"Magnitude and determinants of dental anxiety among adult patients attending public dental clinics in Dar-Es-Salaam, Tanzania".

Abstract

ABSTRACT Introduction: It is estimated that, about 40% of the population suffer from dental anxiety. Dental anxiety is considered to be complex and multifactorial with a wide range of provoking factors which may be patient, provider, or environment-related. Aim: study aimed to assess the magnitude and determinants of dental anxiety among adult patients attending public dental clinics in Dar es Salaam, Tanzania. Methodology: was a descriptive cross-sectional study carried out in 4 public hospitals in Dar es Salaam, Tanzania. It included 300 adult patients who had dental caries, periodontal diseases, or dental trauma. Data were collected using a self-administered Modified Dental Anxiety Scale (MDAS) questionnaire. Data were analyzed using the SPSS computer software version 23. A one-way Analysis of Variance (ANOVA) was used to assess the association between variables, and the significance level was set at p < 0.05. Results: mean age of participants was 32.18 years (±11.06 SD) with a male-to-female ratio of 1 :1.43. (e means MDAS score was 12.84 ± 4.99. Tooth extraction had the highest mean MDAS score. (e majority (261, 87%) of participants had mild-to-severe anxiety. (e most common (72.2%) anxiety-provoking factor was an unsympathetic dentist; others included unawareness of the procedure to be carried out (58.3%) and the presence of apprehensive patients (52.0%). (e level of anxiety was found to be statistically significantly associated (p < 0.05) with young age [p 0.009, AOR 3.06 (95% CI, 1.32, 7.09), female patients [p < 0.001, AOR 4.45 (95% CI, 2.05, 9.70)], and a higher education level [p < 0.05, AOR 2.32 (95% CI, 1.03, 5.25)]. Conclusion. (e prevalence of dental anxiety was high among the participants of this study. Female gender, young age, and a higher level of education constituted determinants of dental anxiety. An unsympathetic practitioner, unawareness of the procedure, and presence of apprehensive patients were the common anxiety-provoking factors. Methods: This was a descriptive cross-sectional study carried out in public hospitals in Dar es Salaam between October 2019 and March 2020. The study included Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences (MUHAS) Dental Clinic, and two regional referral hospitals (Amana and Mwananyamala) in Dar es Salaam, Tanzania.The inclusion criteria included dental patients aged 18 and above, patients with dental caries, periodontal disease, or dental trauma. And the exclusion criteria included all those patients who were not mentally sound, dental patients with maxillofacial bone fractures, and orofacial neoplasms. The sample size was estimated using the population adjustment formula for single proportion estimation [15] based on a 95% confidence level, a precision of 5%, and power of 0.8 with an expected proportion of 22% based on the previous study [11] yielding a total sample of 300 participants. A stratified random sampling method was used to obtain the participants. The included hospitals were used as strata and the simple random sampling method was used for the dental clinic to attain the sample size required (300 participants). Due to the variation in the number of dental patients who visited different dental clinics in the city, dental patients attending MUHAS Dental Clinic contributed 35% of the estimated sample size. Those who attended MNH Dental Clinic comprised 25% and those patients who attended Mwananyamala and Amana Hospitals Dental Clinics constituted 20% each.Patients who met the criteria to participate in the study were interviewed by the same researcher using a predesigned questionnaire in a separate room while they were waiting to be attended/treated (pretreatment). The questionnaire was translated from English to Swahili language, and it was pretested in 30 pilot patients (10% of the estimated sample size) before using it for the study. It is composed of questions on the sociodemographic characteristics, 5 sets of questions from the Modified Dental Anxiety Scale (MDAS) each question scoring 1 to 5, with 1 being not anxious and 5 being extremely anxious. An additional question on the stimuli associated with dental anxiety and a question regarding tooth extraction were also added to the MDAS set of questions. The six questions were summed together to produce a total score ranging from 6 to 30.The data obtained from this study were coded and entered into the computer program and analyzed using SPSS software version 23.0. Data was presented in the form of the mean for continuous variables and percentages for categorical variables. The age of the patients was dichotomized into <40 years and ≥40 years. The level of education for the participants was categorized into those with low level (no formal and primary education) and high level (secondary and tertiary education). Marital status was grouped into those living with partners (married, cohabiting) and those living without partners (single, divorced, widowed). The residence was divided into urban areas (urban center) and suburban areas. Employment status was grouped into those with informal employment, public formal employment, and private formal employment. Since each question has five scores ranging from “not anxious” to “extremely anxious,” in an ascending order from 1 to 5, each question thus caries a possible maximum score of 5 with a total possible maximum score of 30 for the entire scale with higher scores indicative of greater dental fear. A cutoff score of >19 was used to identify individuals with high levels of dental anxiety. Thus, the level of anxiety was classified according to the total score obtained as no anxiety (total score 6), mild-to-moderate anxiety (7–19), severe-to-extreme anxiety (20–30).The data was presented using frequencies and percentages in the form of tables and charts. A one-way Analysis of Variance (ANOVA) was used to assess the differences in dental anxiety for selected factors. The probability level of was selected for statistical significance. Univariate and multivariate linear and logistic regression models were used to assess associations between the sociodemographic characteristic of participants and dental anxiety. Ethical clearance was sought from the MUHAS Institution Review Board, and permission to conduct the study was obtained from the appropriate authorities of different departments of MUHAS Dental Clinic, MNH, Amana, and Mwananyamala Hospitals. Only those participants who freely gave consent to participate were included in the study. All information was handled confidentially and refusal to participate or withdraw from the study did not result in any consequence on the side of the patient. Conclusion: The prevalence of dental anxiety was high among the participants of this study. Females, young patients, and those with higher levels of education were more anxious than their counterparts. An unsympathetic practitioner, unawareness of the procedure, presence of apprehensive patients, and sound of the drill were the common anxiety-provoking factors among the participants in the clinical environment.