Generally fear is defined as an individual?s response to a real threatening event or dangerous situation to protect his or her life [¹]. Three different terms have been used concerning apprehension in dentistry in the literature: dental fear, dental anxiety, and dental phobia. Dental fear is considered to be aroused by a real, immediately present, specific stimulus (e.g. needles, drilling), whereas in the case of anxiety, the source of the threat is unclear, ambiguous, or not immediately present [²,³] However, an individual?s emotional responses are almost the same in both situations [²].

Elements of fear can be divided into two categories: subjective (including emotions and cognitions) and objective (including behavior and physiological reactions) [¹]. The patient?s subjective experience of dental treatment is the most important channel for his or her later behavior (e.g. avoiding or not) with relation to dentistry. Thus, knowledge of a patient?s subjective dental fear is more relevant than knowledge of his or her objective dental fear when considering the development of dental health services. Development of these services has to be based on the patient?s subjective feeling, which must be respected.

Many different kinds of instruments to measure dental fear have been studied [^4-7]. The best known and most used dental fear instruments, the Dental Anxiety Scale (DAS) [⁸,⁹] and the Dental Fear Survey (DFS) [^10-12] (?see Appendix 1 and 2?), have been used in adults, and also in adolescents [⁹,^11-14]. However, for clinical practice purposes, they are rather long questionnaires and their interpretation takes more of the dentist?s time. The dentist needs to know about the patient?s possible dental fear before the first procedure to be able to choose the best way to deal with the patient. Therefore, there is a need for a short clinical dental fear instrument.

The aim of this study was to test a short dental fear instrument for measuring adolescents? dental fear in clinical practice in terms of the general population.

The 15-16-year-old adolescents, who were scheduled for their routine dental examination at two public dental health clinics (Turku and Piikki?) in the study area, were the target group of the study. There were 27 adolescents coming in six weeks study period in the summer 2003. Turku and Piikki? were chosen from a representative sample of the province?s municipalities; Turku represents a city and Piikki? a rural area. All dentists were given the same instructions. Before clinical dental examinations, the adolescents were asked to self-report their dental fear, answering a questionnaire containing the Short Dental Fear Question (SDFQ) (Table 1), the DAS [⁸] (?see Appendix 1 and 2?), and the DFS [¹⁰] in the dentist?s waiting room and to return it in a sealed envelope to the dentist, who forwarded it to the investigator (SJ). None of the adolescents refused to answer the SDFQ, DAS or DFS.

The correlations among the three dental fear measurement instruments were: the SDFQ and DFS: r_s = 0.79 (n = 26, p < 0.001), the DFS and DAS: r_s = 0.72 (n = 26, p < 0.001), the SDFQ and DAS: r_s = 0.69 (n = 27, p < 0.001). DAS and DFS mean scores were clearly higher in the SDFQ fear group compared with the SDFQ relaxed group (Tables 2 and 3).

The short question studied seems to measure dental fear in line with previously validated instruments. Correlations among the three dental fear measurement instruments (SDFQ, DAS, DFS) were relatively high and similar.

The SDFQ was found to work well among adolescents, who had no problems responding to it. The correlations of the SDFQ were tested with two commonly used, valid, reliable, but long dental fear measurement instruments, the DAS and DFS, with good results.

Even if the dentist would like to use more extensive dental fear instruments such as the DAS or DFS with all his or her patients, it is not realistic due to the busy clinical setting. These instruments have mostly been used for research purposes. The need of a shorter dental fear instrument has recently also been highlighted by other researchers [¹⁹]. A shorter dental fear instrument such as the SDFQ is needed as it can be included in the general anamnesis which a new patient fills in before his or her first visit to the dentist. The SDFQ will most probably detect those who are afraid of dentistry, after which it is worth using more detailed and more extensive dental fear instruments, because there are certain special methods which can be used in treatment in a threatening situation, or as tools to be used by the patient [²].

Comparisons of international dental fear measurement instruments consisting of single item questions show that the SDFQ correlates with the DAS and DFS in the same way as the Seattle Survey Item [⁶,²⁰]. When our results with the SDFQ were compared with another Finnish study [²¹] concerning 15-year-old adolescents, it was discovered that the distributions of adolescents into three different fear groups did not differ significantly from each other (?²-test, p = 0.1732). This result shows that the materials correspond and are dependable in both studies. The mean DAS score was 8.6 (SD = 2.5) which is close to Kaakko et al.?s [^22-24] study result of 8.9 (SD = 3.4). The latter mean DAS score is thought to be a rather typical population score [²²]. There were not many adolescents with severe or moderate dental fear in this study, which limits evaluation of the instrument for different cutoff points. However, the present high correlation coefficients indicate high accuracy, and therefore the test could possibly be used as a screening test.

The SDFQ might be a useful instrument for the clinical measurement of dental fear. It is compact and easy to answer and interpret, and thus convenient for use in a busy routine clinical setting for dentists and their patients and also indicate the patient?s potential avoiding behavior, which has been found to be a signal of severe dental fear [¹⁷,²⁵]. Further studies of the SDFQ are needed in clinical settings.

We thank P?ivi Paunio, DDS, PhD, specialist in pediatric dentistry, for initiating this dental fear study in 1991, and for creating the development process of the SDFQ. We thank Prof. Ronald Kleinknecht for making the original Dental Fear Survey instrument available for our study. Ansa Ojanlatva PhD, docent and Kari Schultz, MA are acknowledged for translating the instrument. Olli Kaleva is thanked for the statistical operations and Pirjo Piekka for the secretarial assistance. The Finnish Dental Society Apollonia Research Fund and the Turku Health Authority Centre Research Fund supported the study.