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The relationship between dental anxiety and other kinds of anxiety: a naturalistic, cross-sectional and comparative study

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Dental anxiety is of public health importance because it leads to postponed dental treatment, which comes with health complications. The present study investigated whether there is a correlation between the degree of dental anxiety and other kinds of anxiety and whether there are prognostic factors for the different kinds of anxiety.


In the sample (N = 156) from a dental practice in a large German city, 62% of patients received a check-examination and 38% received dental surgery. The target variables were recorded with validated questionnaires: dental anxiety (IDAF-4c+), subclinical anxiety (SubA), anxiety of negative evaluation (SANB-5), current general anxiety (STAI state), loneliness (LS-S) and self-efficacy (GSW-6). The applied statistics were: t-tests for 31 variables, correlation matrix and multivariate and bivariate regression analyses.


The dental surgery patients displayed more dental anxiety and more dental interventions than the check-examination group. The main result was a positive correlation of all kinds of anxiety with each other, a positive correlation of loneliness and neuroticism with all forms of anxiety and a negative correlation between all forms of anxiety and self-efficacy. Especially dental anxiety is positively associated with other kinds of anxiety. In multivariate regression models only neuroticism is associated with dental anxiety, but feelings of loneliness are positively associated with with the other kinds of anxiety assessed in this study. The higher the self-efficacy, the lower the level of general anxiety.


In dentistry, anxiety from negative experiences with buccal interventions should be distinguished from anxiety caused by personality traits. Self-efficacy tends to protect against anxiety, while loneliness and neuroticism are direct or indirect risk factors for anxiety in this urban dentistry sample. Dental anxiety seems to be independent from biographical strains but not from neuroticism. In practice, more attention must be paid to anxiety control, self-management and efforts to improve the confidence of patients with emotional lability, less self-confidence and propensity to shame.

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Dental health is a keystone of systemic health and quality of life [1, 2], as demonstrated by dental paleoanthropology [3, 4]. Postponing dental treatment and avoiding dentists because of dental anxiety and fear [5] or socio-economic barriers are relevant health factors [6], even as a mediator between one’s psychopathological burden and childhood caries [7]. According to World Health Organization (WHO) estimates, dental anxiety and fear affects 15–20% of the worldwide population, a figure that is of interest for public health because dental anxiety increases the risk of neglecting dental health [5]. The overarching concept is “odontophobia”, which encompasses “dental anxiety”, “dental fear” and “dental phobia” as synonyms but sometimes also as degrees of odontophobia. This concept includes avoidance of indispensable dental treatment, as recognized by Corah et al. [8, 9]. There are validated scales to assess different aspects of dental anxiety [8, 10, 11].

Dental anxiety has traditionally been seen as a separate, independent anxiety caused by bad dental experiences [12]. This view is in line with classical conditioning mediated by anxiety-provoking stimuli like an anaesthesia syringe, noisy drill instruments, or other dental equipment. Therefore, a range of techniques has been introduced in dental medicine in order to gain the patient’s trust and mitigate anxiety [13]. According to a Finnish survey, among anxiety factors, anticipatory anxiety is particularly related to clinical anxiety and depression, especially in males. In females, anticipatory anxiety is also related to treatment dental anxiety [14]. There is increasing evidence that severe anxiety in conjunction with phobia is related to other kinds of anxiety as well as mental disorders, e.g. depression, anxiety disorders and especially post-traumatic stress disorders [13, 15]. Therefore, traumatic experiences are a serious risk factor for dental anxiety, fear, and phobia [16]. Overall, people with severe mental disorders like schizophrenia show high levels of unmet dental needs [17, 18]. However, increasing attention is paid not only to dental patients with anxiety, especially heavily burdened patients, but also to the risk of burnout by dentists themselves due to emotional dysregulation and the social cognitive function of empathy with patients [19, 20].

The present investigation examined the hypothesis that dental anxiety is associated with other kinds of anxiety due to a possible common factor beyond a classical negative conditioning in dental anxiety. The survey was conducted in Germany; therefore, some German epidemiological data must be highlighted. In Germany, every citizen visited the dentist on average 1.5 times in 2018, including 1.4 surgical-conservation consultations; the number of visits has risen slightly but steadily every year over the past 25 years [21]. In Germany, 48% of people over the age of 16 forego a visit to the dentist, even though it would be necessary; a third of these individuals do not go to the dentist for financial reasons [22]. The caries index (decayed, missing and filled teeth per 28 teeth) for the 35–44-year-old group is 14.5 [23].

In line with the literature, the present study further examines whether there are associations between personality traits (especially neuroticism) and adverse biographical conditions or personal resources like self-efficacy or respective risks such as loneliness with dental anxiety.

The principal purpose of the study was to assess possible associations between dental anxiety and other kinds of anxiety as well as possible prognostic factors for different kinds of anxiety in an unselected German urban sample attended in dental offices. The results could focus greater awareness among dental and public health practitioners of anxiety in dentistry, especially considering risk features.


Objective and study design

The main objective was to assess possible associations between dental anxiety and other kinds of anxiety as well as personality traits, including those considered as a resource (self-efficacy) and a risk (loneliness). Since the study goes beyond the collection of routine data, approval was obtained from the ethics committee of the University of Ulm (registration number 285/17). Written informed consent in German was obtained from all participants. The authors started from the hypothesis that dental anxiety arises as a result of classical conditioning by a negative dental experience, as well as life history and personality variables that influence the extent of odontophobia. This main objective includes the following single questions:

  1. (a)

    What is the socio-demographic, personality-related, medical and biographical profile of a dentistry unselected sample in a German urban area?

  2. (b)

    Is there a profile difference between individuals who come to the dentistry office for a check-examination and those who are electively examined because of an acute dental problem?

  3. (c)

    Are there correlations between personality traits, dental fear, other kinds of anxiety, personal resources (self-efficacy) and risks (loneliness)?

  4. (d)

    Are there associations between dental anxiety and other kinds of anxiety?

  5. (e)

    Are there prognostic factors among selected variables for dental fear as well as for other kinds of anxiety in a sample of dentistry patients?

This prospective, naturalistic cross-sectional study was conducted in two metropolitan dental offices to investigate the connections between dental anxiety and other forms of anxiety. The sample (N = 156) was not selected, i.e. there were no further inclusion or exclusion criteria other than informed consent. Fifteen patients (average age 49 years; 53% dental check-up, 47% indicative dental intervention; 60% women) did not consent to the study. The participants were divided into two naturalistic groups: (a) oral health control (62%) and (b) indicative dental intervention (38%).

To determine the psychosomatic correlations with regard to the objective, the following groups of variables were examined (see Tables 1 and 2):

  1. (a)

    socio-demographic variables: age, sex, living alone or not, education level, employment status;

  2. (b)

    dental variables: age at onset of dental problems, dental appointments last 12 months, different dentists during the lifetime;

  3. (c)

    variables for somatic health burden: number of different drugs currently, medical appointments last 12 months;

  4. (d)

    biographical variables (as an indication of the mental health burden): any psychiatric support during the lifetime, appraisal of one’s life and upbringing (scale 0–10), traumatic experiences in childhood and as an adult (dichotomous);

  5. (e)

    resources as an indication of structural resilience (self-efficacy) or of vulnerability (loneliness);

  6. (f)

    personality dimensions as robust features of personality, measured with the Big Five Inventory (BFI-10): extraversion, agreeableness, conscientiousness, neuroticism, openness;

  7. (g)

    anxiety kinds: anxiety as personality trait; current anxiety level; fear of negative evaluation by others, and dental anxiety.

Table 1 Multidimensional description of the sample
Table 2 Psychosomatic profile of assessed sample

Dental anxiety was examined on four levels (emotional, behavioural, physiological and cognitive) and measured with the German version of the IDAF-4c+. Subclinical anxiety as an indicator of personality disposition was measured with the Subclinical Anxiety (SubA) scale. Current anxiety was measured with the state part of the State Trait Anxiety Inventory (STAI). Finally, a personality and biography-relevant form of social anxiety, namely the fear of evaluation/rejection, was measured with the scale Fear facing Negative Evaluation (SANB-5) (see Table 2).

Validated short psychometric tools were used:

  1. (a)

    Big-Five-Inventory, 10 items (BFI-10): good objectivity, re-test reliability after 6 weeks (between 0.49 and 0.62), good convergent validity as well as factor and construct validity [24];

  2. (b)

    Loneliness Scale-Short version (LS-S): psychometric assessments: Cronbach’s α = 0.97, positive correlation with neuroticism (r = 0.27), negative with extraversion (r = − 0.16), well-being (r = − 0.25) and life satisfaction (r = − 0.43) [25,26,27];

  3. (c)

    Generalized Self-Efficacy (GSW-6); psychometric assessments: Cronbach’s α for a sample of patients with heart failure 0.86; test–retest reliability after 12 months 0.50, after 28 months 0.60; negative association with depressivity (r = − 0.45), anxiety (r = − 0.35) and vital exhaustion (r = − 0.35), and positive with mental health (r = 0.36) [28];

  4. (d)

    Subclinical anxiety (SubA): Internal consistence (Cronbach’s α) between 0.64 and 0.84; good convergent validity with impairment of well-being (r = 0.33 to 0.55) and depressivity (r = 0.53 to 0.56); negative association with self-esteem and feeling of control (r = − 0.22 to − 0.42) [29, 30];

  5. (e)

    Negative Assessment Scale (SANB-5): Cronbach’s α = 0.84 to 0.94; positive correlation with test anxiety (r = 0.37) and negative with life satisfaction (r = − 0.44) [31,32,33];

  6. (f)

    State-Trait-Anxiety-Inventory, module state STAI-S: very good internal consistency (r = 0.90), re-test validity for state module after 63 days between r = 0.22 and r = 0.53, good convergent and divergent validity with several scales [34,35,36,37].

  7. (g)

    The IDAF-4c + comprises eight items that correspond to four dental anxiety dimensions: emotional, cognitive, physiological and behaviour [10, 38]. The average score for the German sample assessed by Tönnies et al. was 2.47 (standard deviation [SD] = 1.31) for women and 2.13 (SD = 1.10) for men [10]. Internal consistency for the basic module was α = 0.97, test–retest after 4 months r = 0.82, and good convergent validity with DAS (r = 0.87) and DFS (r = 0.92) [10].

Internal consistency assessed for this sample: GSW-6 (α = 0.83); SANB-5 (α = 0.87); SubA (α = 0.76); LS-S (α = 0.80); STAI, module state (α = 0.93), and IDAF-4c, basic module (α = 0.93).


The first question was assessed by means of descriptive statistics applied to the target variables and the profile variables (see Tables 1 and 2).

The two treatment groups were compared for each metric variable using the parametric t-test for unpaired samples and for the nominal variables using the chi-square test. By increasing the sample size, statistical tests are robust to normality; therefore parametric tests to assess differences were implemented. The effect sizes of the differences were determined using Cohen’s d (for metric variables) or Cramer’s V (for nominal variables; Tables 1 and 2). For Cohen’s d, 0.2 to 0.5 means a small effect, 0.5 to 0.8 a medium effect, and > 0.8 a strong effect (see Tables 1 and 2).

The correlation between personality dimensions, resources and kinds of anxiety was investigated using a correlation matrix with Pearson correlation coefficients and the significance level of the correlations. The effect strength for the Pearson correlations was defined as follows: 0.10–0.30 (small); 0.30–0.50 (medium); and > 0.50 (high) (see Table 3). The designations for Cramer’s V were similar to Pearson correlations.

Table 3 Correlation matrix between personality, resources and anxiety assessment instruments for the whole sample (N = 156)

The fourth question concerning simple associations between dental fear and other kinds of fear was investigated using bivariate regression models that are portrayed as scatter plots in order to appreciate individual differences and their dispersion (see Diagram 1).

The last question about possible prognostic factors for different kinds of fear in a dentistry sample was investigated by means of multivariate linear regression models with robust standard errors in order to calculate more accurate confidence intervals. The explained variance of the dependent variable through the model is given by a pseudo R2. The dependent variables were the four proposed kinds of anxiety and fear as the primary endpoints of the investigation. The independent variables (regressors) were chosen by following specific criteria: the two primary group comparisons (check-examination and dental treatment group); age and sex as basic socio-demographic variables; age of onset for dental problems as a surrogate variable for the burden of dental history; appraisal of one’s life and upbringing as well as trauma in childhood as indicators of biographical adversity at least from a first-person perspective; neuroticism as the most clinically relevant personality dimension; and self-efficacy as a positive and loneliness as a negative resource (see Table 4).

Table 4 Multivariate linear regression models with kinds of anxiety as the dependent variable using robust standard errors

All statistical tests were conducted using the STATA.13 package.


The average age of the participants was 51 years; there were slightly more women (57%) than men. Over two thirds (68%) had completed secondary school, one third lived alone (32%) and only two respondents were unemployed (1.3%). On average, dental problems began at the age of 13. In the previous year, the subjects visited the dentist on average almost three times. The number of diagnoses, doctor’s appointments and medications were subject to a greater variance. Between one third and half of participants reported having suffered a traumatic experience. The global assessment of life and education was high (almost 8 on a scale of 0–10; Table 1), the personality had higher values for neuroticism and openness, while self-efficacy was moderately high and loneliness was low with minimal variation. Dental fear was rather low (1.7 out of a maximum of 5), and fear of rejection was moderately high on average (9.1 out of a maximum of 20) compared to the current fear (35 out of a maximum of 80) and fear traits in personality (2.5 out of a maximum of 21; Table 2).

Except for the dental and medical variables, the metric variables showed little to moderate variation. Apart from the personality dimensions, no metric variables were normally distributed. Therefore, the check-examination and dental treatment groups were compared with the nonparametric Mann–Whitney U test. There were very few statistical differences: the dental treatment group displayed more dental appointments in the past 12 months (3.6 vs. 2.3) and higher levels of dental anxiety (1.9 vs. 1.5), especially for the dimension “emotionality” (2.2 vs. 1.6; Tables 1 and 2).

The correlation study between personality dimensions, resources and anxiety forms showed a highly significant positive association between loneliness and all forms of studied anxiety, especially fear of evaluation/being rejected (r = 0.51). In contrast to this finding, the association between self-efficacy and all forms of anxiety was negative. All forms of anxiety correlated highly with each other (r > 0.30), especially subclinical anxiety and fear of rejection (r = 0.62), as well as fear of dental treatment and current level of anxiety (r = 0.53). In terms of personality dimensions, extraversion and conscientiousness correlated negatively with loneliness and subclinical fear and positively with self-efficacy; neuroticism correlated positively with all forms of fear (except fear of dental treatment) and with loneliness and negatively with self-efficacy (Table 3).

Bivariate regression analyses displayed a statistically significant association between dental fear and other kinds of anxiety, especially for current anxiety (STAI state), but also between loneliness and dental fear. These results displayed graphically the results of the correlation matrix at an individual level, considering that the coefficient of determination of bivariate regression models is the square of the correlation coefficient (see Fig. 1).

Fig. 1
figure 1

Associations between dental anxiety and other kinds of anxiety. In the top left between dental anxiety and subclinical anxiety. In the top right between dental anxiety and current anxiety; in the bottom left between dental anxiety and fear for negative evaluation; in the bottom right between dental anxiety and feeling of loneliness. Parameters: Coeff. = Robust estimator; t = value on a t-distribution; R2 = Coefficient of determination (square of correlation coefficient) as model fit parameter

By means of linear multivariate regression models, few prognostic factors for fear can be identified. Only higher scores of neuroticism were associated with stronger dental fear. For the other kinds of anxiety in the assessed dentistry sample, only self-efficacy was negatively associated with subclinical and current clinical anxiety; conversely, loneliness was overall associated with the investigated kinds of fear. Of importance are the results of the subclinical model since the coefficient of determination explained 51% of variance of the dependent variable. In this model, age was negatively associated with fear (t = − 2.91; p = 0.005), and the biographic appraisal of one’s upbringing was negatively associated with anxiety (t = − 2.60; p = 0.011) (see Table 4).


The main results of the study are the quite high rate of dentistry patients considering traumatic experiences in childhood and adulthood, but on the contrary reporting good appraisal of one’s life and upbringing that are not associated with general anxiety and dental anxiety with the exception of subclinical anxiety. There were no significant differences between individuals receiving dental check-examination and individuals attended because of acute dental problems except more dental anxiety in the last group. All kinds of anxiety were correlated with each other, and self-efficacy was negatively associated with anxiety, contrary to loneliness.

From a psychosomatic perspective, the self-efficacy rating in this study was similarly high for a population-based study (18.1 vs. 17.4) [28]; the feeling of loneliness was on average only “sometimes”. The dental anxiety was significantly lower than in the German validation of the IDAF-4C + (1.7 vs. 2.47 for women and 2.13 for men) [cf. 10]. Compared to population studies, fear as a personality trait (2.5 vs. 2.91) [cf. 30] and fear of negative evaluation (9.1 vs. 10.7) [cf. 33] were lower in the current study, while the state fear was below the cut-off value for clinically relevant fear (35 vs. 40) [cf. 37]. Overall, compared with the general population, the present sample was older, better educated, had a higher level of openness, was healthier than the national average and had lower dental anxiety. Notably, the self-efficacy and other kinds of anxiety in this sample were similar to the general population [cf. 39, 40]. Openness is congruent with quite a positive assessment of life, while neuroticism is possibly congruent with having experienced traumas, at least from a very subjective perspective. In this respect, the sample—which was recruited from an urban region—cannot be considered representative of the German population.

Regardless of the other variables, all the studied anxiety kinds, including dental anxiety, were highly significantly correlated with each other, as already noted in other studies [10, 41, 42]. This study found a positive correlation with feelings of loneliness and a negative correlation with self-efficacy for all kinds of assessed anxiety. These findings indicate that, on the one hand, all anxiety kinds may have common characteristics, and feelings of loneliness and lack of self-efficacy might be due to a common anthropological phenomenon as a general mediator like “self-esteem” or “overall confidence”. A causal direction cannot be assumed, but this factor could be investigated by means of mediation paths in further structural equation modelling. Similar interrelations have been found by Vigu and Stanciu [43].

In multivariate regression models, few variables showed an independent association with each assessed kind of anxiety; especially for dental anxiety, there was no association between it and the other kinds of anxiety. Loneliness and self-efficacy were the best predictors for anxiety, whereas neuroticism showed no association (with the exception of dental anxiety), contrary to results of bivariate correlations reported in other investigations [44]. These results could indicate that in fact dental fear is independent of biographical stress and rather dependent on emotional lability and conditioned by negative circumstances in dental treatment, as assumed in the literature. The other kinds of anxiety could be influenced by other factors than dental fear or could be part of deeper reasons for both interpersonal difficulties and less feeling of self-worth or self-esteem, leading to psychosocial arrangements which can be accompanied by loneliness.

Implications for the practice are the awareness of the importance of adverse psychosocial conditions and psychological features like self-esteem, shame and tendency to isolation as well as emotional lability in dental health, for example in avoiding dental treatment and in narrower compliance. Dentists have to focus on people with psychosocial disadvantages and with poorer psychological resources in order to improve adherence to treatment.

Limitations of the study are the narrow scope of dentistry patients that were not heavily impaired and were recruited from a well-positioned and little sickened middle-class population. There probably are mediators between anxiety and biographical as well as psychological features of importance, but such mediators have yet to be hypothesized. This is perhaps the reason why findings in the literature about the importance of adverse biography and psychosocial conditions were not associated with anxiety in this sample. Causal relationships cannot be established because the sample size is too small for calculations with latent variables in structural equation modelling.


According to the results of this study, it should be of interest with regard to a more individualized dental medicine that dental anxiety is associated with other forms of anxiety, although there are hardly any prognostic factors for dental anxiety, at least in this urban, well-situated German sample. In contrast, age and self-efficacy appear to be protective factors, and neuroticism and feelings of loneliness appear to be risk factors for anxiety. For further health care-related studies, it would be interesting to investigate the extent to which dental anxiety is associated with other factors that are detrimental to health, for which further settings such as general practitioners or psychiatric homes would have to be investigated. The investigation of further risk and protective factors to more accurately assessing the psychological profiles are of epidemiological interest. But above all, a community-oriented dentistry has to investigate measures to increase accessibility, motivation for treatment readiness and the alleviation of anxiety in people suffering from dental anxiety in combination with other psychological burden.

Availability of data and materials

The authors indeed provided all raw data on which the study is based. The Excel table with all raw data is provided in a Additional file 1.

Change history

  • 15 May 2022

    Following the original publication of this article, the funding declaration of the article has been corrected with the addition of the following note: Open Access funding enabled and organized by Projekt DEAL.



Big-Five Inventory, 10 items

chi2 :

Value at chi-square distribution of values


Regression coefficient


Degrees of freedom


Generalisierte Selbstwirksamkeit (generalized self-efficacy)

H0 :

No differences hypothesis between model and population


Index of Dental Anxiety and Fear-four dimensions


Loneliness Scale-short version




Sample size


Level of test’s significance, two-tailed value

R2 :

Proportion of variance of dependent variable explained by whole model


Skala Angst vor negative Bewertung (short version of Fear of Negative Evaluation Scale)


Standard deviation


Standard error of estimate


State-Trait-Anxiety-Inventory, state subscale

Sub A:

Skala Subklinische Angst (subclinical anxiety scale)


T-value on a t-distribution


Variation coefficient: (SD/M) × 100


  1. Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006;94(1):10–21.

    Article  Google Scholar 

  2. Chaffee BW, Rodrigues PH, Kramer PF, Vítolo MR, Feldens CA. Oral health-related quality-of-life scores differ by socioeconomic status and caries experience. Community Dent Oral Epidemiol. 2017;45(3):216–24.

    Article  Google Scholar 

  3. Weyrich LS, Duchene S, Soubrier J, Arriola L, Llamas B, Breen J, et al. Neanderthal behaviour, diet, and disease inferred from ancient DNA in dental calculus. Nature. 2017;544(7650):357–61.

    Article  Google Scholar 

  4. Hardy K, Buckley S, Copeland L. Pleistocene dental calculus: recovering information on Paleolithic food items, medicines, paleoenvironment and microbes. Evol Anthropol. 2018;27(5):234–46.

    Article  Google Scholar 

  5. Torriani DD, Ferro RL, Bonow ML, Santos IS, Matijasevich A, Barros AJ, et al. Dental caries is associated with dental fear in childhood: findings from a birth cohort study. Caries Res. 2014;48(4):263–70.

    Article  Google Scholar 

  6. Hakeberg M, Wide BU. Self-reported oral and general health in relation to socioeconomic position. BMC Public Health. 2017;18(1):63.

    Article  Google Scholar 

  7. Knoblauch U, Ritschel G, Weidner K, Mogwitz K, Hannig C, Viergutz G, Lenk M. The association between socioeconomic status, psychopathological symptom burden in mothers, and early childhood caries of their children. PLoS ONE. 2019;14(10):e0224509.

    Article  Google Scholar 

  8. Ibrahim H, Lyons KM, Armfield JM, Thomson WM. Performance of the Index of Dental Anxiety and Fear in a population-based sample of adults. Aust Dent J. 2017;62(4):478–84.

    Article  Google Scholar 

  9. Tönnies S, Mehrstedt M, Eisentraut I. The Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS)—two questionnaires for the measurement of dental fear. Z Med Psychol. 2002;11:63–72.

    Google Scholar 

  10. Anfield JM. Development and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4c+). Psychol Assess. 2010;22:279–87.

    Article  Google Scholar 

  11. Tönnies S, Mehrstedt M, Frietzsche A. Psychometric assessment of the German version of the Index of Dental Anxiety and Fear (IDAF-4c+)—a new instrument for measuring dental anxiety. Psychother Psych Med. 2014;64:141–9.

    Google Scholar 

  12. De Stefano R. Psychological factors in dental patient care: odontophobia. Medicina. 2019;55:678.

    Article  Google Scholar 

  13. Halonen H, Salo T, Hakko H, Räsänen P. The association between dental anxiety, general clinical anxiety and depression among Finnish university students. Oral Health Dent Manag. 2014;13:320–5.

    PubMed  Google Scholar 

  14. Halonen H, Nissinen J, Lehtiniemi H, Tuula S, Riipinen P, Miettunen J. The association between dental anxiety and psychiatric disorders and symptoms: a systematic review. Clin Pract Epidemiol Ment Health. 2018;14:207–22.

    Article  Google Scholar 

  15. Lenk M, Berth H, Joraschky P, Petrowski K, Weidner K, Hanning C. Fear of dental treatment—an underecognized symptom in people with impaired mental health. Dtsch Arztebl Int. 2013;110:517–22.

    PubMed  PubMed Central  Google Scholar 

  16. Høyvik AC, Lie B, Willumsen T. Dental anxiety in relation to torture experiences and symptoms of post-traumatic stress disorder. Eur J Oral Sci. 2019;127:65–71.

    Article  Google Scholar 

  17. Kranstad V, Søftestad S, Fredriksen TV, Willumsen T. Being considerate every step of the way: a qualitative study analysing trauma-sensitive dental treatment for childhood sexual abuse survivors. Eur J Oral Sci. 2019;127:539–46.

    Article  Google Scholar 

  18. Lam PC, John DA, Galfalvy H, Kunzel C, Lewis-Fernández R. Oral health related quality of life among publicly insured mental health service outpatients with serious mental illness. Psychiatr Serv. 2019;70:1101–9.

    Article  Google Scholar 

  19. Singh P, Aulak DS, Mangat SS, Aulak MS. Systematic review: factors contributing to burnout in dentistry. Occup Med (Lond). 2016;66:27–31.

    Article  Google Scholar 

  20. Nangle MR, Henry JD, von Hippel C, Kjelsaas K. An empirical study on how emotion dysregulation and social cognition relate to occupational burnout in dentistry. Br Dent J. 2019;227:285–90.

    Article  Google Scholar 

  21. Gesundheitsberichterstattung des Bundes und der Länder. Accessed 16 Jan 2020.

  22. Statistisches Bundesamt (DESTATIS). Verzicht auf Zahnarztbesuch 2017 (Selbsteinschätzung) von Personen ab 16 Jahren nach soziodemographischen Merkmalen. In: Wirtschaftsrechnungen. Leben in Europa. Einkommen und Lebensbedingungen in Deutschland und der Europäischen Union. Accessed 16 Jan 2020.

  23. Micheelis W, Schiffner U. Vierte Deutsche Mundgesundheitsstudie (DMS IV). Köln: Deutscher Zahnärzte Verlag DÄV; 2006.

    Google Scholar 

  24. Rammstedt B. The 10-Item Big Five Inventory (BFI-10): norm values and investigation of socio-demographic effects based on a German population representative sample. Eur J Psychol Assess. 2007;23:193–201.

    Article  Google Scholar 

  25. Russell DW, Peplau LA, Cutrona CE. The Revised UCLA Loneliness Scale: concurrent and discriminate validity evidence. J Pers Soc Psychol. 1980;39:472–80.

    Article  Google Scholar 

  26. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys. Results from two population-based studies. Res Aging. 2004;26:655–72.

    Article  Google Scholar 

  27. Richter D, Weinhardt M. Loneliness Scale-SOEP. In: Brähler E, Zenger M, Kemper CJ, editors. Psychologische und sozialwissenschaftliche Kurzskalen (Short scales in psychological and social surveys). Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2014. p. 192–3.

    Google Scholar 

  28. Romppel M, Herrmann-Lingen C, Wachter R, Edelmann F, Düngen HD, Pieske B, et al. A short form of the General Self-Efficacy Scale (GSE-6): development, psychometric properties and validity in an intercultural non-clinical sample and a sample of patients at risk for heart failure. Psychosoc Med. 2013;10:1–7.

    Google Scholar 

  29. Mohr G, Müller A. Non-clinical anxiety. In: Glöckner-Rist, editor. ZUMA—Information System. Electronic manual of social science survey instruments. Version 8.0. Mannheim: Zentrum für Umfragen, Methoden und Analysen; 2004.

  30. Kemper V, Mohr G, Müller A. Skala subklinische Angst (SubA) (Subclinical anxiety scale SubA). In: Brähler E, Zenger M, Kemper CJ, editors. Psychologische und sozialwissenschaftliche Kurzskalen (Short scales in psychological and social surveys). Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2014. p. 303–6.

    Google Scholar 

  31. Watson D, Friend R. Measurement of social-evaluative anxiety. J Consult Clin Psychol. 1969;33:448–57.

    Article  Google Scholar 

  32. Vormbrock F, Neuser J. Konstruktion zweier spezifischer Fragebögen zur Erfassung von Angst in sozialen Situationen (SANB und SVSS) (Construction of two specific trait questionnaires to measure fear in social situations (SANB and SVSS). Diagnostica. 1983;23:165–82.

    Google Scholar 

  33. Kemper CJ, Lutz J, Neuser J. Development and validation of a short version of the Fear of Negative Evaluation Scale (SANB-5). Klin Diagnostik u Evaluation. 2012;4:343–60.

    Google Scholar 

  34. Spielberger Ch, Gorsuch RL, Lushene RE. Manual for the state-trait-anxiety-inventory. 1st ed. Palo Alto: Consulting Psychologists Press; 1970.

    Google Scholar 

  35. Spielberger Ch, Gorsuch RL, Lushene RE, Vaag PR, Jacobs GA. Manual for the state-trait-anxiety-inventory. 2nd ed. Palo Alto: Consulting Psychologists Press; 1983.

    Google Scholar 

  36. Laux L, Glanzmann P, Schaffner P, Spielberger CD. Das state-trait-Angstinventar the Staite-trait anxiety inventory-STAI). 1st ed. Weinheim: Beltz; 1981.

    Google Scholar 

  37. Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for the State-Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J Clinical Psychol. 1983;22:245–9.

    Article  Google Scholar 

  38. Anfield JM. How do we measure dental fear and what are we measuring anyway? Oral Health Prev Dent. 2010;8:107–15.

    Google Scholar 

  39. Statista. Europäische Union: Durchschnittsalter der Bevölkerung in den Mitgliedsstaaten im Jahr 2019. and Anzahl ambulanter ärztlicher Behandlungsfälle und behandelter Personen in Deutschland in den Jahren 2004 bis 2018. Accessed 17 Jan 2020.

  40. Statistisches Bundesamt (DESTATIS). Schulen: Absolventen/Abgänger nach Abschlussarten insgesamt.

  41. Accessed 17.01.2020.

  42. Yakar B, Kaygusuz TO, Pirinçci R. Evaluation of dental anxiety and fear in patients who admitted to the faculty of dentistry: which patients are more risky in terms of dental anxiety. Ethiop J Health Sci. 2019;29(6):719.

    PubMed  PubMed Central  Google Scholar 

  43. Vermaire JH, de Jongh A, Aartman IHA. Dental anxiety and quality of life: the effect of dental treatment. Community Dent Oral Epidemiol. 2008;36(5):409–16.

    Article  Google Scholar 

  44. Vigu A, Stanciu D. When the fear of dentist is relevant for more than one’s oral health. A structural equation model of dental fear, self-esteem, oral-health-related well-being, and general well-being. Patient Prefer Adherence. 2019;13:1229–40.

    Article  Google Scholar 

  45. Halonen H, Salo T, Hakko H, Räsänen P. Association of dental anxiety to personality traits in a general population sample of Finnish University students. Acta Odontol Scand. 2012;70(2):96–100.

    Article  Google Scholar 

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JVS: Conceptualization, methodology, formal analysis (statistics), original draft, review and editing. KH: Training in methodology, data collection, data curation. All authors have read and approved the manuscript.

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Correspondence to Juan Valdes-Stauber.

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Additional file 1

. Row individual data of the study according to assessed variables.

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Valdes-Stauber, J., Hummel, K. The relationship between dental anxiety and other kinds of anxiety: a naturalistic, cross-sectional and comparative study. BMC Psychol 9, 184 (2021).

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