Determinants of dental anxiety in adults attending tertiary care dental centres in Karachi, Pakistan

BACKGROUND: Dental anxiety is a multifactorial condition that negatively affects oral health behaviours, yet evidence on modifiable determinants in developing settings remains limited. This study assessed associations between dental anxiety and sociodemographic, dental attendance, environmental, experiential, and patient-dentist interaction factors among adults in Karachi, Pakistan. METHODOLOGY: A multi-centre cross-sectional study included 400 adults aged ≥ 18 years. Participants completed a structured questionnaire covering sociodemographics, dental attendance, prior dental experiences, environmental triggers, and patient-dentist interactions. Dental anxiety was measured using the Corah Dental Anxiety Scale (DAS). Data were analysed using SPSS v27. Mann-Whitney U and Kruskal-Wallis tests were used for group comparisons, and hierarchical multiple linear regression was performed to identify independent predictors (p < 0.05). RESULTS: Most participants reported low anxiety (81.8%), with a mean DAS score of 8.57 ± 3.39. Higher anxiety was significantly associated with females (U = 15790, p = 0.009) and longer time since last dental visit (H = 11.19, p = 0.011). The regression model was significant (F(28,371) = 10.02, p < 0.001), explaining 43.1% of variance (R² = 0.431; adjusted R² = 0.388). Significant predictors of increased anxiety included clinic environment anxiety (B = 1.48, p < 0.001), exposure to others' expressions of pain (B = 1.54, p < 0.001), drill sound (B = 1.35, p < 0.001), and drill smell (B = 0.73, p = 0.021), while clear explanations (B = - 1.83, p = 0.001) and involvement in decision-making (B = - 1.00, p = 0.031) reduced DAS scores. CONCLUSION: Dental anxiety in this population was more strongly associated with modifiable environmental and communication-related factors than with sociodemographic characteristics. Improvements in patient-centred communication and clinical environments may help reduce anxiety and enhance care experiences; however, causal inferences cannot be drawn from the cross-sectional design.