## 4 Discussion
Future studies should expand their samples and recruit participants from diverse social realities. Furthermore, the finding related to gender differences in high dental anxiety is in line with previous studies, confirming that women are more anxious than men [18]. Regarding the criterion validity, we found significant associations between distressing experiences related to both treatment and the dentist as a person with dental anxiety. This is in line with previous studies highlighting the pivotal role of distressing dental experiences in the development of dental anxiety [7]. On the contrary, neither the negative dental experiences lived in the third person nor general traumatic experiences were associated with dental anxiety, disconfirming the results obtained by [PERSON] et al. [8]. Our findings are more similar to those obtained by [PERSON] and [PERSON] [18], who found that distressing dental experiences had a greater impact on dental anxiety than distressing experiences outside the dental setting. However, among general traumatic experiences, [PERSON] and [PERSON] [18] found that sexual assault was the only general distressing experience outside the dental setting which significantly affected high dental anxiety. In our sample, no participants declared that they had experienced sexual assault. Thus, it is very likely that the lack of any associations between general traumatic experiences and dental anxiety may be related to this consideration. Future studies should expand the sample, including participants who have experienced sexual assault in the past. On the other hand, our results confirmed both the convergent and discriminant validity of the Italian version of the LOE-DEQ. Indeed, except for the subscale GTE, which correlated only with Professionalism, all the other subscales correlated positively with all the subscales of the DBS-R. Furthermore, all the correlations calculated were below 0.60. These findings demonstrate that the LOE-DEQ is able to measure meaningful and independent constructs. The only exception regards the GTE subscale, which did not show a high internal consistency reliability. However, even in the samples recruited by [PERSON] et al. [8] GTE was the subscale with the lowest internal consistency reliability compared to the other subscales, ranging from 0.33 to 0.62, depending on the sample on which it was calculated. This means that Italian researchers and dentists should use this subscale with caution, associating it with the LOE-DEQ other scales measuring general distressing and traumatic events. Regarding the associations between the LOE-DEQ dimensions and high dental anxiety, the results confirmed the hypothesis that distressing dental experiences lived within the dental setting were experiences more predictive of high dental anxiety than both distressing experiences lived outside the dental setting and the emotions associated with the dentist as a person. This finding is in line with a previous study highlighting that mentally anxious patients were more likely to report traumatic dental events than patients with lower levels of dental anxiety [7]. However, more recent studies have reported evidence that multiple pathways in the development of dental anxiety exist, but not all individuals with high levels of dental anxiety report traumatic dental experiences [19]. For this reason, future Italian studies should assess in detail the role of both traumatic and non-traumatic negative events in the development of dental anxiety. The results should be read in the light of important limitations. First, the cross-sectional nature of the study did not allow us to evaluate the convergent validity of the LOE-DEQ completely. Future studies should consider assessing the convergent validity at different measurement times (e.g., before and after specific dental procedures). Secondly, even if acceptable, the sample size was not very large and the participants were recruited from only one social reality, preventing the possibility of any geographical generalizability.