Decoding how macronutrients influence depressive symptoms: Combined insights from regression, nonlinear modeling, and machine learning: a cross-sectional study using NHANES data.

Dental fear and anxiety are prevalent among adults worldwide [] and are closely associated with oral health problems in epidemiological studies []. In accordance with current treatment guidelines [, ], specialist clinics in several countries provide structured interprofessional treatment for dental anxiety [, ]. Evidence from these services indicates that patients with dental anxiety have poorer oral health-related quality of life (QoL), worse oral health status, and greater treatment needs compared with the general population [–]. Dental anxiety encompasses a spectrum of fear and apprehension related to dental treatment, ranging from mild discomfort to significant distress or dental phobia [, ]. Dental phobia is classified as a specific phobia under Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria (and corresponding International Classification of Diseases, 11th Revision category 6B03), characterised by a persistent, disproportionate fear of dental treatment that may lead to marked distress and avoidance of dental care []. The progression from dental anxiety to dental phobia can be explained by Berggren’s vicious cycle model, which describes how anxiety drives avoidance of dental visits, leading to deteriorating oral health and increasingly complex treatment needs, thereby reinforcing and intensifying the original fear [, ]. Findings of a systematic review indicates that while dental anxiety affects approximately 15.0% of adults globally (95% confidence interval [CI]: 10.2–21.2), severe dental anxiety or dental phobia affects 3.3% (95% CI: 0.9–7.1) of the population []. This prevalence varies by demographic factors, with higher rates reported among women and younger adults []. Dental anxiety demonstrates consistent epidemiological patterns across different healthcare systems and cultural contexts [, ]. Effective management of dental anxiety is essential to address poor oral health and extensive treatment needs. Treatment approaches have traditionally been stratified by severity. Mild to moderate dental anxiety is typically managed using behavioural techniques and communication strategies within general dental practice [, ], whereas severe dental anxiety or dental phobia has conventionally required intervention from interdisciplinary teams comprising psychologists, dentists, and dental support staff []. Reports from such specialised treatment programmes indicate poor oral health at baseline, favourable treatment outcomes regarding dental anxiety reduction, and resumed dental attendance following intervention [, ]. However, many individuals with severe dental anxiety or dental phobia still seek care in general dental practices [, ], potentially owing to limited access to specialist services or personal preferences regarding treatment setting.