Dental Anxiety Questionnaire


When do you experience anxiety in relation to a dental situation and how severe is the anxiety?
Please answer the questions in relation to the following statement:
"feel anxious when . . ."
I think that I have a problem with my teeth.
I think that I have to go to the dentist.
I call to make an appointment.
I arrive at the dental office.
I am in the waiting room.
I smell various odors in the dental office.
I hear sounds of instruments in the dental office.
I sit in the dental chair.
The dentist examines my teeth.
I don’t understand what the dentist is explaining
a needle is used to freeze me.
I feel numbness in my mouth from freezing.
I feel the scratching on my teeth by the instruments.
The drill is making a high pitched sound.
The dental instruments are used in my mouth.
I think I could choke during dental treatment.
The rubber dam is used, (because I am afraid to choke or gag).
I realize that I will not see the work being done in my mouth.
I feel the vibration of the drill.
I hear the staff converse during the procedure.
During treatment, I am afraid to move because of the precision of the work done by the dentist.
 
What makes you feel anxious about dental treatment?
Please answer the questions in relation to the following statement:
"I get anxious when I think that . . ."
the proposed treatment will not work.
I will disappoint the dentist, because of my teeth.
the dentist will not be happy about my teeth.
I will not have enough time to talk about the proposed treatment.
the dentist does not share my concern about my teeth.
the dentist does not care about me as a person.
the dentist is in a hurry while treating me.
I could feel some pain during treatment.
I think that my face will stay frozen.
comments are made during the procedure.
I should have brushed my teeth more regularly.
something will go wrong during the procedure.
the dentist is expecting too much from me.
I am not convinced that the treatment is really required.
I spend too much time in the waiting room.
the dentist is often late in relation to my appointment.
I am afraid or not at ease to ask questions.
the dentist always gives me bad news.
I can’t ask question, because they will know I don’t understand
The dentist doesn’t tell me what is happening during treatment
I could feel pain or have problems after the appointment.
 
General Questions
Please answer the following general questions:
  1. Do you consider yourself a dental phobic (anxiety interferes with getting the dental treatment I need)?
    •   
  2. For the purpose of this study can you provide the following information:
    • Age:  
      Sex:     
  3. Do you remember at what age you started being anxious or fearful about dental treatment and how it started:
    • Age noticed:  
      How it started: (simply check the appropriate answer(s))
  4. Who do you feel most comfortable speaking to when you have a dental concern?
    • Simply check the appropriate answer(s):
 
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