Validation of Arabic Version of the Modified Dental Anxiety Scale and Assessment of Cut-off Points for High Dental Anxiety in a Saudi Population

Background: Dental anxiety is a common problem faced by the patients and dental health professionals globally. High levels of anxiety in anticipation of encounters in a dental setting have been linked to a myriad of dental problems such as appointment avoidance and increased chair time. To validate the Arabic version of the modified dental anxiety scale (MDAS) and assess cutoff points for a high dental anxiety in a Saudi population. Materials and Methods: We conducted a crosssectional survey at the King Abdulaziz Medical City in Riyadh, Saudi Arabia in December 2012. The survey included randomly chosen Saudi patients aged 18 or above, who attended dental or family medicine clinics during the survey phase. Results: A total of 24 (37.5%) respondents had missed or cancelled dental appointments due to dental anxiety. The internal consistency of MDAS subscales was high with Cronbach's alpha = 0.90. The factor analysis suggested a single dimension solution accounting for 71.7% of the variance.The cutoff point of 13 had the highest combination of the sensitivity, specificity and the largest area under the curve compared to cutoff points of 16 and 19 in our study population. Respondents with a history of missed appointments (due to anxiety) scored significantly higher on the MDAS than those who had no history of missed appointments (14.5 ± 5.6 vs. 10.1 ± 4.0, P = 0.001). Conclusion: The Arabic MDAS showed high reliability and validity, supporting its use in further studies among Arabicspeakers. A cutoff point of 13 can be used to identify patients who are more likely to exhibit nonattendance behavior.