Dear reader, I am a first year dental student of the School of Dentistry, University of Guyana; who is currently doing a research

paper for a dentistry course - Introduction to Research. My research topic is dental phobia; hence I am carrying out a survey in order to acquire relevant information for my paper. There are two parts of the questionnaire one which I created and the other which is a dental anxiety scale created by Norman Corah. Please note you are not required to put your name on the questionnaire, thus I would appreciate it if you answer the following questions honestly. Thank you for your time and participation in assisting me in my research. Yours truly, T.Shalim

1) What is your sex? Male Female

2) Which age group do you belong to? 13-16

17-20

21-25 25-older

3) Which ethnic group do you belong to? Amerindian Europeans African East Indians Portuguese Chinese Mixed 4) How well are you aware of dentistry? Heard about it Never hear about it Dont really care about it 5) Are you afraid of the dentist? Yes No 6) If yes, can you please state why? 7) How often do you brush your teeth in one day? Once a day

Twice a day Three time a day After every meal Dont brush

8) Do you floss after every meal? Yes No 9) How do you rate your level of care for your teeth? Scale: 1-10 with 10 being the level of care approved the best 6. 10) How often do you visit your dentist? Twice a month Once a month Yearly only when you have a tooth ache Never visited one

Other reason . 11) What is the main purpose of your visit to the dentist?

Tooth ache Routine checkup Cleaning Others

12) Are you aware of dental caries? Yes No 13) If yes, can you state what you know about dental caries?

Corahs Dental Anxiety Scale, Revised (DAS-R)* 1. If you had to go to the dentist tomorrow for a check-up, how would you feel about it? a. I would look forward to it as a reasonably enjoyable experience. b. I wouldn't care one way or the other. c. I would be a little uneasy about it. d. I would be afraid that it would be unpleasant and painful. e. I would be very frightened of what the dentist would do. 2. When you are waiting in the dentist's office for your turn in the chair, how do you feel? a. Relaxed. b. A little uneasy. c. Tense. d. Anxious. e. So anxious that I sometimes break out in a sweat or almost feel physically sick. 3. When you are in the dentist's chair waiting while the dentist gets the drill ready to begin working on your teeth, how do you feel? a. Relaxed. b. A little uneasy. c. Tense. d. Anxious. e. So anxious that I sometimes break out in a sweat or almost feel physically sick. 4. Imagine you are in the dentist's chair to have your teeth cleaned. While you are waiting and the dentist or hygienist is getting out the instruments which will be used to scrape your teeth around the gums, how do you feel? a. Relaxed. b. A little uneasy. c. Tense. d. Anxious. e. So anxious that I sometimes break out in a sweat or almost feel physically sick.

*Developed by Norman Corah, dental researcher and educator.