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PREVALENCE OF DENTAL PHOBIA AMONG PATIENTS AT DENTAL CLINICS IN

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GMJ ORAL PROCEEDINGS
GULF MEDICAL JOURNAL

PREVALENCE OF DENTAL PHOBIA AMONG PATIENTS AT

DENTAL CLINICS IN UAE
Syeda Sheema1, Safa Khan1, Zaid Muayad1, Ali Thaier1, Meera Obaid1*, Hossam A. Eid2
1Level10 Dental Students, College of Dentistry, 2PhD, Associate Professor, Periodontology Department, College of Dentistry,
Gulf Medical University. Ajman, UAE
*Presenting Author

ABSTRACT
Introduction: Dental phobia is a serious psychological condition with a multi-factorial etiology.
Most cases of dental phobia can be attributed to traumatic or painful dental experiences. Patients
with this phobia tend to avoid dental visits, which endangers their oral health.
Objective: The objective of the study was to assess the prevalence and possible causes of dental
phobia in dental patients in the UAE.
Materials & Methods: A random sample of 250 dental patients aged 12–37 years received
questionnaires that covered aspects such as sociodemographic factors, dental anxiety/phobia, and
related causes.
Results: The study indicated that dental phobia was more prevalent among females (22.8%) than
males (18.3%). When the association of dental procedures with dental phobia was evaluated, of 250
patients, 26.5% and 26.3% feared filling procedures and injections, respectively, followed by
extraction (24.8%), scaling (10.5%), and root canal treatments (4.8%). Nearly 23.9% of patients were
afraid of dental instruments, while 17.2% feared dentists themselves. Dental anxiety was more
prevalent in patients above 36 years (30.3%) than those in the age groups of 12–25 years (12.7%) and
26–35 years (22.9%). Caucasians were also observed to be more phobic (30%) than ethnicities such
as Arabs (22.4%), South Asians (20.5%), Filipinos (20%), and Africans (8%). Moreover, uneducated
people experienced greater dental fear (60%) than students from primary schools (33.3%), high
schools (23.6%), secondary schools (20.7%), and universities (17%).
Conclusion: The study showed that dental phobia among some UAE patients negatively affected
their oral health as they postpone routine dental care.
Keywords: Dental phobia, oral health, dental procedures, dental experiences, UAE
Citation: Sheema S, Khan S, Muayad Z, Thaier A, Obaid M, Eid HA. Prevalence of dental phobia
among patients at dental clinics in UAE. Gulf Medical Journal. 2016;5(S1):S136–S142.

INTRODUCTION fear related to the health and status of teeth, has

The word phobia, which has its roots in the
Greek language, refers to an intense,
unreasonable fear from a specific activity, object
or situation1–3. Dental phobia, which refers to
Correspondence: Dr. Hossam Abdelatty Eid
Abdelmagyd (BDS, MSc , PhD Oral Medicine
& Periodontology), Associate Dean and
Associate Professor, Periodontics, College of
Dentistry, Gulf Medical University, Ajman,
UAE. Email: dr.hossam@gmu.ac.ae,
dentaleagle2011@gmail.com
been observed in individuals with different
backgrounds, males and females. However, we
could differentiate based on age. Children
seemed more prone to dental phobia; those
aged 6–12 years harbored greater fear of going
for dental checkups and treatments1–3.
People with dental phobia endanger their
oral health by putting off routine dental care for
years or even decades2–4. Global statistics
regarding the prevalence of dental anxiety or
phobia are heterogeneous. Statistics indicate
that 5–15% of the world’s adult population

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SYEDA SHEEMA, ET AL
suffers from dental phobia (odontophobia).
Dental phobia as a psychological barrier seems
to be prevalent in the UAE (47% males, 53%
females) as well as the entire GCC region.
Studies in Oman indicate that almost 50%
school children have some form of dental
phobia. In Dubai, a study of 5,000 school
students suggested that the dental anxiety rate is
48%4, 5.
Odontophobia has a multifactorial etiology;
most cases of dental phobia can be attributed to
traumatic or painful dental experiences1, 3, 4.
Patients with dental phobia tend to avoid dental
visits, resulting in less anxiety, which leads to
further avoidance; this is termed as operant
conditioning. Dental phobia could be acquired
indirectly through parental or vicarious
pathways. Several studies have found a
significant correlation between children’s fear
and maternal fear. Similarly, individuals may
develop anxiety by observing painful
procedures or hearing about them from others;
this is termed as vicarious learning1, 3.
There is also evidence linking
socioeconomic status with dental anxiety, with
dental anxiety being more prevalent among
patients from a lower socioeconomic status3.
Moreover, a significant inverse relationship
exists between dental awareness and anxiety; the
lower the awareness and knowledge regarding
dental health, the higher the anxiety2. Sex seems
to be a determinant as well, with females
proven to experience greater dental anxiety than
males2, 3. Studies conducted on people aged 18–
65 years (average: 22.3 years) revealed that the
prevalence of dental anxiety is higher among
younger students and adults over the age of
452, 3. Waiting room time seems to be an
aggravating factor for dental anxiety, allowing
anxious patients to further process negative
experiences. Studies show that in a stressful
environment such as the waiting room of a
dental clinic, patients with a high level of dental
anxiety tend to recall more threatening words
than positive words1. This is termed as
cognitive bias and seems to be a common trait
among anxious patients3–7.
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GMJ. ASM 2016;5(S1):S136–S142
Dentists’ apprehension about a treatment
can increase the patients’ fear regarding the
treatment. Therefore, dental practitioners
should ease anxiety among patients8–11. The aim
of this study is to assess the prevalence and
possible causes of dental phobia among patients
at dental clinics in the UAE.
MATERIALS & METHODS
A cross-sectional survey was conducted on a
random sample of 250 dental patients of
various nationalities aged 12–37 years at the Al
Qassimi Hospital, Abu Dhabi private clinics,
GMC clinics, and Abu Dhabi hospitals. All
subjects received adequate verbal and written
information about the purpose, procedure, and
benefit of the study. The study team obtained
consent from participants before administering
the questionnaire, and maintained
confidentiality and anonymity. Consent from
guardians/parents was required for participants
aged 12–18 years. Subjects received structured
questionnaires, including questions on
sociodemographic factors, dental anxiety, and
possible related causes. Subjects were informed
that participation was voluntary. Participants
were selected according to the following
inclusion criteria: age of participants ≥ 12 years
(with consent of parent/guardian for
participants aged 12–18 years). Patients with
mental or psychological disorders and subjects
refusing to provide consent were excluded from
the study. Permission to conduct the study was
obtained from the ethical research committee of
Gulf Medical University’s Centre for Advanced
Biomedical Research and Innovation (CABRI).
The study – which included data collection, data
entry, processing, coding, analysis, and report
preparation – was conducted over six months.
CABRI will store the collected data for three
years after completion of the study.
RESULTS
The collected data were statistically analyzed
with descriptive statistics and inference testing
using the Pearson chi-squared test (p ≤ 0.001).
All calculations were arrived at using SPSS
version 19.0 (IBM Corp, Armonk, NY, USA).
137
PREVALENCE OF DENTAL PHOBIA AMONG PATIENTS AT
DENTAL CLINICS IN UAE GMJ. ASM 2016;5(S1):S136–S142

Table 1. Association between participants’ sociodemographic characteristics and dental phobia (N = 250)
Dental phobia
Sociodemographic characteristics Yes No p value
No. % No. %
Male 21 18.3 94 81.7 0.38
Gender
Female 31 22.8 105 77.2 (NS)
12–25 years 13 12.7 89 87.3
0.01
Age 26–35 years 19 22.9 64 77.1
(p ≤ 0.001)
>36 years 20 30.3 46 69.7
South Asian 18 20.5 70 79.5
Filipino 4 20.0 16 80.0
Ethnicity Arab 22 22.4 76 77.6 --
Caucasian 6 30.0 14 70.0
African 2 8.0 23 92.0
Primary school 5 33.3 10 66.7
Secondary school 6 20.7 23 79.3
Education High school 13 23.6 42 76.4 --
University 25 17.0 122 83.0
Others (illiterate) 3 60.0 2 40.0

Figure 1. Sociodemographic factors

100% 92.00%
87.30% Phobic
90% 81.70% 83.00%
77.20% 77.10% 79.50% 80.00% 77.60% 79.30% 76.40%
80% Non Phobic
69.70% 70.00%
66.70%
70%
60.00%
60%
50%
40.00%
40% 30.30% 33.30%
30.00%
30%
18.30%
22.80% 22.90% 20.50% 20.00% 22.40% 20.70% 23.60%
17.00%
20% 12.70%
8.00%
10%
0%
High School
Female

Primary School
Male

Caucasian
>36 years old

Secondary School

Others (Illiterate)
Filipino

Arab

Africans

University
12-25 years old

26-30 years old

Indian Subcontinent

Gender Age Ethinicity Education

Of the 250 patients evaluated, 22.8% phobic than those of other ethnicities (Arabs:
females suffered from dental phobia compared 22.4%, South Asians: 20.5%, Filipinos: 20%,
with 18.3% for males. Dental anxiety was Africans: 8%). Moreover, dental anxiety was
observed to be more prevalent among patients more prevalent among uneducated people
above 36 years (30.3%) compared with younger (60%) than students in primary schools
age groups (12–25 years: 12.7%, 26–35 years: (33.3%), high schools (23.6%), secondary
22.9%). Caucasians were observed to be more schools (20.7%), and universities (17%).

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SYEDA SHEEMA, ET AL GMJ. ASM 2016;5(S1):S136–S142

Table 2. Association between dental procedures and dental phobia (N = 250)

Dental phobia
Association between dental procedures and dental
Yes No p value
phobia
No. % No. %
Dentists 5 17.2 24 82.8
What are you most Injections 31 26.3 87 73.7
scared of at the dental --
clinic? Dental instruments 16 23.9 51 76.1
Other 0 0.0 14 100
Relaxed 7 9.1 70 90.9
A little uneasy 11 13.3 72 86.7
When you are in the
Tense 18 34.0 35 66.0
dentist’s office for
Anxious 10 38.5 16 61.5 --
your turn in the chair,
how do you feel? So anxious that I sometimes
break out in a sweat and almost 6 85.7 1 14.3
feel physically sick
A traumatic experience at the
27 33.3 54 66.7
dental clinic
How did you develop A friend’s traumatic experience 0.05
11 21.6 40 78.4
this fear? at the dental clinic
Images/TV content/movies 7 17.1 34 82.9
Other 5 13.2 33 86.8
Extraction 36 24.8 109 75.2
Which dental Filling 13 26.5 36 73.5
procedure are you
most scared of? Scaling 2 10.5 17 89.5
Other 1 4.8 20 95.2
Very bad 4 6.9 54 93.1
How do you feel Bad 7 7.7 84 92.3
about having your
Okay 18 28.6 45 71.4 --
teeth scraped and
polished? Good 18 62.1 11 37.9
Very good 5 50.0 5 50.0
Very bad 0 0.0 32 100.0
How do you feel Bad 5 9.3 49 90.7
0.00
about getting an Okay 9 15.0 51 85.0
(p ≤ 0.001)
injection in the gum? Good 17 25.0 51 75.0
Very good 21 56.8 16 43.2
Very bad 2 6.7 28 93.3
Bad 3 4.5 64 95.5
How do you feel 0.00
Okay 11 19.0 47 81.0
about getting a filling? (p ≤ 0.001)
Good 17 29.3 41 70.7
Very good 19 51.4 18 48.6
Very bad 1 4.0 24 96.0
How do you feel Bad 8 16.0 42 84.0
0.00
about getting a tooth Okay 5 10.2 44 89.8
(p ≤ 0.001)
extracted? Good 11 19.3 46 80.7
Very good 27 38.6 43 61.4
Very bad 1 3.0 32 97.0
How do you feel Bad 11 15.3 61 84.7
about having sleep 0.00
Okay 11 14.9 63 85.1
induced for the (p ≤ 0.001)
treatment? Good 11 33.3 22 66.7
Very good 18 47.4 20 52.6

When the association between dental the 250 patients, 26.5% and 26.3% feared filling
procedures and dental phobia was evaluated, of procedures and injections, respectively,

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PREVALENCE OF DENTAL PHOBIA AMONG PATIENTS AT
DENTAL CLINICS IN UAE GMJ. ASM 2016;5(S1):S136–S142
followed by extraction (24.8%), scaling (10.5%),
and root canal treatment (4.8%). Nearly 23.9%
patients were afraid of dental instruments, while
only 17.2% feared dentists themselves. (Pearson
chi-squared test, p ≤ 0.001)
While in the waiting room, most patients
feel anxious and physically sick (85.7%), while
others feel tense (34%) or uneasy (13.3%). A
traumatic dental visit was the main cause for
dental phobia (33.3%) among evaluated
patients, followed by a friend’s traumatic
experience (21.6%), and images, TV content,
and movies (17.1%) (Pearson chi-squared test,
p ≤ 0.001).
A high percentage (42.4%) of the evaluated
patients revealed that dental fear deters them
from booking appointments even if they
needed them, while 45.7% felt a shiver in their
body when the dentist is ready to start the
procedure (Pearson chi-squared test, p ≤ 0.001).
Most (56.5%) phobic patients avoid dental
visits, and this interferes with their social
activities (36%).
When the patients were asked to rate their
level of dental fear, 57.9% reported extreme
dental fear and only 6.3% experienced mild
fear. Many participants (55.9%) complained
about feeling nervous or edgy about upcoming
dental visits (Pearson chi-squared test,
p ≤ 0.001), 58.8% often think about things that
may go wrong before going to the dentist, and
75.7% thought something bad would happen to
them during the procedure. (Pearson chi-
squared test, p ≤ 0.001)
Lastly, among the participants, 27.8% felt at
ease when they had a family member or a friend
by their side during the procedure, followed by
listening to music (23.3%), leniency from the
dentist (17.5%), and being explained the
procedure (15.8%).
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Figure 2. Distribution of dental phobia among some
UAE patients
21%
n = 51
Phobic
Non-phobic
79%
n = 199
DISCUSSION
The results of the present study indicate that
dental phobia was more prevalent among
Caucasians (30%) than those of other
ethnicities (Arabs: 22.4%, South Asians: 20.5%,
Filipinos: 20%, and Africans: 8%). The study
shows that the prevalence of dental phobia was
higher among females (22.8%) than males
(18.3%). This result is similar to that from other
studies, which can be attributed to a difference
in pain thresholds between the genders12–14.
Our findings indicate that a dental anesthetic
injection was the procedure inducing anxiety
the most (26.3%), while a root canal treatment
had the least influence on anxiety (4.8%). These
findings are consistent with the results of
Humphris et al., who found that the dental
anesthetic injection was the most anxiety-
provoking item, with a mean score of 2.45±1.23
across samples15. However, they reported that
scaling and polishing (1.90±1.35) was the least
anxiety-provoking procedure, which is
inconsistent with our findings. Interestingly, in
our study, about 17.2% feared dentists
themselves, which can be attributed to
iatrogenic factors. This finding may be due to
some dentists exhibiting inadequate necessary
communication skills while interacting with
patients. This finding raises the issue of the
responsibility of the dental profession and/or
the practitioner. Basically, the aggravation of
dental anxiety in patients after a dental episode
due to lack of preventive measures could be
considered a result of the concerned
SYEDA SHEEMA, ET AL
professional’s fault. Relevant education should,
hence, be provided to dental students and
professionals16.
The percentage of people with dental
anxiety in this study was 21%, higher than the
results from Western countries, such as the
United Kingdom (11%) and Northern Ireland
(19.5%), and close to findings from Turkey
(23.5%)17, 18. However, these results are lower
than that of a 2014 study among Saudis
(48.3%)19. Our study results indicate anxiety and
phobias increase with an increase in age, in line
with several other studies by Tunc et al. and
Thomson et al. 200017, 20. However, these
findings contradict other study results, which
found that the lowest anxiety scores were
recorded for those aged 50 years or older12, 18, 20,
21. The higher anxiety with increased age in the
current study may be attributed to bad dental
experiences, along with the absence of
appropriate dental education, leading to
permanent psychological damage. The current
study reported that 85.7% patients feel anxious
and physically sick, followed by tense (34%) or
uneasy (13.3%) while waiting at the dental
clinic. Many evaluated patients developed dental
phobia primarily due to a traumatic experience
in the dental office (33.3%), followed by a
friend’s traumatic experience (21.6%) or images,
TV content, and movies (17.1%). Our results
were similar to the findings of some other
studies22, 23. Some studies showed no significant
difference in dental anxiety scores among
participants based on their frequency of dental
visits and duration since the last dental visit24.
According to the present study, dental fear
was more prevalent among uneducated people
(60%) than students from primary schools
(33.3%), high schools (23.6%), secondary
schools (20.7%), and universities (17%). This
result indicates that the relationship between
dental anxiety and sociodemographic factors is
unclear despite some studies showing that
dental anxiety is most frequent in lower
socioeconomic status groups25, 26.
This study had some limitations. The
sample size is small, with significant variation in
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GMJ. ASM 2016;5(S1):S136–S142
the number of individuals representing each
ethnic group, which could have negatively
affected the validity of the study results. This
limits the degree to which the results can be
assumed to apply to the overall UAE
population. A larger heterogeneous sample
would have improved the generalizability of the
results. Another limitation is that criterion
validity could not be established using standard
scales due to the non-availability of translated
and validated dental anxiety questionnaires in
the UAE. The main weakness of this study is
the use of a convenience sample.
CONCLUSION
The results of the study indicate dental phobia
among some UAE patients resulted in routine
dental care being postponed, negatively
affecting their oral health.
ACKNOWLEDGMENTS
The research team wants to thank the members
of the biostatistics department as well as the
staff members of the College of Dentistry, Gulf
Medical University, for helping with the
research. Moreover, the authors appreciate the
help of Al Qassimi Hospital (Sharjah), ADNOC
Hospital (Abu Dhabi), Talat Medical Centre
(Abu Dhabi), and Palmyra Dental Clinic (Abu
Dhabi).
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