CHAPTER ONE
1.1 Background of the Study
The well-being of both individuals and communities is significantly influenced by oral health, covering various dimensions, including physical, mental, social, and economic aspects (Peres et al., 2019). The oral cavity and its associated structures are vital components of the human body, essential for daily functioning and significantly contributing to overall individual welfare. Additionally, the oral cavity serves as a primary channel for human interaction with society, facilitating verbal communication, nutrient intake, communal eating, and the expression of emotions. The condition of an individual's teeth and surrounding structures greatly influences how they are perceived by others and their own self-perception. This perception, in turn, impacts one's ability to work, social standing, and socioeconomic position in society (National Institutes of Health, 2021).
Despite considerable progress in oral health, many people continue to experience chronic oral conditions and lack access to necessary dental care. Furthermore, the prevalence of oral diseases, like numerous chronic health conditions, exhibits social disparities, with the heaviest disease burden falling on impoverished children, racial and ethnic minorities, vulnerable elderly individuals, and socially marginalized groups, including immigrant populations. A broad spectrum of oral health issues includes dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma, and congenital defects like cleft lip and palate. These oral conditions rank among the most widespread noncommunicable diseases on a global scale, impacting approximately 3.5 billion individuals (National Institutes of Health, 2021; World Health Organization, 2022).
Marginalized groups encompass a wide range of categories, including those defined by characteristics such as race, religion, age, financial status, politics, and culture (Li et al., 2018; Hung et al., 2019). Additionally, individuals who may not fit into sociodemographic criteria but have special health care needs (SHCNs) can also face marginalization. These groups not only bear the heaviest burden of oral diseases but also encounter significant obstacles when trying to access routine preventive and other dental services (Parish et al., 2015; Velez et al., 2017; Lebrun-Harris, 2021). The primary barriers to obtaining dental treatment include exorbitant costs, limited availability of dental services in the community, geographical isolation, as well as fear and anxiety, alongside other social and economic factors (Nasseh and Vujicic, 2014; Davis and Reisine, 2015; Vujicic et al., 2016; Gupta et al., 2019).
Fear and anxiety concerning dental visits and procedures are significant factors contributing to the avoidance of dental care (Appukuttan, 2016). Dental anxiety, specifically, refers to the apprehension associated with the prospect of undergoing dental procedures or preventive care. Anxiety is an emotional state experienced in various aspects of everyday life, such as during exams, critical decision-making, workplace situations, and other circumstances (Appukuttan, 2016).
Fear, on the other hand, is a response to a known or perceived threat or danger, triggering a fight-or-flight reaction. Dental fear is a reaction to intimidating stimuli in dental settings. When this fear becomes persistent, unrealistic, and intense, it is classified as a dental phobia, leading to complete avoidance of perceived danger (Appukuttan, 2016).
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dental phobia is categorized as a specific phobia. It involves an excessive fear of the feared object or situation, resulting in marked anxiety, awareness of the fear's impact on daily life, and well-being (LeBeau et al., 2010).
The Adult Dental Health Survey (ADHS) in 2009 reported that nearly 12% of the adult population exhibited dental anxiety at a level indicative of dental phobia (Hill et al., 2013). While many people experience mild to moderate anxiety when visiting the dentist, dental phobia represents a significantly higher level of anxiety that can profoundly affect the health and well-being of the individual.
Beyond its social and psychological consequences, dental phobia can have a detrimental impact on oral health and the quality of life related to oral health (OHR QoL) (Hill et al., 2013). Individuals with dental phobia tend to have more teeth with active disease, fewer restorations, and increased bleeding and plaque indices compared to those without dental phobia (Hill et al., 2013). However, it's important to note that individuals with dental phobia are not a uniform group, and the extent of the phobia's impact can vary, including their willingness to seek dental care.
This paper therefore aims to explore the knowledge and attitudes of oral health patients attending dental clinics regarding dental phobia and to investigate the various prevention strategies.
1.2 Statement of the Problem
Dental phobia has been reported to be a frequently encountered problem in dental offices (Appukuttan, 2016). The biggest challenge with dental phobia is that the individuals with this fear avoid dental treatment at the expense of poor oral health (Schubbs Dental Clinics, 2019).
The fear and anxiety associated with dental procedures can lead to delayed or avoided dental visits, ultimately causing oral health problems to escalate. The consequences of untreated dental issues can be severe, including pain, infection, tooth loss, and a negative impact on one's self-esteem and quality of life. Despite its prevalence and detrimental effects, dental phobia remains poorly understood and inadequately addressed.
Heidari et al (2009) in his study reported that many phobic people (798 [58.5%]) even with an awareness of their dental needs, will wait to seek care and will only attend with painful (infected) symptomatic teeth that exhibit longstanding untreated dental caries. Regular attendance not only leads to maintenance of good oral health but also will prevent active caries progression to ultimately, unrestorable teeth that will require extraction leading to tooth loss and poor OHR QoL.
Thus there is a need to investigate the knowledge and attitudes of oral health patients toward dental phobia and to identify effective prevention and management strategies. This study seeks to address this gap in knowledge.
1.3 Aim of the Study
The aim of this study is to explore the knowledge and attitudes of oral health patients attending dental clinics regarding dental phobia and to investigate the various prevention strategies.
1.4 Objectives of the Study
The specific objectives of this study are as follows:
- To assess the level of knowledge among oral health patients regarding dental phobia.
- To examine the attitudes of oral health patients toward dental phobia and dental care.
- To investigate the relationship between the knowledge and attitude of oral health patients toward dental phobia
- To evaluate the existing prevention and management strategies for dental phobia.
1.5 Research Questions
To achieve the above objectives, this study will address the following research questions:
- What is the level of knowledge among oral health patients regarding dental phobia?
- What are the attitudes of oral health patients toward dental phobia and dental care?
- What is the relationship between the knowledge and attitude of oral health patients toward dental phobia?
- What are the existing prevention and management strategies for dental phobia?
1.6 Research Hypothesis
H0: There is no significant relationship between the knowledge and attitude of oral health patients toward dental phobia.
Ha: There is a significant relationship between the knowledge and attitude of oral health patients toward dental phobia.
1.7 Justification of the Study
This study contributes to the existing body of knowledge by shedding light on the knowledge, attitudes, and preventive measures related to dental phobia among oral health patients. It provides valuable insights into the psychological aspects of oral health care. Dental educators can use the findings to enhance their teaching methods and curriculum, emphasizing the importance of patient psychology and communication in oral health care.
Government health agencies can use the study's recommendations to develop policies and programs aimed at reducing dental phobia and promoting regular dental care, thereby improving overall public health. This study can serve as a foundation for future research on dental phobia and its management. It can inspire more in-depth investigations into the psychological and behavioral aspects of oral health.
1.8 Scope of the Study
This study will focus on oral health patients attending selected dental clinics within Lagos Nigeria. The study will assess their knowledge and attitudes towards dental phobia. The research will involve a cross-sectional survey of a representative sample of oral health patients, and data will be collected through structured interviews and questionnaires.
