Dental anxiety in adolescents and adults. Epidemiological studies based on the Tromsø Study 7 and Fit Futures 1 & 2

Nermo, Hege

dc.contributor.advisor	Johnsen, Jan-Are Kolset
dc.contributor.author	Nermo, Hege
dc.date.accessioned	2021-09-07T09:11:19Z
dc.date.available	2021-09-07T09:11:19Z
dc.date.embargoEndDate	2026-10-01
dc.date.issued	2021-10-01
dc.description.abstract	<p><i>Background:</i> High dental anxiety can hinder individuals from seeking necessary dental treatment and thereby an obstacle in ensuring equal access to health care in the population. The overall aim of this thesis was to advance the understanding of dental anxiety in adolescents and adults, with a focus on the relevance of mental health symptoms, oral health and potentially traumatic events. <p><i>Methods:</i> All the papers included in this thesis uses data from population studies in Tromsø municipality, organized through the Tromsø Study. Fit Future 1 and 2 are repeated health surveys of the adolescent population in Tromsø and Balsfjord municipalities, inviting all registered first year of upper secondary school students at first wave (92.9% participated) and follow-up after two years (69.5% follow up rate). The Tromsø Study 7 is a health survey of the adult population in Tromsø municipality, inviting all registered citizens ≥ 40 years old (65% attendance rate). <p><i>Results:</i> <p>- The initial measures of dental anxiety, mental health symptoms and caries experience were crucial in predicting high dental anxiety over time. However, more caries experience also significantly predicted a reduction of dental anxiety scores. Anticipated pain at the dentist changed in both directions in correspondence with the dental anxiety scores. <p>- When it comes to potentially traumatic events outside the dental setting, sexual abuse directly affects dental anxiety after controlling for covariates and current psychological symptoms. <p><i>Conclusions:</i> High dental anxiety over time is associated with a higher burden of mental health symptoms, avoiding dental health care and poor oral health. However, it seems like positive dental experiences can reduce dental anxiety among adolescents regardless of dental caries and mental health symptoms. There was a direct association between sexual abuse and dental anxiety in the adult population.	en_US
dc.description.doctoraltype	ph.d.	en_US
dc.description.popularabstract	ABSTRACT Background: Oral diseases are common, but the burden of disease disproportionally affects marginalized groups in society. High dental anxiety can hinder individuals seeking necessary dental treatment and thus constitute an obstacle in ensuring equal access to health care in the population. The potential negative consequences that anxiety-related avoidance of dental treatment may have on oral health concern patients and the health services. Untreated oral diseases substantially affect the individual. For individuals suffering from high dental anxiety, there are often severe psychosocial consequences. Both the oral and psychosocial consequences of dental anxiety have a negative impact on their quality of life. Adults with severe dental anxiety in Norway can get help and treatment for their anxiety in the dental public health services. Unfortunately, there are long waiting lists. Years of avoiding dental treatment can be difficult to overcome. Extensive dental treatment needs, acute infections, oral pain and comorbidity with other mental illnesses can further challenge the progression of the multidisciplinary treatment offered. Consequently, dental anxiety in adults can be a high cost to both the individual and society. Many have struggled with their anxiety since childhood or adolescence. Early prevention of dental anxiety has been an important focus in dental care for children, but is there a need for offering treatment for dental anxiety in younger age groups? Adolescence is a critical developmental stage. The resources and experiences acquired during this life phase lay the foundation for future health and wellbeing. Thus, an understanding of what happens during adolescence regarding oral health and dental anxiety appears central. Irrespective of life stage, traumatic or painful dental experiences have been identified as etiological factors of high dental anxiety. According to studies on selected populations, there is an overrepresentation of dentally anxious individuals among survivors of sexual abuse, violence and torture. However, there is scarce and contradictory evidence concerning the link between traumatic events outside the dental setting and dental anxiety in the general population. Aims: The present thesis aims to map dental anxiety among adolescents and adults in northern Norway while building on the theoretical framework from other research concerning dental anxiety, including predisposing factors and development. Specifically, this thesis seeks to answer questions about what maintains high dental anxiety among adolescents and explore the possible effect of potentially traumatic events outside the dental setting on dental anxiety among adults. Methods: All the papers included in this thesis use data from population studies in Tromsø municipality organized through the Tromsø Study. Results: Paper I (Fit Futures 1 - FF1). High dental anxiety (dental anxiety score ≥ 13) was reported by 11.6% of the adolescents. This study found no significant difference between the dentally anxious and those with lower dental anxiety scores on dental caries, psychological distress, and questions related to self-motivation concerning oral health and knowledge. However, there were significant differences among those with high or low dental anxiety concerning anticipated pain at the dentist, avoidance of dental treatment, social motivation concerning oral health, control belief, and sex. Paper II (Fit Futures 2 - FF2). First wave measures (FF1) of dental anxiety, psychological distress, and dental caries significantly predicted high dental anxiety two years later. While most of the population reported decreased dental anxiety levels, highly anxious adolescents felt more anxious over the two years, creating a bigger gap between the anxious and the non-anxious. Nonetheless, the most interesting finding in this study was that more dental caries also significantly predicted reduced dental anxiety. Anticipated pain at the dentist changed in both directions in correspondence with changes in dental anxiety scores, implying that treatment needs offer an opportunity to provide treatment that reduces dental anxiety. Paper III (The Tromsø Study 7). High dental anxiety was reported by 2.9% of the sample and was most prevalent among women and the youngest age groups. Individuals with high dental anxiety reported more mental health symptoms. They were more likely to report poorer oral health and irregular dental visits than individuals with no or lower dental anxiety scores. Among the potential traumatic life events, traumas linked to the dental setting displayed the largest difference between anxiety and the less anxious (a moderate effect). There was a difference between anxious and less anxious adults in all PTEs in the bivariate analyses, but the effect sizes were small. The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital, and childhood neglect significantly predicted dental anxiety in their entered step. Only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms. Conclusions: Findings from these three papers uphold previous findings concerning differences in dental anxiety related to age and sex: High dental anxiety is more prevalent in younger age groups and females. Furthermore, high dental anxiety over time is associated with more mental health symptoms (symptoms of depression or anxiety), avoidance of dental health care and poor oral health. However, it appears that positive dental experiences can reduce dental anxiety among adolescents regardless of dental caries and mental health symptoms. Traumatic events and anticipating pain in the dental setting are important predictors of high dental anxiety. However, when it comes to potentially traumatic events outside the dental setting, sexual abuse seems to directly affect dental anxiety after controlling for covariates and current psychological symptoms. The overall results underline the need for familiarity with trauma-sensitive care among dental health care professionals. Also, severe dental anxiety is an established problem in the adolescent population; untreated, the anxiety only worsens.	en_US
dc.description.sponsorship	The Norwegian Directorate of Health has funded the work behind this thesis carried out at the Public Dental Health Service Competence Centre of Northern Norway and the Department of Clinical Dentistry, Faculty of Health Sciences, UiT Arctic University of Tromsø.	en_US
dc.identifier.uri	https://hdl.handle.net/10037/22435
dc.language.iso	eng	en_US
dc.publisher	UiT The Arctic University of Norway	en_US
dc.publisher	UiT Norges arktiske universitet	en_US
dc.relation.haspart	<p>Paper I: Nermo, H., Willumsen, T. & Johnsen, J.-A.K. (2018). Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance, and anticipated pain in adolescence: a cross-sectional study based on the Tromsø Study, Fit Futures. <i>Acta Odontologica Scandinavica, 77</i>(2), 126-134. Published version not available in Munin due to publisher’s restrictions. Published version available at <a href=https://doi.org/10.1080/00016357.2018.1513558>https://doi.org/10.1080/00016357.2018.1513558</a>. Submitted manuscript version available in Munin at <a href=https://hdl.handle.net/10037/14822>https://hdl.handle.net/10037/14822</a>. <p>Paper II: Nermo, H., Willumsen, T. & Johnsen, J.-A.K. (2018). Changes in dental anxiety among 15- to 21-year-olds. A 2-year longitudinal analysis based on the Tromsø study: Fit futures. <i>Community Dentistry and Oral Epidemiology, 47</i>(2), 127-133. Also available at <a href=https://doi.org/10.1111/cdoe.12434>https://doi.org/10.1111/cdoe.12434</a>. Submitted manuscript version available in Munin at <a href=https://hdl.handle.net/10037/14707>https://hdl.handle.net/10037/14707</a>. <p>Paper III: Nermo, H., Willumsen, T., Kamilla, R., Thimm, J., Wang, C.E.A & Johnsen, J.-A.K. Dental anxiety and traumatic life events: an epidemiological study based on the Tromsø Study: Tromsø 7. (Manuscript in review). Preprint also available at <a href=https://doi.org/10.21203/rs.3.rs-426613/v1> https://doi.org/10.21203/rs.3.rs-426613/v1</a>.	en_US
dc.relation.isbasedon	Tromsøundersøkelsen, The Tromsø Study Fit Futures 1	en_US
dc.relation.isbasedon	Tromsøundersøkelsen, The Tromsø Study Fit Futures 2	en_US
dc.relation.isbasedon	The Tromsø Study: Tromsø7 / Tromsøundersøkelsen: Tromsø7	en_US
dc.rights.accessRights	embargoedAccess	en_US
dc.rights.holder	Copyright 2021 The Author(s)
dc.rights.uri	https://creativecommons.org/licenses/by-nc-sa/4.0	en_US
dc.rights	Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)	en_US
dc.subject	VDP::Medisinske Fag: 700::Klinisk odontologiske fag: 830::Andre kliniske odontologiske fag: 849	en_US
dc.subject	VDP::Medical disciplines: 700::Clinical dentistry disciplines: 830::Other clinical dentistry disciplines: 849	en_US
dc.subject	Tromsøundersøkelsen	en_US
dc.subject	The Tromsø Study	en_US
dc.subject	Fit Futures	en_US
dc.title	Dental anxiety in adolescents and adults. Epidemiological studies based on the Tromsø Study 7 and Fit Futures 1 & 2	en_US
dc.type	Doctoral thesis	en_US
dc.type	Doktorgradsavhandling	en_US