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The proper APA Style reference for this manuscript is:
GILLAHAN, J. E. (2002). The Cause of Dental Anxiety May Not Be Pain. National Undergraduate Research Clearinghouse, 5. Available online at http://www.webclearinghouse.net/volume/. Retrieved October 6, 2022 .

The Cause of Dental Anxiety May Not Be Pain
Missouri Western State University DEPARTMENT OF PSYCHOLOGY

Sponsored by: Brian Cronk (cronk@missouriwestern.edu)
This study was an assessment of the relationship between pain felt during an injection in the dental office and the amount of dental anxiety the patient reported. All 15 of the patients were over the age of 18 and consisted of male and female. A questionnaire was used to assess the patients anxiety. (See Appendix A). This was completed when the patient was placed in the dental chair. A pain scale was used to measure the amount of pain felt during the injection, this was completed immediately following the injection. (See Appendix B). A one-way ANOVA was computed comparing those with low, medium, and high pain to those with low, medium and high anxiety. No relationship was found between pain level and anxiety. The results support the hypothesis of this study and is consistent with past research. This study and others indicate a need for research that might focus in the area of distortions of memory or personality types and anxiety.

The Cause of Dental Anxiety May Not be Pain A commonly held assumption that dental anxiety is the key factor in avoidance of dental treatment has been the focus of much research. Some research indicates that dental anxiety may not be caused by memory of actual pain felt. Van Buren (1979) reported a simultaneous response to anxiety and pain. This report seems unlikely because Arntz, Arnoud, and Heijmans (1990) found the experienced pain was less than the anticipated pain for high anxious subjects. They collected data from high anxiety subjects after one visit and again after a second visit. These visits occurred within 27 day of each other. These subjects anticipated less pain before there second visit than they did before there first visit. Arntz et al. found there was a gradual increase in anticipated pain as more time passed. They based there assumption on the cognitive dissonance theory. If the subject has enough consecutive disconfirming visits to the dentist in a relatively short period of time, the subject will balance there anxiety to agree with their actual experience. Kent (1985) agrees and reported it may require several low pain visits for the subject to extinguish the fear of pain. It has been indicated that early experience of a painful treatment might be the cause for heightened anxiety but according to Klepac, Dowling, and Hauge (1982) early painful experience was remembered by those with low levels of anxiety as well as those with high levels of anxiety. They feel that the distorted cognitive responses to pain are the key factor in developing high levels of anxiety. This distortion can cause confounding avoidance and neglect, which can become a cycle. Another study which supports these hypotheses was completed by Vassend (1993). He hypothesized that improvements in dental technology would decrease anxiety in younger subjects but actually found a higher percent of anxiety for subjects between 15 and 19 years of age than those older. Wardle (1984) conducted a study using dental extractions as the measure of anticipated pain and actual pain felt. He found that expectations are not corrected with experience. The actual experience does not happen often enough eliminate the distorted memory. He feels that rehearsals of the actual experience might help cope with the inaccurate cognitions. Wardle believes those with high levels of anxiety have heightened attention to cues of danger and easier access to memories of danger related distortions of perception and judgment. He also found no relationship between high anxiety and high experienced pain. The assumption that past experience of painful dental treatment as the cause of dental anxiety can be put aside. Treatment of dental anxiety should focus on personality types that distort memory to fit there anxiety levels. The memory of dental treatment will either be a pleasant experience or a painful experience. This depends on the memory processes of the subject. It is expected that this study will support the evidence that a subjects high levels of anxiety are not due to actual dental experiences but due to a subjective way of remembering those experiences.

Participants Approximately 15 dental patients participated in the experiment. Only subjects that received injections for their dental treatment was used. The injection was administered to each patient by the same dentist. The subjects were randomly selected from the office schedule on a daily basis. The subjects were 18 years or older. The subjects consisted of males and females. The experiment was conducted at a dental office located in a town in Northwest Missouri. The population of the town is around 7000. Materials A questionnaire was used to determine the level of anxiety the patient felt before treatment. Refer to Appendix A. Approximately 1.8 cc of ardicaine was used for the injection. A 30 gauge needle was used by the Dentist to administer the ardicaine. A scale to measure the amount of pain felt after the injection was used. Refer to appendix B.Procedure When the subject was placed in the chair they were instructed by the dental assistant that we are conducting an experiment to measure dental anxiety. They were told the experiment was being done for a class at Missouri Western College. It was explained to them that their completed papers were not to have there name on them and the dentist will not see them. After they agreed to participate, they were given a questionnaire to fill out and were left alone to do so. After the Dentist administered the ardicaine he left the room. The dental assistant then instruct the subject that we were measuring pain of the injection with dental anxiety. After the subject agreed to complete the experiment they were given the pain scale. They were left alone again. The assistant collected and stapled the two papers together and placed them with the other papers.

A one-way ANOVA was computed comparing the pain level of those with low, medium, and high anxiety. No significant difference was found between the three sets (F(2,12) = 2.29, P>.05). This analysis compared the pain level of those with high anxiety (m = 6.00, sd = 4.24), those with moderate levels of anxiety (m = 3.88, sd = 2.71), and those with low levels of anxiety (m = 1.50, sd = .57). The results support my hypothesis and indicates a need for research that might focus on memory distortion, personality types, and anxiety. Many who suffer from high dental anxiety live with poor oral hygiene that can lead to pain, tooth loss, and illness. Psychology, as a science, has an obligation to continue research in areas that focus on reduction of dental anxiety. A focus for the future could be memory distortions and personality types as they relate to anxiety.


Arntz, A., Van Eck, M., & Heijmans, M. (1990). Predictions of dental pain: The fear of any expected evil is worse than the evil itself. Behavior Research & Therapy, 28, 29-41. Kent, G. (1985). Memory of dental pain. Pain, 21, 187-194. Klepac, R. K., Dowling, J., & Hauge, G. (1982). Characteristics of clients seeking therapy for the reduction of dental avoidance: Reactions to pain. Journal of Behavior Therapy & Experimental psychiatry, 13, 293-300. Van Buren, J., & Kleinknecht, R. A. (1979) An evaluation of the McGill pain questionnaire for use in dental pain assessment. Pain, 6, 23-33. Vassent, O. (1993). Anxiety, pain and discomfort associated with dental treatment. Behavior Research & Therapy, 31, 659-666. Wardle, J. (1984). Dental pessimism: Negative cognitions in fearful dental patients. Behavior Research & Therapy, 22, 553-556.

Submitted 4/25/2002 9:23:46 PM
Last Edited 4/29/2002 11:08:45 AM
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