Dental anxiety and detrimental oral health behaviours among 12 and 15-year-olds adolescent in England, Northern Ireland and Wales A secondary data analysis from the 2013 Children’s Dental Health Survey

Abstract

Background: Dental anxiety is a dental public health problem that has been associated with avoidant dental attendance patterns, with negative consequences for the affected individuals and wider society. The relationship between dental anxiety and other oral health behaviours remains unclear in the literature and evidence of dental anxiety in adolescence is scarce. Aim: The aims of this study were to assess the association between dental anxiety and oral health-related behaviours amongst adolescents who participated in the Children’s Dental Health Survey (CDHS) 2013 conducted in England, Wales and Northern Ireland. Methods: This study was a secondary data analysis, based on the cross-sectional CDHS 2013. A multistage sampling process to target 5, 8, 12 and 15-year olds children attending state and independent schools in England, Wales and Northern Ireland was used. The main analytical sample comprised 4,045 12 and 15-year olds. The exposure was dental anxiety; outcomes assessed were dental attendance, oral hygiene (toothbrushing), smoking, alcohol consumption and sugar intake (foods/drinks). Logistic regression analyses were carried out to model the relationship between dental anxiety and each oral health-related behaviour. Analyses adjusted for age, sex and socioeconomic position markers (free school meal eligibility and index of multiple deprivation) as potential confounders. Results: One out of nine adolescent participants in the CDHS 2013 reported extreme dental anxiety. Prevalence was higher among females, amongst younger and among those living in more deprived areas. Dental anxiety was strongly associated with higher odds of problem-oriented dental attendance (OR=2.17; 95%CI:1.47–3.20), toothbrushing less than twice a day (OR=2.43; 95%CI:1.57–3.75) and with lower odds of drinking alcohol (OR=0.69; 95%CI:0.53–0.89) compared to those with no or low dental anxiety. No associations were found for sugar consumption (food/drinks), however these results should be viewed with caution due to measurement limitations. A positive association with smoking was suggested (OR=1.68; 95%CI:0.80–3.54), although due to great variability of data and low prevalence of smoking in the sample the result was not statistically significant. Adjusting for SEP did not attenuate any of the above associations. Conclusion: Dental anxiety was common among adolescents in England, Wales and Northern Ireland. It was significantly related to some detrimental behaviours for both oral and general health which may in turn contribute to maintaining dental anxiety over time. Measures to tackle dental anxiety and detrimental health related behaviours should be provided at a population and clinical level. Future research should aim to better understand dental anxiety phenomena and their impacts on oral health-related behaviours.