Dental anxiety is a major public health concern that leads to underutilization of dental care and poor oral health. There is a lack of empirical studies examining potential cognitive-affective risk candidates that may cause or maintain dental anxiety. Much research has associated pain expectancy with increased dental anxiety;however, not all patients with high pain expectancy develop dental anxiety, and the factors that influence how pain expectancy affects dental anxiety remain unclear. Anxiety sensitivity, which is the fear of negative consequences of internal sensations, may amplify the impact of pain expectancy on the experience of dental anxiety. Individuals with high anxiety sensitivity engage in more catastrophic thinking about the consequences of pain (and other internal sensations);therefore, having expectations that dental treatment will be painful may be more likely to increase or maintain dental anxiety for individuals with high anxiety sensitivity. The central hypothesis of th proposed study is that anxiety sensitivity will moderate the relationship between pain expectancy and increases in dental procedure stress reactivity and dental anxiety. We propose to examine this hypothesis by using both cross-sectional and experimental research designs. Participants will be adults seeking treatment at dental clinics who exhibit a range of dental anxiety. Eligible participants will be invited to complete a single laboratory session, during whic they will first complete self- report measures of anxiety sensitivity, pain expectancy, and dental anxiety. Next, participants will watch a series of films of dental procedures and their baseline psychological and physiological stress reactivity to the films will be tested. Participants will thn undergo an experimental manipulation of pain expectancy, which will use a shock threat paradigm in conjunction with an administration of a second series of dental films. Participants will be randomized to one of two pain expectancy conditions: the shock threat condition (expecting to experience electric shocks while watching the second series of dental films) or the safe condition (assured that they will not experience shocks while watching the films). Following the pain expectancy manipulation, participants will view the second series of films of dental procedures another time and their stress reactivity will be re-assessed. Self-reported dental anxiety will also be re-assessed following the pain expectancy manipulation. We expect that for individuals who are high in anxiety sensitivity, pain expectancy will exhibit a stronger relationship with dental procedure stress reactivity and dental anxiety. The knowledge gained from the proposed translational research study will clarify whether anxiety sensitivity moderates the effect of pain expectancy on dental anxiety, which will inform the utility of targeting anxiety sensitivity in brief interventions aimed at preventing or reducing dental anxiety, particularly among patients who report expectations of experiencing pain during dental treatment. This is a crucial step towards bolstering the use of oral health care by dentally anxious patients.

Public Health Relevance

Dental anxiety is a major public health concern that leads to underutilization of dental care and poor oral health. The proposed project is designed to examine whether two cognitive-affective factors, anxiety sensitivity and pain expectancy, work together to increase dental anxiety. A better understanding of the risk factors involved in the maintenance of dental anxiety will inform the development of dental anxiety prevention programs that will effectively target this important barrier to oral health care.

National Institute of Health (NIH)
Predoctoral Individual National Research Service Award (F31)
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NIDR Special Grants Review Committee (DSR)
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Frieden, Leslie A
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Temple University
Schools of Arts and Sciences
United States
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