|Year : 2015 | Volume
| Issue : 2 | Page : 88-92
Personality and psychological factors: Effects on dental beliefs
Siddhi Hathiwala1, S Acharya2, S Patil3
1 Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
2 Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Karnataka, India
3 Department of Public Health Dentistry, School of Dental Sciences, Karad, Maharashtra, India
|Date of Web Publication||15-Apr-2015|
Dr. Siddhi Hathiwala
Rungta College of Dental Sciences and Research, Bhilai - 490 024, Chhattisgarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Dental treatment can be highly unpleasant for anxious patients. Despite all advancements, dental anxiety continues to upset the dentist-patient relationship. The psychological factors like individual personality and familial and peer influence may alter the dental beliefs of a patient. Aim: A cross-sectional questionnaire study was conducted among young adolescents to investigate the relationship among various psychological factors and the dental beliefs of an individual. Materials and Methods: A self-administered questionnaire was distributed among higher secondary school children, aged 15−17 years in Udupi district. The dental anxiety of the participants was measured using Modified Dental Beliefs scale and the personality traits were assessed using the Ten-Item Personality Inventory. Pearson's correlation and chi-square analysis were performed among these scales. Independent t-test was performed to compare dental anxiety scores with different socio-demographic and psychological characteristics. Results: In all 198 students, with a mean age of 16.6 years, completed the questionnaire. A majority of the participants had lower MDBS scores. The personality traits like Emotional Stability and Openness to New Experiences showed a negative correlation with the Dental Belief scores. Apart from these, the experience at first dental visit and peer support also affected the dental beliefs of the adolescents. Conclusion: Various psychological traits of adolescents influence their dental anxiety.
Keywords: Adolescents, dental anxiety, dental beliefs, personality
|How to cite this article:|
Hathiwala S, Acharya S, Patil S. Personality and psychological factors: Effects on dental beliefs. J Indian Soc Pedod Prev Dent 2015;33:88-92
|How to cite this URL:|
Hathiwala S, Acharya S, Patil S. Personality and psychological factors: Effects on dental beliefs. J Indian Soc Pedod Prev Dent [serial online] 2015 [cited 2018 Aug 20];33:88-92. Available from: http://www.jisppd.com/text.asp?2015/33/2/88/155110
| Introduction|| |
There have been great advancements in the field of dentistry in recent times. Increasing attention is being paid to the improvement in service delivery methods, thus reducing the suffering caused during the dental procedures in earlier times. A 'pain-free' dental practice has annulled the fear of getting any dental treatment. However, there are still a great number of people who have apprehension toward dentists.  People with dental fear and anxiety are known to avoid regular dental care, causing further deterioration of their oral health status. They are thus more likely to utilize emergency dental services once they suffer with dental pain and have a negative dental experience. 
Dentally anxious people usually experience emotional problems in dental settings and have a tendency to develop negative views about the dentist and dental treatment. In many conditions, the dental anxiety of a patient is due to his or her negative dental beliefs.  The negative beliefs about the dentist in particular or the dental profession in general result in aversion to dental treatment in apprehension of a frightful dental visit. This attitude tends to increase their anxiety further, thus forming a vicious cycle of dental anxiety and poor dental beliefs.  Assessing the dental beliefs of a person can serve as a gauge of the dental anxiety. The Dental Beliefs Survey (DBS) is a method to assess the patient's perceptions about the dentist and dental treatment in various aspects. Higher scores in DBS indicate greater negative beliefs. 
The origin of dental anxiety has been found in different ages, the etiology differing with the age groups.  The major causes have been related to various psychoanalytic, behavioral and conditional attributes of the individual. Dental fear and negative dental beliefs have been believed to develop through direct conditioning, modeling or information-gathering (Rachman's model).  The basic personality traits of a person have also been shown to affect dental anxiety. In psychology, the main personality factors have been discovered as Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism. This is also referred as the Big Five Personality traits, or Five Factor Model.  This model assesses the self-perceived personality of an individual in these five dimensions.
The presence of dental anxiety has been related to neuroticism, introversion, dependency and other vulnerable personality traits in a person. It is related to temperament and self-consciousness and Locus of Control of the patients. This relation differs among individuals with different age, gender, socio-economic status, oral health status, history of dental visit, and psychological factors. ,,,
Dentally anxious individuals have a poor oral health-related quality of life.  Emotional factors, including guilt, shame, embarrassment, and loss of self-esteem are common in people with dental anxiety. Many people may feel apprehensive about helplessness, loss of control in dental chair, about technical efficiency of dentist, or any catastrophic consequences that can occur during a dental appointment. This may also prevent development of a healthy dentist-patient relationship. An assessment of the psychological factors causing negative dental beliefs in individuals with different personality traits will help in appropriate management for anxious dental patients.
So this study was conducted with an aim to investigate the relationship between dental beliefs and various socio-demographic factors and psychological factors like personality traits, conditioning influence by familial or peer attitude, and previous dental experiences among young adolescents.
| Materials and Methods|| |
This survey was conducted among higher secondary school children, aged 15-17 years, recruited from randomly selected schools in Udupi district, during January-February, 2013. The sample size was calculated after assuming α (two sided) = 0.05, power = 80%, and difference in prevalence of negative dental beliefs among people with good or bad personality to be 10%. This gave a sample size of 184.
Before commencing the study, an ethical clearance was obtained from the Institutional Review Board. List of all higher secondary schools in the district was obtained. Three randomly selected higher secondary schools in the area were visited and permission was sought from respective authorities for conducting a survey in their premises. The students of first and second PUC in the schools that gave permission were briefed about the purpose of the study and invited to participate in the study. The students, who knew English and gave consent, were included in the study and were provided with self-administered questionnaires.
A self-administered questionnaire was designed to assess the socio-demographic and psychological characteristics of the participants. The dental beliefs of the participants were collected using Modified Dental Beliefs scale (MDBS) and the personality traits were assessed using the Ten-Item Personality Inventory (TIPI). A pilot study was conducted to assess the content validity of the questionnaire using 15 adolescents. The final questionnaire consisted of following sections.
First section assessed the socio-demographic details of the participants. It assessed various life course factors regarding childhood socio-economic status and late childhood psychological factors of the child. It also consisted of single-item questions assessing the self-perceived general and oral health, and past dental experiences. It was also enquired whether any dental visit was delayed or prevented due to dental fear of the participant, or any influence of parents' or friends' dental fear.
Second section consisted of two psychometric questionnaires for evaluating the dental beliefs and personality traits of the participants. The dental beliefs were assessed using the MDBS. This is a 17-item questionnaire, adapted from the Revised Dental Beliefs Survey (R-DBS), modified to be used in Indian population.  Items 1-6 belonged to the 'professionalism' subscale, items 7-12 to the 'lack of communication' subscale, and items 13-17 to the 'lack of control' subscale of the R-DBS. The responses were divided on a five-point Likert scale, ranging from 'never' to 'nearly always'. Total scores for the MDBS ranged from 17 to 85 with higher scores indicating greater negative beliefs.
The personality traits of the participants were assessed using TIPI.  This questionnaire evaluates the Big-Five personality dimensions of Extroversion, Agreeableness, Conscientiousness, Emotional stability, and Openness to new experiences. This instrument consists of 10 items with a common stem of 'I see myself as -'. Each item consists of two descriptors that represent one pole of the Big-Five personality dimensions. The responses are rated on a seven-point Likert scale, ranging from 'disagree strongly' to 'agree strongly'. The score on each of the TIPI personality dimensions subscales is measured and ranges from 2 to 14.
Following the form completion, the data was entered in the Statistical Package for Social Sciences (SPSS) version 16.0 (Chicago, USA) for analysis. The responses to various continuous variables were categorized and dichotomized. The MDBS scores were dichotomized into positive and negative groups based on the median of scores of all the participants.
Descriptive analyses were performed to calculate the frequencies of various socio-demographic and life course characteristics of the participants. The mean scores of the responses to each item in the MDBS and TIPI scales were calculated and Pearson's correlation analysis was performed among subscales. After the categorization of the participants according to their MDBS scores, the mean scores of the personality subscales for each group were compared using Chi-square analysis. Independent t-test was performed to compare the distribution of MDBS scores among the participants of different socio-demographic and psychological characteristics. A P value of <0.05 was considered to be significant.
| Results|| |
For this study, 215 students present on the days of examination in six pre-university classes of three schools were invited to complete the questionnaire; among them 206 (95.8%) returned the forms. The participants who had not answered all the questions were excluded from the final sample. A final data from 198 participants could be analyzed, giving a response rate of 92%. The age of the participants ranged from 16 to 19 years, and their mean age was 16.9 years.[Table 1]
|Table 1: Distribution of the participants according to socio-demographic characteristics|
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The mean of the responses to the questions in MDBS scale ranged from 1.74 ± 0.97 for the question 4, to 2.89 ± 1.44 for the question 2. [Table 2] The most negative beliefs among the participants were concerning the information provided by the dentists regarding the treatment options (rank 17), about the comfort in asking questions to the dentists (rank 16), the reluctance of the dentists to stop the procedure even when it is hurting them (rank 15), and about the technical competence of the dentists (rank 14). On the other hand, the less prevalent beliefs were the fear that dentists would say one thing and do another thing (rank 1), that they would be reluctant to correct their work (rank 2), or that they would not believe if the patient felt pain (rank 3), or they would not take time to speak with the patients (rank 5).
|Table 2: Distribution of the mean scores of the MDBS scale and the ranking of questions according to the mean scores|
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The total MDBS scores of the participants ranged from 17 to 79, while the mean scores of the personality measures ranged from 8.0-9.3. A majority of the participants had lower MDBS scores. A maximum of 19 (9.5%) participants had a total MDBS score of 43, while other 14 (7%) participants had score of 38. Only 14 (7%) participants had a total MDBS score more than 50. The mean and median values for the MDBS scores of the participants were 36.7 and 38, respectively. [Table 3]
|Table 3: Distribution of the mean scores of the sub-scales of MDBS scale and the measures of personality according to TIPI|
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[Table 4] shows that the openness to new experiences showed a negative correlation with negative beliefs regarding professionalism, lack of communication, and lack of control. The other measures of personality like agreeableness, conscientiousness, and emotional stability showed a negative correlation with the beliefs regarding the lack of control. The measures that showed a correlation with the total MDBS scores were emotional stability and openness to new experiences, and these were negatively correlated. These correlations though statistically significant were weak with the correlation coefficients ranging from 0.169-0.27 (P value < 0.05).
When the participants with higher MDBS scores were compared with those having lower MDBS scores, all the measures of personality (except agreeableness) showed statistically significant lower scores among the participants having lower MDBS scores (P value < 0.003). [Table 5]
|Table 5: Distribution of the TIPI measures in relation to high and low MDBS scores|
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The results of independent t-test showed that males (P < 0.001), the first pre-university students (P < 0.001), and the participants with lower family income (P = 0.012) had higher MDBS scores. [Table 6] It also showed that the participants who reported good friends' support (P = 0.001), who had a bad experience at their first dental visit (P = 0.04), and who reported dental fear preventing any dental visit (P = 0.047) had higher MDBS scores.
|Table 6: Comparison of the socio-demographic and psychological characteristics of the participants with their MDBS scores|
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| Discussion|| |
Dental beliefs and perceptions of the people have been regarded as an important factor for dental care utilization. Positive dental beliefs of a patient leads to better dentist-patient relationship, better compliance to oral hygiene instructions, and also regular visits for check-up. However, the people with more negative dental beliefs about dental treatment usually have a symptomatic-treatment seeking behavior, which in turn increases their fear about dental visit further.
This was the first cross-sectional survey assessing the influence of personality over the dental beliefs in this population. MDBS and TIPI were used to collect the information from adolescents. MDBS had been used and validated in this population in an earlier study.  It is modified version of R-DBS scale, which is a valid and stable measure for measuring dental beliefs in both clinical and non-clinical populations. ,, This scale has shown a positive correlation with Dental Anxiety scale and Dental Fear scale. 
TIPI is a short version of the Big-Five personality trait, which is commonly used to assess various personality traits. This short version takes only about one minute to complete and it shows good psychometric properties compared with longer instruments used to measure the Big-Five personality dimensions. 
The mean MDBS score indicated an overall positive outlook of the participants towards the dental profession. The most negative beliefs among the participants were concerning the information provided by the dentists regarding the treatment options, about the comfort in asking questions to the dentists, the reluctance of the dentists to stop the procedure even when it is hurting them and about the technical competence of the dentists. Similar results were obtained in earlier studies. ,
The personality traits were found to be weakly correlated with dental beliefs. Emotional stability and openness to new experiences were significantly and negatively correlated with the MDBS scores. A reduced emotional stability or neuroticism would affect coping, and result in blaming dentist for anxiety. An individual who is receptive to new experiences would tolerate the dental experiences easily, and would report more positive beliefs about the dentist and treatment. Also, participants with more negative beliefs had significantly lower extraversion, lesser conscientiousness, emotional stability, and openness.
Similar findings were reported by Venham et al., (1979) who had assessed the clinical anxiety in the first visit and found that it was more in patients with aggressiveness and depressiveness, self-rejection, and in those who were less willing to take risk.  Frazer and Hampson (1988) suggested that patients with dental anxiety were more neurotic but less extrovert.  In a follow-up study, Hagglin et al., (2001) found that neurotic people were more likely to retain anxiety for a long period. 
The higher rating for friends' support was associated with poor MDBS scores indicating the potent influence of the peer group in modifying dental outlook of a person in adolescence. The experience at first dental visit also influenced the dental beliefs, suggesting the importance of behavior management during initial dental acquaintance. A good first dental experience helps in building a healthy dentist-patient relationship, which is important for patient satisfaction, compliance, regular use of oral health care services, dental attitudes and beliefs. 
A non-clinical adolescent population was used in this study, which helped in identifying the occurrence of negative dental beliefs in general population in this age group. It was highly desirable as this is the age group when the personality begins to mould itself according to the peer group and family influences. The assessment of the effect of life course events in developing the dental beliefs gives further strength to this study. However, this study is not devoid of biases associated with the self-administered questionnaires. Only a weak relationship was found between dental beliefs and personality measures. It could not be assessed that whether poor personality measures lead to more negative beliefs in an individual or the negative dental beliefs affected the personality. Also, the presence of dental professionals while the participants answered the questionnaire might have influenced the reporting of dental beliefs.
Nevertheless, this study was the first attempt to assess the effect of dental beliefs in Indian adolescent population. It showed that the personality parameters were important moderators, if not a complete explanation for the dental treatment-related fear and anxiety. It highlighted the importance of inculcating a preventive approach in dental practice so that more complex and painful procedures can be avoided. It also suggested that imparting knowledge to dental students for psychological assessment and counseling of the dentally anxious patients would play a vital role in management of these patients. For future studies, it can be suggested to conduct a study with larger sample size and also compare people with and without dental experience to get more insight into the dynamics of effect of dental beliefs on dental visiting patterns or vice versa.
| Conclusion|| |
This study concluded that:
- The adolescents studying in pre-university schools of Udupi district had a positive attitude toward the dental profession and treatment.
- The personality parameters, Emotional stability and Openness to New Experiences were weakly and negatively correlated with the dental beliefs.
- Other characteristics of the adolescents that were found affecting their dental beliefs included their gender, family income, experience at first dental visit, and peer support.
| Acknowledgement|| |
I would like to acknowledge the support of my teachers and colleagues and also the study participants for the timely completion of this study.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]