A hypothesis that a vicious cycle exists between dental anxiety, oral health and oral health status has been proposed by multiple researchers that focus on this area of research. As clinicians, many of us have seen this firsthand. A recently published cross-sectional study in the journal BMC Public Health aimed to “investigate the relationship between health belief factors, oral health, and dental anxiety based on the constructs of the Health Belief Model (HBM).”1
The study recruited 1207 second grade students form 12 different secondary schools in Hong Kong. These children were selected randomly, after selection the children were assessed using the DMFT index to determine their oral health status. The students were then asked to complete a questionnaire to establish levels of dental anxiety and HBM constructs. The children were monitored during the questionnaire by teachers to ensure they did not interact which could compromise the integrity of the data. Of the 1207 participants, 1159 participated an attrition rate of around 4%.
The results indicate that HBM factors are risk factors for caries and dental anxiety among this cohort. The findings indicate that perceived susceptibility, perceived barriers, self-efficacy, and cues to action may predict oral health behaviors. In a previous study the authors claimed reducing barriers was one of the most useful strategies to encourage oral health behaviors.
Previous negative dental experiences may cause negative expectations of dental treatment and contribute to dental phobia. The HBM identifies threat perception based on two beliefs: 1) perceived susceptibility and 2) perceived severity. Perceived susceptibility
is the individual’s perception of the chance of obtaining a disease or painful state, while perceived severity is the individual’s belief towards the effect and psychological harm the disease could create. Considering dental disease is often painless, until it’s not, many people have a higher incidence of perceived severity which causes them to avoid seeking regular dental care. Individuals with a higher level of perceived susceptibility had a positive effect on oral health. This may be due to the individuals fear of acquiring disease being more significant than their fear of psychological harm.
Overall, the HBM variables predicted 14% of the variance in oral health behaviors and dental anxiety. This study showed “dental anxiety is a risk factor for caries” but also “poorer oral health practices are correlated with dental anxiety levels.” The HBM factors observed in this study predicted dental anxiety and oral health behaviors, however 86% of the variance is unaccounted for, indicating there are other important determinants of health behaviors and dental anxiety not identified by HBM.
The authors conclude by stating, “Our analysis of dental anxiety and oral health from a cognitive theory model perspective, such as the HBM, provides a clearer explanation for one of the mechanisms involved in oral health and dental anxiety among adolescents. Thus, there is a tangible application for the implementation of theory-based behavioral interventions targeting the promotion of oral health behaviors in schools as an alternative strategy in reducing dental anxiety and prevent oral disease in adolescents.”
Xiang B, Wong HM, Perfecto AP, McGrath CPJ. Modelling health belief predictors of oral health and dental anxiety among adolescents based on the Health Belief Model: a cross-sectional study. BMC Public Health. 2020;20(1):1755. Published 2020 Nov 23. doi:10.1186/s12889-020-09784-1