This research is conducted by Munir Gomaa in his third and fourth years of dental school and is titled "Influence of Irrational Health Beliefs in Adults on Dental-Related Perceptions, Practices, and Diseases in Adult and Pediatric Patients." The research examines how, as an example, irrational fears related to going to a dentist might contribute to that patient's overall oral health.

1. Influence of Irrational Health
Beliefs in Adults on Dental-
Related Perceptions, Practices,
and Diseases in Adult and
Pediatric Patients

2. Original Objectives
 To determine whether or not general health-related
cognitive distortions (i.e irrational health beliefs) have
any consequent effect on patients’ perceptions of
dental treatment, personal oral health practices and
presence of oral health diseases
 Furthermore, this study will investigate whether or not
parents’ cognitive distortions related to both general
health information influence the perceptions of dental
treatment, personal oral health practices and presence
of oral health diseases in their children

3. What contributes to dental fear
and anxiety?
 According to to one study (n=3937), dental fear is
strongly linked with the Cognitive Vulnerability Model.
 This model suggests that one’s perceptions of certain
characteristics of a situation creates a schema of
vulnerability that contributes primarily to the
development of fear and phobias
 Three cognitive vulnerability-related perceptions,
uncontrollability, unpredictability, and
dangerousness, were strongly associated with dental
fear (Armfield, Slade, Spencer, 2008)

4. Relevance to Clinicians
 Dental fear/anxiety triggers “vicious cycle dynamic”, in
which fear of dental treatment, lessened use of dental
services, and consequent oral diseases consistently
reinforce one another (Crego et al, 2014)
 Alleviating/managing dental phobia would likely lead to
a sharp decline in oral disease in the population
 The onset of dental fear and anxiety usually occurs in
childhood (Locker, Liddell, Dempster, Shapiro, 1999;
Berggren, Maynert, 1984).

5. Parental Influence...
 Children’s dental fear and cognitive vulnerability
perceptions were significantly associated with those of
their parents (Crego et al, 2013) .
 More interestingly, mothers’ and fathers’ levels of
cognitive vulnerability significantly predicted their
children’s levels of dental fear
 Other studies show that anxious adults and children
tend to have distorted cognitions, such as
overestimating danger and underestimating their ability
to cope with danger, when faced with ambiguous
situations (Bogels & Zigterman, 2000).

6. What are Health-Related
Cognitive Distortions (Irrational
Health Beliefs)?
 Overgeneralizations or irrationally drawn conclusions
about health-related experiences based on biased or
unfounded evidence
 “This advice was not useful when I had disease X,
therefore it is not useful for any other condition”
 “If everybody eats like this, it can’t be bad for you”
 “if anybody is going to have side effects, it’s going to
be me”
 “Both my parents smoke and they’re fine, so I’ll be
fine”

7. The Irrational Health Belief Scale
(IHBS)
 20-item measure of health-related cognitive distortions
among individuals
 Designed for the purpose of examining whether critical
health behaviors are influenced by a more general
tendency to possess distorted beliefs about scenarios
and information related to health (Christensen, Moran &
Wiebe, 1999).
 Reliability and validity verified

8. Higher IHBS scores:
  Less positive pattern of health practices (as defined
by Personal Lifestyle Questionnaire)
  In diabetic patients, higher hemoglobin HbA1,
indicative of poorer adherence to a professionally
recommended diabetic regimen
  Poorer adherence to cardiac rehabilitation in patients
with cardiovascular disease
  Greater illness frequency
  Anxiety and hypochondria
 Hypochondria  less + health practices -- irony?

9. Higher IHBS scores:
  Higher self-reported anxiety in general
  Lower perception of controllability
 Uncontrollability previously linked with dental fear
 Dental fear?

10. Dental Cognitions Questionnaire
 An assessment of the frequency and believability of
negative cognitions related to dental treatment
 Strongly discriminate between dental phobics and non-
phobics (de Jongh et al, 1995)
 Study shows dental phobics possess many negative
(several being irrational) cognitions and self-statements
about what may happen throughout treatment

11. Unanswered questions..
 This study demonstrates an association between IHB’s
related to dentistry and dental phobia, but does not
examine the broader potential relationship between
general irrational health beliefs and dental phobia.
 Studies have not explored how this relationship may
consequently influence oral health practices and oral
health statuses of patients, including caries incidence,
periodontal status, and oral hygiene status.
 Studies have not explored the implicated connection
between parental cognitive distortions and their
children’s perceptions, health habits, and health status

12. Hypotheses
 1) General irrational health beliefs in adults serve as a
predictor for dental-related fear/anxiety, poorer oral
health practices and poorer oral health status
 2) General irrational health beliefs in adults serve as
a predictor for dental-related fear/anxiety, poorer
oral health practices and poorer oral health status in
their children – main focus

13. Methods/Materials
 2 Groups
 Group A: Adults at SDM main clinic attending their own
appts
 Group B: Adults at ESL clinic attending their child’s appt
 In both groups, IHBS survey and DCQ given to adults
before their appt
 Note: Group’s must be surveyed after their TP appt
All survey participants receive a $10 Wal-Mart gift card upon
completion

14. Methods/Materials cont.
 For group A
 Adult EHR’s assessed for DMFT scores, periodontal diagnoses,
brush/floss habits (from dental health history)
 Perceptions of dental tx obtained from DMQ—second part of
survey
 For group B
 Child’s EHR’s assessed for dmet scores, periodontal diagnoses,
brush/floss habits (from dental health history)
 Perceptions of dental tx obtained from DMQ—second part of
survey
 Perceptions of child’s dental tx obtained from tx notes

15. Challenges
 Time needed with EHR’s –must be in clinic!
 Misreported/incomplete information in EHR’s
 Perio diagnoses in children – almost always plaque-induced
gingivitis – may eliminate this variable altogether
 Due to the difficulty in obtaining a large enough sample size
for Group A, it will be eliminated to focus on obtaining results
for Group B
 Group A (n=5)
 Group B (n=45)
 Remaining surveys – 37
 Will continue surveying at ESL!

16. Revised objectives
 To determine whether or not general health-related
cognitive distortions (i.e irrational health beliefs) have
any consequent effect on patients’ perceptions of
dental treatment, personal oral health practices and
presence of oral health diseases
 Furthermore, this study will investigate whether or not
parents’ cognitive distortions related to both general
and dental health information influence the perceptions
of dental treatment, personal oral health practices and
presence of oral health diseases in their children

17. Questions?

18. References
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doi: 10.1002/jclp.20769
Schwenzer M, Mathiak K. Hypochondriacal attitudes may reflect a general cognitive bias that is not limited to illness-related
thoughts. Psychol Health. 2012;26:965–973.
Saigal, P. (2007). The relationship between irrational health beliefs, health locus of control, health behaviors, and physical
illness. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol. 68(4-B), pp. 2669
Crego A, Carrillo-Diaz M, Armfield JM, Romero M. From public mental health to community oral health: the impact of dental
anxiety and fear on dental status. Front Public Health. 2014;2:16. doi: 10.3389/fpubh.2014.00016.
Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res. 1999;78:790–6.
Armfield J. M., Slade G. D., Spencer A. J. Cognitive vulnerability and dental fear. BMC Oral Health.2008;8(1, article 2) doi:
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Crego A, Carrillo-Díaz M, Armfield JM, Romero M. Applying the cognitive vulnerability model to the analysis of cognitive and
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Bögels S.M., Zigterman D. Dysfunctional cognitions in children with social phobia, separation anxiety disorder, and generalized
anxiety disorder. J. Abnorm. Child Psychol. 2000;28:205–211.
Jongh A., Muris P., Schoenmakers N., Ter Horst G. Negative cognitions of dental phobics: reliability and validity of the Dental
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