Overlap between dental anxiety, gagging and Blood-Injection-Injury related fears — A spectrum of one multidimensional phenomenon

Galit Almoznino*, Avraham Zini, Yair Sharav, Robert Yanko, Alex Lvovsky, Doron J. Aframian

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background and objectives Dental anxiety (DA) and gagging (GAG) are prevalent problems that severely impact social behavior and quality of life. Furthermore, because dental phobia is considered a Blood-Injection-Injury (B-I-I) phobia, the present study contrasted DA, GAG and control subjects regarding the severity of dental anxiety and investigated the comorbidity of GAG, DA and B-I-I fears. Methods Demographics, Verbal Pain Scale (VPS), Oral Health Impact Profile-14 (OHIP-14), Decay, Missing and Filled Teeth (DMFT), Dental Anxiety Scale (DAS) and response to phobic stimuli were collected from 53 GAG, 68 DA and 80 control subjects. Results GAGs exhibited results between DA and controls regarding the likelihood to have high-anxiety/phobia (DA group: OR = 55.56; GAG group: OR = 17.24), self-assessed dental anxiety (OR = 29.14; OR = 17.48), fear of dental injections (OR = 8.51; OR = 2.91) and dental drills (OR = 12.02; OR = 5.82). DA and GAG had similar results regarding: DAS score (p = 0.13), fear of blood tests (OR = 4.68; OR = 4.09) and blood donations (OR = 3.13; OR = 3.10). Overlap between GAG, DA and a B-I-I fear was observed. GAG and DA patients and worse maximal VPS and OHIP-14 scores retained their significant positive association with the DAS score in the multivariate analysis. Conclusions The co-occurrence of DA, GAG and B-I-I-related fears suggests these entities are linked. However, different anxiety levels, symptoms and triggers, reflect the broad spectrum of fear of medical/dental situations.

Original languageAmerican English
Pages (from-to)231-238
Number of pages8
JournalPhysiology and Behavior
StatePublished - 15 Oct 2016

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Inc.


  • Blood-Injection-Injury phobia
  • Dental Anxiety Scale
  • Dental fear
  • Dental phobia
  • Diagnostic and Statistical Manual of Mental Disorders
  • Exacerbated gag reflex


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