(PS1-66) Toward an Ontology of Dental Care-Related Fear and Anxiety: Diagnostic Implications

Dental care-related fear, anxiety, and phobia (DFA) broadly refer to distressing cognitive, physiological, and behavioral responses related to receiving professional dental care. Affecting approximately 15% of the population globally across the lifespan, DFA is dimensional, ranging from mild discomfort to phobia.  In its extreme manifestations, it presents a complex diagnostic picture, as it can be classified as a situationally specific phobia or as blood-injection-injury phobia. Additionally, high levels of DFA can be one manifestation of generalized anxiety disorder, or with a history of trauma during dental care, can be conceptualized as post-traumatic stress disorder. There is lack of clarity in the literature about the conceptualization of DFA and even what terms to use to describe it (e.g., dental anxiety, dental fear, dental phobia). A standard nosology for DFA is not presently available, although dental phobia has been (imperfectly) categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). To address these shortcomings in DFA terminology and classification, this research describes the process of developing the Ontology of Dental care-related Fear, Anxiety, and/or Phobia (ODFA), and presents results from analyses of existing data. Garnering data from five different population-based secondary data sources that used various DFA measures allowed for a broad array of samples with different sociodemographic characteristics and social identities.  Concept mapping of the various self-assessment instruments revealed 18+ components that relate to the over-arching construct of DFA.  Avoidance behavior is associated with many of the concepts in the DFA mapping. Despite improvements in dental care (e.g., pain control) and advances in behavioral approaches to patients (e.g., “chairside” manner), high levels of DFA are not abating; high levels of DFA including phobia have persisted at a relatively constant level over the past 50 years. While access-to-care issues, such as availability of dental care and dental insurance status, impacts dental care-seeking, DFA may be additive to or synergistic with such barriers.  Since oral health is associated with systemic health issues, DFA and avoidance may well affect not only oral health, but health in general. Furthermore, the patterns of utilization by those who are highly fearful or anxious (e.g., avoiding preventive care often until pain or dysfunction makes it necessary) place significant strain on the care delivery system in terms of delay of preventive and timely care, as well as missed appointments (e.g., late cancellations). The ODFA provides a means to better understand and define DFA, and to relate it to avoidance behavior.