When the fear of dentist is relevant for more than one’s oral health. A structural equation model of dental fear, self-esteem, oral-health-related well-being, and general well-being

Figures & data

Figure 1 Conceptual model of the relationships between the general perceived well-being as the outcome variable and the oral-specific well-being, dental-specific anxiety, and self-esteem, as the predictor variables (the arrows represent the hypothesized directions of influence and the plus/minus sign designates the positive/negative association).

Notes: In our model, the potentially counterintuitive positive association between dental fear and oral-health-related well-being is due to the fact that oral-health well-being was a reverted measure, estimated by the severity of the health conditions, which transformed it into a measure of discomfort. This aspect is made clearer in the final outputs of the structural equation models.

Table 1 Scales’ items

Scale	Item Code	Item
DFS	DFS_01_DTA*	To put off making any appointment?
	DFS_02_DTA	To cancel or not appear for an appointment?
	DFS_03_PA	My muscles become tense
	DFS_04_PA	My breathing rate increases …
	DFS_05_PA	I perspire
	DFS_06_PA*	I feel nauseated and sick to my stomach
	DFS_07_PA	My heart beats faster
	DFS_08_DTA	Making an appointment for dentistry
	DFS_09_DTA	Approaching the dentist’s office
	DFS_10_DTA	Sitting in the waiting room
	DFS_11_DTA	Being seated in the dental chair
	DFS_12_DTA	The smell of the dentist’s office
	DFS_13_DTA	Seeing the dentist walk in
	DFS_14_FR	Seeing the anesthetic needle
	DFS_15_FR	Feeling the needle injected
	DFS_16_FR	Seeing the drill
	DFS_17_FR	Hearing the drill
	DFS_18_FR	Feeling the vibrations of the drill
	DFS_19_FR*	Having your teeth cleaned
	DFS_20_DTA	All things considered, how fearful are you of having dental work done
FLS	FLS_01	I lead a purposeful and meaningful life
	FLS_02	My social relationships are supportive and rewarding
	FLS_03	I am engaged and interested in my daily activities
	FLS_04	I actively contribute to the happiness and well-being of others
	FLS_05	I am competent and capable in the activities that are important to me
	FLS_06	I am a good person and live a good life
	FLS_07	I am optimistic about my future
	FLS_08	People respect me
OHIP	OHIP_01_FL*	Trouble with pronunciation
	OHIP_02_FL*	Worsened sense of taste
	OHIP_03_PhP*	Painful aching in the mouth
	OHIP_04_PhP*	Discomfort while eating
	OHIP_05_PsDc	Feeling self-conscious
	OHIP_06_PsDc	Feeling tense
	OHIP_07_PhDb	Unsatisfactory diet
	OHIP_08_PhDb	Interrupted meals
	OHIP_09_PsDb	Difficult to relax
	OHIP_10_PsDb	Being embarrassed
	OHIP_11_SDb	Being irritable
	OHIP_12_SDb	Difficult to do usual jobs
	OHIP_13_HC	Life less satisfying
	OHIP_14_HC	Inability to function at ail
SES	SES_01_D	I feel that I am a person of worth, at least on an equal basis with others.
	SES_02_D	I feel that I have a number of good qualities.
	SES_03_R	I really feel that I am a failure.
	SES_04_D	I am able to do things as well as most other people.
	SES_05_R	I do not have much to be proud of.
	SES_06_D	I take a positive attitude toward myself
	SES_07_D	On the whole, I am satisfied with myself.
	SES_08_R*	I wish I could have more respect for myself.
	SES_09_R	I certainly feel useless at times.
	SES_10_R	At times I think I am no good at all.

Note: The asterisk (“*”) indicates items discarded following the EFA.

Abbreviations: SES, self-esteem; DFS, Dental Fear Survey; OHIP, Oral Health Impact Profile; FLS, Flourishing Scale; EFA, exploratory factor analysis.

Table 2 Item loadings

Item	DFS	OHIP	SES	FLS
DFS_02_DTA	0.59
DFS_03_PA	0.62
DFS_04_PA	0.66
DFS_05_PA	0.62
DFS_07_PA	0.75
DFS_08_DTA	0.89
DFS_09_DTA	0.86
DFS_10_DTA	0.83
DFS_11_DTA	0.91
DFS_12_DTA	0.66
DFS_13_DTA	0.75
DFS_14_FR	0.73
DFS_15_FR	0.74
DFS_16_FR	0.85
DFS_17_FR	0.85
DFS_18_FR	0.79
DFS_20_DTA	0.82
OHIP_05_PsDc		0.68
OHIP_06_PsDc		0.73
OHIP_07_PhDb		0.70
OHIP_08_PhDb		0.69
OHIP_09_PsDb		0.76
OHIP_10_PsDb		0.76
OHIP_11_SDb		0.75
OHIP_12_SDb		0.76
OHIP_13_HC		0.78
OHIP_14_HC		0.70
FLS_01			0.63
FLS_02			0.69
FLS_03			0.56
FLS_04			0.69
FLS_05			0.79
FLS_06			0.86
FLS_07			0.76
FLS_08			0.72
SES_01_D				0.63
SES_02_D				0.79
SES_03_R				0.65
SES_04_D				0.53
SES_05_R				0.66
SES_06_D				0.74
SES_07_D				0.68
SES_09_R				0.61
SES_10_R				0.55

Abbreviations: SES, self-esteem; DFS, Dental Fear Survey; OHIP, Oral Health Impact Profile; FLS, Flourishing Scale.

Figure 2 Final pathway model of the relationships between the general perceived well-being as the outcome variable and the oral-specific well-being, dental-specific anxiety, and self-esteem, as the predictor variables (the dotted pathways marked “n.s.” indicate nonsignificant relationships).

Note: The positive association between dental fear and oral-health-related well-being, and the negative association between oral-health-related well-being and self-esteem is due the fact that the oral-health-related well-being was measured via the severity of the oral health conditions, which made it a measure of discomfort.
Abbreviations: SES, self-esteem; DFS, Dental Fear Survey; OHIP, Oral Health Impact Profile; FLS, Flourishing Scale.

Table 3 Construct validity and reliability

Construct	CR	AVE	MSV	MaxR(H)	SES	DFS	OHIP	FLS
SES	0.886	0.467	0.444	0.905	0.683
DFS	0.958	0.579	0.137	0.967	−0.364	0.761
OHIP	0.914	0.518	0.137	0.919	−0.240	0.370	0.720
FLS	0.918	0.586	0.444	0.925	0.666	−0.281	−0.101	0.765

Abbreviations: SES, self-esteem; DFS, Dental Fear Survey; OHIP, Oral Health Impact Profile; FLS, Flourishing Scale.

Table 4 Fit indices for the pathway model

Model	CMIN	DF	SRMR	CFI	RMSEA	L090	HI90	PCLOSE
Default	1529.393	875	0.054	0.928	0.052	0.047	0.056	0.257

Note: CMIN = Chi-square value, DF = degrees of freedom, SRMR = standardized root mean residual, CFI = Comparative Fit Index, RMSEA = root mean square error of approximation, LO90 = lower bound of the Confidence Interval for RMSEA, HI90 = higher bound of the Confidence Interval for RMSEA, PCLOSE = p of close fit.