Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2004

Open Access 01-12-2004 | Research article

The contribution of embarrassment to phobic dental anxiety: a qualitative research study

Authors: Rod Moore, Inger Brødsgaard, Nicole Rosenberg

Published in: BMC Psychiatry | Issue 1/2004

Login to get access

Abstract

Background

Embarrassment is emphasized, yet scantily described as a factor in extreme dental anxiety or phobia. Present study aimed to describe details of social aspects of anxiety in dental situations, especially focusing on embarrassment phenomena.

Methods

Subjects (Ss) were consecutive specialist clinic patients, 16 men, 14 women, 20–65 yr, who avoided treatment mean 12.7 yr due to anxiety. Electronic patient records and transcribed initial assessment and exit interviews were analyzed using QSR"N4" software to aid in exploring contexts related to social aspects of dental anxiety and embarrassment phenomena. Qualitative findings were co-validated with tests of association between embarrassment intensity ratings, years of treatment avoidance, and mouth-hiding behavioral ratings.

Results

Embarrassment was a complaint in all but three cases. Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks. Intense embarrassment was manifested in both clinical and non-clinical situations due to poor dental status or perceived neglect, often (n = 9) with fear of negative social evaluation as chief complaint. These nine cases were qualitatively different from other cases with chief complaints of social powerlessness associated with conditioned distrust of dentists and their negative behaviors. The majority of embarrassed Ss to some degree inhibited smiling/laughing by hiding with lips, hands or changed head position. Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment. Especially after many years of avoidance, embarrassment phenomena lead to feelings of self-punishment, poor self-image/esteem and in some cases personality changes in a vicious circle of anxiety and avoidance. Embarrassment intensity ratings were positively correlated with years of avoidance and degree of mouth-hiding behaviors.

Conclusions

Embarrassment is a complex dental anxiety manifestation with qualitative differences by complaint characteristics and perceived intensity. Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect.
Appendix
Available only for authorised users
Literature
1.
Johnson B, Mayberry WE, McGlynn FD: Exploratory factor analysis of a sixty-item questionaire concerned with fear of dental treatment. J Behav Ther Exp Psychiatr. 1990, 21: 199-203. 10.1016/0005-7916(90)90007-8.CrossRef
2.
Kvale G, Raadal M, Vika M, Johnsen BH, Skaret E, Vatnelid H, Oiama I: Treatment of dental anxiety disorders. Outcome related to DSM-IV diagnoses. Eur J Oral Sci. 2002, 110: 69-74. 10.1034/j.1600-0722.2002.11204.x.CrossRefPubMed
3.
de Jongh A, Aartman I, N. Brand: Trauma-related phenomena in anxious dental patients. Community Dent Oral Epidemiol. 2003, 31: 52-58. 10.1034/j.1600-0528.2003.00025.x.CrossRefPubMed
4.
Locker D, Shapiro D, Liddell A: Negative dental experiences and their relationship to dental anxiety. Community Dent Health. 1996, 13: 86-92.PubMed
5.
Vassend O: Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. 1993, 31: 659-666. 10.1016/0005-7967(93)90119-F.CrossRefPubMed
6.
Kaakko T, Coldwell SE, Getz T, Milgrom P, Roy-Byrne PP, Ramsay DS: Psychiatric diagnoses among self-referred dental injection phobics. J Anxiety Disord. 2000, 14: 299-312. 10.1016/S0887-6185(00)00024-4.CrossRefPubMed
7.
Moore R, Brødsgaard I, Birn H: Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population. Behav Res Ther. 1991, 29: 51-60.CrossRefPubMed
8.
Moore R, Brødsgaard I: Differential diagnosis of odontophobic patients using the DSM-IV. Eur J Oral Sci. 1995, 103: 121-126.CrossRefPubMed
9.
Roy-Byrne PP, Milgrom P, Tay K-M, Weinstein P, Katon W: Psychopathology and psychiatric diagnosis in subjects with dental phobia. J Anxiety Disord. 1994, 8: 19-31. 10.1016/0887-6185(94)90020-5.CrossRef
10.
Locker D: Psychosocial consequences of dental fear and anxiety. Community Dent Oral Epidemiol. 2003, 31: 144-151.CrossRefPubMed
11.
Berggren U, Meynert G: Dental fear and avoidance - causes, symptoms and consequences. J Am Dent Assoc. 1984, 109: 247-251.CrossRefPubMed
12.
Berggren U, Carlsson SG, Gustafsson JE, Hakeberg M: Factor analysis and reduction of a Fear Survey Schedule among dental phobic patients. Eur J Oral Sci. 1995, 103: 331-338.CrossRefPubMed
13.
Liddell A, Gosse V: Characteristics of early unpleasant dental experiences. J Behav Ther Exp Psychiatry. 1998, 29: 227-237. 10.1016/S0005-7916(98)00014-7.CrossRefPubMed
14.
Bernstein DA, Kleinknecht RA, Alexander LD: Antecedents of dental fear. J Public Health Dent. 1979, 39: 113-124.CrossRefPubMed
15.
16.
Stouthard MEA, Hoogstraten J: Ratings of fears associated with twelve dental situations. J Dent Res. 1987, 66: 1175-1178.CrossRefPubMed
17.
Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Bobes J, Beidel DC, Ono Y, Westenberg HG: Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 1998, 59: 54-60.PubMed
18.
Ballenger JC: Recognizing the patient with social anxiety disorder. Int Clin Psychopharmacol. 2000, 15: S1-S5.CrossRefPubMed
19.
Zerbe KJ: Uncharted waters: psychodynamic considerations in the diagnosis and treatment of social phobia. Bull Menninger Clin. 1994, 58: A3-20.PubMed
20.
Bruce TJ, Saeed SA: Social anxiety disorder: a common, underrecognized mental disorder. Am Fam Physician. 1999, 60: 2311-2320, 2322.PubMed
21.
Katzelnick DJ, Greist JH: Social anxiety disorder: an unrecognized problem in primary care. J Clin Psychiatry. 2001, 62 Suppl 1: 11-15.PubMed
22.
Weinshenker NJ, Goldenberg I, Rogers MP, Goisman RM, Warshaw MG, Fierman EJ, Vasile RG, Keller MB: Profile of a large sample of patients with social phobia: comparison between generalized and specific social phobia. Depress Anxiety. 1997, 4: 209-216. 10.1002/(SICI)1520-6394(1996)4:5<209::AID-DA1>3.3.CO;2-Q.CrossRef
23.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM-IV. 1994, Washington, D. C., American Psychiatric Association
24.
Spitzer RL, Williams JBW, Gibbon M, First MB: Structured Clinical Interview for DSM-III-R - Patient Version (SCID-P, 5/1/89). 1989, New York, Biometrics Research Department, New York State Psychiatric Institute
25.
Eisenberg N: Emotion, regulation, and moral development. Annu Rev Psychol. 2000, 51: 665-697. 10.1146/annurev.psych.51.1.665.CrossRefPubMed
26.
Higuchi M, Fukada H: A comparison of four causal factors of embarrassment in public and private situations. J Psychol. 2002, 136: 399-406.CrossRefPubMed
27.
Moore R, Berggren U, Carlsson SG: Reliability and clinical usefulness of psychometric measures in a self-referred population of odontophobics. Community Dent Oral Epidemiol. 1991, 19: 347-351.CrossRefPubMed
28.
29.
Milgrom P, Weinstein P, Kleinknecht R, Getz T: Treating Fearful Dental Patients - A Patient Management Handbook. 1995, Seattle, WA, University of Washington Press, Second
30.
Spielberger CD, Gorsuch RL, Lushene RE: STAI manual for the state-trait anxiety inventory. 1970, Palo Alta, CA, Consulting Psychologists Press
31.
Hakeberg M, Gustafsson JE, Berggren U, Carlsson SG: Multivariate analysis of fears in dental phobic patients according to a reduced FSS-II scale. Eur J Oral Sci. 1995, 103: 339-344.CrossRefPubMed
32.
Johansson P, Berggren U, Hakeberg M, Hirsch JM: Measures of dental beliefs and attitudes: their relationships with measures of fear. Community Dent Health. 1993, 10: 31-39.PubMed
33.
Sheehan DV, Sheehan KH: The classification of phobic disorders. Int J Psychiatr Med. 1983, 12: 243-266.CrossRef
34.
Richards T, Richards L: Q.S.R. (Qualitative Solutions and Research) Manual, NUD*IST (Nonnumerical Unstructured Data * Indexing, Searching and Theory building). 1995, London, Sage
35.
36.
Kahn DL, Steeves RH: The experience of suffering: conceptual clarification and theoretical definition. J Adv Nurs. 1986, 11: 623-631.CrossRefPubMed
37.
Bjercke O, Blomberg S, Linde A: [Psychiatric evaluation of patients with pronounced fear of dental treatment] Psykiatrisk bedömning av patienter med tandvårdskräck. Läkertidningen. 1977, 74: 1390-1392.
38.
Wolpe J: The dichotomy between classical conditioned and cognitively learned anxiety. J Behav Ther Exp Psychiatr. 1981, 12: 35-42. 10.1016/0005-7916(81)90027-6.CrossRef
39.
Moore R, Brødsgaard I, Mao TK, Kwan HW, Shiau YY, Knudsen R: Fear of injections and report of negative dentist behavior among Caucasian American and Taiwanese adults from dental school clinics. Community Dent Oral Epidemiol. 1996, 24: 292-295.CrossRefPubMed
40.
Moore R, Brødsgaard I, Mao T-K, Miller ML, Dworkin SF: Perceived need for local anesthesia in tooth drilling among AngloAmericans, mandarin Chinese and Scandinavians. Anesth Prog. 1998, 45: 22-28.PubMedPubMedCentral
41.
Gustavsson B: The human values of Swedish management. J Human Values. 1995, 1: 153-172.CrossRef
42.
Olofsson J: About the Nordeners: Subject 2.6 The essence of Nordishness, 2.6.1 What is Janteloven? The Jante Law. http://​www lysator liu se/nordic/scn/faq26 html. 1998
43.
Kirmayer Laurence J.: Cultural variations in the response to psychiatric disorders and emotional distress. Soc Sci Med. 1989, 29: 327-339. 10.1016/0277-9536(89)90281-5.CrossRefPubMed
Metadata
Title
The contribution of embarrassment to phobic dental anxiety: a qualitative research study
Authors
Rod Moore
Inger Brødsgaard
Nicole Rosenberg
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2004
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-4-10

Other articles of this Issue 1/2004

BMC Psychiatry 1/2004 Go to the issue

Research article

Family structure and risk factors for schizophrenia: case-sibling study

Research article

Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram

Research article

Social Phobia in an Italian region: do Italian studies show lower frequencies than community surveys conducted in other European countries?

Research article

Subjective and objective evaluation of alertness and sleep quality in depressed patients

Research article

Ethnicity, sleep, mood, and illumination in postmenopausal women

Research article

Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: A double blind and randomized trial [ISRCTN64132371]