Dental Anxiety, Oral Health Behavior Neglect, and Unmet Restorative Treatment Need: A Cross-Sectional Mediation Analysis

Dental Anxiety, Oral Health Behavior, Oral Health Hygiene, Unmet Restorative Treatment, Dental Health Outcome iotic prophylaxis; preoperative dental assessment; prosthetic valve endocarditis.

1
Ahmed Al Kuwaiti, PhD,
Department of Dental Education,
College of Dentistry & Deanship
of
Quality
and
Academic
Accreditation,
Imam
Abdulrahman
Bin
Faisal
University, Dammam, Saudi
Arabia, [email protected]
Mick
Nagra,
Governors
Academy, Massachusetts, cofounder North American Youth
Research
Society,
[email protected]
2

Felicia
Gabriela
Beresescu,
University
of
Medicine,
Pharmacy,
Science
and
Technology of Targu Mureș,
Târgu
Mureș,
Romania,
[email protected]
3

Dylan
Nagra,
Governors
Academy, co-founder, North
American
Youth
Research
Society,
[email protected]
4

Samantha Karolina Maldonado
López, Cooperativa Juventud
Ecuatoriana Progresista, Ecuador,
[email protected]
5

European Journal of Prosthodontics and Restorative Dentistry (2026) 34 (04s), 358-366

Dental Anxiety, Oral Health
Behavior Neglect, and Unmet
Restorative Treatment Need:
A Cross-Sectional Mediation
Analysis

Dental anxiety is an important factor in poor oral hygiene behaviours, delayed dental attendance and higher restorative treatment demands. This study evaluated the association between dental anxiety and oral health behaviour neglect and the unmet need for restorative treatment in community-dwelling adults. A cross-sectional study was carried out in the community with 450 adult samples obtained by purposive sampling. Adults ≥18 years who had at least one natural tooth were eligible. Dental anxiety was measured by the Modified Dental Anxiety Scale (MDAS) and oral health behavior and unmet restorative treatment need by self-reported validated indicators. G*Power analysis was used to determine sample size. IBM SPSS Statistics and bootstrapped structural equation modelling were used to analyze the data, controlling for age, sex, education and income. The study revealed moderate dental anxiety, oral health behavior neglect, and unmet restorative treatment need among the study participants. All variables were found to be significantly positively correlated (r = .48–.57, p < .001). The indirect effect of oral health behavior neglect on unmet dental restorative treatment need was significant (β = .20, p < .001) in a mediation analysis performed. Behavioral neglect and need for restorative treatment were negatively related to higher education and income. The structural model fit very well (CFI = .964, RMSEA = .043). Dental anxiety is a factor in oral health behavior neglect and unmet restorative treatment needs and so anxiety-focused interventions are important to extend the scope of preventive dental care and oral health outcomes.

Samar H. Khater, Oral Surgery and Diagnostic Sciences Department, Faculty of Dentistry, Applied Science Private University, Amman, Jordan, [email protected] 6

Received-17-05-2026 Revised-23-06-2026 Accepted-27-06-2026

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