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Fear of injections and reports of negative dentist behavior and associations with dental anxiety and avoidance of treatment were explored among 951 adults from dental school clinics in Iowa City, Iowa and Taipei, Taiwan. Use and fear of anesthetic injections and negative dentist behavior were assessed by written questionnaire to test associations with demographics, overall dental anxiety (Dental Anxiety Scale or "DAS") and utilization behaviors. Frequency and logistic regression analyses showed that use of dental anesthetics for routine treatment was much greater overall among caucasian Americans than Taiwanese, as was fear of injections. Taiwanese and Americans with high dental anxiety (DAS 12) had similar high fear of injections, but inspite of similar fears about dental drilling, high anxiety Taiwanese reported using much less local anesthesia for routine treatments than did high anxiety Americans. Report of condescending remarks to patients ("put downs") by dentists was mainly an American phenomenon associated with high dental anxiety. Avoidance of appointment making was high for persons afraid of injections and for Americans reporting negative dentist behavior. Avoidance was highest in subjects with high dental anxiety. That predominant characteristics or etiologies of dental anxiety can differ by cultural differences in dental health care systems, dentist beliefs and/or expectations of patients within those systems was discussed in relation to the literature.

A total of 2033 university students (1161 boys, 872 girls, ages ranged from 17 to 32 years) were examined according to an examination form. Pain and functional disorders of the head and neck muscles and TM joints, as well as the dental occlusal conditions were recorded. Questionnaires relating to personal history, oral habits, experience of pain and disorder, and psychoemotional status were also given and replied. It was found that 42.9% of the students had one or more signs of TMD, and girls suffered slightly more often. The prevalence was not as high as in junior college students, and was about the same as in teenagers reported in the previous two years. Occlusal factors like slide in centric, balancing side contact, dental restoration and molar guidance during protrusion were more often found in the TMD group, while missing teeth, incisal overlap, attrition and cross bite were not. About 34% of the students had a previous experience of TM joint pain and/or clicking while only 20% of them had such symptoms during the examination. More than 60% of the students having joint clicking were not aware of this symptom. The oral habit and bruxism were not found to be more often in the TMD group. Emotional factors such as Type A personality, emotion, stress, anger, etc. had a higher score in the TMD group while tension, anxiety, and competition did not. It could be concluded that TMD is a fairly common syndrome in the youth of Taiwan although not serious or treatment demanded. Psychoemotional factors are as important as dental factors in relation to the TMD symptomatology, if not more important.