Work along both lines: a modified model of the vicious circle of Dental Fear and Anxiety (DFA)

Yuqi Li; Yiting Zhang; Jie Huang; Xiaoying Wu; Wenfei Hu; Yangke Zhao

doi:10.54254/3049-5458/2025.24232

Article Information

Received: 14 June 2025

Published: 1 July 2025

DOI: https://doi.org/10.54254/3049-5458/2025.24232

Article Type: Research Article

Cite this article

Li,Y.;Zhang,Y.;Huang,J.;Wu,X.;Hu,W.;Zhao,Y. (2025). Work along both lines: a modified model of the vicious circle of Dental Fear and Anxiety (DFA). Journal of Clinical Technology and Theory,3(2),40-45.

Data availability

The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.

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Volume Title: JCTT Vol.3

Part of Series: Journal of Clinical Technology and Theory

ISSN: 3049-5458 (Print) / 3049-5466 (Online)

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[1]Murad, M. H., Ingle, N. A., & Assery, M. K. (2020). Evaluating factors associated with fear and anxiety to dental treatment-A systematic review. Journal of family medicine and primary care, 9(9), 4530–4535.

[2]Liu, D., Liu, Y., Wang, J. (2022). Research progress of dental phobia. Guangxi Medical Journal, 44(20), 2418-2421.

[3]Silveira, E. R., Cademartori, M. G., Schuch, H. S., Armfield, J. A., & Demarco, F. F. (2021). Estimated prevalence of dental fear in adults: A systematic review and meta-analysis. Journal of dentistry, 108, 103632.

[4]Grisolia, B. M., Dos Santos, A. P. P., Dhyppolito, I. M., Buchanan, H., Hill, K., & Oliveira, B. H. (2021). Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses. International journal of paediatric dentistry, 31(2), 168–183.

[5]Dadalti MT, Cunha AJ, Souza TG, Silva BA, Luiz RR, Risso PA. Anxiety about dental treatment - a gender issue. Acta Odontol Latinoam. 2021 Aug 1;34(2):195-200.

[6]Katanec T, Singh S, Majstorovic M, Klaric I, Herman NG, Moursi AM. Gender Differences in Dental Anxiety and Medical Fear in Croatian Adolescents. J Clin Pediatr Dent. 2018;42(3):182-187.

[7]Gustafsson A, Broberg A, Bodin L, Berggren U, Arnrup K. Dental behaviour management problems: the role of child personal characteristics. Int J Paediatr Dent. 2010;20:242–53.

[8]Yap AU, Lee DZR. Dental fear and anxiety in Asian youths: response components and inducing stimuli. Clin Oral Investig. 2022 Sep;26(9):5953-5960.

[9]Wang Z.Analysis of the utilization and cost of oral health care services for urban and rural residents in Beijing. Chin J Stomatol. 2003;2:70–73.

[10]Chang DJ, Debiec J. Neural correlates of the mother-to-infant social transmission of fear. J Neurosci Res. 2016 Jun;94(6):526-34.

[11]Maganur, P. C., Vishwanathaiah, S., Ali Quadri, M. F., Alsabi, M., Modarba, W., Aqeel, W., Rawi, N. A., Uthman, A., Reda, R., Jafer, M., Testarelli, L., & Patil, S. (2024). Color perception and its relation to dental anxiety in children. Dental and medical problems, 61(5), 671–677.

[12]Stein Duker, L. I., Grager, M., Giffin, W., Hikita, N., & Polido, J. C. (2022). The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model. International journal of environmental research and public health, 19(4), 2380.

[13]Seligman LD,Hovey JD,Chacon K,et al.Dental anxiety: an understudied problem in youth[J].Clin Psychol Rev,2017,55:25-40.

[14]Meurman JH, Sanz M, Janket SJ. Oral health, atherosclerosis, and cardiovascular disease. Crit Rev Oral Biol Med. 2004 Nov 1;15(6):403-13.

[15]Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clin Interv Aging. 2015 Feb 11;10:461-7.

[16]Supriya, Singh, R., & Ahsan, A. (2024). Relevance of Emotion of Anxiety and Fear of Dentistry as Motivational Conflict in Oral Health Behaviors. The journal of contemporary dental practice, 25(3), 280–288.

[17]Locker D. Psychosocial consequences of dental fear and anxiety. Community Dent Oral Epidemiol. 2003 Apr;31(2):144-51.

[18]Armfield JM. Predicting dental avoidance among dentally fearful Australian adults. Eur J Oral Sci. 2013 Jun;121(3 Pt 2):240-6.

[19]Moore R, Brødsgaard I.(2001).Dentists' perceived stress and its relation to perceptions about anxious patients. [J]. Community dentistry and oral epidemiology,29,73-80.

[20]Eli I.(1993).Dental anxiety: a cause for possible misdiagnosis of tooth vitality. International endodontic journal, 26, 251–253.

[21]Cianetti, S., Lombardo, G., Lupatelli, E., Pagano, S., Abraha, I., Montedori, A., Caruso, S., Gatto, R., De Giorgio, S., and Salvato, R. (2017). Dental fear/anxiety among children and adolescents. A systematic review. European journal of paediatric dentistry, 18, 121–130.

[22]Berggren U, Meynert G. Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc. 1984 Aug;109(2):247-51.

[23]Bouma J, Uitenbroek D, Westert G, Schaub RM, van de Poel F. Pathways to full mouth extraction. Community Dent Oral Epidemiol. 1987 Dec;15(6):301-5.

[24]Silveira ER, Cademartori MG, Schuch HS, Corrêa MB, Ardenghi TM, Armfield J, Horta BL, Demarco FF. The vicious cycle of dental fear at age 31 in a birth cohort in Southern Brazil. Community Dent Oral Epidemiol. 2021 Aug;49(4):354-361.

[25]Thomson WM, Stewart JF, Carter KD, Spencer AJ. Dental anxiety among Australians. Int Dent J. 1996 Aug;46(4):320-4.

[26]Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health. 2007 Jan 14;7:1.

[27]Armfield JM. 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.

[28]Hall RK. Management of the sick and handicapped child in general dental practice. Aust Dent J. 1967 Aug;12(4):323-31.

[29]De Jongh A, Schutjes M, Aartman IH. A test of Berggren's model of dental fear and anxiety. Eur J Oral Sci. 2011 Oct;119(5):361-5.

[30]Carlsson V, Hakeberg M, Wide Boman U. Associations between dental anxiety, sense of coherence, oral health-related quality of life and health behavior--a national Swedish cross-sectional survey. BMC Oral Health. 2015 Sep 2;15:100.

[31]Moore R, Brødsgaard I, Rosenberg N. The contribution of embarrassment to phobic dental anxiety: a qualitative research study. BMC Psychiatry. 2004 Apr 19;4:10.

[32]Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety. Community Dent Health. 1996 Jun;13(2):86-92. PMID: 8763138IF: 1.7 B4.

[33]Vassend O. Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. 1993 Sep;31(7):659-66.

[34]Moore R, Brødsgaard I. Differential diagnosis of odontophobic patients using the DSM-IV. Eur J Oral Sci. 1995 Apr;103(2 ( Pt 1)):121-6.

[35]Liddell A, Gosse V. Characteristics of early unpleasant dental experiences. J Behav Ther Exp Psychiatry. 1998 Sep;29(3):227-37.

[36]Armfield JM, Slade GD, Spencer AJ. Cognitive vulnerability and dental fear. BMC Oral Health. 2008 Jan 24;8:2.

[37]Barlow DH. Anxiety and its disorders: the nature and treatment of anxiety and panic. New York: Guilford press; 2002.

[38]Skinner BF. Science and human behavior. New York: Free Press; 1965.

[39]Appukuttan D. P. (2016). Strategies to manage patients with dental anxiety and dental phobia: literature review. Clinical, cosmetic and investigational dentistry, 8, 35–50.

[40]Buhre W,Disma N,Hendrickx J,et al.European society of anaesthesiology task force on nitrous oxide:a practice [J]. BrJAnaesth,2019,122(5):587-604.

[41]Kharouba J,Somri M,Hadjittofi C,et al.Effectiveness and safety of nitrous oxide as a sedative agent at 60%and 70% compared to 50% concentration in pediatric dentistry setting [J].J Clin Pediatr Dent,2020,44(1):60-65.

[42]Atkin T, Comai S, Gobbi G. Drugs for insomnia beyond benzodiazepines:pharmacology, clinical applications, and discovery[J]. Pharmacol Rev, 2018,70(2): 197-245.

[43]Steinvik, L. M., Svartdal, F., & Johnsen, J. K. (2023). Delay of Dental Care: An Exploratory Study of Procrastination, Dental Attendance, and Self-Reported Oral Health. Dentistry journal, 11(2), 56.

[44]Anderson, K., & Priebe, S. (2021). Concepts of Resilience in Adolescent Mental Health Research. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 69(5), 689–695.

[45]Sharma, R., George, M., & Krishnan, M. (2024). Efficacy of Preemptive Analgesia on Pain Perception After Simple Tooth Extraction: A Prospective Study. Cureus, 16(4), e58262.

[46]Davis TE, May A, Whiting SE. Evidence-based treatment of anxiety and phobia in children and adolescents: current status and effects on the emotional response. Clin Psychol Rev. 2011 Jun;31(4):592–602.

[47]Janthasila, N., & Keeratisiroj, O. (2023). Music therapy and aromatherapy on dental anxiety and fear: A randomized controlled trial. Journal of dental sciences, 18(1), 203–210.