Objective: To assess the factorial structure and construct validity for the Chinese version of the Modified Dental Anxiety Scale (MDAS). Materials and methods:A cross-sectional survey was conducted in March 2006 from adults in the Beijing area. The questionnaire consisted of sections to assess for participants' demographic profile and dental attendance patterns, the Chinese MDAS and the anxiety items from the Hospital Anxiety and Depression Scale (HADS). The analysis was conducted in two stages using confirmatory factor analysis and structural equation modelling. Cross validation was tested with a North West of England comparison sample.Results: 783 questionnaires were successfully completed from Beijing, 468 from England. The Chinese MDAS consisted of two factors: anticipatory dental anxiety (ADA) and treatment dental anxiety (TDA). Internal consistency coefficients (tau non-equivalent) were 0.74 and 0.86 respectively. Measurement properties were virtually identical for male and female respondents. Relationships of the Chinese MDAS with gender, age and dental attendance supported predictions. Significant structural parameters between the two sub-scales (negative affectivity and autonomic anxiety) of the HADS anxiety items and the two newly identified factors of the MDAS were confirmed and duplicated in the comparison sample. Conclusion:The Chinese version of the MDAS has good psychometric properties and has the ability to assess, briefly, overall dental anxiety and two correlated but distinct aspects.

The single question has good validity, specificity, and sensitivity and may be used with confidence to assess dental fear in such situations as national health surveys or in routine dental practice where a multi-item dental anxiety questionnaire is not feasible.

The adoption of a community-based approach assisted in promoting dental registration and access to dental services for preschool children residing in areas of high social deprivation.