Skip to content

Research at St Andrews

The social gradient in oral health: is there a role for dental anxiety?

Research output: Research - peer-reviewArticle



Objective: To evaluate the contribution of dental anxiety to social gradients in different oral health outcomes and whether social gradients in oral health persist once dental anxiety is removed from the population examined. 
Methods: Data from 9035 British adults were analysed. Participants’ socioeconomic position (SEP) was measured through education and household income. Dental anxiety was measured with the Modified Dental Anxiety Scale. Poor subjective oral health, oral impacts on quality of life and edentulism among all adults and the number of teeth, DMFS and sextants with pocketing among dentate adults were the oral health outcomes. The contribution of dental anxiety to absolute and relative social inequalities in each oral health outcome (measured with the Slope and Relative Index of Inequality [SII and RII], respectively) was estimated from regression models without and with adjustment for dental anxiety and quantified with the percentage attenuation. Interactions between each SEP indicator and dental anxiety were used to test what would happen if dental anxiety were removed from the whole population.
Results: The largest contribution of dental anxiety to explaining oral health inequalities was found for education gradients in perceived outcomes (11-13%), but dental anxiety explained <4% of social gradients in edentulism. Among dentate adults, dental anxiety accounted for <5% and <7% of education and income gradients, respectively. Only four of the 24 interactions tested were statistically significant. Hence, the education- and income-based SII and RII for oral impacts were non-significant among anxiety-free adults but were significant at higher levels of dental anxiety. 
Conclusions: Little support was found for the role of dental anxiety in explaining social inequalities in various perceived and clinical oral health measures. Oral health inequalities were found among both non-dentally anxious and anxious participants.


Original languageEnglish
JournalCommunity Dentistry and Oral Epidemiology
Issue number4
Early online date28 Mar 2017
StatePublished - Aug 2017

    Research areas

  • Anxiety, Disparities, Psychosocial aspects of oral health

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Multimorbidity and socioeconomic deprivation in primary care consultations

    Mercer, S. W., Zhou, Y., Humphris, G. M., McConnachie, A., Bakhshi, A., Bikker, A., Higgins, M., Little, P., Fitzpatrick, B. & Watt, G. C. M. Mar 2018 In : Annals of Family Medicine. 16, 2, p. 127-131 5 p.

    Research output: Research - peer-reviewArticle

  2. Fear of cancer recurrence in oral and oropharangeal cancer patients: an investigation of the clinical encounter

    Ozakinci, G., Swash, B., Humphris, G., Rogers, S. N. & Hulbert-Williams, N. J. Jan 2018 In : European Journal of Cancer Care. 27, 1, e12785

    Research output: Research - peer-reviewArticle

Related by journal

  1. Maternal and paternal contribution to intergenerational psychosocial transmission of paan chewing

    Madathil, S. A., Rousseau, M-C., Allison, P., Netuveli, G., Humphris, G. M., Varghese, I., Shiraz, S., Castonguay, G., Thekkepurakkal, A-S., Shahul, H. P. & Nicolau, B. Aug 2015 In : Community Dentistry and Oral Epidemiology. 43, 4, p. 289-297 9 p.

    Research output: Research - peer-reviewArticle

  2. Obesity and dental caries in children: a systematic review and meta-analysis

    Hayden, C., Bowler, J., Chambers, S., Freeman, R., Humphris, G. M., Richards, D. & Cecil, J. E. 16 Nov 2012 In : Community Dentistry and Oral Epidemiology.

    Research output: Research - peer-reviewArticle

  3. Fluoride rinsing and dental health inequalities in 11-year-old children: an evaluation of a supervised school-based fluoride rinsing programme in Edinburgh

    Levin, K. A., Jones, C. M., Wight, C., Valentine, C., Topping, G. V. A. & Naysmith, R. Feb 2009 In : Community Dentistry and Oral Epidemiology. 37, 1, p. 19-26 8 p.

    Research output: Research - peer-reviewArticle

ID: 249229215