Abstract
<title>Abstract</title> <p>Background Dental anxiety is a widespread barrier to oral health care, often resulting in treatment avoidance and poor compliance. Globally, approximately 36% of adults report some degree of dental anxiety. While previous studies have linked dental anxiety to poorer oral health outcomes, evidence from Iraq, particularly Karbala City, remains limited. Objectives This study aimed to assess the dental anxiety prevalence and severity, determine associated sociodemographic factors, and examine its association with oral health status among adult patients attending a private dental clinic in Karbala City. Methods A cross-sectional study was conducted between February 2023 and March 2024 involving 510 adult patients (≥ 17 years) undergoing dental procedures under local anaesthesia. Dental anxiety was assessed using the validated Arabic version of the Modified Dental Anxiety Scale (MDAS). Oral health status was evaluated using the DMFT and OHI-S indices. Sociodemographic data were collected using a structured questionnaire. Binary logistic regression was employed to identify the associated factors of dental anxiety, in addition to the Independent t-test and the Mann-Whitney U test. Results The prevalence of dental anxiety was 86%, with a mean MDAS score of 11.36. Among anxious participants, 47% reported low anxiety, 23% moderate, and 16% high anxiety. The mean DMFT score was 13.9, with no significant difference between anxious and non-anxious groups. However, anxious patients had significantly more filled teeth (mean = 4.0 vs. 2.8, p = 0.004). They demonstrated significantly better oral hygiene status (mean OHI-S = 1.5) than non-anxious patients (p = 0.001). Binary logistic regression revealed significant associations between dental anxiety and younger age (AOR = 2.15, 95% CI: 1.01–4.63, p = 0.049), female gender (AOR = 6.65, 95% CI: 3.29–13.44, p < 0.001), tertiary education (AOR 2.66, 95% CI: 1.18–6.01, p = 0.018), and hypertension (OR = 7.52, 95% CI: 1.67–33.93, p = 0.009). Conclusions Dental anxiety is highly prevalent among adult patients attending one private clinic in Karbala, particularly among women, younger individuals, those with higher education, and hypertensive patients. Although anxiety was not associated with DMFT scores, anxious patients exhibited significantly better oral hygiene. These findings highlight the need to integrate behavioural management strategies into routine dental care and to recognise dental anxiety as a public health priority in private clinics, Karbala city/Iraq.</p>