The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London

Abstract

Objective: To investigate whether the relationship between dental anxiety and referral for treatment under sedation is explained by attendance patterns and oral health.

Methods: Structural Equation Modeling was used on the covariance matrix of the covariates to test hypothesized inter-relationships. Subsequently, we modeled the probability of referral for treatment under sedation with a multiple logistic regression taking into account inter-relationships between the independent variables.

Results: A direct significant association of referral with dental anxiety and attendance patterns was detected, but not with oral health status. However, oral health and anxiety were highly correlated. Also signaled were correlations between age and education and between gender and bad past experience.

Conclusion: Referral for treatment under sedation appears to be motivated by both fear and irregular patterns of attendance. Coupled with behavioral treatments to address dental fear and attendance, sedation can be an important part of comprehensive care where curative treatments are long or unpleasant for patients.

Figure 1

Path diagram for the final model showing anxiety as the primary predictor of referral for sedation. The paths onto Referral to Sedation correspond to estimators of the log-odds-ratio and their standard errors of the model presented in Table 2.