Cognitive Vulnerability and the Aetiology and Maintenance of Dental Anxiety

Objectives: Dental anxiety prevalence has not changed markedly in the last 30 years, in spite of more modern and less painful technology. The objective of this study was to explore the four components (dangerousness, uncontrollability, unpredictability and disgustingness) of the Cognitive Vulnerability Model (CVM) in relation to the acquisition and maintenance of dental anxiety/phobia.

Methods: Three hundred and seventy-five participants were recruited through two dental anxiety online support groups. They completed an online questionnaire which included: a formal dental anxiety measure; open-ended questions regarding the perceived origins of their dental anxiety, and questions specifically assessing the CVM components in the acquisition and maintenance of their fear.

Results: Perceptions of the dental context as uncontrollable and unpredictable were considered important in fear acquisition, however 'dangerousness' was not as fully established and 'disgustingness' was not considered salient by participants. Three of the key components of the CVM (controllability, dangerousness and disgustingness) predicted current dental anxiety scores explaining 54% of the variance. Unpredictability was not found to have a significant independent relationship with dental anxiety.

Conclusions: These findings show general support for the CVM as an explanatory model for maintaining dental anxiety, though its role as a model for fear acquisition is still not fully established.