiety score
61 9 18 12
149 23 45 29
8.5 10.7 13.0 14.7
246
Table I. Reasons for not attending the dentist as often as they thought thev should Reason Anxiety inconvenience/time Only go when in pain Dislike going Laziness Forget cost Unclassified Total
Number mentioning reason :: 27 19 11 9 6 15 164
Woolgrove
Here some 30 per cent ofthe sample sometimes or often delayed treatment because of fear. Of greater interest is the high correlation between anxiety and delaying treatment: those who had never delayed receiving treatment because of fear had a mean anxiety score of 8.5, while those who often did so had a mean score of 14.7. Over half of the sample chose to answer: “If you fear going to the dentist, please try to explain why”. Table II gives a classification of the 146 reasons produced by 13 1 respondents. Pain was mentioned twice as often as any other reason. “Has your dental treatment caused you any pain?”
no pain slight pain moderate pain much pain
%
n
Anxiety score
25 42 22 11
62 102 54 27
8.1 10.0 11.3 14.2
Total
“Have you ever had a very unpleasant experience at the dentist?”
no yes
%
n
Anxiety score
47 53
113 126
9.0 11.3
Total
239
The age at which these experiences happened varied from 1 to 38 years, with a mean of 14. Anxiety was related to the amount of pain dental treatment had caused and to expectations of treatment being unpleasant; here anxiety scores of those who expected treatment to be unpleasant were almost twice those who expected it to be not at all unpleasant: your next dental treatment
not at all unpleasant slightly unpleasant moderately unpleasant very unpleasant Total
Dental
211
anxiety
Table Il. Reasons for dental anxiety Reason
Number mentioning reason
Pain The unexpected injections Nervous disposition Traumatic experiences Waiting Fillings Dentist’s manner Dental probing Sight of instruments Lack of control Unclassified
40 17 15 11 11 7 6 5 4 4 4
22 146
Total
People differed quite markedly in their perceptions of their sensitivity to pain: “How sensitive are you to pain?”
245
Here again there is a very marked difference in anxiety scores betweeen the groups who had different experiences of pain. While only one-third of the respondents admitted to moderate or much pain, over half of them claimed a very unpleasant experience at the dentist:
“Do you expect unpleasant?”
and Cumberbatch:
to be
%
n
Anxiety score
31 43 14 11
77 106 35 27
7.7 10.3 12.4 15.2
245
very sensitive
slightly more sensitive than most people slightly less sensitive than most people only slightly sensitive
Anxiety score
%
n
30
72
12.1
20
47
11.0
24 26
57 63
9.8 8-O
239
Total
As expected these perceptions were related to the anxiety felt about treatment, with those who felt they were very sensitive feeling the most anxious. While those who preferred extraction to tilling were slightly more anxious than those who preferred tilling, these differences were small: “If you went to the dentist with an aching front tooth, would you want it taken out or filled?”
taken out tilled
%
n
Anxiety score
31 69
75 167
11.2 9.8
Total
242
“If you went to the dentist with an aching back tooth, would you want it taken out or filled?”
taken out tilled Total
%
n
Anxiety score
45
133
55
109
11.0 9.4
242
212
J. Dent.
1986;
14:
No. 5
Table ill. Attendance pattern by frequency of attendance Regular check-up
Occasional check-up
6 months 6 months-l year l-3 years Less than every 3 years
67 15 2 0
3 19 17 0
Total
84
39
Frequency
While it might be expected that dental hygiene might be related to anxiety about treatment, this was not evident from our data: “How often do you clean your teeth?”
less than once per day once per day twice per day more than twice per day Total
%
n
Anxiety score
10 38 40 12
25 93 98 30
9.1 10.7 10.4 9.2
246
Table ZZZshows the reported attendance pattern broken down by claimed frequency of attendance.
DISCUSSION
Only 35 per cent of the respondents claimed to visit the dentist for regular check-ups. This is less than the 43 per cent reported by Todd et al. (1982), presumably because casual attenders were over-represented in patients awaiting diagnosis in a dental hospital. Only 80 per cent of the people who claimed to attend the dentist for regular checkups also claimed to visit every 6 months; indeed two people admitted to attending less than once per year. Eddie ( 1984) reported a surprisingly large difference between the number of people who said they went regularly for a dental check-up and the number who actually attended frequently. Part of the difference noted by Eddie would seem to arise because some people perceive regular dental check-ups as being infrequent. The mean for the Corah Dental Anxiety Scale was 10.2, which compares with a mean of 9.7 for a group of London adults (Liddell and May, 1984). This is explained by the greater prevalence of casual attenders in our sample. A strong inverse relationship between frequency of attendance and anxiety was evident-6-monthly attenders had an anxiety score of 8.9 against 11.4 for people attending at intervals greater than 3 years. Table Zshows that anxiety was the most common reason for people not attending the dentist as often as they thought they should.
Trouble only 0 6 39 75
Total 70 40 58 75
120
Furthermore, 39 per cent of the sample admitted that they had avoided or delayed a dental visit because of fear. These findings confirm that anxiety is a major barrier to seeking dental care. Over half the respondents reported having had one or more very unpleasant experiences at the dentists and these respondents had an elevated Corah anxiety score. Most of these experiences had occurred in childhood, supporting the suggestion by Lautch ( 197 1) that children go through a susceptible period during which they can be easily sensitized to experiences. These results demonstrate the importance of good patient management with children to avoid damaging experiences. Table ZZshows that many people blame their fear upon expectation of pain or procedures causing pain such as injections. High levels of dental anxiety were associated with a history of painful dental treatment and unpleasant dental experiences. The more dentally anxious respondents considered themselves to be particularly sensitive to pain and expected future dental treatment to be painful. These findings support a classical conditioning model of dental anxiety, but do not exclude the possibility of cognitive influences such as reconstruction of memory as suggested by Kent (1985).
References
Anonymous (1984) The missing patients. Br. Dent. J. 156,
73. Corah N. L. (1969) Development of a dental anxiety scale. J. Dent. Res. 48, 596. Eddie S. (1984) Frequency of attendance in the general dental service in Scotland. Br. Dent. J. 157, 267-270. Elderton R. J. (1985) Routine six-monthly checks for dental disease. Br. Dent. J. 159, 277-278. Green R. M. and Green A. (1984) What about the reluctant patients? Br. Dent. J. 156, 387. Kent G. (1985) Cognitive processes in dental anxiety. Br. J. Clin. Psychol. 24, 259-264. Lautch H. (1971) Dental phobia. Br. J. Psychiatry 119, 151-158. Levine R. S. (1985) The scientific basis of dental health education: a Health Education Council policy document. Br. Dent. J. 158,223-226. Liddell A. and May B. (1984) Some characteristics of regular and irregular attenders for dental check-ups. Br. J. Clin. Psychol. 23, 19-26.
Woolgrove and Cumberbatch:
Lindsay S. and Woolgrove J. (1982) Fear and pain in dentistry. Bull. Br. Psych&. SW. 35, 225-228. Schuurs A. H. B., Duivenvoorden H. J., Thoden van Velzen S. A. et al. (1984) Dental anxiety, the parental family and regularity of dental attendance. Community Dent. Oral Epidemiol. 12, 89-95.
Correspondence
Dental anxiety
213
Sheiham A. (1977) Is there a scientific basis for the six-monthly dental examination? Lancer ii, 424-444. Todd J. E., Walker A. M. and Dodd P. (1982) Adult Dental Health, vol. 2. London, HMSO.
should be addressed to: Mr J. Woolgrove, Lister Health Centre, 1 Camden Square, Peckham, London, SE15 3LW.
1986;
14: 209-213
Printed
Dental anxiety attendance
in Great Britain
209
and regularity
of dental
J. Woolgrove Department
of Community
Dental Health, King’s College School of Medicine and Dentistry, London
G. Cumberbatch Applied Psychology Division, Aston University, Birmingham J. Dent. 1986;
14: 209-213
(Received
14 April 1986;
accepted
9 June
1986)
ABSTRACT The relationship between dental anxiety and regularity of dental attendance was investigated by means of a questionnaire study of 248 dentate adults. The results confirmed that anxiety was a major barrier to seeking dental care. High levels of dental anxiety were associated with a history of painful dental treatment, unpleasant dental experiences and the expectation that future dental treatment would be painful. The findings support a classical conditioning model of dental anxiety, and highlight the importance of good patient management with children to avoid damaging experiences.
INTRODUCTION Regular dental visits have been generally recommended by the dental profession (Levine, 1985), although their frequency has been the subject of some debate (Sheiham, 1977; Elderton, 1985). However, self-reported dental attendance behaviour has suggested that only about half the British population visit the dentist for regular check-
ups (Todd et al., 1982). A recent study by Eddie (1984) suggested that actual attendance behaviour is even less frequent. The dental profession’s concern over ‘missing patients’ led to the formation of a General Dental Services Working Party whose remit was “to study methods of encouraging the very large group of the population which rarely visits the dentist to seek more dental care” (Anonymous, 1984). Green and Green (1984) have stated that there is a paucity of sound data on adults’ attitudes to dental treatment, but there is considerable evidence to suggest that anxiety is a barrier to dental care (Lindsay and Woolgrove, 1982; Schuurs et al., 1984). The aim of this study was to investigate the relationship between dental anxiety and dental attendance amongst dentate adults.
METHOD The survey was carried out by means of a standardized questionnaire. Questions covered dental attendance behaviour, dental experiences and expectations, and
dental attitudes. The Corah Dental Anxiety Scale (Corah, 1969) was included to yield a measure of anxiety on a scale from 4 to 20 from responses to the following four questions: 1. If you had to go to the dentist tomorrow, how would you feel about it? a, I would look forward to it as a reasonably enjoyable experience (score 1). b, I wouldn’t care about it one way or the other (score 2). c, I would be a little uneasy about it (score 3). d, I would be afraid it would be unpleasant and painful (score 4). e, I would be very frightened of what the dentist might do (score 5 ). 2. feel? a, b, c, d, e, almost
You are in the dentist’s waiting room, how do you Relaxed (score 1). A little uneasy (score 2). Tense (score 3). Anxious (score 4). So anxious that I sometimes break out in a sweat or feel physically sick (score 5).
3. When you are in the dentist’s chair waiting while he gets his drill ready to begin working on your teeth, how do you feel? Same responses as in question 2.
210
4.
J. Dent.
1986; 14: No. 5
You are in the dentists chair to have your teeth
cleaned. While you are waiting and the dentist is getting out the instruments which he will use to scrape your teeth around the gums, how do you feel? Same responses as in question 2.
“How often do you usually visit the dentist?”
every 6 months 6 months to 1 year l-3 years less than every 3 years
%
n
Anxiety score
29 16 24 31
70 40 58 75
8.9 10.3 10.2 11.4
243
Total SAMPLE A sample of 386 casual patients (i.e., patients without an appointment) awaiting examination at Birmingham Dental Hospital was asked to complete the questionnaire. This sample produced 333 questionnaires and 53 refusals. Many of the people who refused to complete the questionnaire had a poor command of the English language. Ten of the questionnaires were completed by people outside the study population-seven wore full dentures and three were under 16 years of age. A further 73 questionnaires were not fully completed (because patients were summoned for treatment before they had time to complete the questionnaire) and two questionnaires were spoiled. Thus the eligible sample was 303, which provided 248 questionnaires for analysis, representing an 82 per cent response rate. However, some questionnaires had one or two questions unanswered, and consequently not all the results are based on a sample size of 248. The age of the respondents (59 per cent male and 41 per cent female) ranged from 16 to 65 years with a mean of 30.
The Corah Dental Anxiety Scale produced a mean score of 10.2 for the total sample with the expected sex and age differences: males had a lower score (9.3) than females (11*4), and respondents over 30 years old had a lower score (9.6) than younger subjects (10.7). The following list of questions shows the number of people giving each response and the mean Corah anxiety score for each group: “Do you normally visit the dentist for?”
Total
“How often do you think that people should visit the dentist?”
every 6 months 6 months to 1 year l-3 years more than 3 years
%
n
Anxiety score
71 21 5 3
173 52 13 7
10.5 9.6 9.9 9.3
245
Total
Here 92 per cent of the sample thought that they should visit once a year or more. In order to investigate the discrepancy between the above results and people’s actual attendance patterns, we asked: “If you go to the dentist less often than you think you should, please say why”. Table I offers a classification of the 164 spontaneously mentioned reasons produced by 15 1 respondents. While anxiety predominates as the most frequent reason given, some ofthe other explanations (e.g., only go when in pain) may disguise anxiety-related reasons. In order to explore anxiety directly we asked: “Have you ever avoided or delayed a dental visit because of fear?”
RESULTS
a regular check-up occasional check-up when teeth give trouble
A significant minority (3 1 per cent) attended less often than once in 3 years, but ignorance of the need for regular check-ups was not the main reason for this:
%
n
Anxiety score
35 16 50
85 39 122
9.1 9.6 11.3
246
Those who normally visited the dentist only when they were having trouble with their teeth showed higher anxiety scores and were the majority in this sample. This is not surprising in a sample of casual patients.
never rarely sometimes often Total
%
n
Anxiety score
61 9 18 12
149 23 45 29
8.5 10.7 13.0 14.7
246
Table I. Reasons for not attending the dentist as often as they thought thev should Reason Anxiety inconvenience/time Only go when in pain Dislike going Laziness Forget cost Unclassified Total
Number mentioning reason :: 27 19 11 9 6 15 164
Woolgrove
Here some 30 per cent ofthe sample sometimes or often delayed treatment because of fear. Of greater interest is the high correlation between anxiety and delaying treatment: those who had never delayed receiving treatment because of fear had a mean anxiety score of 8.5, while those who often did so had a mean score of 14.7. Over half of the sample chose to answer: “If you fear going to the dentist, please try to explain why”. Table II gives a classification of the 146 reasons produced by 13 1 respondents. Pain was mentioned twice as often as any other reason. “Has your dental treatment caused you any pain?”
no pain slight pain moderate pain much pain
%
n
Anxiety score
25 42 22 11
62 102 54 27
8.1 10.0 11.3 14.2
Total
“Have you ever had a very unpleasant experience at the dentist?”
no yes
%
n
Anxiety score
47 53
113 126
9.0 11.3
Total
239
The age at which these experiences happened varied from 1 to 38 years, with a mean of 14. Anxiety was related to the amount of pain dental treatment had caused and to expectations of treatment being unpleasant; here anxiety scores of those who expected treatment to be unpleasant were almost twice those who expected it to be not at all unpleasant: your next dental treatment
not at all unpleasant slightly unpleasant moderately unpleasant very unpleasant Total
Dental
211
anxiety
Table Il. Reasons for dental anxiety Reason
Number mentioning reason
Pain The unexpected injections Nervous disposition Traumatic experiences Waiting Fillings Dentist’s manner Dental probing Sight of instruments Lack of control Unclassified
40 17 15 11 11 7 6 5 4 4 4
22 146
Total
People differed quite markedly in their perceptions of their sensitivity to pain: “How sensitive are you to pain?”
245
Here again there is a very marked difference in anxiety scores betweeen the groups who had different experiences of pain. While only one-third of the respondents admitted to moderate or much pain, over half of them claimed a very unpleasant experience at the dentist:
“Do you expect unpleasant?”
and Cumberbatch:
to be
%
n
Anxiety score
31 43 14 11
77 106 35 27
7.7 10.3 12.4 15.2
245
very sensitive
slightly more sensitive than most people slightly less sensitive than most people only slightly sensitive
Anxiety score
%
n
30
72
12.1
20
47
11.0
24 26
57 63
9.8 8-O
239
Total
As expected these perceptions were related to the anxiety felt about treatment, with those who felt they were very sensitive feeling the most anxious. While those who preferred extraction to tilling were slightly more anxious than those who preferred tilling, these differences were small: “If you went to the dentist with an aching front tooth, would you want it taken out or filled?”
taken out tilled
%
n
Anxiety score
31 69
75 167
11.2 9.8
Total
242
“If you went to the dentist with an aching back tooth, would you want it taken out or filled?”
taken out tilled Total
%
n
Anxiety score
45
133
55
109
11.0 9.4
242
212
J. Dent.
1986;
14:
No. 5
Table ill. Attendance pattern by frequency of attendance Regular check-up
Occasional check-up
6 months 6 months-l year l-3 years Less than every 3 years
67 15 2 0
3 19 17 0
Total
84
39
Frequency
While it might be expected that dental hygiene might be related to anxiety about treatment, this was not evident from our data: “How often do you clean your teeth?”
less than once per day once per day twice per day more than twice per day Total
%
n
Anxiety score
10 38 40 12
25 93 98 30
9.1 10.7 10.4 9.2
246
Table ZZZshows the reported attendance pattern broken down by claimed frequency of attendance.
DISCUSSION
Only 35 per cent of the respondents claimed to visit the dentist for regular check-ups. This is less than the 43 per cent reported by Todd et al. (1982), presumably because casual attenders were over-represented in patients awaiting diagnosis in a dental hospital. Only 80 per cent of the people who claimed to attend the dentist for regular checkups also claimed to visit every 6 months; indeed two people admitted to attending less than once per year. Eddie ( 1984) reported a surprisingly large difference between the number of people who said they went regularly for a dental check-up and the number who actually attended frequently. Part of the difference noted by Eddie would seem to arise because some people perceive regular dental check-ups as being infrequent. The mean for the Corah Dental Anxiety Scale was 10.2, which compares with a mean of 9.7 for a group of London adults (Liddell and May, 1984). This is explained by the greater prevalence of casual attenders in our sample. A strong inverse relationship between frequency of attendance and anxiety was evident-6-monthly attenders had an anxiety score of 8.9 against 11.4 for people attending at intervals greater than 3 years. Table Zshows that anxiety was the most common reason for people not attending the dentist as often as they thought they should.
Trouble only 0 6 39 75
Total 70 40 58 75
120
Furthermore, 39 per cent of the sample admitted that they had avoided or delayed a dental visit because of fear. These findings confirm that anxiety is a major barrier to seeking dental care. Over half the respondents reported having had one or more very unpleasant experiences at the dentists and these respondents had an elevated Corah anxiety score. Most of these experiences had occurred in childhood, supporting the suggestion by Lautch ( 197 1) that children go through a susceptible period during which they can be easily sensitized to experiences. These results demonstrate the importance of good patient management with children to avoid damaging experiences. Table ZZshows that many people blame their fear upon expectation of pain or procedures causing pain such as injections. High levels of dental anxiety were associated with a history of painful dental treatment and unpleasant dental experiences. The more dentally anxious respondents considered themselves to be particularly sensitive to pain and expected future dental treatment to be painful. These findings support a classical conditioning model of dental anxiety, but do not exclude the possibility of cognitive influences such as reconstruction of memory as suggested by Kent (1985).
References
Anonymous (1984) The missing patients. Br. Dent. J. 156,
73. Corah N. L. (1969) Development of a dental anxiety scale. J. Dent. Res. 48, 596. Eddie S. (1984) Frequency of attendance in the general dental service in Scotland. Br. Dent. J. 157, 267-270. Elderton R. J. (1985) Routine six-monthly checks for dental disease. Br. Dent. J. 159, 277-278. Green R. M. and Green A. (1984) What about the reluctant patients? Br. Dent. J. 156, 387. Kent G. (1985) Cognitive processes in dental anxiety. Br. J. Clin. Psychol. 24, 259-264. Lautch H. (1971) Dental phobia. Br. J. Psychiatry 119, 151-158. Levine R. S. (1985) The scientific basis of dental health education: a Health Education Council policy document. Br. Dent. J. 158,223-226. Liddell A. and May B. (1984) Some characteristics of regular and irregular attenders for dental check-ups. Br. J. Clin. Psychol. 23, 19-26.
Woolgrove and Cumberbatch:
Lindsay S. and Woolgrove J. (1982) Fear and pain in dentistry. Bull. Br. Psych&. SW. 35, 225-228. Schuurs A. H. B., Duivenvoorden H. J., Thoden van Velzen S. A. et al. (1984) Dental anxiety, the parental family and regularity of dental attendance. Community Dent. Oral Epidemiol. 12, 89-95.
Correspondence
Dental anxiety
213
Sheiham A. (1977) Is there a scientific basis for the six-monthly dental examination? Lancer ii, 424-444. Todd J. E., Walker A. M. and Dodd P. (1982) Adult Dental Health, vol. 2. London, HMSO.
should be addressed to: Mr J. Woolgrove, Lister Health Centre, 1 Camden Square, Peckham, London, SE15 3LW.