Dental Anxiety Assessment Form

Kigo dental - Self Assessment form for Dental Anxiety

The following is a self-assessment to help you identify factors that may put you or your child at risk of developing or having dental anxiety. The assessment is meant to be informative but does not substitute for a comprehensive evaluation by your dentist or healthcare professional to determine your or your child’s actual risk and condition.

Assessment Form

Be sure to answer all the questions honestly to obtain an accurate score. Hereafter "you" can be related to you, your child, or any person in need of taking this test.

1. Do you feel nervous or anxious about going to the dentist?
Yes No

2. Do you feel physically ill or experience symptoms such as sweating or trembling when you think about visiting the dentist?
Yes No

3. Have you had negative experiences at the dentist, such as pain or discomfort during a procedure or feeling like you were not listened to or understood?
Yes No

4. Do you avoid going to the dentist or delay scheduling appointments due to fear?
Yes No

5. Do you have difficulty sleeping the night before a dental appointment?
Yes No

6. Do you have difficulty sitting still or relaxing in the dental chair, or find yourself gripping the armrests or tensing your muscles during procedures?
Yes No

7. Do you feel like you are not in control during dental procedures or worry about feeling trapped or helpless in the chair?
Yes No

8. Do you experience pain or discomfort during dental procedures or fear needles, drills, or other dental instruments?
Yes No

9. Do you feel like your dentist or dental team does not listen to your concerns or address your anxiety, or feel like they are dismissive of your feelings?
Yes No

10. Have you ever been diagnosed with a mental health condition like anxiety, depression, or post-traumatic stress disorder (PTSD)?
Yes No

11. Do you prefer to have music or other distractions during procedures?
Yes No

12. Would you like to have a friend or family member accompany you to appointments for support?
Yes No

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Remember that dental anxiety is very common and manageable. It is important to prioritize your or your child’s oral health even if you experience anxiety about dental procedures. With the proper support and care that kigo dental offers, you can maintain your oral health and overcome your fear about visiting the dentist or getting dental treatment.

Dental Anxiety Assessment Form

Kigo dental - Self Assessment form for Dental Anxiety

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