Clinical Oral Investigations

, Volume 23, Issue 9, pp 3613–3621 | Cite as

Is there a relationship of negative oral health beliefs with dental fear and anxiety regarding diverse dental patient groups? A systematic review and meta-analysis

  • Anna Paola Strieder
  • Thaís Marchini Oliveira
  • Daniela Rios
  • Agnes Fátima Pereira Cruvinel
  • Thiago CruvinelEmail author
Original Article



This systematic review and meta-analysis aimed to critically appraise the evidence on the relationship of oral health beliefs with dental fear and anxiety in distinct patient groups.

Materials and methods

Observational studies were retrieved by Cochrane, Embase Search, Portal BVS, Clinical Trials, Ovid, Open Gray, PubMed, Scopus, and Web of Science, and they were manually checked for the inclusion of additional articles of interest. The assessment of quality of studies was performed by the application of three different versions of the Newcastle-Ottawa Scale, for cohort, case-control, and cross-sectional studies. Only studies with low or unclear/moderate risk of bias contributed to meta-analyses, regarding the analysis of random effects of mean differences of dental beliefs scores between dental fear/anxiety and control groups, and the correlation of dental beliefs with dental fear and anxiety measures.


Of 276 articles initially retrieved, 10 were included in the systematic review, while only 6 studies with unclear/moderate risk of bias were considered in meta-analyses. The mean difference of dental beliefs effects was higher in patients with dental fear and anxiety compared to controls (1.20; 95% CI 0.27–2.14; P = 0.01). Additionally, a moderate positive correlation was observed between dental beliefs and dental fear measures (r = 0.54, 95% CI 0.47–0.60;P< 0.001).


Based on these results, the presence of negative health beliefs is directly related to the increase of dental fear and anxiety; however, these findings are supported in studies with unclear/moderate risk of bias.

Clinical relevance

Dental fear and anxiety is an important obstacle for the access of dental treatment and patient-dentist relationship, leading to inadequate oral health levels.


Dental fear Dental anxiety Beliefs Health behavior 



The work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES, Brazil.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of DentistryUniversity of São PauloBauruBrazil
  2. 2.Discipline of Public Health, School of MedicineFederal University of Fronteira SulChapecóBrazil

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