## 4 Discussion  
The current study aimed to evaluate the psychometric characteristics of the LOE-DEQ in an Italian sample of dental patients. The results obtained through the CFA showed an appropriate fit to the data, confirming the original 4-factor structure. Furthermore, our analysis demonstrated that the LOE-DEQ has a good criterion, convergent, and discriminant validity in the Italian sample. To the best of our knowledge, this is the first measure of the impact of distressing dental events available for use in the Italian context, providing Italian researchers and dentists with a valuable instrument to assess this dimension in the Italian population. The participants of the current study showed a rate of dental anxiety significantly higher than that detected in the study validating the MDAS in the Italian context, where 2.4% of dental patients and 13.9% \begin{table}
\begin{tabular}{c c c c c} \hline \hline  & **Univariate Analysis** & \multicolumn{3}{c}{**Multivariate Analysis**} \\ \hline  & **OR (95\% CI)** & \(p\) **Value** & **AOR (95\% CI)** & \(p\) **Value** \\ \hline LOE-DEQ-DBPE & 1.29 (1.1, 1.5) & 0.002 & 1.18 (0.9, 1.4) & 0.085 \\ LOE-DEQ-DDP & 1.53 (1.2, 1.9) & 0.001 & 1.43 (1.1, 1.9) & 0.015 \\ LOE-DEQ-ODDE & 1.17 (0.8, 1.7) & 0.392 & 1.17 (0.7, 1.7) & 0.607 \\ LOE-DEQ-GTE & 0.94 (0.7, 1.2) & 0.658 & 0.77 (0.6, 1.1) & 0.114 \\ \hline \hline \end{tabular}  
* LOE-DEQ-DBPE = Dentists’ behaviour and patients’ emotions; LOE-DEQ-DDP = Distressing dental procedures; LOE-DEQ-ODDE = Other distressing dental events; LOE-DEQ-GTE = General traumatic events; OR = Odds Ratio; CI = Confidence Intervals; AOR = Adjusted Odds Ratio.  
\end{table} 
Table 4: Logistic regression of LOE-DEQ on high dental anxiety. \begin{table}
\begin{tabular}{c c c c c c c c c c c} \hline \hline
**Scales** & **1** & **2** & **3** & **4** & **5** & **6** & **7** & **8** & **9** & **10** \\ \hline
1. LOE-DEQ (tot) & 1.00 & & & & & & & & & & \\
2. LOE-DEQ-DBPE & 0.83 \({}^{***}\) & 1.00 & & & & & & & & & \\
3. LOE-DEQ-DDP & 0.73 \({}^{***}\) & 0.50 \({}^{***}\) & 1.00 & & & & & & & & \\
4. LOE-DEQ-ODDE & 0.49 \({}^{***}\) & 0.22 \({}^{***}\) & 0.12 & 1.00 & & & & & & & \\
5. LOE-DEQ-GTE & 0.57 \({}^{***}\) & 0.18 \({}^{**}\) & 0.25 \({}^{***}\) & 0.29 \({}^{***}\) & 1.00 & & & & & & \\
6. MDAS & 0.23 \({}^{**}\) & 0.26 \({}^{***}\) & 0.18 \({}^{**}\) & 0.10 & 0.01 & 1.00 & & & & & \\
7. DBS-R (tot) & 0.41 \({}^{***}\) & 0.41 \({}^{***}\) & 0.33 \({}^{**}\) & 0.20 \({}^{**}\) & 0.08 & 0.27 \({}^{***}\) & 1.00 & & & & \\
8. DBS-R-P & 0.42 \({}^{***}\) & 0.40 \({}^{***}\) & 0.31 \({}^{***}\) & 0.22 \({}^{***}\) & 0.14 \({}^{***}\) & 0.23 \({}^{***}\) & 0.92 \({}^{***}\) & 1.00 & & & \\
9. DBS-R-C & 0.33 \({}^{***}\) & 0.34 \({}^{***}\) & 0.28 \({}^{***}\) & 0.15 \({}^{*}\) & 0.03 & 0.21 \({}^{***}\) & 0.93 \({}^{***}\) & 0.76 \({}^{***}\) & 1.00 & & \\
10. DBS-R-LC & 0.37 \({}^{***}\) & 0.39 \({}^{***}\) & 0.30 \({}^{***}\) & 0.17 \({}^{**}\) & 0.03 & 0.31 \({}^{***}\) & 0.91 \({}^{***}\) & 0.71 \({}^{***}\) & 0.83 \({}^{***}\) & 1.00 \\ \hline \hline \end{tabular}  
* Note: LOE-DEQ-DBPE = Dentists’ behaviour and patients’ emotions; LOE-DEQ-DDP = Distressing dental procedures; LOE-DEQ-ODDE = Other distressing dental events; LOE-DEQ-GTE = General traumatic events; MDAS = Modified Dental Anxiety Scale; DBS-R-P = Professionalism; DBS-R-C = Communication; DBS-R-LC = Lack of Control; \({}^{**}\)\(p<0.05;^{**}\)\(p<0.01;^{***}\)\(p<0.001\).  
\end{table} 
Table 3: Correlations between LOE-DEQ, Modified Dental Anxiety Scale, and Dental Beliefs Surveyof online respondents matched the criteria to be categorized as highly anxious individuals [17]. Similarly, our sample also showed higher levels of dental anxiety than those detected in the representative UK study upon which MIDAS was created (28.7% vs. 11.6%). This finding may be explained through the sample size which, although acceptable if compared to that recruited for the Italian validation of the MDAS [17] was not so large and was recruited from only one clinic.