Relationships among psychological functioning, dental anxiety, pain perception, and coping in ...

107 Pages·2017·0.3 MB·English

by  Meghan L. Marsac

The University of Toledo
The University of Toledo Digital Repository
Theses and Dissertations
2008
Relationships among psychological functioning,
dental anxiety, pain perception, and coping in
children and adolescents
Meghan L. Marsac
The University of Toledo
Follow this and additional works at:http://utdr.utoledo.edu/theses-dissertations
Recommended Citation
Marsac, Meghan L., "Relationships among psychological functioning, dental anxiety, pain perception, and coping in children and
adolescents" (2008).Theses and Dissertations. 1212.
http://utdr.utoledo.edu/theses-dissertations/1212
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A Dissertation
Entitled
Relationships among Psychological Functioning, Dental Anxiety, Pain Perception,
and Coping in Children and Adolescents
By
Meghan L. Marsac
Submitted as partial fulfillment of the requirements for
The Doctor of Philosophy degree in
Psychology

Jeanne B. Funk, Ph.D. Wesley Bullock, Ph.D.
Advisor Committee Member

Michele Knox, Ph.D. Kamala London, Ph.D.
Committee Member Committee Member

Mojisola F. Tiamiyu, Ph.D.
Committee Member

The University of Toledo
August 2008
Copyright © 2008
This document is copyrighted material. Under copyright law, no parts of this document
may be reproduced without the expressed permission of the author.
An Abstract of

Relationships among Psychological Functioning, Dental Anxiety, Pain Perception,
and Coping in Children and Adolescents

by
Meghan L. Marsac
Submitted as partial fulfillment of the requirements for
The Doctor of Philosophy degree in Psychology

The University of Toledo
August 2008

Children and adolescents often face a variety of stressful dental procedures and
experience dental anxiety when attending appointments. Previous research has identified
a positive relationship between avoidant coping and dental anxiety and a negative
relationship between approach coping and dental anxiety. In addition, dental anxiety has
been found to be negatively related to global psychological functioning. Further,
research findings that dental anxiety and perception of pain are positively related
indicates the importance of addressing a child’s dental anxiety. Both approach and
avoidant coping have been found useful in reducing pain perception in children in dental
situations. However, the overall relationship among dental anxiety, psychological
functioning, coping, and pain perception remains unclear. Additionally, findings about
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the relationship between a child and parent’s dental anxiety and coping styles are mixed.
Thus, the present study sought to help clarify these relationships.
Participants included a total of 129 dental patients and 84 parents. Specifically,
the sample included 69 (31 female) children (ages 9-11) and 60 (29 female) adolescents
(ages 12-15). Youth completed the Dental Subscale of the Children’s Fear Survey
Schedule (DS-CFSS; Cuthbert & Melamed, 1982), the Measure of Dental Coping Styles
(MDCS), and a 5-point Visual Analogue Scale for pain. Parents completed a
demographics questionnaire, Corah’s Dental Anxiety Scale (DAS; Corah, 1968), the
Strengths and Difficulties Questionnaire (SDQ; Goodman, 2001), and the COPE (Carver,
Scheier, & Weintraub, 1989).
The results revealed no significant differences for gender or age for any of the
dependent variables. Correlational analyses indicated positive relationships between
dental anxiety and total psychological symptoms as well as between dental anxiety and
pain perception for child and adolescent dental patients. Both child and parent coping
measures were examined using principal axis factor analysis and clear 2-factor structures
(i.e., approach and avoidant coping factors) emerged. For the COPE, both the approach
(α = .97) and avoidant (α = .85) factors were conceptually sound and had high internal
consistencies. On the MCDS both factors were also conceptually strong and had
acceptable internal consistencies (approach α = .65; avoidant α = .63). Youth’s approach
coping was negatively related to both dental anxiety and pain perception; youth’s use of
avoidant coping was also negatively related to dental anxiety. A small, negative
relationship emerged between parent avoidant coping and child approach coping. There
was no significant relationship between parent and child dental anxiety. Psychological
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functioning served as a mediator in the predication of pain perception from dental
anxiety.
Overall, findings suggest that both coping and psychological functioning are
important variables in relation to dental anxiety and pain. Further, dental anxiety might
be an indicator of additional psychological symptoms that dental professionals and
clinicians should consider in treatment planning. Future research should assess the
accuracy and generalizability of the results. Additionally, research should examine the
effectiveness of programs targeted to teach positive coping styles (i.e., particularly aimed
at increasing approach coping) and decrease general psychological symptoms with the
purpose of reducing dental anxiety and pain perception.

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ACKNOWLEDGEMENTS

The author would like to thank the Committee Chair, Dr. Jeanne Funk, for her
encouragement and dedication throughout the project. Additionally, the author would
like to thank Committee members including Dr. Mojisola Tiamiyu, Dr. Michele Knox,
Dr. Kamala London, and Dr. Wesley Bullock for their continued support. Finally, the
author would like to thank the participating dental offices in Northwestern and
Northeastern, Ohio, without whom this project would not have been possible.

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Table of Contents
Copyright ii
Abstract iii
Acknowledgements vi
Table of Contents vii
Lists of Figures x
Lists of Tables xi
I. Introduction 1
II. Literature Review 4
A. Theories of Dental Anxiety 4
B. Dental Anxiety and Child Behavior 10
C. Factors Influencing Children’s Dental Fears 15
D. Pain Perception and Dental Pain 17
E. Coping Styles and Dental Procedures 20
F. Summary of Research Regarding the Relationships Among
Psychological Functioning, Dental Anxiety, Type of Coping
and Pain Perception in Children in Dental Settings 31
G. Research Questions and Hypotheses 33
III. Methods 37
A. Participants 37
a. Demographic Information 37
B. Procedure 38
C. Measures 40
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a. Youth Dental Anxiety 40
b. Youth Coping 40
c. Youth Pain Perception 42
d. Youth Psychological Functioning 42
e. Parent Dental Anxiety 43
f. Parent Coping 43
IV. Results 46
A. Preliminary Analyses 46
B. Scale Structure and Descriptive Analyses 46
C. Hypothesis Testing 52
a. Demographic Variables 52
b. Parent and Child Dental Anxiety 52
c. Parent and Child Coping with Dental Stressors 52
d. Youth Dental Anxiety and Psychological Functioning 53
e. Youth Dental Anxiety and Pain Perception 53
f. Youth Coping, Psychological Functioning, Dental Anxiety 53
g. Youth Coping and Pain Perception 54
h. Mediators and Moderators in Predicting Pain 54
V. Discussion 58
A. Dental Anxiety, Psychological Functioning, and
Pain Perception 58
B. Dental Anxiety, Coping, and Pain 60
C. Mediating Variables in the Prediction of Pain Perception 63
viii
D. Additional Factors Affecting Youth Dental Anxiety and
Pain Perception 64
E. Psychometric Properties of the Measure of Dental Coping
the (MDCS) and the COPE 67
F. Cultural Similarities/Differences in Dental Anxiety 69
G. Limitations 71
H. Clinical/Community Implications 72
I. Future Research 74
J. Summary and Conclusions 76
References 77
Appendices 87

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