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Anxiety is a relevant problem in dental practice. The Visual Analogue Scale for Anxiety (VAS‐A), introduced in dentistry in 1988, has not yet been validated in large series. The aim of this study is to check VAS‐A effectiveness in more than 1000 patients submitted to implantology. The VAS‐A and the Dental Anxiety Scale (DAS) were administered preoperatively to 1114 patients (459 males and 655 females, age 54.7 ± 13.1 years). Statistical analysis was conducted with Pearson correlation coefficient, the receiver operating characteristic (ROC) curve, and McNemar tests. A close correlation between DAS and VAS‐A was found (r = 0.57, P < .0001); the VAS‐A thresholds of dental anxiety and phobia were 5.1 and 7.0 cm, respectively. Despite a significant concordance of tests in 800 cases (72%), disagreement was found in the remaining 314 cases (28%), and low DAS was associated with high VAS‐A (230 cases) or vice versa (84 cases). Our study confirms that VAS‐A is a simple, sensitive, fast, and reliable tool in dental anxiety assessment. The rate of disagreement between VAS‐A and DAS is probably due to different test sensitivities to different components of dental anxiety. VAS‐A can be used effectively in the assessment of dental patients, using the values of 5.1 cm and 7.0 cm as cutoff values for anxiety and phobia, respectively.
Distribution and linear regression of preoperative Visual Analogue Scale for Anxiety (VAS‐A) and Dental Anxiety Scale (DAS) scores in 1114 patients submitted to implantology. A significant correlation between the tests is observed, but a large dispersion of data is present with a wide range of VAS‐A values for each DAS score.
Receiver operating characteristic (ROC) curve calculated for Visual Analogue Scale for Anxiety (VAS‐A) using the Dental Anxiety Scale (DAS) as the stated variable, where a DAS > 12 was selected as an indicator of dental anxiety (area under the curve [AUC] = 0.805; P < .001). A VAS‐A cutoff value = 5.1, corresponding to the best product of sensitivity (69.5%) and specificity (72.6%), has been chosen as a threshold for anxiety.
Distribution of preoperative Visual Analogue Scale for Anxiety (VAS‐A) and Dental Anxiety Scale (DAS) scores in 1114 patients submitted to implantology. Using DAS > 12 and VAS‐A > 5.0 as indicators of dental anxiety, the figure can be divided into the following four quadrants: (A) area of test discordance, where a low DAS is associated with a high VAS‐A; (B) area of anxiety, where both tests show a high score; (C) area of no anxiety, where both tests show a low score; and (D) area of inverse test discordance, where high DAS scores are associated with low VAS‐A values.
Receiver operating characteristic (ROC) curve calculated for Visual Analogue Scale for Anxiety (VAS‐A) using the Dental Anxiety Scale (DAS) as the stated variable, where a DAS > 15 was selected as an indicator of dental phobia (area under the curve [AUC] = 0.833; P < .001). A VAS‐A cutoff value = 7.0, corresponding to the best product of sensitivity (60.2%) and specificity (87.2%), has been chosen as a threshold for dental phobia.
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