[How to evaluate dental fear]

The measurement of complex behavioral phenomena like dental fear requires allegiance to two great domains that often seem to conflict with one another: natural scientific method and the seemingly unpredictable human psyche. The need to preserve strict objectivity in scientific observations and yet flexibility enough to appreciate the contextual facets of psychological and social variables are a difficult combination. There are differing scientific philosophies that are presented here not as incompatible opposites, but as a complementary team of approaches to aid human behavioral problem solving in dental clinical science. The "positivistic falsification" tradition requires "objective" double-blind type experimental hypothesis testing, while the "phenomenologic-hermaneutic" tradition requires the researcher to grasp the context of the phenomena to be studied in order to understand and thereafter test the most relevant variables. Thus, there is a need for both traditions, since the relevant variables should be systematically evaluated (qualitative phase) before they can be adequately tested (quantitative phase). Clinical evaluation of dental fear draws on information gathered about a patient's verbal (cognitive) descriptions, behavioral symptoms and physiologic reactions. Commonly used psychometric testing scales developed to differentiate fears specific to dentistry, as opposed to general anxiety syndromes, are the result of observations made in several qualitative studies that not all dental phobics have general anxiety symptoms. Examples of these and other tests are listed and described, noting that verbal and behavioral testing appear more reliable than physiologic indicators. The patient's subjective sense of improvement is deemed to be an important factor in their confidence and efficacy to deal with the threats that the dental environment can bring them.(ABSTRACT TRUNCATED AT 250 WORDS)