Integrating multi-survey data into an ontological model of dental-care related fear and anxiety

Dental care-related fear and anxiety (DFA) affects a significant proportion of people worldwide, leading to treatment avoidance, delayed care, and poor oral health outcomes. However, current assessment tools and clinical practices conflate fear and anxiety as interchangeable constructs, despite their distinct psychological and temporal characteristics. We extend the Oral Health and Disease Ontology (OHD) to represent dental-care related fear and anxiety, structured around the behavioral, physiological, and temporal dimensions of DFA. The ontology integrates data from multiple DFA studies such as the ADA Oral Health and Well-Being study, the Center for Oral Health Research in Appalachia (COHRA) studies, and the Black Women’s Health Study. We analyze the questions from multiple DFA surveys by whether their answers are about dental care-related fear or anxiety occurring before a dental encounter, encompassing pre-appointment anxiety and anticipatory concerns, during a dental encounter, including in-office experiences (waiting room, examination, procedures), or after a dental encounter, covering post-treatment recovery and lingering anxieties. This temporal framework allows for a more nuanced understanding of how DFA evolves throughout the patient journey. We rely on temporal relationships such as ‘precedes’, ‘occurs during’, or ‘follows’ to specify the relation of emotional and cognitive responses to the dental visit. Determining whether a survey item corresponds to dental care-related fear or anxiety involves mapping each item and determining whether the dental stimulus is distal or proximal to the dental encounter. The ontology will enable clinicians and researchers to identify specific triggering factors for individual patients and implement personalized interventions, moving to evidence-based, targeted treatment strategies that improve patient outcomes and reduce dental care avoidance.