Recent research indicates that dental fear may be a universal barrier to oral health and that culture determines the mode of expression of dental fear. This fear of dental treatment appears to be a major problem in studies of the Japanese with Japanese samples reporting four times as much pain at their last appointment as the American sample. It appears that a “cycle of fear” may exist for developing nations and for our own emergency-based dental care delivery systems. Pathology unchecked by preventive services leads to painful dental treatment; this results in fear and subsequent avoidance. Knowledge of etiologic factors is incomplete; however a study of conditioning, expectation and latent inhibition appears promising. Particular attention to developmental factors is needed. A primary prevention program with children that includes creation of a safe environment, careful positive exposure and choice of non-invasive procedures is recommended. Secondary and tertiary preventive procedures for fearful children are also discussed.
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Philip M. Weinstein (1990) studied this question.