Introduction

Of all visits to the doctor, a visit to the dentist is likely one of the most unpleasant (Willershausen et al., 1999). The very thought of the smell at a dentist's office sends a cold shiver down some people's spines, not to mention the thought of the sound of the drill. At the same time, a smile characterized by a healthy white row of teeth makes for a good first impression and may be worth the visit to the dentist. Besides the fear of going to the dentist, there are also other reasons for postponing this visit. Some tend to put off this appointment as well as other appointments in their daily routine that they know are necessary. This phenomenon is called procrastination.

Procrastination is defined as a voluntary postponing of tasks that one knows should be done (Steel, 2007) and is a well-researched phenomenon (Klingsieck, 2013; Rozental & Carlbring, 2014; Steel, 2007). One prominent explanation is that more attractive, more pleasant tasks are preferred to less attractive, more aversive tasks (Pychyl et al., 2000; Steel, 2007). If we assume that procrastinators prefer the reception of short-term rewards, or the avoidance of short-term punishment, to long-term consequences, it is understandable why a healthy smile in the long run is not sufficiently opposed to the possible pain of dental treatment. However, procrastination research was initially focused strongly on the academic domain for decades (Lee, 2005; Moon & Illingworth, 2005; Steel & Klingsieck, 2016). This is not surprising, as up to 75% of students report that they procrastinate and the negative effects of procrastination have been demonstrated especially in academia (for an overview see, Steel, 2007). Recent studies show that procrastination also has an impact on life beyond the academic sector. Hen and Goroshit (2018) identified several areas where people suffer from procrastination (e.g., health, finances, friendships). In their study, health stood out the most from the eleven different areas of life presented to the participants. In fact, 40% of the participants reported to suffer in their health care due to procrastination.

The negative influence of procrastination on health is also illustrated by Sirois (2007) in the procrastination-health model. This model postulates that procrastination might have a negative impact on health in two ways – the direct and the indirect path. In the direct path, procrastination causes stress, which results in a permanent activation of the stress response. This in turn can lead to a deterioration of the immune system due to subsequent release of cortisol, which can result in various diseases on the one side. On the other side, it provokes the arousal of the autonomous nervous system which can lead to an elevated heart rate besides other health problems. In the indirect path, procrastination leads to illness because health-promoting behaviours are poorly performed or not performed at all. For instance, exercising or eating healthy are repeatedly postponed which often does not have a negative effect on health immediately, but in the long term.

Some studies have already shown this (negative) impact of procrastination on health-promoting behaviour, e.g. going to bed on time (Kroese et al., 2014, 2016; Rapoport et al., 2023) or exercise regularly (Kelly & Walton 2021; Klingsieck & Weigelt, 2016; Rapoport et al., 2022). It has been shown that high procrastinators exercise less than they intended to, sleep less, do not keep to their scheduled bedtimes, and generally report more health problems. The importance of studying procrastination of health-related behaviours such as sleep, exercise, and healthy eating has thus already been recognised. For this reason, special questionnaires were developed in these areas to assess domain-specific procrastination. In the area of bedtime procrastination, there is the Bedtime Procrastination Scale by Kroese et al. (2014), and for sports, there are the questionnaires by Klingsieck and Weigelt (2016) and by Kelly and Walton (2021). Haghbin and Pychyl (2016) also developed the Exercise and Healthy Diet Procrastination Scales.

However, in addition to a healthy diet, regular exercise and adequate sleep, preventive check-ups with a doctor are also part of a healthy lifestyle and known to ensure healthiness. Crucially, regular check-ups at the doctors can diagnose and treat diseases more quickly, which leads to a healthy and long life in the long run (Hung et al., 2014). It is not without reason that there are recommendations for certain preventive examinations from certain age groups onwards (Virgini et al., 2015). Nevertheless, these examinations are often associated with unpleasant feelings ("What if something bad comes out?") and are therefore all the more suitable for being postponed or avoided altogether. In the surprisingly few studies on procrastination of medical examinations so far, it has been found that procrastinators tend to put off medical (Sirois, 2003) and mental (Stead et al., 2010) treatments. Crucially, Sirois (2007) presented first data that procrastination is also associated with less medical (r = -.22) and dental (r = -.30) check-ups.

Dental check-ups are a particularly interesting area. Dental hygiene is one of the few medical areas where a regular annual check-up is recommended at any age, and it represents an area of the body that is usually difficult to hide from others. However, dental hygiene simultaneously is an undeniably difficult issue. One third of the English population reports not to go to the dentist regularly (Steele et al., 2009). Globally, the number of unattended dental check-ups is estimated at 54% (Reda et al., 2018). In a recent study by Inoue et al. (2021), 63% of respondents (of the Japanese population) reported delays in their dental check-ups. This makes it obvious that this is a widespread global problem. At the same time, the study by McGrath and Bedi (2001) shows that people who have seen a dentist in the year of the survey believe that their dental health has a positive impact on their quality of life. In addition, there is a direct negative correlation between dental disease (e.g. formation of caries) and the frequency of dental visits (Aldossary et al., 2015). This is not surprising, because regular visits to the dentist are also associated with good dental hygiene (Hill et al., 2013). This in turn also determines the quality of life, for example through the absence of pain, the ability to eat as well as social factors like smiling (Spanemberg et al., 2019). Dental health is also associated with mental stability, whereas poor oral hygiene can be associated with lack of self-esteem and depression (O’Neil et al., 2014).

Until now, little attention has been paid to underlying personality factors in the research of dental attendance. When investigating the causes, most studies assume that dental anxiety (fear before and during dental treatment that leads to visiting dentists only in case of pain) is the main reason for low attendance or postponement of dental appointments (Hill et al., 2013). In response, there are efforts to remedy this problem of missed dental attendance through the use of mobile schedulers (Foley & O’Neill, 2009) or the use of rewards for regular check-ups (** strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns. European Journal of Oral Sciences, 121, 270–276." href="/article/10.1007/s12144-023-04598-x#ref-CR5" id="ref-link-section-d107753164e2612">2013) and slightly more procrastination (Steel, 2007), these results need to be re-examined in future studies that should include more men. In addition, the sample was partly collected at a university and through social media, which may represent a bias. Less than a third of the participants were students, yet still the sample does not reflect the demographic distribution. Further differentiation would be conceivable in future studies in order to compare different age groups and possibly develop more focused interventions.

The results of the present study open up further interesting lines of inquiry for future studies. For instance, it would be interesting to take a deeper look at the exact dental behaviour – how long/regular do participants brush their teeth or to let them rate their overall oral hygiene. As mentioned above, it is difficult to compare our data with the data from the sports study (Rapoport et al., 2022), as the results in our study do not refer to direct behaviours. For example, one could also collect desired and current dental status. In the survey of the current dental status, more objective data, such as dental recordings, could also be used. In addition, it would also be interesting to collect data on other factors that may lead people further away from their desired dental status, such as smoking and drinking sugary soft drinks. It is conceivable that self-compassion in particular would play a role in achieving these statutory goals.

In summary, this study showed that there are other factors besides dental anxiety that can reinforce postponement of dental visits. Determining these factors is important to help people lead a healthy lifestyle, which in the long run can lead not only to improved health but also to savings of money by the state and health insurance companies. The study represents a first step towards establishing domain-specific dentist procrastination.