What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance

Community Dent Oral Epidemiol. 2013 Jun;41(3):279-87. doi: 10.1111/cdoe.12005. Epub 2012 Sep 25.


Objectives: A vicious cycle is believed to operate in the maintenance of dental fear, whereby greater dental fear leads to the delay or avoidance of dental visiting, deteriorated oral health and problem-oriented treatment, which then serves to reinforce the fear. The current study sought to uncover the existence of this vicious cycle pattern and to investigate the role of both dental fear and avoidance in terms of their hypothesized effect on treatment needs and visiting for problems.

Methods: Study participants were 1036 (response rate = 71.6%) dentate Australians (aged 15+) from all Australian states and territories.

Results: Dental fear was associated with avoidance, treatment need and problem-oriented visiting. For people with moderate to high dental fear, 38.5% fit the hypothesized vicious cycle pattern of avoiding dental visiting because of fear, having treatment need and visiting for a problem. This compared with only 0.9% of people with no dental fear. Avoiding going to the dentist was an important predictor of treatment need and problem-oriented visiting independent of dental fear. Dental fear was a statistically significant predictor of treatment need and problem-oriented visiting and also acted as an effect modifier on avoidance because of fear.

Conclusion: The results support the premises underlying the vicious cycle model of dental fear maintenance. Dental fear appears to act as a determinant of avoiding or delaying dental visit, which has flow-on effects in terms of greater treatment need and problem-oriented visiting.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health
  • Australia
  • Dental Anxiety / psychology*
  • Dental Care / psychology*
  • Female
  • Health Services Needs and Demand
  • Humans
  • Income
  • Male
  • Middle Aged
  • Oral Health*
  • Self Report
  • Social Class
  • Stress, Psychological / psychology
  • Young Adult