Present study is the first study conducted among adults in Eastern Province in Sri Lanka on Dental anxiety. The findings revealed a high prevalence of dental anxiety, with most adults (70%) experiencing moderate level of anxiety. Dental anxiety was significantly higher among young adults (below the age of 35 years). This percentage is notably higher compared to previous studies conducted in other provinces of Sri Lanka, where the prevalence was 32% in the Central Province and 39% in the Western Province. These variations in prevalence could be attributed to differences in the age groups of the samples and the socio-demographic characteristics unique to people living in each province. Considering the global studies, a study involving dental patients aged between 18 and 76 years revealed that 37% of these patients experienced dental anxiety and majority of these individuals were not new patients but rather individuals who had previous experiences with dental care [20]. Consistent with the findings of the present study, research conducted in Pakistan revealed a high prevalence of dental anxiety among adults, with a rate of 86% [21]. The study also found that dental anxiety scores were higher among younger age groups within the sample. Similarly, in Saudi Arabia, a study focused on individuals between the ages of 21 and 50 years found that dental anxiety was prevalent in 51.9% of the participants and the study also observed that dental anxiety scores decrease with advancing age [22]. These results were further supported by a cross-sectional study conducted in Bethlehem city, which found similar patterns of high prevalence of dental anxiety among adults [23]. Another study conducted among new patients visiting an Australian regional university student dental clinic has revealed that anxiety levels were significantly lower among older adults compared to young adults and the reason could be due to increase exposures over time allowing patients to be more familiar and comfortable with the dental clinic environment [7]. In contrast to the present findings, a study conducted in New Zealand revealed that only 13.3% of adults experienced dental anxiety. It is important to note that this study carried out in New Zealand was a nationally representative study with a larger sample size, in comparison to the present study, which focused on 400 adults in a specific area in Sri Lanka [24].

The high prevalence of dental anxiety observed in the present study may also be attributed to the sample, as the participants were awaiting dental treatments. This is supported by a study conducted in Israel, which found that the type of dental treatment has the strongest impact on anxiety levels [25].

Aligned with the global research, this study observed a significantly higher prevalence of dental anxiety among females [24, 26, 27], however, another study on patients with severe dental treatment fears reported that such fears were more pronounced in males [28]. The high prevalence of dental anxiety among females in this study group could be attributed to previous experiences, social and cultural influences, and the tendency of females to more openly communicate their fears compared to males [29]. Many studies have observed that dental anxiety is more prevalent among socioeconomically disadvantaged groups and groups with lower income levels [24, 30]. Similarly, the present study found that dental anxiety scores were significantly higher among adults with a monthly family income below LKR 20,000 (approximately 65 USD). This suggests that health service managers and planners should be more focused on individuals from lower-income households.

An interesting finding from the present study was that dental anxiety scores were higher among participants who received dental treatments in the public sector as opposed to the private sector. This difference could potentially be due to the higher workload experienced by healthcare providers in the public sector. With limited time for each patient, the doctor-patient relationship may not be as strong and creating higher levels of anxiety among patients. Another important finding was that dental anxiety was higher when the treatment provider was a female compared to a male. This may be linked to societal attitudes and perceptions, where some individuals perceive male doctors as more competent and stronger.

The present study found that there was a significant negative correlation between the DMFT score, MT, and anxiety score. However, the correlation was weak. DMFT index reflects all decayed, missing due to caries, filled teeth. In the present study weak correlation exists with the missing teeth. This could be due to utilization of dental services more frequently, leading to a reduction in their anxiety levels. Similarly, a study conducted in India has found that dental anxiety was significantly associated with FT [20]. The DMFT index is associated with various factors such as knowledge, attitudes, practices like brushing and dietary habits, utilization of services, and health literacy [31]. This complexity could be one of the reasons for the weak correlation between DMFT scores and anxiety scores.

One significant limitation of this study is its confinement to a single hospital within one specific province in Sri Lanka, which restricts the generalizability of the findings to the entire country. Despite limitations, the findings of this study highlight several important areas. The high prevalence of dental anxiety observed in this study has significant implications for oral health status, dental attendance patterns, and quality of life [32, 33]. Understanding the factors associated associations with dental anxiety would facilitate to reorientation of oral health services and to develop policies to improve accessibility to dental care [34]. The findings of this study are valuable for dental practitioners, to consider effective communication and how to manage patients who experience dental anxiety. Strategies can be developed to address the specific needs of anxious individuals, ensuring their comfort, and promoting positive dental experiences [35]. Health promotional programs should also be implemented, particularly targeting vulnerable groups that are more prone to dental anxiety. By raising awareness about dental anxiety and offering support and resources, these programs can help individuals overcome their fears and improve their oral health outcomes.

Furthermore, the present study has not addressed the anxiety levels of dental care professionals, which can negatively impact their professional performance [36, 37] and, in turn, influence the anxiety levels of their patients. Consequently, future research in this area is recommended to develop the most suitable interventions for reducing dental anxiety among patients ultimately enhancing the quality of life. Further research among a larger representative sample and on various other aspects of this topic is recommended.