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Dental Anxiety Quiz

Please answer the following questions by selecting the appropriate response.
Dental Anxiety Scale
If you had to go to the dentist tomorrow, how would you feel about it?
- Relaxed
- A little uneasy
- Tense / Anxious
- So anxious that I sometimes break out in a sweat or almost feel physically sick
- I start thinking of ways to cancel the appointment or not show up
When you are waiting in the dentist’s office for your turn in the chair, how do you feel about it?
- Relaxed
- A little uneasy
- Tense / Anxious
- So anxious that I sometimes break out in a sweat or almost feel physically sick
When you are in the chair waiting while the dentist prepares to give you an injection, how do you feel?
- Relaxed
- A little uneasy
- Tense / Anxious
- So anxious that I sometimes break out in a sweat or almost feel physically sick
When you are in the chair waiting while the dentist gets the drill, how do you feel?
- Relaxed
- A little uneasy
- Tense / Anxious
- So anxious that I sometimes break out in a sweat or almost feel physically sick
When you are waiting in the chair while the hygienist is getting out the instruments to scrape your teeth around the gums, how do you feel?
- Relaxed
- A little uneasy
- Tense / Anxious
- So anxious that I sometimes break out in a sweat or almost feel physically sick
Common Dental Beliefs Among Dental Phobics
I feel that dentists do not like it when I make a request.
- Agree
- Partially agree
- Disagree
Dentists are efficient, but it often seems they’re in a hurry.
- Agree
- Partially agree
- Disagree
I feel like dentists do not provide clear explanations.
- Agree
- Partially agree
- Disagree
I feel that dentists do not really listen to what I say.
- Agree
- Partially agree
- Disagree
I feel that the dentist will do what he/she wants to do no matter what I say.
- Agree
- Partially agree
- Disagree
Dental professionals say things to make me feel guilty about the way I care for my teeth.
- Agree
- Partially agree
- Disagree
I am not sure I can believe what the dentist says about the work that is needed.
- Agree
- Partially agree
- Disagree
I think that dentists say things in a way to try and fool me.
- Agree
- Partially agree
- Disagree
I feel that dentists do not take my worries (fears) seriously.
- Agree
- Partially agree
- Disagree
I feel that dentists put me down (make light of my fears).
- Agree
- Partially agree
- Disagree
I worry if dentists are technically competent to do a good quality job.
- Agree
- Partially agree
- Disagree
If I were to indicate that a treatment hurts, I don’t think the dentist would stop and try to correct the problem.
- Agree
- Partially agree
- Disagree
When I am in the chair, I feel like I can’t stop the treatment for a rest, if I feel the need.
- Agree
- Partially agree
- Disagree
Contact Information
Name*
First Last
Email*
Phone
I would like the Blende Dental Group to contact me to discuss my test results
- Yes
- No
How would you like us to contact you?
- Email
- Phone
Best time to contact you?
- Day
- Night
- Either one

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