Oral health literacy and dental anxiety: A study among dental patients in Malaysia
https://doi.org/10.36377/ET-0067
Abstract
AIM. The study’s objective was to assess the levels of oral health literacy (OHL) and dental anxiety (DA) among patients and to examine any potential correlation between OHL and DA.
MATERIALS AND METHODS. This study is a cross-sectional analysis of 97 dental patients at AIMST Dental Centre in Malaysia. Oral Health Literacy (OHL) was assessed with the Oral Health Literacy Instrument (OHLI), while Dental Anxiety (DA) was evaluated by the Modified Dental Anxiety Scale (MDAS) questionnaire.
RESULTS. A significant proportion (70.1%) of participants exhibited sufficient oral health literacy, although moderate levels of anxiety were observed in 39.8% of individuals as measured by the MDAS. OHL exhibited a strong correlation with age (p = 0.031) and education (p < 0.001), while DA showed no significant association with any sociodemographic parameters. Ultimately, OHL had a substantial correlation with the MDAS (p = 0.004).
CONCLUSIONS. Our study revealed a substantial correlation between oral health literacy (OHL) and dental anxiety (DA) among participants, indicating a necessity for oral health education to enhance OHL and therefore improve oral health outcomes, perhaps mitigating their DA.
About the Authors
J. Pillay
AIMST University
Malaysia
Competing Interests:
Malaysia
Jegarajan Pillay – Faculty of Dentistry
Kedah
Competing Interests:
The authors report no conflict of interest.
S. Selvaraj
D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth
India
Competing Interests:
India
Siddharthan Selvaraj – Department of Dental Research Cell
Pune 411018
Competing Interests:
The authors report no conflict of interest.
V. Mehta
D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth
India
Competing Interests:
India
Vini Mehta – Department of Dental Research Cell
Pune 411018
Competing Interests:
The authors report no conflict of interest.
E. Y.E. Leng
D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth
Malaysia
Competing Interests:
Malaysia
Elaine You Ee Leng – Faculty of Dentistry
Kedah
Competing Interests:
The authors report no conflict of interest.
E. Ting
AIMST University
Malaysia
Competing Interests:
Malaysia
Elin Ting – Faculty of Dentistry
Kedah
Competing Interests:
The authors report no conflict of interest.
E. L.J. Shin
AIMST University
Malaysia
Competing Interests:
Malaysia
Evangelina Lau Jia Shin – Faculty of Dentistry
Kedah
Competing Interests:
The authors report no conflict of interest.
G. E. Wei
AIMST University
Russian Federation
Competing Interests:
Russian Federation
Goh Ee Wei – Faculty of Dentistry
Kedah
Competing Interests:
The authors report no conflict of interest.
A. K. Tabnjh
Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg; College of Applied Medical Sciences, Jordan University of Science and Technology
Jordan
Competing Interests:
Jordan
Abedelmalek Kalefh Tabnjh – Department of Cariology; Department of Applied Dental Sciences
Irbid
Competing Interests:
The authors report no conflict of interest.
References
1. Ratzan S.C., Parker R.M. Introduction. In: Selden C.R., Zorn M., Ratzan S.C., Parker R.M. (Eds.), National library of medicine current bibliographies in medicine: Health literacy. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 2000.
2. Jaafar A., Al-Kadhim A.H.A., Ab Malik N. Oral health literacy among public university undergraduate students and associated factors. IIUM Medical Journal Malaysia. 2020;19(3):73–79. https://doi.org/10.31436/imjm.v19i3.1668
3. Schiavo J.H. Oral health literacy in the dental office: the unrecognized patient risk factor. J Dent Hyg. 2011;85(4):248–555. Available at: https://jdh.adha.org/content/85/4/248 (accessed: 13.02.2025).
4. Cianetti S., Lombardo G., Lupatelli E., Pagano S., Abraha I., Montedori A. et al. Dental fear/anxiety among children and adolescents. A systematic review. Eur J Paediatr Dent. 2017;18(2):121–130. https://doi.org/10.23804/ejpd.2017.18.02.07
5. Bernson J.M., Hallberg L.R., Elfström M.L., Hakeberg M. “Making dental care possible: a mutual affair”: a grounded theory relating to adult patients with dental fear and regular dental treatment. Eur J Oral Sci. 2011;119(5):373–380. https://doi.org/10.1111/j.1600-0722.2011.00845.x
6. Brahm C.-O., Lundgren J., Carlsson S.G., Nilsson P., Corbeil J., Hägglin C. D Dentists’ views on fearful patients. Problems and promises. Swed Dent J. 2012;36(2):79–89.
7. Carter A.E., Carter G., Boschen M., AlShwaimi E., George R. Pathways of fear and anxiety in dentistry: A review. World J Clin Cases. 2014;2(11):642–653. https://doi.org/10.12998/wjcc.v2.i11.642
8. Armfield J.M., Spencer A.J., Stewart J.F. Dental fear in Australia: who’s afraid of the dentist? Aust Dent J. 2006;51(1):78–85. https://doi.org/10.1111/j.1834-7819.2006.tb00405.x
9. Berggren U., Meynert G. Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc. 1984;109(2):247–251. https://doi.org/10.14219/jada.archive.1984.0328
10. Armfield J.M. How do we measure dental fear and what are we measuring anyway? Oral Health Prev Dent. 2010;8(2):107–115.
11. McGrath C., Bedi R. The association between dental anxiety and oral health-related quality of life in Britain. Community Dent Oral Epidemiol. 2004;32(1):67–72. https://doi.org/10.1111/j.1600-0528.2004.00119.x
12. Appukuttan D.P. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35–50. https://doi.org/10.2147/CCIDE.S63626
13. Shin W.K., Braun T.M., Inglehart M.R. Parents’ dental anxiety and oral health literacy: effects on parents’ and children’s oral health-related experiences. J Public Health Dent. 2014;74(3):195–201. https://doi.org/10.1111/jphd.12046
14. Barasuol J.C., da Silva Assunção L.R., Fraiz F.C., Menezes J.V.N.B. Oral health literacy as a predictor of dental anxiety in parents of children undergoing dental treatment. J Dent Child (Chic). 2017; 84 (3):125–131.
15. Sriram K., Leelavathi L. Effect of parent’s dental anxiety and oral health literacy on children’s oral health. Drug Invention Today. 2019;11(10).
16. Sekertzi C.G. An empirical investigation of oral health literacy and its relationship with dental anxiety among university students. Thesis. Thessaloniki; 2021. 128 p. Available at: https://dspace.lib.uom.gr/bitstream/2159/25543/1/SekertziChristinaMSc.pdf (accessed: 13.02.2025).
17. Sabbahi D.A., Lawrence H.P., Limeback H., Rootman I. Development and evaluation of an oral health literacy instrument for adults. Community Dent Oral Epidemiol. 2009;37(5):451–462. https://doi.org/10.1111/j.1600-0528.2009.00490.x
18. Ramlay M.Z., Saddki N., Tin-Oo M.M., Arifin W.N. Cross-cultural adaptation and validation of Oral Health Literacy Instrument (OHLI) for Malaysian adults. Int J Environ Res Public Health. 2020;17(15):5407. https:// doi.org/10.3390/ijerph17155407
19. Humphris G.M., Freeman R., Campbell J., Tuutti H., D’Souza V. Further evidence for the reliability and validity of the Modified Dental Anxiety Scale. Int Dent J. 2000;50(6):367–370. https://doi.org/10.1111/j.1875-595x.2000.tb00570.x
20. Sitheeque M, Massoud M, Yahya S, Humphris G. Validation of the Malay version of the Modified Dental Anxiety Scale and the prevalence of dental anxiety in a Malaysian population. J Investig Clin Dent. 2015;6(4):313–320. https://doi.org/10.1111/jicd.12106
21. Nunes C., de Almeida C.V., Belim C. Health literacy in younger age groups: Health care perceptions: Informed people will be more prepared people. Open Access Library Journal. 2020;7:e6187. https://doi.org/10.4236/oalib.1106187
22. Karobari M.I., Siddharthan S., Adil A.H., Khan M.M., Venugopal A., Rokaya D. et al. Modifiable and nonmodifiable risk factors affecting oral and periodontal health and quality of life in South Asia. Open Dent J 2022;16(1): e187421062209270. https://doi.org/10.2174/18742106-v16-e2209270
23. Akram Z., Safii S.H., Vaithilingam R.D., Baharuddin N.A., Javed F., Vohra F. Efficacy of non-surgical periodontal therapy in the management of chronic periodontitis among obese and non-obese patients: a systematic review and meta-analysis. Clin Oral Investig. 2016;20(5):903–914. https://doi.org/10.1007/s00784-016-1793-4
24. Singh S.K.N., Maykanathan D., Xing J.T.Y. Oral Health Related Quality of Life (OHRQoL) and its association with socio-demographics and weight status among adults in Klang Valley, Malaysia. Journal of Oral Health & Research. 2015;6(4):1–10.
25. Pillay J., Natarajan M., Selvaraj S., Rao S.M., Chandrasekaran N.D. Oral health related quality of life among Malaysian rural children: A study using Child-OIDP index. Res J Pharm Technol. 2023;16(5):2347–2342. https:// doi.org/10.52711/0974-360X.2023.00386
26. Ho M.H., Montayre J., Chang H.R., Joo J.Y., Naghibi Sistani M.M., Lin Y.K. et al. Validation and evaluation of the Mandarin version of the oral health literacy adult questionnaire in Taiwan. Public Health Nurs. 2020;37(2):303–309. https://doi.org/10.1111/phn.12688
27. Naghibi Sistani M.M., Yazdani R., Virtanen J., Pakdaman A., Murtomaa H. Determinants of oral health: does oral health literacy matter? ISRN Dent. 2013;2013:249591. https://doi.org/10.1155/2013/249591
28. Atchison K.A., Gironda M.W., Messadi D., Der-Martirosian C. Screening for oral health literacy in an urban dental clinic. J Public Health Dent. 2010;70(4):269–275. https://doi.org/10.1111/j.1752-7325.2010.00181.x
29. Jones M., Lee J.Y., Rozier R.G. Oral health literacy among adult patients seeking dental care. J Am Dent Assoc. 2007;138(9):1199–1208. https://doi.org/10.14219/jada.archive.2007.0344
30. Beaton L., Freeman R., Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23(4):295–301. https://doi.org/10.1159/000357223
31. Scandurra C., Gasparro R., Dolce P., Bochicchio V., Muzii B., Sammartino G. et al. The role of cognitive and non-cognitive factors in dental anxiety: A mediation model. Eur J Oral Sci. 2021;129(4):e12793. https://doi.org/10.1111/eos.12793
32. Armfield J.M., Slade G.D., Spencer A.J. Cognitive vulnerability and dental fear. BMC Oral Health. 2008;8:2. https://doi.org/10.1186/1472-6831-8-2
33. Locker D. Psychosocial consequences of dental fear and anxiety. Community Dent Oral Epidemiol. 2003;31(2):144–151. https://doi.org/10.1034/j.1600-0528.2003.00028.x
34. Bergdahl M., Bergdahl J. Temperament and character personality dimensions in patients with dental anxiety. Eur J Oral Sci. 2003;111(2):93–98. https://doi.org/10.1034/j.1600-0722.2003.00028.x
35. Jeevan M.B., Yah T.S., Chen T.Y., Shan T.K., Rao S.M., Selvaraj S. OPG based study to analyze essential parameters of impacted lower third molar among north Malaysian population: A retrospective study. Res J Pharm Technol. 2023;16(6):2979–2974. https://doi.org/10.52711/0974-360X.2023.00492
36. Chellappah N.K., Vignehsa H., Milgrom P., Lam L.G. Prevalence of dental anxiety and fear in children in Singapore. Community Dent Oral Epidemiol. 1990;18(5):269–271. https://doi.org/10.1111/j.1600-0528.1990.tb00075.x
37. Tan A., Lee S.T., Lim L.P. Factors associated with dental anxiety among adults in Malaysia: A systematic review. Journal of Oral Health and Dental Management. 2019;18(2):75–82.
38. Ekanayake L., Dharmawardena D. Dental anxiety in patients seeking care at the University Dental Hospital in Sri Lanka. Community Dent Health. 2003;20(2):112–116.
39. Selvaraj S., Naing N.N., Wan-Arfah N. Effect of periodontal health in marital life. Res J Pharm Technol. 2021;14(8):4463–4465. https://doi.org/10.52711/0974-360X.2021.00775
40. Özdemir A.K., Özdemir H.D., Coşkun A., Taşveren S. Diş Hekimliği Fakültesinde profitez kliniği ile diğer kliniklerde hasta anksiyetesinin araştırılması. CÜ Diş Hek Fak Derg. 2001;4:71–74.
41. Ay S., Özdemir D., Öztürk M., Polat S. An assessment of dental anxiety in oral surgery patients. Gülhane Tıp Dergisi. 2002;44(4):395–398.
Review
For citations:
Pillay J., Selvaraj S., Mehta V., Leng E.Y., Ting E., Shin E.L., Wei G.E., Tabnjh A.K. Oral health literacy and dental anxiety: A study among dental patients in Malaysia. Endodontics Today. 2025;23(1):139-147. https://doi.org/10.36377/ET-0067
Email this article 