Objectives: The aim of this longitudinal study was to investigate causal pathways among as well as interrelationships between changes in dental fear and dental attendance in a nationally representative sample of adult Finns aged 19 years or older in 2000, with 11 years of follow‐up.

Methods: Data from the Health 2000 and 2011 Surveys (BRIF8901) in Finland were used. The Health 2000 survey used a stratified two‐stage cluster sampling design (N=9742). Of the participants in 2000, 7964 were eligible and invited to participate in 2011. Of the participants in 2011 (n=5806), 3,631 (63%) responded to both dental fear and attendance questions in both years. Both fear and attendance were assessed using single questions and dichotomized. The background variables included were age, gender and education. Path analysis and logistic regression models were used.

Results: Dental fear led to nonhabitual use of dental services rather than vice versa (−0.07 to 0.04 vs. 0.00). When confounders were considered, in both age groups (29‐39 years and 40+ years) an increase in fear predicted nonhabitual dental attendance. This association was stronger among the younger age group (OR = 4.91) than among those aged 40 years and older (OR = 2.88). Among the younger age group, improved dental fear decreased the risk of nonhabitual dental attendance (OR = 0.16), while among older age group, stable fear increased the risk of nonhabitual dental attendance (OR = 2.33).

Conclusions: Dental fear causes nonhabitual dental attendance, and decreasing dental fear increases habitual attendance. Oral health personnel should adapt measures to prevent and treat dental fear.