1 Professor of Oral Medicine, Department of Oral Medicine, Dental School, Kerman of University of Medical Sciences, Kerman, Iran, Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Social Determinants on Oral Health Research Center, Kerman University of Medical Sciences, Kerman, Iran, 2 Private Practice, Dental School, Kerman of University of Medical Sciences,Kerman, Iran

3 General Dentist, Dental School, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND AND AIM: Several research works show that anxiety is more common in women,
low‑income classes, and middle‑aged and elderly populations. The present study aimed to investigate
the role of positive and negative memories in patients’ anxiety referred to the dental clinics, offices,
and schools of Kerman, Iran, in 2018–2019.
MATERIALS AND METHODS: In this cross‑sectional, descriptive, analytical study, the participants
were selected among individuals referred to the dental offices, schools, and clinics of Kerman, Iran.
In this study, 500 questionnaires were distributed among the participants (based on census method),
and of these, 482 of which were reviewed (response rate = 96.4%). The questionnaire used in this
study contained four categories of questions, including demographic information, general questions
about dentistry, Corah’s Dental Anxiety Scale, and Autobiographical Memory Questionnaire. Analysis
of variance, t‑test, and Chi‑square test were used to analyze.
RESULTS: Overall, 281 participants were female, and 201 were male. Based on the findings, dental
visits were enjoyable and pleasant experiences for 154 participants, and 165 patients were anxious
while the dentist prepared for a restorative treatment. This study showed that people with negative
memories had more anxiety. Anxiety was also significantly associated with positive memories, higher
education, and gender (female) (P < 0.05). Also, the most negative memories of dental treatments
were associated with increased anxiety about dental treatments in adults (P < 0.05), while positive
memories did not have a relationship any with decreased anxiety (P > 0.05).
CONCLUSION: The most negative memories of dental treatments were associated with increased
anxiety about dental treatments in adults, while positive memories did not have any expected inverse
relationship with anxiety.


1. Sylvers P, Lilienfeld SO, LaPrairie JL. Differences between trait
fear and trait anxiety: Implications for psychopathology. Clin
Psychol Rev 2011;31:122‑37.
2. Steers ML, Quist MC, Bryan JL, Foster DW, Young CM,
Neighbors C. I want you to like me: Extraversion, need for
approval, and time on facebook as predictors of anxiety. Transl
Issues Psychol Sci 2016;2:283‑93.
3. Ellis DM, Hudson JL. The metacognitive model of generalized
anxiety disorder in children and adolescents. Clin Child Fam
Psychol Rev 2010;13:151‑63.
4. Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of dental
anxiety among dental patients in Saudi Arabia. J Int Soc Prev
Community Dent 2017;7:100‑4.
5. Halonen H, Nissinen J, Lehtiniemi H, Salo T, Riipinen P,
Miettunen J. The association between dental anxiety and
psychiatric disorders and symptoms: A systematic review. Clin
Pract Epidemiol Ment Health 2018;14:207‑22.
6. Milgrom P, Newton JT, Boyle C, Heaton LJ, Donaldson N. The
effects of dental anxiety and irregular attendance on referral
for dental treatment under sedation within the National
Health Service in London. Community Dent Oral Epidemiol
7. Caltabiano ML, Croker F, Page L, Sklavos A, Spiteri J, Hanrahan L,
et al. Dental anxiety in patients attending a student dental clinic.
BMC Oral Health 2018;18:48.
8. Appukuttan DP. Strategies to manage patients with dental anxiety
and dental phobia: Literature review. Clin Cosmet Investig Dent
9. López‑Valverde N, Muriel‑Fernández J, López‑Valverde A,
Valero‑Juan LF, Ramírez JM, Flores‑Fraile J, et al. Use of virtual
reality for the management of anxiety and pain in dental
treatments: Systematic review and meta‑analysis. J Clin Med
10. Hamissi J, Hamissi H, Ghoudosi A, Gholami S. Factors affecting
dental anxiety and beliefs in an Iranian population. Inter Collab
Res Inte Med Public Health 2012;5:585‑93.
11. Kaviani H, Rahimi‑Darabad P, Naghavi HR. Autobiographical
memory retrieval and problem‑solving deficits of Iranian
depressed patients attempting suicide. J Psychopathol Behav
Assess 2005;27:39‑44.
12. Armfield JM. What goes around comes around: Revisiting
the hypothesized vicious cycle of dental fear and avoidance.
Community Dent Oral Epidemiol 2013;41:279‑87.
13. Kani E, Asimakopoulou K, Daly B, Hare J, Lewis J, Scambler S,
et al. Characteristics of patients attending for cognitive behavioural
therapy at one UK specialist unit for dental phobia and outcomes
of treatment. Br Dent J 2015;219:501‑6.
14. Obeidat SR, Alsa’di AG, Taani DS. Factors influencing dental care
access in Jordanian adults. BMC Oral Health 2014;14:127.
15. Farid H, Pasha L, Majeed M. Psychometric assessment of the Urdu
version of the index of dental anxiety and fear. Malays J Med Sci
16. Seligman LD, Talavera‑Garza L, Geers AL, Murray AB, Ibarra M,
Hovey JD. Development of a measure of fearful implicit
associations with dental stimuli in youth. Child Psychiatry Hum
Dev 2021
17. Xu JL, Xia R. Influence factors of dental anxiety in patients
with impacted third molar extractions and its correlation with
postoperative pain: A prospective study. Med Oral Patol Oral
Cir Bucal 2020;25:e714‑9.
18. Yakar B, Kaygusuz TÖ, Pırınçcı E. Evaluation of dental anxiety
and fear in patients who admitted to the faculty of dentistry:
Which patients are more risky in terms of dental anxiety. Ethiop
J Health Sci 2019;29:719‑26.
19. Levin L, Eli I, Ashkenazi M. Dental anxiety among young Israeli
male adults as related to treatment received during childhood. J.
Public Health Dent. 2006;66:147–151.
20. Dewanto I, Koontongkaew S, Widyanti N. Characteristics of
dental services in rural, suburban, and urban areas upon the
implementation of Indonesia national health insurance. Front
Public Health 2020;8:138.
21. Locker D, Thomson WM, Poulton R. Psychological disorder,
conditioning experiences, and the onset of dental anxiety in early
adulthood. J Dent Res 2001; 80:1588–1592.
22. Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale.
J Am Dent Assoc 1978;97:816‑9.
23. Corah NL. Development of a dental anxiety scale. J Dent Res
24. Javadinejad S, Farajzadegan Z, Madahain M. Iranian version
of a face version of the Modified Child Dental Anxiety Scale:
Transcultural adaptation and reliability analysis. J Res Med Sci
25. Morowatisharifabad M, Razavinia M, Haerian Ardakani A,
Falahzadeh H. Study of dental anxiety among patients referred
to private offices in Mashhad. Tolooebehdasht 2012;11:119‑30.
26. Vadiati Saberi B, Neshandaar Asli H, Sharifiyan HR. Evaluation
of dental anxiety level and related factors in patients referred to
dental school. J Guilan Univ Med Sci 2018;27:9‑16.
27. GhasempoorM, HaddadiA. Dental fear and anxiety among dental
and medical students of Babol University of Medical Sciences.
J Islamic Dent Assoc Iran 2005;17:9‑14.
28. Peretz B, Efrat J. Dental anxiety among young adolescent patients
in Israel. Int J Paediatr Dent. 2000;10:126–32.
29. Drachev SN, Brenn T, Trovik TA. Prevalence of and factors
associated with dental anxiety among medical and dental
students of the Northern State Medical University, Arkhangelsk,
North‑West Russia. Int J Circumpolar Health 2018;77:1454786.
30. Tarazona B, Tarazona‑Álvarez P, Peñarrocha‑Oltra D,
Rojo‑Moreno J, Peñarrocha‑ Diago M. Anxiety before extraction
of impacted lower third molars. Med Oral Patol Oral Cir Bucal
31. Pohjola V, Kunttu K, Virtanen JI. Psychological distress, dental
health, and dental fear among Finnish university students:
A national survey. Int J Environ Res Public Health 2021;18:10245.
32. Talo Yildirim T, Dundar S, Bozoglan A, Karaman T, Dildes N,
Acun Kaya F, et al. Is there a relation between dental anxiety, fear
and general psychological status? Peer J 2017;5:e2978.
33. Onwuka CI, Udeabor SE, Al‑Hunaif AM, Al‑Shehri WA,
Al‑Sahman LA. Does preoperative dental anxiety play a role in
postoperative pain perception after third molar surgery? Ann Afr
Med 2020;19:269‑73.
34. Lundberg A, Srinivasan M. Effect of the presence of an aquarium
in the waiting area on the stress, anxiety and mood of adult dental
patients: A controlled clinical trial. PLoS One 2021;16:e0258118.
35. Carrillo‑Díaz M, Migueláñez‑Medrán BC, Nieto‑Moraleda C,
Romero‑Maroto M, González‑Olmo MJ. How can we reduce
dental fear in children? The importance of the first dental visit.
Children (Basel) 2021;8:1167.
36. Kankaala T, Laine H, Laitala ML, Rajavaara P, Vähänikkilä H,
Pesonen P, et al. 10‑year follow‑up study on attendance pattern
after dental treatment in primary oral health care clinic for fearful
37. Carter AE, Carter G, Boschen M, AlShwaimi E, George R.
Pathways of fear and anxiety in dentistry: A review. World J Clin
Cases 2014;2:642‑53.
38. van Houtem CM. A PhD completed 8. Are extreme dental
treatment anxiety, fainting or gagging separate or overlapping
phenomena? Ned Tijdschr Tandheelkd 2017;124:42‑4.
39. MehrstedtM, JohnMT, Tonnies S, MicheelisW. Oral health‑related
quality of life in patients with dental anxiety. Community Dent
Oral Epidemiol 2007;35:357–363.
40. Risløv Staugaard S, Jøssing M, Krohn C. The role of negative and
positive memories in fear of dental treatment. J Public Health Dent
41. Khan SD, Alqannass NM, Alwadei MM, Alnajrani MD,
Alshahrani ZM, Al Alhareth AY, et al. Assessment of the
relationship between dental anxiety and oral health‑related
quality of life. J Pharm Bioallied Sci 2021;13:S359‑62.
42. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence,
patient satisfaction, and perceptions of post‑surgical pain: Results
from a US national survey. Curr Med Res Opin 2014;30:149‑60.
43. Oliveira MA, Bendo CB, Ferreira MC, Paiva SM, Vale MP,
Serra‑Negra JM. Association between childhood dental
experiences and dental fear among dental, psychology and
mathematics undergraduates in Brazil. Int J Environ Res Public
Health. 2012;9:4676‑4687.
44. Morales S, Fu X, Pérez‑Edgar KE. A developmental neuroscience
perspective on affect‑biased attention. Dev Cogn Neurosci
45. Oosterink FMD, de Jongh A, Hoogstraten J. Prevalence of dental
fear and phobia relative to other fear and phobia subtypes. Eur J
Oral Sci. 2009;117:135‑43.
46. Rajeev A, Patthi B, Janakiram C, Singla A, Malhi R, Kumari M.
Influence of the previous dental visit experience in seeking dental
care among young adults. J Family Med Prim Care 2020;9:609‑13.
47. Van Houtem CM, van Wijk AJ, de Jongh A. Presence, content,
and characteristics of memories of individuals with dental phobia.
Appl Cogn Psychol 2015;29:515‑23.
48. Linzbach A, Nitschke D, Rothaug J, Komann M, Weinmann C,
Schleußner E, et al. Peripartal pain perception and pain therapy:
Introduction and validation of a questionnaire as a quality
instrument. Arch Gynecol Obstet 2021;20:7‑14.
49. Sakamoto E, Yokoyama T. Pain and anxiety in dentistry and oral
and maxillofacial surgery focusing on the relation between pain
and anxiety. Ann Pain Med 2018;1:1002‑110.