Dental anxiety in adolescents and adults. Epidemiological studies based on the Tromsø Study 7 and Fit Futures 1 & 2

Background: High dental anxiety can hinder individuals from seeking necessary dental treatment and thereby an obstacle in ensuring equal access to health care in the population. The overall aim of this thesis was to advance the understanding of dental anxiety in adolescents and adults, with a focus on the relevance of mental health symptoms, oral health and potentially traumatic events. Methods: All the papers included in this thesis uses data from population studies in Tromsø municipality, organized through the Tromsø Study. Fit Future 1 and 2 are repeated health surveys of the adolescent population in Tromsø and Balsfjord municipalities, inviting all registered first year of upper secondary school students at first wave (92.9% participated) and follow-up after two years (69.5% follow up rate). The Tromsø Study 7 is a health survey of the adult population in Tromsø municipality, inviting all registered citizens ≥ 40 years old (65% attendance rate). Results: - The initial measures of dental anxiety, mental health symptoms and caries experience were crucial in predicting high dental anxiety over time. However, more caries experience also significantly predicted a reduction of dental anxiety scores. Anticipated pain at the dentist changed in both directions in correspondence with the dental anxiety scores. - When it comes to potentially traumatic events outside the dental setting, sexual abuse directly affects dental anxiety after controlling for covariates and current psychological symptoms. Conclusions: High dental anxiety over time is associated with a higher burden of mental health symptoms, avoiding dental health care and poor oral health. However, it seems like positive dental experiences can reduce dental anxiety among adolescents regardless of dental caries and mental health symptoms. There was a direct association between sexual abuse and dental anxiety in the adult population