Dental Anxiety and Dental Fear as Potentiators of Mental Disorders in Lower Academic Level of Education

Dental anxiety and dental fear in a dental office constitutes a problem both for the patient and for the dentist who treats him, favoring a vicious circle (vicious circle of Berggren 1984), where the patient will defer, avoid or cancel his next appointments with his dentist, encouraging the increase of caries, oral infections, periodontitis, among others, which will cause the loss of a large number of teeth. Translating into poorer oral health and therefore, a poorer quality of life). This situation can foster a possible social embarrassment that prevents their normal socialization both in their work and private life [1], which can lead to further destabilization of their already altered psyche [2]. It should be taken into account that a patient with anxiety disorder, adaptive disorder or mixed anxiety-depression disorder, are more prone to develop dental anxiety and/or dental fear [3] causing a synergistic relationship that will exacerbate both their psychiatric condition and their dental anxiety and/or dental fear, favoring the appearance of different syndromes and potentiating those that already were [4].

However, we should not forget the socio-demographic factors such as academic education that can play an important role in the management of patients with dental anxiety, dental fear and/or mental disorders (anxiety disorder, adaptive disorder and mixed anxiety-depression disorder), so we will provide brief clinical data on the influence of the lower level of academic education in patients with dental anxiety, dental fear and/or mental disorders mentioned above.

According to the articles consulted, there are more researches advocating that a lower level of academic education (lower studies) can exacerbate dental anxiety and dental fear, due to the fact that a patient with lower level of academic education possesses lower strategies to cope with their anxiogenic and dental fear component [3,5,6]. And from there, their underlying mental disorder could be enhanced [4]. There are even articles, which advocate that pregnant woman living in a rural environment, with low level of education and socio-economic status may be related to higher level of depression, there being scientific evidence in the literature of this statement in non-pregnant patients [7].

Independently of the patient’s academic training, there are also other associated socio-demographic factors that can influence the patient’s behaviour and for which we should place special emphasis on patients who suffer from mental disorders, since they can be aggravated by dental anxiety and/or fear that will reduce visits to the dentist [2]. Therefore, further studies will be necessary to clarify the possible causes that relate dental anxiety and fear as an enhancer of mental disorders at a lower level of academic training as well as other related socio-demographic factors and the possible relationship between oral disease and mental disorders [8]. Since dental anxiety and fear are multifactorial and are common in the population, a good medical history, both general and dental, should be taken in case there is an associated mental disorder or other disease of dental concern. If the patient suffers from a mental disorder and/or anxiety or dental fear, the dentist should consult with the psychiatrist, so that the patient does not avoid dental treatment [9].

A lower level of academic education can constitute a sociodemographic risk factor to be taken into account in patients with mental disorders, which can be aggravated by dental anxiety and fear.

I thank Dr Professor Juan Antonio Bermúdez Sánchez, my father, for instilling in me his love for psychiatry. Now I will be able to help from the field of dentistry to those people who are suffering from some kind of mental disorder and those who are free of it.

1. Berggren U, Meynert G (1984) Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc 109(2): 247-251.
2. Bermúdez B, Bermúdez S, Ruiz R, Serrera F, Gutiérrez P, et al. (2022) D Analysis of psychic imbalance, caused by screening of a video of surgical extraction of a lower third molar in a simple of mental patients as compared to the general population. J Clin Exp Dent 14(9): e726-39.
3. Talo YT, Dundar S, Bozoglan (2017) Is there a relation between dental anxiety, fear and general psychological status? Peer J 15(5): e2978.
4. Bermúdez BE, Bermúdez S, Ruiz R, Baus D, Serrera F, et al. (2024) Influence of education on dental anxiety and fear in mental disorders after viewing a molar extraction in three types of mental disorder compared to persons with no mental disorder. J Clin Med 13(3): 3868.
5. Appukuttan D, Subramanian S, Tadepalli A (2015) Dental anxiety among adults: An epidemiological study in south India. North Amer J Med Sci 7(1): 13-8.
6. Talo Y (2016) Revaluating the relations of the dental fear with dental health status and awareness. J Clin Diagn Res 10(7): ZC105-ZC109.
7. Malvania EA, Ajithkrishnan CG (2011) Prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending a dental institution in Vadodara city, Gujarat, India. Indian J Dent Res 22(1): 179-80.
8. Skallevod HE, Rokaya N, Wongsirichat N, Rokaya D (2023) Importance of oral health in mental health disorders: An updated review. J Oral Biol Craniofac Res 13(5): 544-552.
9. Halonen H, Salo T, Hakko H, Räsänen P (2014) The association between dental anxiety, general clinical anxiety and depression among Finnish university students. Oral Health Dent Manag 13(2): 320-325.