ADULT PATIENTS' LIVED EXPERIENCE OF DENTAL ANXIETY DURING ROUTINE DENTAL CARE: A QUALITATIVE META-SYNTHESIS

Background: Dental anxiety affects a substantial proportion of adults and is associated with avoidance of care and poorer oral health outcomes. Qualitative research has examined patients' subjective experience of this phenomenon, but individual studies are small and dispersed across differing populations, and, to the author's knowledge, their findings have not previously been synthesised.

Objective: To integrate qualitative evidence on adult patients' lived experience of dental anxiety during routine dental care, using as an interpretive anchor the six themes identified in the author's phenomenologically informed primary study of 12 adult patients in Pakistan.

Method: PubMed/MEDLINE was searched on 1 October 2026 with no lower date limit, supplemented by a Pakistan-focused PubMed search and a targeted search of Pakistani dental journals. Studies were eligible if they reported primary qualitative or mixed-methods data on adult patients' first-person experience of dental anxiety. Included studies were appraised with the CASP Qualitative Studies Checklist and synthesised using thematic synthesis adapted as a best-fit framework synthesis; reporting followed the ENTREQ statement.

Results: Of 315 records screened, 11 studies (eight qualitative and three mixed methods) from seven countries were included, contributing approximately 830 adults whose accounts were analysed qualitatively. All six themes of the primary study were supported by multiple independent studies. The moderating role of the dental practitioner and team was the most consistently reported theme (clear support in 9 of 11 studies), and every study offered at least partial support for powerlessness and the struggle for control. A seventh theme not identified in the primary study emerged: shame, concealment, and the burden of disclosure (5 studies). Prayer was recorded as a coping strategy in one study, but only as a frequency count; no included study examined religious or spiritual coping qualitatively, including the two conducted in Muslim-majority Türkiye and Pakistan. Apart from one mixed-methods study, research on dental anxiety in Pakistan was exclusively quantitative, although its findings were consistent with the synthesised themes.

Conclusion: The lived experience of dental anxiety appears broadly consistent across countries and study designs, converging on a narrative of losing, and attempting to regain, control, in which the conduct of the dental team is the principal reported moderator and in which shame frequently inhibits disclosure. These findings support trauma-informed, patient-centred dental care and identify the meaning of religious coping, and the role of shame, as priorities for future qualitative research, particularly in Pakistan, where qualitative evidence is almost entirely lacking.