J Dent Res 78(3): 790-796, March, 1999

Age of Onset of Dental Anxiety

Abstract. Little attention has been given to the issue of the Introduction
age of onset of dental anxiety, even though it may have a
bearing on the origins of this type of fear. This study aimed
to identify the age of onset of dental anxiety and to identify Dentally anxious individuals are not a homogenous group
differences by age of onset with respect to potential etiologi- but differ in terms of the origins and/or manifestations of
cal factors, such as negative dental experiences, family his- their fears of dental treatment (Milgrom et al., 1985). For
tory of dental anxiety, and general psychological states. example, Weiner and Sheehan (1990) suggested that they
Data were collected by means of two mail surveys of a ran- could be classified into two groups, exogenous and endoge-
dom sample of the adult population. Of 1420 subjects nous, with respect to the source of their anxiety. In the for-
returning questionnaires, 16.4% were dentally anxious. Half, mer, dental anxiety is the result of conditioning via
50.9%, reported onset in childhood, 22.0% in adolescence, traumatic dental experiences or vicarious learning, while in
and 27.1% in adulthood. Logistic regression analyses indi- the latter, it has its origins in a constitutional vulnerability to
cated that negative dental experiences were predictive of anxiety disorders, as evidenced by general anxiety states,
dental fear regardless of age of onset. A family history of multiple severe fears, and disorders of mood. This classifica-
dental anxiety was predictive of child onset only. tion suggests that not all dentally anxious subjects become
Adolescent-onset subjects were characterized by trait anxi- fearful as a result of conditioning.
ety and adult-onset subjects by multiple severe fears and Evidence for the role of conditioning in dental anxiety,
symptoms indicative of psychiatric problems. The three through either aversive experiences or family influences,
groups were similar in terms of their physiological, cogni- has been provided by Shoben and Borland (1954), Lautch
tive, and behavioral responses to dental treatment.
However, adolescent- and adult-onset subjects were more (1971), Kleinknecht et al. (1973), Berggren and Meynert
hostile toward and less trusting of dentists. These results (1984), Ost and Hugdahl (1985), Davey (1989), Milgrom et al.
indicate that child-onset subjects were more likely to fall (1995), Locker et al. (1996a), and Poulton et al. (1997).
into the exogenous etiological category suggested by Weiner Evidence for the role of additional severe fears and psychi-
and Sheehan (1990), while adult-onset subjects were more atric problems has been provided by Fiset et al. (1989),
likely to fall into the endogenous category. Moore et al. (1991), and Roy-Byrne et al. (1994). However, to
date, no study has addressed the relative contributions of
Key words: dental anxiety, etiology, age, psychological negative experiences, familial attitudes, and general psycho-
factors. logical states to dental anxiety.
One issue which may have a bearing on the origins of
dental anxiety is that of age of onset (Marks and Gelder,
1966). In a study of six different types of phobia, Ost (1987)
found significant differences in age of onset. Animal and
blood phobias were largely acquired in childhood, social
phobias in adolescence, and agoraphobia and claustropho-
bia in adulthood. Of some importance was the fact that
these different ages of onset were associated with distinct
Received October 7, 1997; Last Revision May 27, 1998; modes of acquisition and differences in psychological char-
Accepted June 5, 1998 acteristics.

790
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j Dent Res 78(3) 1999 Onset of Dental Anxiety 791

The age of onset with respect to dental anxiety has (1988). Any subjects who scored 12 and above on the DAS, 8 or
received relatively little attention (Ost, 1987), largely because above on the Gatchel FS, or reported being very afraid or terri-
dental anxiety is usually viewed as a fear originating in fied of dental treatment were considered to be dentally anxious.
childhood which persists into later life. However, two stud- This approach was adopted since each of these measures alone
ies that have addressed this issue do not support this point fails to identify some dentally anxious subjects (Locker et al.,
of view. Ost (1987) studied a group of dental phobics and 1996b). The Dental Fear Survey (DFS) (Kleinknecht and
found that almost 20% reported onset after the age of 14 Bernstein, 1978) was used to assess the severity of dental anxi-
years. Similarly, a population-based study by Milgrom et al. ety. Subjects rated the amount of anxiety evoked by nine inva-
(1988) found that 33.3% became anxious during adolescence sive and six non-invasive stimuli in the dental setting, using a
or adulthood. six-point scale ranging from 1 (not at all) to 6 (very much).
Apart from these data, little is known about variations in
the age of onset of dental anxiety and its implications in Age of onset. Subjects were asked to indicate whether they
terms of etiology. This paper reports the results of a study became dentally anxious during childhood (12 years of age or
which aimed to: (1) describe the distribution of the dentally less), adolescence (age 13 to 17 years), or adulthood (18 years
anxious population according to age of onset, and (2) iden- and over).
tify differences by age of onset with respect to etiological
factors such as negative dental experiences, family history, Conditioning experiences. Questions were asked about negative
and general psychological states. The main hypothesis we experiences in the dental setting, such as events which were
tested was that child-onset subjects would be more likely to painful, frightening, or embarrassing, and the age at which they
fall into the exogenous category described by Weiner and first occurred. The family history with regard to dental anxiety
Sheehan (1990), having acquired their anxiety through con- was assessed by items pertaining to fear of dental treatment on
ditioning experiences, while adult-onset subjects would be the part of each subject's mother, father, and siblings.
more likely to fall into the endogenous category and demon-
strate a heightened constitutional vulnerability to anxiety Psychological characteristics. General fearfulness was measured
disorders. by a short form of the Fear Survey Schedule II (FSS II) (Geer,
1966). The degree of fear or anxiety created by each of 20 objects
or events was rated on a scale ranging from 0 (none) to 6 (ter-
Methods ror). Fears rated 5 or 6 were considered to be severe. Trait anxi-
ety was assessed by the 20-item Speilberger Trait Anxiety Index
The design of the study, its data collection methods, and proce- (STAI) (Speilberger et al., 1983). In response to each item, sub-
dures for obtaining informed consent and ensuring confidential- jects rate how they generally feel using a four-point scale in
ity were approved by the University of Toronto's Human which 1 indicates 'almost never' and 4 indicates 'almost
Subjects Certification process. always'. The 12-item version of the General Health
Questionnaire (GHQ) (Goldberg and Williams, 1988) was used
to measure the frequency of symptoms potentially indicative of
Survey procedures psychiatric disturbance. This also uses a four-point response
The data were collected during the baseline phase of a longitu- scale which varies according to each item. For each scale, scores
dinal, population-based study of the epidemiology of dental were generated from the sum of the responses to each item.
anxiety. The target population for the study was all persons Subsequently, a cut-off of the mean score plus one standard
aged 18 years and over living in the City of Etobicoke, one of deviation was used to differentiate between subjects who had
five municipalities which comprise Metropolitan Toronto. The 'high' and those who had 'low' scores.
sampling frame was the list of voters covering this community.
Since this is compiled by a household enumeration procedure, it Other characteristics. Physiological responses during dental treat-
contains the names of approximately 97% of persons eligible to ment were assessed by six items from the DFS. These included
vote. A two-stage random-start systematic sampling procedure events such as increases in breathing rate, increased heart rate,
was used, with sampling fractions designed to give a sample of and feeling nauseous. Cognitive responses were measured by
6360 subjects. means of a 13-item scale concerning the negative thoughts sub-
Data were collected by means of two mail surveys based on jects had prior to and during dental treatment (Kent and
the Total Design Method recommended by Dillman (1978). Gibbons, 1987). Behavioral responses to dental anxiety were
Initially, all 6360 subjects were sent a basic questionnaire on measured by means of questions concerning the use of dental
dental anxiety. To maximize the response rate, we sent three fol- services, avoidance of dental care, canceling appointments, and
low-up mailings. Subsequently, a 60% subsample of those com- failing to show up because of anxiety about dental treatment.
pleting the first questionnaire were sent a second questionnaire The Dental Beliefs Survey (Milgrom et al., 1985) was used to
containing a number of psychological measures. assess subjects' perceptions of four components of the dentist-
patient relationship that have a bearing on dental anxiety;
namely, communication, belittlement, lack of control, and trust.
Measures
Dental anxiety. Dental anxiety was measured with Corah's
Dental Anxiety Scale (DAS) (Corah, 1969), the Gatchel Fear Data analysis
Scale (Gatchel, 1989), and the single item used by Milgrom et al. Subjects were classified into one of four groups: (1) not dentally
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792 Locker et al. J Dent Res 78(3) 1999

anxious, (2) dentally anxious-childhood onset, (3) dentally (2.7), 13.7 (2.8), and 13.5 (2.7), respectively; these were not
anxious-adolescent onset, and (4) dentally anxious-adult significantly different. However, those with child-onset den-
onset. Two sets of analyses were undertaken, the first compar- tal anxiety reported significantly more distress than adoles-
ing the three dentally anxious groups with each other, and the cent- and adult-onset subjects with respect to six of the nine
second comparing each of these groups with the non-anxious. DFS items concerned with invasive procedures and two of
In this respect, those who were not dentally anxious were used the six DFS items referring to non-invasive procedures.
as a normative or reference group. Chi-square tests were used to Consequently, those with child onset had significantly higher
assess the significance of differences in proportions, and odds scores than the others on a scale constructed by summing the
ratios and their 95% confidence intervals were used to indicate response codes to all 15 DFS items (means of 54.5, 49.7, and
and compare the strengths of associations. The significance of 48.0, respectively; p < 0.01, one-way analysis of variance).
differences in means was assessed with one-way analysis of
variance. Logistic regression analysis was used to assess the
independent effects of potential etiological factors on the proba- Conditioning experiences and family history
bility of dental anxiety. Overall, 74.8% reported painful dental experiences, 30.7%
experiences which were frightening, and 13.3% experiences
which were embarrassing. There was an association between
Results dental anxiety status and the age at which negative experi-
ences were first encountered (Table 1). Those with child-
onset anxiety were the most likely to have had their first
Response experience in childhood, those with adolescent onset were
The initial questionnaire was completed by 3055 subjects. the most likely to have had their first experience in adoles-
This represents 60.4% of the 5061 individuals presumed to cence, and those with adult onset were the most likely to
be alive and living at the listed address. Of these, 1420 com- have had their first experience as adults. For the non-anx-
pleted the second psychological questionnaire. Census data ious, the first negative dental experiences were more evenly
indicated that, when compared with the target population, distributed with respect to age.
subjects completing both questionnaires were somewhat There were no differences among the three groups of
older and better educated. dentally anxious subjects in the proportions reporting nega-
tive dental experiences (Table 2). However, all three groups
were significantly different from the non-anxious. Odds
Age of onset ratios, obtained by comparing each dentally anxious group
Using the definition cited above, we classified 16.4% (n = with the non-anxious reference group, indicated that the
233) of subjects as being dentally anxious. One half, 50.9% (n association between aversive events and dental anxiety was
= 111), reported becoming fearful of dental treatment in strongest for the child-onset group (OR = 9.2) and weakest
childhood, 22.0% (n = 48) suffered onset in adolescence, and for the adult-onset group (OR = 3.7).
27.1% (n = 59) became anxious as adults. There were no dif- Age of onset of dental anxiety and family history of den-
ferences among the three groups in terms of gender. The tal anxiety were associated (Table 2). Half (55.9%) of those
mean (SD) ages of the three groups at the time of data collec- with childhood onset had a mother, father, or sibling who
tion were 45.1 (13.7) years, 43.8 (13.7) years, and 49.6 (14.9) was anxious about dental treatment compared with one-
years, respectively (ns: one-way analysis of variance). The third (35.6%) of those with adult onset (p < 0.05). The associ-
mean (SD) age of the non-anxious reference group was 48.7 ated odds ratios and their 95% confidence intervals
(16.6) years. indicated that a family history of dental anxiety was a pre-
The mean (SD) DAS scores of the three groups were 14.1 dictor of child-onset anxiety only.

Table 1. Age at first traumatic dental experience by dental anxiety Psychological characteristics
status (%) Table 3 shows the proportions in each group with high
scores on the three scales measuring general psychological
Age at First Traumatic states. The odds ratios and 95% confidence intervals indicate
Dental Experience
no differences between child-onset subjects and the non-
Dental Anxiety Status Child Adolescent Adult anxious reference group. Adolescent-onset subjects were
Not dentally anxious 39.4 22.3 38.3 significantly different on two of the three measures, and
(n= 1187) adult-onset subjects were significantly different on all three.
Child-onset 67.9 18.3 13.8 The odds ratios indicated that the associations were
(n= 111) strongest for adult-onset subjects.
Adolescent-onset 31.1 46.7 22.2
(n = 48)
Adult-onset 27.3 10.9 61.8 Independent predictors of dental anxiety by age of onset
(n = 59) Three logistic regression analyses were undertaken. The first
Differences in proportions between dentally anxious groups: p < compared child-onset subjects with the non-anxious refer-
0.0001: Chi-square test. ence group, the second compared the adolescent-onset sub-
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j Dent Res 78(3) 1999 Onset of Dental Anxiety 793

jects with the reference group, and the third Table 2. Perc( ent reporting one or more negative dental experiences and a family his-
compared the adult-onset subjects with the tory of dental anxiety: Comparison of each dentally anxious group with the non-anx-
reference group. The three types of negative ious referencee group
dental experiences (painful, frightening,
embarrassing) were entered as separate vari- Dental Percent Reporting Percent Reporting
ables. Gender was included in the models as Anxiety Negative Dental Family History of
a control variable. All dependent and inde- Status Experiences Dental Anxiety
pendent variables were in a binary format Odds Odds
coded 0 and 1. The results are summarized in % Ratio 95% CI % Ratio 95% CI
Table 4. Not dentally aanxious 74.4 1.0 35.4 1.0
In the model predicting child-onset dental Child- t 96.4a 9.2 3.2-21.6 55.9a 2.3 1.5-3.5
anxiety, only a family history of dental anxi-
ety and the three variables describing aver- Adolescent-oi nset 93.8b 5.2 1.5-15.8 47.9 1.7 0.9-3.1
sive experiences entered the regression Adult-onset 91.5b 3.7 1.4-10.7 35.6 1.0 0.8-1.8
equation. For adolescent-onset anxiety, nega- a Differences in proportions between the dentally anxious group and the non-dentally
tive experiences and the score on the Trait anxious refezrence group significant: Chi-square test p < 0.0001.
Anxiety Index were significant predictors, b Differences:in proportions between the dentally anxious group and the non-dentally
while for adult-onset anxiety, frightening anxious refeZrence group significant: Chi-square test p < 0.01.
experiences and the scores on the FSS II and
the GHQ emerged as significant predictors.
These results tend to confirm the hypothesis being tested. tions of Milgrom et al. (1988) and challenge the view that
Direct and vicarious conditioning experiences are important dental anxiety is invariably a fear which has its origins in
with respect to child-onset dental anxiety, while general childhood. Although the DAS scores of the three groups
psychological states play a more prominent role in adult- were similar, scores derived from the Dental Fear Survey
onset anxiety. suggested that the anxiety of child-onset subjects was more
severe than that of adolescent-onset and adult-onset sub-
jects. This was largely due to the fact that the former
Other characteristics reported significantly more anxiety with respect to stimuli
There were no differences among the three groups in terms associated with invasive dental procedures, such as restora-
of physiological, cognitive, or behavioral responses to dental tions and the extraction of teeth. Kleinknecht and Lenz
treatment. However, the Dental Belief Scale scores of the (1989) have suggested that since such treatments involve
three groups (4.5, 5.9, and 5.9, respectively; p < 0.05, one- blood and body injury types of stimuli, these anxiety
way analysis of variance) indicated that adolescent- and responses may be linked to blood and body injury fears,
adult-onset subjects were significantly more negative con- which typically arise in childhood (Ost, 1987). Such fears are
cerning dentists and their behavior toward patients than characteristic of approximately one-third of dentally anxious
were child-onset subjects. adults (Locker et al., 1997).
Rachman (1977) has suggested that three types of condi-
tioning may play a role in the acquisition of fears. While
Discussion many fears have their origins in direct experience, others
Although the response to the study
was acceptable, there were differ- Table 3. Proportions wiith high scores on the three measures of general anxiety and fearfulness:
ences between study subjects and Comparison of each derntally anxious group with the non-anxious reference group
the population from which they
were drawn. The former were older General Anxiety and Fearfulness
and somewhat better educated than Fear Survey Trait General Health
the latter. Since the magnitude and Dental Anxiety Status Schedule II Anxiety Index Questionnaire
direction of bias induced by these Odds Ratio Odds Ratio Odds Ratio
differences are difficult to judge, % 95% CI % 95% CI % 95% CI
some caution needs to be exercised Not dentally anxious 15.3 1.0 12.5 1.0 7.7 1.0
when the results of the study are Child-onset 21.6 1.5/0.9-2.5 16.2 1.4/0.7-2.4 12.6 1.7/0.9-3.3
generalized. 27.1a 2.1/1.1-4.1 27.1b 2.6/1.3-5.2 14.6 2.0/0.8-3.9
Among the dentally anxious sub- Adolescent-onset
jects identified in this population- Adult-onset 42.4c 4.0/2.3-7.2
28.8c 2.8/1.5-5.3 23.3c 3.7/1.9-7.4
based study, only half reported a Difference between th e dentally anxious group and the non-anxious reference group signifi-
becoming dentally anxious in child- cant; p < 0.05, Chi-squiare test.
hood. One-fifth reported adolescent b Difference between thie dentally anxious group and the non-anxious reference group signifi-
onset, and almost one-third cant; p < 0.01: Chi-squiare test.
reported onset in adulthood. These c Difference between thie dentally anxious group and the non-anxious reference group signifi-
results confirm the earlier observa- cant; p < 0.001, Chi-sqjuare test.
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794 Locker et al. J Dent Res 78(3) 1999
Table 4. Results of the logistic regression analyses adulthood, and almost two-fifths
of adult-onset subjects reported
Model 1 Model 2 Model 3 such experiences prior to becom-
Independent Child-onset vs. Adolescent-onsi et Adult-onset vs.
Variable: Reference Group vs. Reference Group Reference Group ing dentally anxious. Davey
p Odds Ratio p Odds Rati o (1989), in exploring
inhibition p Odds Ratio
hypothesis,thehaslatent
pro-
Family history of vided evidence to demonstrate
dental anxiety that the relationship between
(Yes = 1; No = 0) < 0.05 1.8 ns ns traumatic experiences and dental
Painful dental anxiety is not a simple one. In his
experiences studies, traumatic experiences
(Yes = 1, No = 0) < 0.01 4.5 < 0.05 3.1 ns were more likely to give rise to
Frightening dental dental anxiety if they occurred
experiences
(Yes = 1; No = 0) < 0.001 4.2 < 0.05 2.4 < 0.05 2.5 early in an individual's dental
care history than if they were pre-
Embarrassing dental ceded by a series of relatively
experiences
(Yes = 1; No = 0) < 0.05 2.2 < 0.05 2.8 ns -painless dental visits. While this
Fear Schedule
explains why many non-dentally
Survey II score anxious subjects report traumatic
(High = 1;Low= 0) ns ns < 0.05 2.6 dental experiences, it does not
Trait Anxiety account for the patterns observed
Index score in this study. Milgrom and
(High = 1; Low = 0) ns < 0.05 2.6 ns - Weinstein (1993) have suggested
General Health that the consequences of trau-
Questionnaire score matic experiences are dependent
(High= 1;Low= 0) ns ns < 0.05 2.8 upon the context in which they
occur. That is, pain inflicted by a
Sex (Male 1; Female 0)
= = ns ns ns dentist who is perceived as caring
is likely to have less psychologi-
Model chi-square 87.4 38.1 38.0 cal impact than pain inflicted by a
dentist who is cold and control-
df 8 8 8 ling.
p < 0.0001 < 0.0001 <0.0001 These observations indicate
that while direct conditioning
experiences are important in the
may arise via modeling or exposure to threatening informa- genesis of dental anxiety regardless of age of onset, factors
tion. This theory helps explain why not all fearful individu- other than trauma appear to be involved. Rachman's (1977)
als have been exposed to a traumatic conditioning episode. model of fear acquisition suggests that the family history of
With respect to direct conditioning experiences, there fears and phobias is important, while Weiner and Sheehan
were no differences among the three groups of dentally anx- (1990) suggest that general psychological traits and states
ious subjects in terms of their reports of dental experiences play a role.
involving pain, fear, or embarrassment. However, in both In this study, a family history of dental anxiety was
bivariate and multivariate analyses, the associated odds important with respect to child-onset anxiety only. This
ratios indicate that such experiences made a greater contri- finding is consistent with the study by Ost (1987), who
bution to child-onset anxiety than adult-onset anxiety. The reported that phobias acquired in adulthood were less likely
multivariate analyses also suggested that while all three than those acquired in childhood to be ascribed to modeling
types of experiences were important with respect to the for- and/or vicarious learning. It is also consistent with the find-
mer, only frightening experiences were influential with ings of Milgrom et al. (1995), who found that direct condi-
respect to the latter. That child-onset subjects were more tioning and modeling were both important predictors of
fearful of invasive procedures and adolescent- and adult- dental anxiety originating in childhood.
onset subjects more negative concerning dentists' behavior Bivariate and multivariate analyses of our data suggested
may also reflect differences in the types of conditioning that general psychological states and traits made a contribu-
experiences giving rise to dental anxiety (Locker et al., tion to adolescent- and adult-onset anxiety but not child-
1996a). onset anxiety. Adolescent-onset subjects were more likely to
Although there was an association between age of onset have high trait anxiety, while adult-onset subjects were
and age of first negative dental experience, there was a more likely to have multiple severe fears and symptoms
degree of discordance in each group of dentally anxious potentially indicative of psychiatric disorder. There is grow-
subjects with respect to the timing of traumatic experiences. ing evidence that, for some dentally anxious adults, fears
Almost one-third of child-onset subjects reported that their concerning dental treatment are linked to or symptomatic of
first traumatic experience did not occur until adolescence or broader psychological problems (Kent, 1997). The evidence
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j Dent Res 78(3) 1999 Onset of Dental Anxiety 795

with respect to children is less clear, perhaps because appro- ies and qualitative research. It is entirely plausible, for exam-
priate measures have not been widely used in studies of ple, that the psychological states which characterize adult-
children. Milgrom et al. (1995) found no association between onset subjects are related more to the maintenance of dental
dental anxiety and a measure of behavioral problems and anxiety than to its origins. In this regard, Liddell and Locker
social competency in children. However, studies have found (1994) reported that adults who carried their dental anxiety
a link between child temperament and anxiety regarding into old age were more generally fearful than subjects who
dental treatment (Liddell, 1990). had been dentally anxious but recovered with aging.
The role played by general psychological factors in the Another implication of the study for research into dental
acquisition of dental anxiety appears to be a complex one. anxiety is that greater recognition needs to be given to the
Davey (1997), in describing how contemporary conditioning fact that the dentally anxious population is not homogenous
models help explain the acquisition and maintenance of but is comprised of groups which differ along several psy-
phobias, has suggested that they are associated with a ten- chological and other dimensions. If data are not analyzed
dency to focus on and rehearse the negative outcomes of specific to these subgroups, then important associations may
encounters with feared objects and events. Since subjects be masked or attenuated. For example, when the logistic
with high trait anxiety selectively process threatening infor- regression analysis was repeated comparing all dentally
mation, they inflate the unpleasantness of unconditioned anxious subjects with the non-anxious reference group, a
stimuli and experience conditioned responses of a higher family history of dental anxiety and scores on the FSS II and
magnitude. Davey (1997) cites experimental evidence in the MHQ did not enter the model.
support of this characterization of the way in which fears are The main implication of this study for dental practice is
induced. that the dental team needs to take as much care with adult
The data presented here support the classification of den- patients as with child patients and use appropriate commu-
tally anxious subjects suggested by Weiner and Sheehan nication techniques which enhance trust and feelings of con-
(1990) and indicate that child-onset subjects were more trol. This preventive approach may reduce the incidence of
likely to be exogenous, while adult-onset subjects were more dental anxiety in psychologically vulnerable individuals. In
likely to be endogenous. There was, however, a degree of addition, although child-onset subjects have more severe
overlap in that all subjects were characterized by exogenous anxiety concerning dental treatment, adult-onset patients,
factors. Consequently, this classification scheme should be because of their psychological characteristics and greater
considered to be dimensional rather than categorical. hostility toward dentists, may be more difficult for the prac-
A major limitation of the study was its cross-sectional titioner to manage. Information on dental anxiety and age of
design. Even though the analysis approximated a case-con- onset, then, should be collected from dental patients so that
trol study, temporal relationships cannot be established. At dentists may plan an appropriate management and/or treat-
best, we have documented associations between potential ment strategy.
etiological factors and dental anxiety originating at different
points in the life span. Even so, the associations between
direct conditioning experiences and dental anxiety were Acknowledgments
based on subjects' retrospective reports, which may be sub-
ject to problems of recall and retrospective re-interpretation. The research on which this paper is based was supported by
For example, Kent (1985) found that dentally anxious Grant No. 5 RO1 DE10622-02 from the NIDR/NIH.
patients reported more pain three months after treatment
than was reported immediately following treatment. This
reconstruction made their actual experiences more consis- References
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