IntroductionThe aim of this study was to improve upon the Modified Dental Anxiety Scale (MDAS) by developing the empathy-based International-Modified Dental Anxiety Scale (I-MDAS). This new measure was then utilized to compare the dental anxiety of patients cross-culturally.Methodology. This study was a descriptive cross-sectional study adapting the MDAS into the I-MDAS by adding the International scale. The study surveyed 465 participants from a dental clinic, SurveySwap, and distributed flyers. Data was collected through Qualtrics through the self-administered I-MDAS and analyzed through the SPSS computer software version 28. Participants were categorized into two subgroups where 41.3% received dental care only within the United States and are termed the domestic population, and 58.7% received dental care outside of the United States and are labeled the nondomestic population. Information about demographics, past negative dental experiences, and current dental anxiety was collected. The conducted analyses utilized an independent samplet-test to compare the subgroups' anxiety levels, a bivariate correlation to find the Pearson correlation, a Cronbach's coefficientα, and a one way ANOVA test to compare the genders' I-MDAS scores.ResultsThere was no significant difference in dental anxiety levels between the domestic population (M= 12.73, SD = 5.13) and the nondomestic population (M= 12.76, SD = 5.06);t(463) = −0.58,p= 0.95). The I-MDAS shows evidence of validity and reliability. There was a significant and positive relationship between the International scale items and the MDAS scale items (r(463) = 0.60,p< 0.001), indicating the criterion validity of the I-MDAS. Content validity was strengthened by expanding the inquired topics in the new measure. The Cronbach'sαvalue of 0.85 shows that the I-MDAS is reliable for clinical applications.ConclusionsThe I-MDAS improves upon the MDAS by providing dentists with a tool for encouraging empathy. Dental clinicians across nations can use the I-MDAS to combat the vicious cycle of dental anxiety.