Magnification of Fear and Intention of Avoidance of Non-Experienced Dental Treatment

Magnification of Fear and Intention of Avoidance of Non-Experienced Dental Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Magnification of Fear and Intention of Avoidance of Non-Experienced Dental Treatment Chia-Shu Lin, Chen-Yi Lee, Li-Ling Chen, Tze-Fang Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-119910/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background. Dental fear is associated with the experience of prior dental treatment and avoidance of dental visits. It remains unclear if individuals show an intention of avoidance (IA) towards treatments that they have not received (i.e., non-experienced dental treatment). Methods. We investigated fear/IA of 12 common conditions of dental treatment of 402 adults. If subjects have experienced the condition, fear and IA were assessed based on subjects’ prior experience (i.e., ExpFear/ExpIA). If they have not experienced the condition, fear and IA were assessed based on their anticipation (i.e., NExpFear/NExpIA). Trait dental anxiety was assessed using the Index of Dental Anxiety and Fear (IDAF-4C+). Results. We found that (A) NExpFear and NExpIA were significantly higher than ExpFear and ExpIA, respectively. (B) The IDAF-4C+ scores are positively correlated with NExpFear/NExpIA and negatively correlated with the magnification of fear (i.e., the discrepancy in the fear/IA of non-experienced vs. experienced conditions). (C) The condition ‘extraction of a wisdom tooth’ and ‘root canal treatment’ showed the highest ratings on NExpFear. Conclusions. Individuals may develop a high degree of fear and IA of the treatment they have not received. Trait dental anxiety plays a key role in the magnification of the fear of non-experienced treatment. Dentistry Psychology fear avoidance dental anxiety pain Figures Figure 1 Figure 1 Figure 2 Figure 2 Introduction Traditional views hold that one’s prior experience of dental treatment plays a key role in shaping dental fear/anxiety [ 1-3 ]. Clinical evidence supports the notion that fear of dental treatment is closely associated with previous negative treatment experience [ 4-7 ]. A recent cross-sectional study reported that the experience of past dental appointments may influence patients’’ intentions of future appointments, highlighting the importance of patients' evaluation and anticipation for their intentions of dental attendance [ 8 ]. Notably, patients’ anticipation of fear and pain towards coming treatment may not reliably reflect their actual experience of treatment. Individuals may expect a stimulus to be more painful than what they actually perceived [ 9 , 10 ]. Moreover, individuals may ‘overestimate’ the fear of pain of the dental treatment that they who have not experienced, compared to those they have experienced in the past [ 11 ]. Such an ‘overestimation’ of fear of pain may be associated with trait dental anxiety [ 11 ]. Critically, fear and anxiety are not only associated with pain but also avoidance of dental treatment. Around 15% to 20% of the adult population avoid or delay visiting dentists [ 12-14 ], which results in a ‘vicious cycle’ of oral health [ 12 ]. While individuals may magnify their fear of the treatment that they have not received [ 11 ], it has remained unclear if individuals also show an intention of avoidance (IA) towards the treatment that they have not experienced (i.e., non-experienced treatment). The current study aims to investigate the association between fear/IA of experienced and non-experienced conditions of dental treatment in adults. Because dental treatment consists of a variety of procedures, which show different anxiety-stimulating effects [ 15 ], we investigated fear and IA of 12 conditions about common dental procedures. Self-ratings of fear and IA were assessed based on subjects’ prior experience if they have experienced a condition (i.e., ExpFear/ExpIA), or based on their anticipation if they have not experienced a condition (i.e., NExpFear/NExpIA). Three major hypotheses were tested: A) Hypothesis 1: Based on the previous findings of overestimation about fear of dental pain [ 11 ], we hypothesized that fear/IA ratings are higher for the non-experienced vs. the experienced conditions of treatment. B) Hypothesis 2A: Due to the close relationship between fear and avoidance [ 13 ], we hypothesized that one’s fear of experienced treatment is positively correlated with not only the IA of experienced treatment but also the IA of non-experienced treatment. Hypothesis 2B: Anxiety refers to a future-oriented state responding to an anticipated threat [ 16 ]. Therefore, we hypothesized that individual scores of trait dental anxiety are positively correlated with their fear/IA of non-experienced treatment. C) Hypothesis 3: Different dental procedures have different anxiety-stimulating effects [ 15 ]. Some dental procedures may show a greater magnification factor (i.e., a greater discrepancy in the fear/IA of non-experienced vs. experienced conditions). We hypothesized that individuals would magnify fear/IA to a lesser degree for the conditions that more people have experienced (i.e., with a higher prevalence). Materials & Methods Participants Two samples were recruited independent for the current study: 201 participants from a local community recruited via advertisement and 201 dental patients from the outpatient clinic of Taipei Veterans General Hospital (Table 1). The participants provided written informed consent, approved by the Institutional Review Board of National Yang-Ming University (ID: YM106095E) and Taipei Veterans General Hospital (ID: 2018-12-003AC) before all the assessment started. Experimental Procedure Dental Treatment Experience The questionnaire for dental treatment experience was customized with descriptions about 12 conditions of common dental procedures (Table 2), based on our previous study [ 17 ] and an earlier study [ 11 ] that adopted a set of selected dental procedures. To ensure that the conditions are common to most patients, we excluded the procedures about complicated orofacial surgery or orthodontic therapy. Trait dental anxiety was assessed using the Chinese version [ 18 ] of the Index of Dental Anxiety and Fear (IDAF-4C+) [ 19 ]. For each condition of dental treatment, the participants were asked to indicate (a) whether they have experienced that condition of treatment in the past (i.e., history of treatment, HT), the degree of (b) fear of the condition (Fear), and (c) intention of avoidance of the condition (IA), respectively, according to the following instruction: ‘ If you have previously experienced a condition about the treatment, please rate the degree of fear and intention of avoidance about that condition, by recalling your prior experience about it. ’ ‘ If you have never experienced a condition about the treatment, please rate the degree of fear and intention of avoidance about that condition, by anticipating what you would feel about it, according to what you know the treatment. ’ All the ratings were scored based on a 10-point numerical rating scale, ranging from 1 (the least degree of fear/IA) to 10 (the maximal degree of fear/IA). The scores of HT, fear of experienced treatment (ExpFear), IA of experienced treatment (ExpIA), fear of non-experienced treatment (NExpFear), and IA of non-experienced treatment (NExpIA), were calculated by including the ratings from all the 12 conditions, according to the following methods: The conditions that subjects have experienced were indexed by the value ‘1’ and those they have not experienced were indexed by the value ‘0’. The average HT was the mean of the 12 values, denoting the proportion of conditions that a subject has experienced. ExpFear and ExpIA were calculated as the mean of Fear and IA, respectively, across the conditions that subjects have experienced (i.e., the conditions valued as ‘1’ for HT). NExpFear and NExpIA were calculated as the mean of Fear and IA, respectively, across the conditions that subjects have not experienced (i.e., the conditions valued as ‘0’ for HT). Statistical Analysis Analysis of descriptive statistics The analysis of descriptive statistics was conducted for all the variables (age, sex, and the average of HT, IDAF-4C+, ExpFear, ExpIA, NExpFear, and NExpIA), across all subjects (n=402) and respectively for the community and the clinical groups (n=201 for each). Normality of the score distribution was assessed using the Shapiro-Wilk test, with p<0.1 indicating non-normality. For each of the 12 conditions of treatment, the analysis descriptive statistics was also conducted for the following variables: IDAF-4C+, ExpFear, ExpIA, NExpFear, and NExpIA. For each condition, the prevalence of experiencing a condition was calculated as the mean HT averaged across all subjects. The magnification factor, i.e., the discrepancy in the fear/IA of non-experienced vs. experienced conditions, was calculated as follows: (a) Magnification factor of fear = 100% X (NExpFear – ExpFear) / ExpFear (b) Magnification factor of IA = 100% X (NExpIA – ExpIA) / ExpIA Analysis 1: Comparison between experienced and non-experienced fear/IA To test Hypothesis 1, we performed the Wilcoxon signed-rank test for comparing the scores between ExpFear and NExpFear as well as the scores between ExpIA and FearIA, across all subjects. The choice of non-parametric method is based on the non-normality of the distribution of the scores (Table 1). Analysis 2: Association between dental anxiety, experienced and non-experienced fear/IA To test Hypotheses 2A, we examined the strength of association between (a) ExpFear and ExpIA and (b) between ExpFear and NExpIA, using the Spearman’s rho coefficient. To test Hypotheses 2B, we examined the strength of association between (a) IDAF-4C+ and NExpFear and (b) between IDAF-4C+ and NExpIA. Analysis 3: Association between the magnification factor of a dental condition and the prevalence of experiencing it To test Hypothesis 3, we examined the strength of association between (a) the prevalence of experiencing a condition and its magnification factor of fear and (b) the association between the prevalence and its magnification factor of IA, using the Spearman’s rho coefficient. All the statistical analyses were performed using IBM SPSS Statistics (v. 24). For all the statistical tests, the level of statistical significance (alpha) was 0.05. Results Descriptive Analysis The results of descriptive analyses were shown in Table 1. Due to the non-normality of the data distribution, we adopted non-parametric methods for the subsequent statistical analyses. The proportion of sex was not significantly different (two-tailed Chi-square test with the Yates continuity correction, p > 0.05) and age, IDAF-4C + score, ExpFear, ExpIA, NExpFear, and NExpIA were not significantly different (two-tailed Mann-Whitney U test, p > 0.05) between the two groups. Table 2 revealed that the conditions “root canal treatment” and “extraction of a wisdom tooth” showed the highest scores of both ExpFear and NExpFear. The conditions “extraction of primary tooth” and “failure to relieve postoperative pain” showed the highest scores of ExpIA. In contrast, the conditions “receiving local anesthesia” and “root canal treatment” showed the highest scores of NExpIA and also the highest magnification factor of IA (Table 2). Analysis 1: Comparison between experienced and non-experienced fear/IA Confirming Hypothesis 1 , we found that NExpFear was significantly higher than ExpFear (two-tailed Wilcoxon signed-rank test, p < 0.001) and NExpIA was significantly higher than ExpIA (two-tailed Wilcoxon signed-rank test, p < 0.001) (Fig. 1 A). Analysis 2: Association between dental anxiety, experienced and non-experienced fear/IA Confirming Hypothesis 2, we found a positive correlation between ExpFear and ExpIA (rho = 0.62, p < 0.001) as well as a positive correlation between ExpFear and NExpIA (rho = 0.51, p < 0.001) (Fig. 1 B). Additionally, we found a positive correlation between NExpFear and NExpIA (rho = 0.64, p < 0.001) as well as a positive correlation between ExpIA and NExpIA (rho = 0.67, p < 0.001). Confirming Hypotheses 2B, we found a positive correlation between IDAF-4C + and NExpFear (rho = 0.53, p < 0.001) as well as a positive correlation between IDAF-4C + and NExpIA (rho = 0.49, p < 0.001) (Fig. 1 C). Additionally, IDAF-4C + was positively correlated with ExpFear (rho = 0.63, p < 0.001) and ExpIA (rho = 0.59, p < 0.001). We additionally examined if the discrepancy between non-experienced (NExpFear) and experienced (ExpFear) ratings, i.e., the magnification factor of fear, was associated with dental anxiety. The analysis showed a significant negative correlation between the magnification factor of fear and IDAF-4C+ (rho=-0.14, p = 0.008) (Fig. 1 D). The correlation between the magnification factor of IA and IDAF-4C + did not show a significant result (rho = 0.05, p = 0.3) (Fig. 1 D). Analysis 3: Association between the magnification factor of a dental condition and the prevalence of experiencing it We first identified the association between ExpFear and NExpFear as well as the association between ExpIA and NExpIA, across the 12 conditions. As shown in Fig. 2 A, the scores of experienced and non-experienced conditions showed a significant positive correlation for fear (rho = 0.85, p < 0.001) but not for IA (rho = 0.54, p = 0.07). Critically, we did not find a significant correlation between the prevalence and the magnification factor of fear (rho = 0, p = 1.0) or between the prevalence and the magnification factor of IA (rho = 0.29, p = 0.37). The results thus disconfirmed Hypothesis 3 . However, an additional analysis revealed that the prevalence is only negatively correlated with ExpIA (rho=-0.63, p = 0.027) (Fig. 2 B). The correlation between the prevalence and ExpFear, NExpFear, or NExpIA, was not statistically significant. Discussion Major findings from the current study The current study aims to investigate the association between fear/IA of experienced and non-experienced conditions of dental treatment in adults. Our major findings are: NExpFear was significantly higher than ExpFear. Likewise, NExpIA was significantly higher than ExpIA (Fig. 1 A). ExpFear is positively correlated with ExpIA as well as NExpIA (Fig. 1 B). The individual IDAD-4C + scores are positively correlated with NExpFear and NExpIA (Fig. 1 C). Moreover, they are negatively correlated with the magnification factor of fear (Fig. 1 D). Among conditions of dental treatment, ‘extraction of a wisdom tooth’ and ‘root canal treatment’ showed the highest ratings on ExpFear and NExpFear (Table 2). The prevalence of experiencing a condition is negatively correlated with ExpIA (Fig. 2 B)). Association between fear and intention of avoidance It has been widely observed that prior experience of receiving dental procedures is associated with the fear of dental treatment [ 4 – 7 ]. For example, patients with negative experience about dental injections would report stronger pain and anxiety during treatment [ 10 ]. Fear and pain are also associated with patients’ memory about receiving a procedure [ 20 ]. Notably, fear is considered a critical factor of avoidance of dental treatment [ 12 – 14 , 21 ]. Our findings revealed that fear may be associated with the intention of avoidance of dental treatment, even if individuals have not experienced the treatment. The findings implied that apart from prior experience, other factors may play a key role in avoidance. Apart from personal experience, social learning via language communication or observation also contributed to the development of fear [ 22 ]. Furthermore, pain can be potentiated by imagination [ 23 ] or the iconic impressions described by mass media [ 24 ]. Personal factors, such as trait dental anxiety, may play a key role in fear/IA of non-experienced conditions of treatment. Increased anxiety is associated with the response towards a future-oriented and anticipated threat [ 16 ], consistent with the condition when patients receive a procedure they have never met before. Critically, we found that an increased trait dental anxiety, indexed by the IDAF-4C + score, was associated with a decreased magnification factor of fear (Fig. 1 D). The finding echoed the conclusion from van Wijk and Hoogstraten’s work, which reported that the ‘overestimation’ of fear of pain was reduced in the sample of highly anxious patients, relative to the non-anxious group [ 11 ]. By extending this finding, we found that on the individual basis, subjects with a higher trait dental anxiety tended to rate the fear of the procedures not experienced higher than the fear of the procedures they have experienced (Fig. 1 D). Our findings highlight that trait dental anxiety not only reflects increased pain [ 25 ] but also signifies a greater risk for patients to avoid the procedures even they have never experienced. Fear of dental treatment of common procedures Our findings revealed that the experience of more invasive procedures (e.g., root canal treatment and extraction of a wisdom tooth) were fearful for both the subjects who have and have not experienced it (Table 2 and Fig. 2 A). Consistently, the study by van Wijk and Hoogstraten has reported that surgical procedures (e.g., “Having a lump cut open in the mouth”, “Being drilled in the jawbone”, and “An incision in the gums”, tooth extraction, and root canal treatment, as the conditions with a high degree of overestimation in fear of pain [ 11 ]. Our results also echoed the findings from Oosterink et al., which revealed that root canal treatment and extraction of a molar as the dental experiences with the highest anxiety-provoking score (#3 and #5 in the ranking, respectively) among 67 dental stimuli [ 15 ]. By extending these findings, we identified a positive correlation between ExpFear and NExpFear, across the conditions (Fig. 2 A). The findings may be interpreted from two aspects. First, the fear perceived by the patients who experienced a treatment (i.e., ExpFear) may be disseminated to people who have not experienced it, probably, via media or social networks, because fear can be acquired by social learning [ 22 ]. This interpretation is consistent with the findings that these two conditions are not rare to the subjects (with a prevalence of 68% and 38%, respectively) (Table 2). A second interpretation is that a negative impression (e.g., “Tooth extraction must be scaring!” has already existed, and therefore, people have already expected a greater fear towards the treatment (i.e., a greater NExpFear) and the patients who experienced it just re-confirmed that impression (i.e., a greater ExpFear). The hypotheses regarding the cause-effect relationship between ExpFear and NExpFear may require further investigation. Intention of avoidance of dental treatment of common procedures Do the fearful experience of dental treatment make people avoid receiving further dental treatment? Our results have shown some critical clues regarding the fear-avoidance association. First, ExpFear was positively correlated with NExpIA (Fig. 1 B), suggesting that prior experience may play a key role in the IA of the non-experienced treatment. Second, the IA scores are generally lower than the fear scores. As shown in Table 1, the median for ExpIA and NExpIA is 1.2 and 1.8, respectively, but the median for ExpFear and NExpFear is 3.1 and 4.3, respectively. The findings suggested that even though stronger fear is associated with a higher IA, in general, people are likely to attend dental treatment, evidenced by the relatively lower IA scores. In terms of the Health Belief Model [ 26 ], patients may see dentists because they perceive the symptom more severe (e.g., symptomatic pulpitis), even with a greater fear about the treatment (e.g., receiving root canal treatment). Also, the low IA may be associated with a decreased barrier of dental attendance. The approachability and availability to see a dentist in Taiwan (especially in the urban area) [ 27 ] and the lower financial burden of dental treatment due to National Health Insurance [ 28 ] may contribute to the lower IA of dental treatment. Limitations of the study The results from our research need to be interpreted with several considerations from the study design. First, the dental experience questionnaire that we adopted only focuses on 12 conditions related to common dental procedures. Therefore, the findings cannot be generalized to the treatment associated with complicated or elective procedures, such as orthodontic, prosthodontic, or cosmetic therapies. Second, due to the non-normal distribution of scores, we do not perform more sophisticated analyses (e.g., multivariable analyses) for investigating the relationship between each variable. Third, it is noteworthy that patients’ intention of attendance of dental visits is associated with positive expectations, such as getting pain relieved or improving mastication. The interplay between the negative (fear) and positive expectations would need further investigation. Clinical implications Based on our novel findings presented here, we suggest three aspects for further considerations in clinical practice. Individuals with a higher trait dental anxiety may tend to magnify the fear of the procedures that they have not experienced. Therefore, the assessment of dental anxiety will be helpful for predicting patients’ dental-visiting experience. Extraction of a wisdom tooth and root canal treat present the highest fear regardless of individual prior experience. Therefore, dentists may pay attention if a negative impression about the treatment has been cast on patients, leading to their fear and avoidance. Finally, recent evidence has gradually disclosed the biological mechanisms of dental fear, including its association with genetic variations [ 29 ] and brain activation [ 17 , 30 ]. The biological mechanisms underlying fear/avoidance towards non-experienced stimuli would require further investigation. Conclusion Our novel findings suggest that individuals may develop a high degree of fear and intention to avoidance toward the conditions of dental treatment they have not experienced. Individual variations in trait dental anxiety play a key role in the magnification of the fear of non-experienced treatment. Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board of National Yang-Ming University (ID: YM106095E) and Taipei Veterans General Hospital (ID: 2018-12-003AC). The participants provided written informed consent before all the assessment started, in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets generated during and analyzed during the current study are not publicly available due to regulations on the privacy of the subjects according to the guidelines from local Internal Review Board but are available from the corresponding author on reasonable request. Competing interests Conflict of Interest: All the authors declare no conflict of interest. Funding C-S. Lin was funded by the Ministry of Science and Technology of Taiwan (MOST 107-2314-B-010-030-MY2). Authors' contributions CS Lin, CY Lee, and TF Wang conceptualized and designed the research. CS Lin, CY Lee, and TF Wang conducted the research. CS Lin and LL Chen collected data. CS Lin and LL Chen analyzed data. CS Lin drafted the manuscript. CS Lin, CY Lee, and TF Wang finalized and approved the manuscript. 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Tables Table 1 Results of the analysis of descriptive statistics across subjects Total Sex Age IDAF-4C+ HT ExpFear ExpIA NExpFear NExpIA n 402 402 402 402 401 401 384 384 Male 202 Female 200 max 86 5.0 100% 9.1 10.0 10.0 10.0 Q3 60 2.1 83% 5.0 2.8 6.3 4.0 median 47 1.4 67% 3.1 1.2 4.3 1.8 Q1 33 1.1 58% 2.0 1.0 2.5 1.0 min 20 1.0 0% 1.0 1.0 1.0 1.0 mean 47 1.8 67% 3.6 2.2 4.5 2.8 S.D. 16 0.9 20% 2.0 1.8 2.4 2.4 Community Sex Age IDAF-4C+ HT ExpFear ExpIA NExpFear NExpIA n 201 201 201 201 200 200 188 188 Male 105 Female 96 max 86 5.0 100% 8.9 10.0 10.0 10.0 Q3 60 2.1 83% 4.8 2.9 6.0 4.1 median 46 1.4 67% 3.1 1.3 4.0 2.0 Q1 30 1.1 58% 2.0 1.0 2.3 1.0 min 20 1.0 0% 1.0 1.0 1.0 1.0 mean 45 1.8 65% 3.6 2.3 4.4 2.9 S.D. 17 0.9 21% 2.0 1.9 2.4 2.4 Clinical Sex Age IDAF-4C+ HT ExpFear ExpIA NExpFear NExpIA n 201 201 201 201 201 201 196 196 Male 97 Female 104 max 86 5.0 100% 9.1 9.1 10.0 10.0 Q3 61 2.0 83% 5.0 2.5 6.5 4.0 median 48 1.4 67% 3.1 1.1 4.5 1.6 Q1 37 1.0 58% 2.0 1.0 2.7 1.0 min 20 1.0 8% 1.0 1.0 1.0 1.0 mean 49 1.7 68% 3.6 2.1 4.7 2.7 S.D. 16 0.9 18% 2.1 1.7 2.4 2.3 Comparison * n.s. n.s. n.s. n.s. n.s. n.s. n.s. n.s. * Due to the non-normality of the distribution of all the variables, comparison between two subgroups was performed using Mann-Whitney U test. ExpFear: fear of experienced conditions, ExpIA: intention of avoidance of experienced conditions, HT: history of treatment, IDAF-4C+: the Index of Dental Anxiety and Fear, NExpFear: fear of non-experienced conditions, NExpIA: intention of avoidance of non-experienced conditions, n.s.: statistically not significant, Q1: the first quartile, Q3: the third quartile, S.D.: standard deviation. Table 2 Results of the analysis of descriptive statistics of each procedure Conditions of dental treatment Prevalence Fear IA Magnification factor Exp NExp Exp NExp Fear IA Receiving a local anesthetic injection in the mouth 94% 4.2 5.4 2.1 3.9 30% 84% Having a painful tooth tapped by the dentist 85% 3.7 4.3 2.2 2.7 14% 23% Having a primary tooth (milk teeth) extracted in the childhood 48% 4.5 4.3 3.2 3.3 -3% 2% Receiving ultrasonic scaling for removing dental stone 92% 2.5 2.5 1.7 2.1 -1% 21% A molar being drilled to remove caries 85% 4.0 3.9 2.4 2.5 -4% 6% Receiving a root canal treatment 68% 4.6 6.1 2.6 4.0 33% 56% Having a wisdom tooth extracted by surgery 38% 4.8 5.9 2.7 3.7 22% 37% Feeling painful hypersensitivity when rinsing cold water 77% 2.5 2.0 1.7 1.6 -22% -5% A caries tooth being explored with a dental instrument 91% 3.8 3.9 2.2 2.5 3% 13% Having the swelling gum incised and pus drained 33% 4.1 5.0 2.4 2.9 22% 18% Feeling excruciating postoperative pain; not being relieved even with painkillers 34% 4.5 4.1 2.8 2.4 -9% -14% Receiving a wedge and band in between the teeth during restoration 54% 2.6 3.5 1.9 2.4 35% 27% Exp: experienced conditions; IA: intention of avoidance, NExp: non-experienced conditions. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 12 Apr, 2021 Reviews received at journal 15 Mar, 2021 Reviewers agreed at journal 09 Mar, 2021 Reviewers invited by journal 25 Dec, 2020 Editor assigned by journal 16 Dec, 2020 Editor invited by journal 10 Dec, 2020 Submission checks completed at journal 10 Dec, 2020 First submitted to journal 01 Dec, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-119910","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":6250030,"identity":"af96be8c-0582-40d8-bd7b-6a610280203c","order_by":0,"name":"Chia-Shu Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYDACZiB+YMAgB+bwEK0lwYDBGKZFgjibEhgYEhuI1mJwnPfwh4SCO+kbrh1gfPC2jaHO4AAhLYf5EgwSDJ7lbridwGw4t41BgqAWs8M8BgkJBodBWtikeYFazIjRcgCoJd3gdgL7b2K1GDYAtSQAtbAxE6XF/jCPMTCQDxvOvJ3YLDnnnITkfkJaJPvPGH/48OewPN/t5IMf3pTZ8Es2ENACBwoHGEFqiYxJMJAn2vBRMApGwSgYcQAAwspAaqecr74AAAAASUVORK5CYII=","orcid":"","institution":"National Yang Ming University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chia-Shu","middleName":"","lastName":"Lin","suffix":""},{"id":6250031,"identity":"f6715715-ae49-4cf0-8f33-bfd2f1948107","order_by":1,"name":"Chen-Yi Lee","email":"","orcid":"","institution":"Kaohsiung Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chen-Yi","middleName":"","lastName":"Lee","suffix":""},{"id":6250032,"identity":"0c5cb976-e84e-406c-88d3-810a91e0e8cd","order_by":2,"name":"Li-Ling Chen","email":"","orcid":"","institution":"National Yang Ming University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li-Ling","middleName":"","lastName":"Chen","suffix":""},{"id":6250033,"identity":"fc00ef2e-2009-4101-bb1f-f48056d66296","order_by":3,"name":"Tze-Fang Wang","email":"","orcid":"","institution":"National Yang Ming University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tze-Fang","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2020-12-02 01:44:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-119910/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-119910/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":4255712,"identity":"b92da848-5ca1-4fec-8334-157d4bda7609","added_by":"auto","created_at":"2020-12-14 21:26:22","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":221349,"visible":true,"origin":"","legend":"Association between experienced and non-experienced fear/intention of avoidance (IA). (A) Fear of non-experienced conditions (NExpFear) is significantly higher than fear of experienced conditions (ExpFear). IA of non-experienced conditions (NExpIA) is significantly higher than fear of experienced conditions (ExpIA). (B) ExpFear is significantly positively correlated with ExpIA and IA of non-experienced conditions (NExpIA). (C) Trait dental anxiety (IDAF-4C+ score) is significantly positively correlated with fear of non-experienced conditions (NExpFear) and NExpIA. (D) Trait dental anxiety is significantly negatively correlated with the magnification factor of fear but not that of IA.","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-119910/v1/eca4bf3b1519a2c6805fbcfb.jpg"},{"id":4255709,"identity":"a7ff5679-72c7-493e-9209-6feee8b2b2b5","added_by":"auto","created_at":"2020-12-14 21:26:15","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":221349,"visible":true,"origin":"","legend":"Association between experienced and non-experienced fear/intention of avoidance (IA). (A) Fear of non-experienced conditions (NExpFear) is significantly higher than fear of experienced conditions (ExpFear). IA of non-experienced conditions (NExpIA) is significantly higher than fear of experienced conditions (ExpIA). (B) ExpFear is significantly positively correlated with ExpIA and IA of non-experienced conditions (NExpIA). (C) Trait dental anxiety (IDAF-4C+ score) is significantly positively correlated with fear of non-experienced conditions (NExpFear) and NExpIA. (D) Trait dental anxiety is significantly negatively correlated with the magnification factor of fear but not that of IA.","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-119910/v1/dad7124eb3533315713e5a5f.jpg"},{"id":4255713,"identity":"e9f4e596-b095-4357-ac6b-e3a3d55d63b7","added_by":"auto","created_at":"2020-12-14 21:26:22","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":172361,"visible":true,"origin":"","legend":"Analysis of fear and intention of avoidance (IA) by conditions of dental treatment. (A) Fear of subjects have an experience (ExpFear) and subjects without an experience (NExpFear) is significantly positively correlated across the 12 conditions. IA of subjects have an experience (ExpIA) and subjects without an experience (NExpIA) is not significantly correlated. The area with a gray shade indicates the conditions with a magnification of fear/IA in non-experienced subjects. (B) The prevalence of experiencing a condition is significantly negatively correlated with ExpIA but not NExpIA.","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-119910/v1/0ae27c6ab029ce80c4ffed63.jpg"},{"id":4255710,"identity":"2ca7edbc-bd82-4eaf-8cf8-8306a278c038","added_by":"auto","created_at":"2020-12-14 21:26:16","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":172361,"visible":true,"origin":"","legend":"Analysis of fear and intention of avoidance (IA) by conditions of dental treatment. (A) Fear of subjects have an experience (ExpFear) and subjects without an experience (NExpFear) is significantly positively correlated across the 12 conditions. IA of subjects have an experience (ExpIA) and subjects without an experience (NExpIA) is not significantly correlated. The area with a gray shade indicates the conditions with a magnification of fear/IA in non-experienced subjects. (B) The prevalence of experiencing a condition is significantly negatively correlated with ExpIA but not NExpIA.","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-119910/v1/0145b3b9c81e0911a8a6c267.jpg"},{"id":13631740,"identity":"d6d1c867-ca11-4069-af83-790d8cd1dd6a","added_by":"auto","created_at":"2021-09-17 08:18:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1258079,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-119910/v1/6db39537-2ea4-4bde-ab64-a9123512a8b5.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eMagnification of Fear and Intention of Avoidance of Non-Experienced Dental Treatment\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraditional views hold that one\u0026rsquo;s prior experience of dental treatment plays a key role in shaping dental fear/anxiety [\u003ca href=\"#_ENREF_1\"\u003e1-3\u003c/a\u003e]. Clinical evidence supports the notion that fear of dental treatment is closely associated with previous negative treatment experience [\u003ca href=\"#_ENREF_4\"\u003e4-7\u003c/a\u003e]. A recent cross-sectional study reported that the experience of past dental appointments may influence patients\u0026rsquo;\u0026rsquo; intentions of future appointments, highlighting the importance of patients' evaluation and anticipation for their intentions of dental attendance [\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e]. Notably, patients\u0026rsquo; anticipation of fear and pain towards coming treatment may not reliably reflect their actual experience of treatment. Individuals may expect a stimulus to be more painful than what they actually perceived [\u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e, \u003ca href=\"#_ENREF_10\"\u003e10\u003c/a\u003e]. Moreover, individuals may \u0026lsquo;overestimate\u0026rsquo; the fear of pain of the dental treatment that they who have not experienced, compared to those they have experienced in the past [\u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e]. Such an \u0026lsquo;overestimation\u0026rsquo; of fear of pain may be associated with trait dental anxiety [\u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eCritically, fear and anxiety are not only associated with pain but also avoidance of dental treatment. Around 15% to 20% of the adult population avoid or delay visiting dentists [\u003ca href=\"#_ENREF_12\"\u003e12-14\u003c/a\u003e], which results in a \u0026lsquo;vicious cycle\u0026rsquo; of oral health [\u003ca href=\"#_ENREF_12\"\u003e12\u003c/a\u003e]. While individuals may magnify their fear of the treatment that they have not received [\u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e], it has remained unclear if individuals also show an intention of avoidance (IA) towards the treatment that they have not experienced (i.e., non-experienced treatment). The current study aims to investigate the association between fear/IA of experienced and non-experienced conditions of dental treatment in adults.\u003c/p\u003e\n\u003cp\u003eBecause dental treatment consists of a variety of procedures, which show different anxiety-stimulating effects [\u003ca href=\"#_ENREF_15\"\u003e15\u003c/a\u003e], we investigated fear and IA of 12 conditions about common dental procedures. Self-ratings of fear and IA were assessed based on subjects\u0026rsquo; prior experience if they have experienced a condition (i.e., ExpFear/ExpIA), or based on their anticipation if they have not experienced a condition (i.e., NExpFear/NExpIA). Three major hypotheses were tested:\u003c/p\u003e\n\u003cp\u003eA) Hypothesis 1: Based on the previous findings of overestimation about fear of dental pain [\u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e], we hypothesized that fear/IA ratings are higher for the non-experienced vs. the experienced conditions of treatment.\u003c/p\u003e\n\u003cp\u003eB) Hypothesis 2A: Due to the close relationship between fear and avoidance [\u003ca href=\"#_ENREF_13\"\u003e13\u003c/a\u003e], we hypothesized that one\u0026rsquo;s fear of experienced treatment is positively correlated with not only the IA of experienced treatment but also the IA of non-experienced treatment. Hypothesis 2B: Anxiety refers to a future-oriented state responding to an anticipated threat [\u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e]. Therefore, we hypothesized that individual scores of trait dental anxiety are positively correlated with their fear/IA of non-experienced treatment.\u003c/p\u003e\n\u003cp\u003eC) Hypothesis 3: Different dental procedures have different anxiety-stimulating effects [\u003ca href=\"#_ENREF_15\"\u003e15\u003c/a\u003e]. Some dental procedures may show a greater magnification factor (i.e., a greater discrepancy in the fear/IA of non-experienced vs. experienced conditions). We hypothesized that individuals would magnify fear/IA to a lesser degree for the conditions that more people have experienced (i.e., with a higher prevalence).\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo samples were recruited independent for the current study: \u0026nbsp;201 participants from a local community recruited via advertisement and 201 dental patients from the outpatient clinic of Taipei Veterans General Hospital (Table 1). The participants provided written informed consent, approved by the Institutional Review Board of National Yang-Ming University (ID: YM106095E) and Taipei Veterans General Hospital (ID: 2018-12-003AC) before all the assessment started.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDental Treatment Experience\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire for dental treatment experience was customized with descriptions about 12 conditions of common dental procedures (Table 2), based on our previous study [\u003ca href=\"#_ENREF_17\"\u003e17\u003c/a\u003e] and an earlier study [\u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e] that adopted a set of selected dental procedures. To ensure that the conditions are common to most patients, we excluded the procedures about complicated orofacial surgery or orthodontic therapy. Trait dental anxiety was assessed using the Chinese version [\u003ca href=\"#_ENREF_18\"\u003e18\u003c/a\u003e] of the Index of Dental Anxiety and Fear (IDAF-4C+) [\u003ca href=\"#_ENREF_19\"\u003e19\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eFor each condition of dental treatment, the participants were asked to indicate (a) whether they have experienced that condition of treatment in the past (i.e., history of treatment, HT), the degree of (b) fear of the condition (Fear), and (c) intention of avoidance of the condition (IA), respectively, according to the following instruction:\u003c/p\u003e\n\u003col style=\"list-style-type: upper-alpha;\"\u003e\n\u003cli\u003e\u0026lsquo;\u003cem\u003eIf you have previously experienced a condition about the treatment, please rate the degree of fear and intention of avoidance about that condition, by recalling your prior experience about it.\u003c/em\u003e\u0026rsquo;\u003c/li\u003e\n\u003cli\u003e\u0026lsquo;\u003cem\u003eIf you have never experienced a condition about the treatment, please rate the degree of fear and intention of avoidance about that condition, by anticipating what you would feel about it, according to what you know the treatment.\u003c/em\u003e\u0026rsquo;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAll the ratings were scored based on a 10-point numerical rating scale, ranging from 1 (the least degree of fear/IA) to 10 (the maximal degree of fear/IA). The scores of HT, fear of experienced treatment (ExpFear), IA of experienced treatment (ExpIA), fear of non-experienced treatment (NExpFear), and IA of non-experienced treatment (NExpIA), were calculated by including the ratings from all the 12 conditions, according to the following methods:\u003c/p\u003e\n\u003col style=\"list-style-type: lower-alpha;\"\u003e\n\u003cli\u003eThe conditions that subjects have experienced were indexed by the value \u0026lsquo;1\u0026rsquo; and those they have not experienced were indexed by the value \u0026lsquo;0\u0026rsquo;. The average HT was the mean of the 12 values, denoting the proportion of conditions that a subject has experienced.\u003c/li\u003e\n\u003cli\u003eExpFear and ExpIA were calculated as the mean of Fear and IA, respectively, across the conditions that subjects have experienced (i.e., the conditions valued as \u0026lsquo;1\u0026rsquo; for HT).\u003c/li\u003e\n\u003cli\u003eNExpFear and NExpIA were calculated as the mean of Fear and IA, respectively, across the conditions that subjects have not experienced (i.e., the conditions valued as \u0026lsquo;0\u0026rsquo; for HT).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnalysis of descriptive statistics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of descriptive statistics was conducted for all the variables (age, sex, and the average of HT, IDAF-4C+, ExpFear, ExpIA, NExpFear, and NExpIA), across all subjects (n=402) and respectively for the community and the clinical groups (n=201 for each). Normality of the score distribution was assessed using the Shapiro-Wilk test, with p\u0026lt;0.1 indicating non-normality.\u003c/p\u003e\n\u003cp\u003eFor each of the 12 conditions of treatment, the analysis descriptive statistics was also conducted for the following variables: IDAF-4C+, ExpFear, ExpIA, NExpFear, and NExpIA. For each condition, the prevalence of experiencing a condition was calculated as the mean HT averaged across all subjects. The magnification factor, i.e., the discrepancy in the fear/IA of non-experienced vs. experienced conditions, was calculated as follows:\u003c/p\u003e\n\u003cp\u003e(a) Magnification factor of fear = 100% X (NExpFear \u0026ndash; ExpFear) / ExpFear\u003c/p\u003e\n\u003cp\u003e(b) Magnification factor of IA = 100% X (NExpIA \u0026ndash; ExpIA) / ExpIA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnalysis 1: Comparison between experienced and non-experienced fear/IA\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo test Hypothesis 1, we performed the Wilcoxon signed-rank test for comparing the scores between ExpFear and NExpFear as well as the scores between ExpIA and FearIA, across all subjects. The choice of non-parametric method is based on the non-normality of the distribution of the scores (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnalysis 2: Association between dental anxiety, experienced and non-experienced fear/IA \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo test Hypotheses 2A, we examined the strength of association between (a) ExpFear and ExpIA and (b) between ExpFear and NExpIA, using the Spearman\u0026rsquo;s rho coefficient. To test Hypotheses 2B, we examined the strength of association between (a) IDAF-4C+ and NExpFear and (b) between IDAF-4C+ and NExpIA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnalysis 3: Association between the magnification factor of a dental condition and the prevalence of experiencing it\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo test Hypothesis 3, we examined the strength of association between (a) the prevalence of experiencing a condition and its magnification factor of fear and (b) the association between the prevalence and its magnification factor of IA, using the Spearman\u0026rsquo;s rho coefficient.\u003c/p\u003e\n\u003cp\u003eAll the statistical analyses were performed using IBM SPSS Statistics (v. 24). For all the statistical tests, the level of statistical significance (alpha) was 0.05.\u003c/p\u003e"},{"header":"Results","content":" \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Analysis\u003c/h2\u003e \u003cp\u003eThe results of descriptive analyses were shown in Table\u0026nbsp;1. Due to the non-normality of the data distribution, we adopted non-parametric methods for the subsequent statistical analyses. The proportion of sex was not significantly different (two-tailed Chi-square test with the Yates continuity correction, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and age, IDAF-4C\u0026thinsp;+\u0026thinsp;score, ExpFear, ExpIA, NExpFear, and NExpIA were not significantly different (two-tailed Mann-Whitney U test, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between the two groups.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2 revealed that the conditions \u0026ldquo;root canal treatment\u0026rdquo; and \u0026ldquo;extraction of a wisdom tooth\u0026rdquo; showed the highest scores of both ExpFear and NExpFear. The conditions \u0026ldquo;extraction of primary tooth\u0026rdquo; and \u0026ldquo;failure to relieve postoperative pain\u0026rdquo; showed the highest scores of ExpIA. In contrast, the conditions \u0026ldquo;receiving local anesthesia\u0026rdquo; and \u0026ldquo;root canal treatment\u0026rdquo; showed the highest scores of NExpIA and also the highest magnification factor of IA (Table\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis 1: Comparison between experienced and non-experienced fear/IA\u003c/h2\u003e \u003cp\u003eConfirming Hypothesis \u003cspan refid=\"FPar1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, we found that NExpFear was significantly higher than ExpFear (two-tailed Wilcoxon signed-rank test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and NExpIA was significantly higher than ExpIA (two-tailed Wilcoxon signed-rank test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis 2: Association between dental anxiety, experienced and non-experienced fear/IA\u003c/h2\u003e \u003cp\u003eConfirming Hypothesis 2, we found a positive correlation between ExpFear and ExpIA (rho\u0026thinsp;=\u0026thinsp;0.62, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as well as a positive correlation between ExpFear and NExpIA (rho\u0026thinsp;=\u0026thinsp;0.51, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Additionally, we found a positive correlation between NExpFear and NExpIA (rho\u0026thinsp;=\u0026thinsp;0.64, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as well as a positive correlation between ExpIA and NExpIA (rho\u0026thinsp;=\u0026thinsp;0.67, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Confirming Hypotheses 2B, we found a positive correlation between IDAF-4C\u0026thinsp;+\u0026thinsp;and NExpFear (rho\u0026thinsp;=\u0026thinsp;0.53, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as well as a positive correlation between IDAF-4C\u0026thinsp;+\u0026thinsp;and NExpIA (rho\u0026thinsp;=\u0026thinsp;0.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). Additionally, IDAF-4C\u0026thinsp;+\u0026thinsp;was positively correlated with ExpFear (rho\u0026thinsp;=\u0026thinsp;0.63, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ExpIA (rho\u0026thinsp;=\u0026thinsp;0.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eWe additionally examined if the discrepancy between non-experienced (NExpFear) and experienced (ExpFear) ratings, i.e., the magnification factor of fear, was associated with dental anxiety. The analysis showed a significant negative correlation between the magnification factor of fear and IDAF-4C+ (rho=-0.14, p\u0026thinsp;=\u0026thinsp;0.008) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD). The correlation between the magnification factor of IA and IDAF-4C\u0026thinsp;+\u0026thinsp;did not show a significant result (rho\u0026thinsp;=\u0026thinsp;0.05, p\u0026thinsp;=\u0026thinsp;0.3) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eAnalysis 3: Association between the magnification factor of a dental condition and the prevalence of experiencing it\u003c/span\u003e \u003c/p\u003e \u003cp\u003eWe first identified the association between ExpFear and NExpFear as well as the association between ExpIA and NExpIA, across the 12 conditions. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, the scores of experienced and non-experienced conditions showed a significant positive correlation for fear (rho\u0026thinsp;=\u0026thinsp;0.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but not for IA (rho\u0026thinsp;=\u0026thinsp;0.54, p\u0026thinsp;=\u0026thinsp;0.07). Critically, we did not find a significant correlation between the prevalence and the magnification factor of fear (rho\u0026thinsp;=\u0026thinsp;0, p\u0026thinsp;=\u0026thinsp;1.0) or between the prevalence and the magnification factor of IA (rho\u0026thinsp;=\u0026thinsp;0.29, p\u0026thinsp;=\u0026thinsp;0.37). The results thus disconfirmed Hypothesis \u003cspan refid=\"FPar3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. However, an additional analysis revealed that the prevalence is only negatively correlated with ExpIA (rho=-0.63, p\u0026thinsp;=\u0026thinsp;0.027) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The correlation between the prevalence and ExpFear, NExpFear, or NExpIA, was not statistically significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eMajor findings from the current study\u003c/h2\u003e\n\u003cp\u003eThe current study aims to investigate the association between fear/IA of experienced and non-experienced conditions of dental treatment in adults. Our major findings are:\u003c/p\u003e\n\u003col style=\"list-style-type: upper-alpha;\"\u003e\n\u003cli\u003e\n\u003cp\u003eNExpFear was significantly higher than ExpFear. Likewise, NExpIA was significantly higher than ExpIA (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eA).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eExpFear is positively correlated with ExpIA as well as NExpIA (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eB). The individual IDAD-4C\u0026thinsp;+\u0026thinsp;scores are positively correlated with NExpFear and NExpIA (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eC). Moreover, they are negatively correlated with the magnification factor of fear (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eD).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAmong conditions of dental treatment, \u0026lsquo;extraction of a wisdom tooth\u0026rsquo; and \u0026lsquo;root canal treatment\u0026rsquo; showed the highest ratings on ExpFear and NExpFear (Table\u0026nbsp;2). The prevalence of experiencing a condition is negatively correlated with ExpIA (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eB)).\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eAssociation between fear and intention of avoidance\u003c/h2\u003e\n\u003cp\u003eIt has been widely observed that prior experience of receiving dental procedures is associated with the fear of dental treatment [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. For example, patients with negative experience about dental injections would report stronger pain and anxiety during treatment [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. Fear and pain are also associated with patients\u0026rsquo; memory about receiving a procedure [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Notably, fear is considered a critical factor of avoidance of dental treatment [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our findings revealed that fear may be associated with the intention of avoidance of dental treatment, even if individuals have not experienced the treatment. The findings implied that apart from prior experience, other factors may play a key role in avoidance. Apart from personal experience, social learning via language communication or observation also contributed to the development of fear [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, pain can be potentiated by imagination [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e] or the iconic impressions described by mass media [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003ePersonal factors, such as trait dental anxiety, may play a key role in fear/IA of non-experienced conditions of treatment. Increased anxiety is associated with the response towards a future-oriented and anticipated threat [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e], consistent with the condition when patients receive a procedure they have never met before. Critically, we found that an increased trait dental anxiety, indexed by the IDAF-4C\u0026thinsp;+\u0026thinsp;score, was associated with a decreased magnification factor of fear (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eD). The finding echoed the conclusion from van Wijk and Hoogstraten\u0026rsquo;s work, which reported that the \u0026lsquo;overestimation\u0026rsquo; of fear of pain was reduced in the sample of highly anxious patients, relative to the non-anxious group [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. By extending this finding, we found that on the individual basis, subjects with a higher trait dental anxiety tended to rate the fear of the procedures not experienced higher than the fear of the procedures they have experienced (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eD). Our findings highlight that trait dental anxiety not only reflects increased pain [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e] but also signifies a greater risk for patients to avoid the procedures even they have never experienced.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eFear of dental treatment of common procedures\u003c/h2\u003e\n\u003cp\u003eOur findings revealed that the experience of more invasive procedures (e.g., root canal treatment and extraction of a wisdom tooth) were fearful for both the subjects who have and have not experienced it (Table\u0026nbsp;2 and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA). Consistently, the study by van Wijk and Hoogstraten has reported that surgical procedures (e.g., \u0026ldquo;Having a lump cut open in the mouth\u0026rdquo;, \u0026ldquo;Being drilled in the jawbone\u0026rdquo;, and \u0026ldquo;An incision in the gums\u0026rdquo;, tooth extraction, and root canal treatment, as the conditions with a high degree of overestimation in fear of pain [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our results also echoed the findings from Oosterink et al., which revealed that root canal treatment and extraction of a molar as the dental experiences with the highest anxiety-provoking score (#3 and #5 in the ranking, respectively) among 67 dental stimuli [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eBy extending these findings, we identified a positive correlation between ExpFear and NExpFear, across the conditions (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA). The findings may be interpreted from two aspects. First, the fear perceived by the patients who experienced a treatment (i.e., ExpFear) may be disseminated to people who have not experienced it, probably, via media or social networks, because fear can be acquired by social learning [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. This interpretation is consistent with the findings that these two conditions are not rare to the subjects (with a prevalence of 68% and 38%, respectively) (Table\u0026nbsp;2). A second interpretation is that a negative impression (e.g., \u0026ldquo;Tooth extraction must be scaring!\u0026rdquo; has already existed, and therefore, people have already expected a greater fear towards the treatment (i.e., a greater NExpFear) and the patients who experienced it just re-confirmed that impression (i.e., a greater ExpFear). The hypotheses regarding the cause-effect relationship between ExpFear and NExpFear may require further investigation.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003eIntention of avoidance of dental treatment of common procedures\u003c/h2\u003e\n\u003cp\u003eDo the fearful experience of dental treatment make people avoid receiving further dental treatment? Our results have shown some critical clues regarding the fear-avoidance association. First, ExpFear was positively correlated with NExpIA (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eB), suggesting that prior experience may play a key role in the IA of the non-experienced treatment. Second, the IA scores are generally lower than the fear scores. As shown in Table\u0026nbsp;1, the median for ExpIA and NExpIA is 1.2 and 1.8, respectively, but the median for ExpFear and NExpFear is 3.1 and 4.3, respectively. The findings suggested that even though stronger fear is associated with a higher IA, in general, people are likely to attend dental treatment, evidenced by the relatively lower IA scores. In terms of the Health Belief Model [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e], patients may see dentists because they perceive the symptom more severe (e.g., symptomatic pulpitis), even with a greater fear about the treatment (e.g., receiving root canal treatment). Also, the low IA may be associated with a decreased barrier of dental attendance. The approachability and availability to see a dentist in Taiwan (especially in the urban area) [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e] and the lower financial burden of dental treatment due to National Health Insurance [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e] may contribute to the lower IA of dental treatment.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eLimitations of the study\u003c/h2\u003e\n\u003cp\u003eThe results from our research need to be interpreted with several considerations from the study design. First, the dental experience questionnaire that we adopted only focuses on 12 conditions related to common dental procedures. Therefore, the findings cannot be generalized to the treatment associated with complicated or elective procedures, such as orthodontic, prosthodontic, or cosmetic therapies. Second, due to the non-normal distribution of scores, we do not perform more sophisticated analyses (e.g., multivariable analyses) for investigating the relationship between each variable. Third, it is noteworthy that patients\u0026rsquo; intention of attendance of dental visits is associated with positive expectations, such as getting pain relieved or improving mastication. The interplay between the negative (fear) and positive expectations would need further investigation.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003eClinical implications\u003c/h2\u003e\n\u003cp\u003eBased on our novel findings presented here, we suggest three aspects for further considerations in clinical practice.\u003c/p\u003e\n\u003col style=\"list-style-type: upper-alpha;\"\u003e\n\u003cli\u003e\n\u003cp\u003eIndividuals with a higher trait dental anxiety may tend to magnify the fear of the procedures that they have not experienced. Therefore, the assessment of dental anxiety will be helpful for predicting patients\u0026rsquo; dental-visiting experience.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eExtraction of a wisdom tooth and root canal treat present the highest fear regardless of individual prior experience. Therefore, dentists may pay attention if a negative impression about the treatment has been cast on patients, leading to their fear and avoidance.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eFinally, recent evidence has gradually disclosed the biological mechanisms of dental fear, including its association with genetic variations [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e] and brain activation [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. The biological mechanisms underlying fear/avoidance towards non-experienced stimuli would require further investigation.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e"},{"header":"Conclusion","content":" \u003cp\u003eOur novel findings suggest that individuals may develop a high degree of fear and intention to avoidance toward the conditions of dental treatment they have not experienced. Individual variations in trait dental anxiety play a key role in the magnification of the fear of non-experienced treatment.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board of National Yang-Ming University (ID: YM106095E) and Taipei Veterans General Hospital (ID: 2018-12-003AC). The participants provided written informed consent before all the assessment started, in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and analyzed during the current study are not publicly available due to regulations on the privacy of the subjects according to the guidelines from local Internal Review Board but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConflict of Interest: All the authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eC-S. Lin was funded by the Ministry of Science and Technology of Taiwan (MOST 107-2314-B-010-030-MY2). \u003cstrong\u003e\u003cbr /\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCS Lin, CY Lee, and TF Wang conceptualized and designed the research. CS Lin, CY Lee, and TF Wang conducted the research. CS Lin and LL Chen collected data. CS Lin and LL Chen analyzed data. CS Lin drafted the manuscript. CS Lin, CY Lee, and TF Wang finalized and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMilgrom P, Weinstein P, Getz T: \u003cb\u003eTreating fearful dental patients\u003c/b\u003e. 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USA: Oxford University Press; 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin CS, Wu SY, Wu LT: \u003cb\u003eThe anterior insula and anterior cingulate cortex are associated with avoidance of dental treatment based on prior experience of treatment in healthy adults\u003c/b\u003e. \u003cem\u003eBMC neuroscience\u003c/em\u003e 2015, \u003cb\u003e16\u003c/b\u003e:88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang TF, Wu YT, Tseng CF, Chou C: \u003cb\u003eAssociations between dental anxiety and postoperative pain following extraction of horizontally impacted wisdom teeth: A prospective observational study\u003c/b\u003e. \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e 2017, \u003cb\u003e96\u003c/b\u003e(47):e8665.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmfield JM: \u003cb\u003eDevelopment and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4C+)\u003c/b\u003e. \u003cem\u003ePsychol Assess\u003c/em\u003e 2010, \u003cb\u003e22\u003c/b\u003e(2):279\u0026ndash;287.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcNeil DW, Helfer AJ, Weaver BD, Graves RW, Kyle BN, Davis AM: \u003cb\u003eMemory of pain and anxiety associated with tooth extraction\u003c/b\u003e. \u003cem\u003eJournal of dental research\u003c/em\u003e 2011, \u003cb\u003e90\u003c/b\u003e(2):220\u0026ndash;224.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Jongh A, Schutjes M, Aartman IH: \u003cb\u003eA test of Berggren's model of dental fear and anxiety\u003c/b\u003e. \u003cem\u003eEuropean journal of oral sciences\u003c/em\u003e 2011, \u003cb\u003e119\u003c/b\u003e(5):361\u0026ndash;365.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlsson A, Phelps EA: \u003cb\u003eSocial learning of fear\u003c/b\u003e. \u003cem\u003eNature neuroscience\u003c/em\u003e 2007, \u003cb\u003e10\u003c/b\u003e(9):1095\u0026ndash;1102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgino Y, Nemoto H, Inui K, Saito S, Kakigi R, Goto F: \u003cb\u003eInner experience of pain: imagination of pain while viewing images showing painful events forms subjective pain representation in human brain\u003c/b\u003e. \u003cem\u003eCereb Cortex\u003c/em\u003e 2007, \u003cb\u003e17\u003c/b\u003e(5):1139\u0026ndash;1146.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore R, Birn H: \u003cb\u003e[Phenomenon of dental fear]\u003c/b\u003e. \u003cem\u003eTandlaegebladet\u003c/em\u003e 1990, \u003cb\u003e94\u003c/b\u003e(2):34\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin CS, Wu SY, Yi CA: \u003cb\u003eAssociation between Anxiety and Pain in Dental Treatment\u003c/b\u003e: \u003cb\u003eA Systematic Review and Meta\u003c/b\u003e-\u003cb\u003eanalysis\u003c/b\u003e. \u003cem\u003eJournal of dental research\u003c/em\u003e 2017, \u003cb\u003e96\u003c/b\u003e(2):153\u0026ndash;162.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanz NK, Becker MH: \u003cb\u003eThe Health Belief Model: a decade later\u003c/b\u003e. \u003cem\u003eHealth Educ Q\u003c/em\u003e 1984, \u003cb\u003e11\u003c/b\u003e(1):1\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng FC, Yu-Fong Chang J, Lin TC, Chang WC, Chang YT, Chiang CP: \u003cb\u003eDentist manpower development and geographical distribution of dentists in Taiwan\u003c/b\u003e. \u003cem\u003eJ Dent Sci\u003c/em\u003e 2020, \u003cb\u003e15\u003c/b\u003e(2):121\u0026ndash;131.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng TM: \u003cb\u003eTaiwan's new national health insurance program: genesis and experience so far\u003c/b\u003e. \u003cem\u003eHealth Aff (Millwood)\u003c/em\u003e 2003, \u003cb\u003e22\u003c/b\u003e(3):61\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRandall CL, McNeil DW, Shaffer JR, Crout RJ, Weyant RJ, Marazita ML: \u003cb\u003eFear of Pain Mediates the Association between MC1R Genotype and Dental Fear\u003c/b\u003e. \u003cem\u003eJournal of dental research\u003c/em\u003e 2016, \u003cb\u003e95\u003c/b\u003e(10):1132\u0026ndash;1137.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeung A, Goto TK, Leung WK: \u003cb\u003eBrain responses to stimuli mimicking dental treatment among non\u003c/b\u003e-\u003cb\u003ephobic individuals\u003c/b\u003e: \u003cb\u003eA meta\u003c/b\u003e-\u003cb\u003eanalysis\u003c/b\u003e. \u003cem\u003eOral Dis\u003c/em\u003e 2019, \u003cb\u003e25\u003c/b\u003e(1):34\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 \u003cem\u003eResults of the analysis of descriptive statistics across subjects\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003eIDAF-4C+\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003eHT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003eExpFear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003eExpIA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003eNExpFear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003eNExpIA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e402\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e402\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e402\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e402\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e401\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e401\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e384\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e384\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e202\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emax\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e9.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eQ3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e83%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e6.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emedian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e67%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e3.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e4.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eQ1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e58%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emean\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e67%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e3.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e4.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eS.D.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e20%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCommunity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003eIDAF-4C+\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003eHT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003eExpFear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003eExpIA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003eNExpFear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003eNExpIA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e188\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd 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width=\"46\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e8.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eQ3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e83%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e4.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd 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width=\"73\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e196\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e196\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emax\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e9.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e9.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eQ3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e83%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e6.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emedian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e67%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e3.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e4.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eQ1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e58%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e2.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003emean\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e68%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e3.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e4.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eS.D.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003e18%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eComparison\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"38\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"46\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003en.s.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eDue to the non-normality of the distribution of all the variables, comparison between two subgroups was performed using Mann-Whitney U test.\u003c/p\u003e\n\u003cp\u003eExpFear: fear of experienced conditions, ExpIA: intention of avoidance of experienced conditions, HT: history of treatment, IDAF-4C+: the Index of Dental Anxiety and Fear, NExpFear: fear of non-experienced conditions, NExpIA: intention of avoidance of non-experienced conditions, n.s.: statistically not significant, Q1: the first quartile, Q3: the third quartile, S.D.: standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003cem\u003eResults of the analysis of descriptive statistics of each procedure\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"169\"\u003e\n\u003cp\u003eConditions of dental treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"84\"\u003e\n\u003cp\u003ePrevalence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eFear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"124\"\u003e\n\u003cp\u003eIA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"104\"\u003e\n\u003cp\u003eMagnification factor\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eExp\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003eNExp\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003eExp\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003eNExp\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003eFear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eIA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eReceiving a local anesthetic injection in the mouth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e94%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e5.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e30%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e84%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eHaving a painful tooth tapped by the dentist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e85%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e3.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e4.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e23%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eHaving a primary tooth (milk teeth) extracted in the childhood\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e48%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e4.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e3.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eReceiving ultrasonic scaling for removing dental stone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e92%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e21%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eA molar being drilled to remove caries\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e85%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eReceiving a root canal treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e68%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e6.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e33%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e56%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eHaving a wisdom tooth extracted by surgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e38%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e5.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e37%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eFeeling painful hypersensitivity when rinsing cold water\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e77%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e-5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eA caries tooth being explored with a dental instrument\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e91%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e3.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eHaving the swelling gum incised and pus drained\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e33%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e18%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eFeeling excruciating postoperative pain; not being relieved even with painkillers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e34%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e4.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e-14%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eReceiving a wedge and band in between the teeth during restoration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e54%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e35%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e27%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eExp: experienced conditions; IA: intention of avoidance, NExp: non-experienced conditions.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"fear, avoidance, dental anxiety, pain","lastPublishedDoi":"10.21203/rs.3.rs-119910/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-119910/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground. \u003c/strong\u003eDental fear is associated with the experience of prior dental treatment and avoidance of dental visits. It remains unclear if individuals show an intention of avoidance (IA) towards treatments that they have not received (i.e., non-experienced dental treatment). \u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods. \u003c/strong\u003eWe investigated fear/IA of 12 common conditions of dental treatment of 402 adults. If subjects have experienced the condition, fear and IA were assessed based on subjects’ prior experience (i.e., ExpFear/ExpIA). If they have not experienced the condition, fear and IA were assessed based on their anticipation (i.e., NExpFear/NExpIA). Trait dental anxiety was assessed using the Index of Dental Anxiety and Fear (IDAF-4C+). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults. \u003c/strong\u003eWe found that (A) NExpFear and NExpIA were significantly higher than ExpFear and ExpIA, respectively. (B) The IDAF-4C+ scores are positively correlated with NExpFear/NExpIA and negatively correlated with the magnification of fear (i.e., the discrepancy in the fear/IA of non-experienced vs. experienced conditions). (C) The condition ‘extraction of a wisdom tooth’ and ‘root canal treatment’ showed the highest ratings on NExpFear. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions. \u003c/strong\u003eIndividuals may develop a high degree of fear and IA of the treatment they have not received. Trait dental anxiety plays a key role in the magnification of the fear of non-experienced treatment.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Magnification of Fear and Intention of Avoidance of Non-Experienced Dental Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-12-14 21:26:14","doi":"10.21203/rs.3.rs-119910/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-04-12T05:30:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-03-15T04:31:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8cfebc6e-8bc0-4555-a410-f662ae220369","date":"2021-03-09T12:05:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-12-26T04:11:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-12-16T18:30:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-12-10T21:47:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-12-10T21:43:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2020-12-02T01:42:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7050cef8-53c0-476d-8201-d7dd1ece31df","owner":[],"postedDate":"December 14th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":1475510,"name":"Dentistry"},{"id":1475511,"name":"Psychology"}],"tags":[],"updatedAt":"2021-06-19T01:44:03+00:00","versionOfRecord":[],"versionCreatedAt":"2020-12-14 21:26:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-119910","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-119910","identity":"rs-119910","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}