The dental anxiety scale (DAS) - psychometric properties and longitudinal findings among middle-aged adults

The Dental Anxiety Scale (DAS) is a well-established instrument for assessing dental anxiety. While numerous cross-sectional studies have examined the DAS, longitudinal research investigating age-related changes, reliability, validity over time, associations with mental and physical health, and demographic determinants remains limited. Furthermore, the possibility of longitudinal changes in its factor structure has received limited attention.

In 2013/2014, N = 329 German adults (53.6% female, mean age 40.20 years) and in 2019/2020, N = 323 adults (55.7% female, mean age 47.15 years) completed questionnaires, including the DAS, Oslo Social Support Scale (OSSS-3), Health-Score (G-Score), Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Screener (GAD-2), Short Scale for General Life Satisfaction (L-1), and oral health behavior items. DAS reliability was assessed using Cronbach's alpha and McDonald's omega, and factor structure via principal component analyses (PCA). Longitudinal dynamics were analyzed using McNemar's test. Associations between dental anxiety and independent variables were investigated using correlational analyses and Wilcoxon signed-rank tests.

DAS significantly declined from 2013/2014 (M = 9.47) to 2019/2020 (M = 9.21). Internal consistency was excellent (α/Ω = 0.93), and a correlation of dental anxiety across waves was high (rs = 0.79). PCA revealed a stable one-factor structure (2013/2014: 82.25%, 2019/2020: 82.86% explained variance). McNemar test indicated no significant changes in the proportion of subjects with or without dental anxiety over time. Higher dental anxiety was significantly correlated with lower levels of: life satisfaction, perceived influence over health, condition of health, physical and mental health, and social support in both waves (all rs ≥ 0.14; p ≤ 0.015). A significant decrease in dental anxiety over time was observed in participants with frequent tooth brushing, no indication for depression, and at least moderate social support (all z ≤ -2.07, all p ≤ 0.019).

This study provides evidence for DAS's reliability, temporal stability, and construct validity. Although dental anxiety showed a statistically significant decline it remains relatively stable for most participants. Findings indicate meaningful associations with psychosocial, behavioral, and health-related factors, supporting the potential value of interdisciplinary approaches that include psychological support in oral health care.