Community Dent Oral Epidemiol 2005; 33: 289–97 Copyright
Blackwell Munksgaard 2005

All rights reserved

Trilby Coolidge1, Masahiro Heima1,2,

Psychometric properties of the Susan E. Coldwell1, Philip Weinstein1
and Peter Milgrom1

Revised Dental Beliefs Survey

1
Dental Public Health Sciences, University of
Washington, Seattle, WA, USA, 2Okayama
University Graduate School of Medicine and
Dentistry, Okayama, Japan
Coolidge T, Heima M, Coldwell SE, Weinstein P, Milgrom P. Psychometric
properties of the Revised Dental Beliefs Survey. Community Dent Oral
Epidemiol 2005; 33: 289–97.
Blackwell Munksgaard, 2005

Abstract – Objectives: The objectives of this pair of studies were to examine the
internal reliability, test–retest reliability, and construct validity of the Revised
Dental Beliefs Survey. Methods: A total of 108 college students completed two
questionnaires containing the Revised Dental Beliefs Survey, as well as the
Key words: dental anxiety; Dental Beliefs
Revised Iowa Dental Control Index, and Desirability of Control scales. As part Survey; dental fear; dentist–patient
of another experiment, 141 study participants with dental injection phobia relationship; psychometrics
completed the Revised Dental Beliefs Survey and the Dental Anxiety Scale.
Trilby Coolidge, PhD, Dental Public Health
Results: Both the internal and test–retest reliabilities of the Revised Dental Sciences, Box 357475, University of
Beliefs Survey were high. The measure demonstrated good convergent and Washington, Seattle, WA 98195-7475, USA
discriminant validities. Conclusion: The Revised Dental Beliefs Survey is well- e-mail: [email protected]
suited for use with clinical and nonclinical populations, in which a stable and Submitted 5 January 2004;
valid measure of perceptions of the dental situation is desired. accepted 6 August 2004

Dental fears are common, affecting as many as 50% personality, history of receiving negative informa-
of adults (1). Approximately 5–15% of adults have tion about dentistry from others, and prior history
extreme or phobic levels of dental fear (2, 3). Dental of trauma in general. The third cluster, ‘existential
fear is complex, related in most cases to prior painful threat’, included fears of violation and loss of
dental treatment and/or exposure to fearful models. autonomy/independence.
Other etiologic factors include perceptions of insen- Researchers who have not assessed dental fear
sitive treatment or negative personality (4). per se have nevertheless identified similar concerns.
Patient perceptions of behaviors and attitudes of For example, in a study of patients’ perceptions of
dentists are associated with dental fear. For example, giving consent for treatment, individuals com-
Corah et al. (5) found that dentists’ communicative plained of feeling rushed by the dentist, stated
styles (‘information–communication’ and ‘under- that the dentist did not explain procedures, or that
standing–acceptance’), as well as perceived techni- the dentist lied about the treatment (8). Lahti et al.
cal competence, were predictive of levels of dental (9, 10) examined patients’ views of ideal dentist
anxiety during treatment. Rouse and Hamilton (6) behaviors and the actual behaviors of the dentist.
found similar factors in a nonclinical sample, and From the patient’s point of view, the most import-
also identified a third factor consisting of interper- ant aspect of the dentist’s behavior was the extent
sonal items (e.g. ‘My dentist takes me seriously’). to which he/she was ‘communicative and inform-
In interviews with phobics, researchers found ative’. Discrepancies between preferred and actual
statements about the ‘unsupportive dentist’ to be behaviors of the dentist were the greatest for these
one of three clusters which characterized dental items.
fear experiences (7). This cluster included percep-
tions that the dentist was unempathic and disres-
pectful, distrust/doubtfulness about the dentist’s
skills, and a perceived lack of support from
Dental Beliefs Survey
other dental personnel. A second cluster, termed The Dental Beliefs Survey (DBS) was developed to
‘vulnerability’, included having an anxiety-prone assess the patient’s views about the dentist and

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Coolidge et al.

dental treatment in three areas (subscales): Profes-

Reliability and validity of the DBS
sionalism, Communication, and Lack of Control
(11, 12). Sample items include: ‘I feel that dentists do The reliability of the DBS has been measured in two
not provide clear explanations’ and ‘I feel that ways. First, the internal consistency of the 15-item
dentists do not take my worries (fears) seriously.’ version has been found to be good, with alpha
Patients answer each item on a five-point scale; coefficients of 0.86–0.93 reported in fearful dental
higher scores are indicative of more negative beliefs patients, patients requesting emergency dental
about dentistry. A 15-item version has been used treatment, and general dental patients (2, 3, 14, 18,
most frequently, although some researchers have 19). Secondly, one researcher examined the stability
used a 14-item version, and one study (13) reported of the DBS over time, finding the test–retest reliab-
a 16-item version. The questionnaire has been ility of the 14-item version to be 0.80 (15).
translated into a number of languages, including In terms of construct validity, researchers have
Swedish, German, Norwegian, and Danish (2, 14– found that DBS scores are related to attitudes and
16); in addition to research with adults in countries behavior consistent with what the scale was to
of these languages, it has also been used with measure. For example, dentally fearful adults have
English-speaking adolescents in Singapore (17). higher scores than dental patients in general (2).
Higher scores on DBS have also been found to be
predictive of dental fear in adolescents (17).
Patients who experience pain at the time of treat-
Psychometric characteristics: ment have higher scores than those who are pain-
reliability and validity free (15); although individuals might seek out
Scales should have adequate reliability and valid- emergency care because of pain, dentally fearful
ity. These terms refer to the stability of the scale, adults have higher scores than patients seeking
and whether the scale measures what it is sup- emergency dental care (19). Dental phobics with an
posed to. Reliability may be measured in two ways: additional psychiatric diagnosis have higher scores
examining the internal consistency of the scale, and compared with those without additional diagnoses
examining the test–retest stability of the scale over (20). Fearful individuals who also meet the Diag-
time. Validity may be measured in several ways, nostic and Statistical Manual (DSM) criteria for
the most important of which are criterion validity Social Phobia score higher than those without this
and construct validity. Criterion validity may be diagnosis (21). Following treatment for dental fear,
established when the scale is found to be highly adults show decreases in their DBS scores (12, 14,
correlated with a criterion of interest (e.g. a labor- 22–26).
atory test result has good criterion validity if it A pair of studies concerning appointment can-
accurately predicts actual disease status). This kind cellations provides additional evidence for con-
of validity is, however, often difficult to establish in struct validity. Higher DBS scores at age 20 years
research involving attitudes and behavior. In this are associated with a history of cancellations and
situation, construct validity, including measures of missed appointments between ages 12 and 20 years
both convergent and discriminant validity, is then (27). DBS scores were a better predictor of cancel-
used. Construct validity assesses the degree to lations and missed appointments than were scores
which a scale measures the underlying construct on the Dental Fear Survey. Similarly, Skaret et al.
one is interested in. This is typically done by (28) found that adolescents with higher DBS scores
finding correlations between the scale and other were more likely to avoid treatment.
similar scales, resulting in convergent validity. To With regard to the subscales, only one study has
assess discriminant validity, one finds very low examined these. Dentally fearful adults who
correlations between the scale and other scales showed decreases on items in the Communication
which are thought not to be related to the under- subscale early in their dental fear treatment were
lying construct. Other ways of measuring construct more likely to be successful (18).
validity include assessing the performance of the
scale in theoretically driven research. For example,
we can administer a scale measuring anger to two
Revised DBS
samples which should score very differently, and
look to see if, in fact, the two groups do score Getz et al. (29) revised and expanded the DBS to a
differently. 28-item version (referred to here as the Revised

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Revised Dental Beliefs Survey

DBS, R-DBS), reflecting increased understanding of study, we used data from a larger experiment of
the concerns of fearful patients. The items are treatment for dental injection phobia. Participants
organized into three subscales: Professionalism completed the R-DBS and a measure of dental fear
(e.g. technical competence, whether the dentist before treatment; we used these data to provide
appears to make treatment decisions based on his/ additional assessments of the construct validity of
her best interests rather than those of the patient), the R-DBS. Both studies were also designed to
Communication (e.g. ease of patient–dentist com- explore any differences in reliability or validity
munication, attitude of the dentist towards the between the full 28-item questionnaire and the
patient), and Lack of Control (e.g. feeling helpless, 25-item best-fitting factor analysis solution.
feeling unable to take a rest during treatment). As
with the original DBS, respondents use a five-point
scale to describe how they feel about dentistry in
general; options range from ‘never’ (1) to ‘nearly
Study I
always’ (5). Higher scores indicate greater negative Participants
beliefs. The R-DBS and item assignments to the One hundred and eight liberal arts students aged
three subscales appear in the Appendix. ‡18 years enrolled in two private colleges in Seattle
To date, only two studies have examined the took part in this study. Thirty-four percent were
psychometric properties of the R-DBS. In an exam- males, and most (75%) were between 18 and
ination of the differences between adults seeking 24 years of age.
emergency versus nonemergency dental care, high-
er scores were found for those seeking emergency Questionnaires
care (30). An internal reliability of 0.95 was reported Three scales were included on the questionnaires:
in a sample of dentally fearful adults (31). A factor the R-DBS, the Revised Iowa Dental Control Index
analysis of the R-DBS in this sample generally (R-IDCI), and the Desirability of Control (DC) scale.
supported the contents of the subscales, and indi- The 28-item R-DBS and the nine-item R-IDCI were
cated that 25 of the 28 items provided the best fit, on included on both questionnaires, while the 20-item
four factors: Ethics (here called Professionalism, to DC scale was only included on the second ques-
be consistent with terminology used in the original tionnaire because of time constraints.
citation), Communication, Control (here called Lack
of Control, again to be consistent with the original R-DBS: internal and test–retest reliabilities
terminology), and a new factor called Trust. The The R-DBS was included on both questionnaires,
Trust factor is primarily composed of a subset of administered 2–3 weeks apart, so that test–retest
items from the Lack of Control subscale; the most reliability could be computed. The internal reliab-
important items are two that refer to the perception ility of the scale could also be measured on either
that the dentist will not be empathic with the administration.
patient’s experience of pain. These four factors of
the 25-item version of the R-DBS appear in the R-IDCI: convergent validity
Appendix. The R-IDCI is a nine-item scale assessing both
These initial results are promising. However, to Desired Control in the dental setting, and Predicted
date no test–retest reliability has been calculated Control in the same setting (32). Scores are inter-
for the R-DBS, nor has it been subjected to more preted by looking at Desired and Predicted Control
rigorous construct validity analysis. As was true simultaneously. Individuals who wish to have
for the original DBS, we hypothesized that the greater control (higher scores on Desired Control),
R-DBS would show good test–retest reliability and but who perceive themselves to have lesser actual
construct validity. We did not know whether the control (lower scores on Predicted Control), have
reliability and validity would differ for the full been found to have higher levels of distress while
28-item version and the 25-item best fit version. To with the dentist (32). This measure was chosen to
test these hypotheses, we conducted two studies assess the convergent validity of the R-DBS, as both
with the R-DBS. Our first study, in which college measures appear to be based on similar constructs.
students completed the R-DBS twice, as well as
other scales, was designed to assess the internal DC: discriminant validity
reliability, test–retest reliability, and aspects of the The DC scale is a 20-item scale measuring one’s
construct validity of the R-DBS. For our second general desire to have control over life events (33).

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Coolidge et al.

Higher scores indicate a preference for greater Data analyses

amounts of control over one’s life. As this measure The questionnaire responses were checked and
appears to be assessing an overall trait-like prefer- then entered into a computer file. If a participant
ence for control, it may not be able to predict which gave two answers to an item, the mean value was
individuals prefer greater levels of control in substituted. No other changes were made to the
specific settings. Therefore, it was included to answers. The data were analyzed by SPSS Version
assess the discriminant validity of the R-DBS. 11.5 for Windows. Summary scores were computed
for all scales and subscales. Cronbach’s alpha
Procedures values were computed for the R-DBS to determine
Institutional Review Boards gave approval for its internal reliabilities, and Pearson’s correlations
the study. Participating faculty members briefly were computed for the R-DBS to assess its test–
described the study to the students in advance. One retest reliabilities. Pearson’s correlations were com-
researcher came to each participating class, and puted to examine convergent and discriminant
described the study further. Students were validities. As a result of the lack of time, several
informed that their participation was voluntary. students in one class did not complete the first
The questionnaires were anonymous; however, in questionnaire. Therefore, we decided to use data
order to pair questionnaires for the test–retest from the second questionnaire where possible. For
correlations, students were asked to make up a each analysis, only participants who had comple-
‘code name’ for themselves, to be used on both ted the relevant scale(s) or subscale(s) were inclu-
questionnaires. As an incentive, participating stu- ded. Two sets of analyses were performed, one
dents were offered the chance to win a gift certifi- with all 28 items included and the other with the
cate for $100 from their campus bookstore by filling 25 items identified as comprising the best-fit model.
out a separate form. The researcher administered
the questionnaires twice, 2–3 weeks apart. Results
About 97% of the students who were present
Hypotheses during the days of the questionnaire administra-
We predicted that the R-DBS would be positively tion participated; 78% participated in both admin-
correlated with the Desired Control subscale of the istrations. The means and standard deviations for
R-IDCI, and negatively correlated with the Predic- all measures are presented in Table 1.
ted Control subscale of the R-IDCI. Of the R-DBS
subscales, we also predicted that the correlation Reliability
between Lack of Control (R-DBS) and Predicted The internal reliabilities of the R-DBS and its
Control (R-IDCI) would be the greatest. We also subscales were high. Cronbach’s alpha values for
predicted that the correlation between DC and the the 28-item version were 0.95 for the total score,
R-DBS scales would be low. 0.86 for Professionalism, 0.91 for Communication,

Table 1. Study I: college student’s scores on measures

Scale Possible scores Range n Mean SD
Revised Dental Belief Survey
28-item version
Total 28–140 28–108 89 51.5 17.6
Professionalism 11–55 11–38 92 20.1 6.3
Communication 9–45 9–36 90 16.7 6.3
Lack of Control 8–40 8–38 92 15.0 6.0
25-item version
Total 25–125 25–97 90 46.6 15.8
Professionalism 10–50 10–35 92 18.5 6.3
Communication 7–35 7–27 90 12.9 4.9
Lack of Control 4–20 4–20 92 8.1 3.4
Trust 6–30 6–23 92 10.4 4.1
Revised-Iowa Dental Control Index
Desired Control 5–25 8–24 88 16.5 3.3
Predicted Control 4–20 6–20 88 12.6 3.4
Desirability of Control 20–140 61–121 76 94.8 12.5

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Revised Dental Beliefs Survey

Table 2. Study I: Pearson’s correlations between Revised Dental Beliefs Survey (28- and 25-item versions) and other
measures in college students
Scale R-IDCI Desired Control R-IDCI Predicted Control Desirability of Control
28-item version
Total 0.35** )0.52*** )0.15
Professionalism 0.31** )0.37*** )0.14
Communication 0.23* )0.53*** )0.13
Lack of Control 0.44*** )0.55*** )0.17
25-item version
Total 0.35** )0.53*** )0.16
Professionalism 0.30** )0.39** )0.11
Communication 0.24* )0.50*** )0.12
Lack of Control 0.39*** )0.57*** )0.19
Trust 0.39*** )0.50*** )0.17
*P < 0.05; **P < 0.01; ***P < 0.001.

and 0.87 for Lack of Control. The results for the a DSM-IV (34) diagnosis of Specific Phobia of dental
25-item version subscale were similar: 0.95 for the injections completed a battery of questionnaires
total score, and 0.85, 0.88, 0.83, and 0.83 for including the 28-item R-DBS and the Dental Anxiety
Professionalism, Communication, Lack of Control, Scale [DAS; (35, 36); for details on the larger study,
and Trust, respectively. including information about procedures, see
Test–retest reliabilities were also high. Pearson’s Ref. 20]. These adults were aged 18 to 66 years
correlations for all items, Professionalism, Com- (mean ¼ 36.3; SD ¼ 12.1), and 64% were female.
munication, and Lack of Control subscales on the
28-item version were 0.88, 0.79, 0.76, and 0.80, Questionnaires
respectively (all P < 0.01). On the 25-item version, R-DBS: internal reliability and validity
the test–retest reliabilities were 0.86, 0.80, 0.76, 0.70, As the participants have fear of an aspect of dental
and 0.77 for all items and Professionalism, Com- treatment, they should score higher on the R-DBS
munication, Lack of Control, and Trust factors, than the college students in study I. Therefore, a
respectively (all P < 0.01). comparison of the mean scores provides a method
of assessing construct validity. In addition, internal
Convergent and discriminant validity reliability can also be measured.
As predicted, the R-DBS and each of its subscales
were positively correlated with the Desired Control DAS: convergent validity
scale on the R-IDCI, and negatively correlated with The DAS consists of four items about the dental
the Predicted Control scale of the R-IDCI. The situation, ranging from thinking about a dental
correlations were very similar for the 28- and appointment ‘tomorrow’ to waiting in the chair for
25-item versions of the R-DBS. In general, the cleaning or drilling. Each item is scored on a five-
values were higher for the Predicted Control scale point scale, and the total is summed. Higher scores
than the Desired Control scale. The largest corre- are indicative of greater levels of dental anxiety. It
lation of each analysis was found for Lack of was used here as a further measure of convergent
Control (R-DBS) and Predicted Control (R-IDCI); validity.
these values were )0.55 for the 28-item version,
and )0.57 for the 25-item version. Moreover, as Hypotheses
predicted, DC did not correlate with the R-DBS We predicted that the R-DBS and DAS would be
scales on either version. The correlation coefficients positively correlated, and that the R-DBS scores
are presented in Table 2. would be higher in this sample than in the college
students.

Data analyses
Study II Statistical analyses were carried out as described
Participants for study I. In addition, independent-sample t-tests
As part of a larger experimental study investigating were computed in order to compare the R-DBS
treatment of dental injection phobia, 141 adults with scores of the injection phobic and student samples.

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Coolidge et al.

Table 3. Study II: dental injection phobics’ scores on Revised Dental Beliefs Survey and Dental Anxiety Scale
Scale Possible scores Range n Mean SD
Revised Dental Belief Survey
28-item version
Total 28–140 28–131 126 78.25 25.61
Professionalism 11–55 11–50 131 28.44 9.46
Communication 9–45 9–44 137 24.98 9.07
Lack of Control 8–40 8–40 135 25.14 8.31
25-item version
Total 25–125 25–116 127 68.96 23.13
Professionalism 10–50 10–45 135 25.16 8.59
Communication 7–35 7–35 137 19.50 7.23
Lack of Control 4–20 4–20 134 12.62 4.45
Trust 6–30 6–30 138 16.84 6.27
Dental Anxiety Scale 4–20 8–20 141 15.90 2.80

We computed all statistics twice, for the 25- and 28- similar to that reported by Kvale et al. (31) for
item versions. dentally fearful patients, and slightly superior to
values reported for the shorter version of the DBS
Results for fearful and nonfearful dental patients (2, 3, 18,
The mean and standard deviation values for the 19). This is true of both the 25- and 28-item
R-DBS and the DAS are presented in Table 3. versions, and is evident in both populations. In
addition to providing support for the revised scale
Reliability and validity in general, this also indicates that the scale’s
Internal reliability of the R-DBS was high. The internal consistency is evident in a nonclinical
reliability of the 28-item version was 0.96. The population. Similarly, the test–retest reliability of
reliabilities for the Professionalism, Communica- both the 25- and the 28-item versions is somewhat
tion, and Lack of Control subscales were 0.89, 0.91, higher than that reported for a shorter version (15),
and 0.90, respectively. For the 25-item version, the which indicates that the underlying constructs are
reliabilities for the total scale, Professionalism, stable.
Communication, Lack of Control, and Trust factors
were 0.96, 0.89, 0.88, 0.85, and 0.89, respectively. Validity
As predicted, individuals with dental phobia The relationships between the R-DBS and the
scored significantly higher on the R-DBS than the R-IDCI provide evidence for convergent validity
college students. This was true for both the 28-item in both the 25- and 28-item versions. Individuals
version (t(213) ¼ 8.54, P < 0.0001) and the 25-item who experience greater perceptions of personal
version (t(215) ¼ 7.96, P < 0.0001). Moreover, as control have fewer negative beliefs. This relation-
predicted, the R-DBS and the DAS were signifi- ship is strongest for the subscale measuring per-
cantly correlated. The correlations between the ceived lack of control, indicating the similarity of
28-item version and the DAS were 0.49 for the full the underlying factor measured by these two
scale, and 0.42, 0.50, and 0.46 for Professionalism, subscales. However, the relationship is also strong
Communication, and Lack of Control, respectively. for the Communication subscale, consistent with
For the 25-item version, the correlations were 0.48 findings that perceived problems in dentist–patient
for the full scale, and 0.41, 0.50, 0.40, and 0.42 for communication are more common in dentally
Professionalism, Communication, Lack of Control, fearful individuals. For the 25-item version, the
and Trust, respectively. All values were significant relationship is also strong for the Trust factor. The
at the P < 0.001 level. most important items on this factor are related to
the perception that the dentist will not take the
pain of the patient seriously; this is also consistent
with Rouse and Hamilton’s (6) description of an
Discussion
interpersonal factor in the prediction of dental fear.
Reliability While less strong, the relationship between Predic-
Our results indicate that the revised DBS is reliable. ted Control (R-IDCI) and Professionalism (R-DBS)
The internal consistency of the overall R-DBS is is significant, indicating that concerns over whether

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Revised Dental Beliefs Survey

the dentist truly has the patient’s best interests in In conclusion, our data provide strong evidence
mind are greater in individuals who perceive that for the reliability and construct validity of the
they have less control in the dental setting, com- Revised Dental Beliefs Survey. Its good perform-
pared with those who perceive that they have ance in a nonclinical sample is also evidence that its
greater control. underlying constructs are stable outside of the
The relationships between Desired Control dental setting, as well as with a sample of individ-
(R-IDCI) and the R-DBS are significant, indicating uals who are not selected for high dental fear. Thus,
that individuals who have more negative beliefs it can be useful in a variety of clinical and
also prefer to have greater levels of control at the nonclinical settings in which measuring percep-
dentist. Among the subscales, the highest correla- tions about dentistry is important.
tion is for Lack of Control in both the 25- and
28-item version subscales, and for both Lack of
Control and Trust in the 25-item version; recalling
that the Trust items in the 25-item version are
Acknowledgements
found in the Lack of Control subscale of the full This research was supported by Grants P60DE13061,
T32DE07132, and RO1DE10735 from NIDCR/NIH.
version of the R-DBS, these correlations provide
additional evidence for the congruence of what the
Desired Control and the Lack of Control/Trust
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Revised Dental Beliefs Survey

Appendix
Revised Dental Beliefs Survey

28-Item version 25-Item version

Item subscale factor
1. I am concerned that dentists recommend work that is not really needed Professionalism Professionalism
2. I believe dentists say/do things to withhold information from me Professionalism Professionalism
3. I worry if the dentist is technically competent and is doing quality work Professionalism N/A
4. I have had dentists say one thing and do another Professionalism Professionalism,
Trust
5. I am concerned that dentists provide all the information I need to make Professionalism Professionalism
good decisions
6. Dentists don’t seem to care that patients sometimes need a rest Professionalism Lack of Control
7. I’ve had dentists seem reluctant to correct work unsatisfactory to me Professionalism Professionalism
8. When a dentist seems in a hurry I worry that I’m not getting good care Professionalism Professionalism
9. I am concerned that the dentist is not looking out for my best interests Professionalism Professionalism
10. Dentists focus too much on getting the job done and not enough on the Professionalism Trust
patient’s comfort
11. I’m concerned that dentists might not be skilled enough to deal with my Professionalism N/A
fears or dental problems
12. I feel dentists do not provide clear explanations Communication Professionalism
13. I am concerned that dentists do not like to take the time to really talk to Communication Professionalism
patients
14. I feel uncomfortable asking questions Communication Communication
15. Dental professionals say things to make me feel guilty about the way I care Communication Communication
for my teeth
16. I am concerned that dentists will not take my worries (fears) about Communication Communication
dentistry seriously
17. I am concerned that dentists will put me down (make light of my fears) Communication Communication
18. I am concerned that dentists do not like it when a patient makes a request Communication Communication
19. I am concerned that dental personnel will embarrass me over the Communication Communication
condition of my teeth
20. I believe that dentists don’t have enough empathy for what it is really like Communication Communication
to be a patient
21. When I am in the chair I don’t feel like I can stop the appointment for a Lack of Control Lack of Control
rest if I feel the need
22. Dentists don’t seem to notice that patients sometimes need a rest Lack of Control Lack of Control
23. Once I am in the chair I feel helpless (that things are out of my control) Lack of Control Lack of Control
24. If I were to indicate that it hurts, I think that the dentist would be reluctant Lack of Control Trust,
to stop and try to correct the problem Professionalism
25. I have had dentists not believe me when I said I felt pain Lack of Control Trust
26. Dentists often seem in a hurry, so I feel rushed Lack of Control Trust
27. I am concerned that the dentist will do what he wants and not really listen Lack of Control Trust
to me while I’m in the chair
28. Being overwhelmed by the amount of work needed (all the bad news) Lack of Control N/A
could be enough to keep me from beginning or completing treatment

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