Background <p>Smokers have a high prevalence of oral health issues, placing them at greater risk for dental fear and anxiety and appointment non-attendance. To our knowledge, no studies examine patient’s characteristics associated with dental fear and anxiety in smokers. We investigated the association between a constellation of factors and dental fear and anxiety in cigarette smokers to guide future intervention development.</p> Methods <p>This is a secondary analysis of baseline data collected between 12/15/20 and 7/28/24 from adult dental patients who were scheduled for an appointment at one of two urban university-affiliated dental school clinics and enrolled in a trial on motivating smoking cessation (<i>n</i> = 424, 48.2% female, M age = 47.5+/-12.9, 32.0% below poverty level). Participants completed measures electronically: demographics (age, gender, education, ethnicity, race, relationship status, employment status), smoking history (smoking frequency, Fagerström Test for Nicotine Dependence, motivation to quit in 30 days, confidence to quit), psychosocial factors (Perceived Stress Scale and PHQ-2 depression), dental-related factors (subjective dental health, pain level during dental cleanings, and past-year dental cleaning visit), and the 8-item Index of Dental Anxiety and Fear (IDAF-C). We fit four bivariate linear regression models based on the above categories to identify variables associated with IDAF-C at <i>p</i> ≤ .15, which were then entered into a multivariable regression model to examine significant (<i>p</i> &lt; .05) associations with IDAF-C.</p> Results <p>Bivariate models identified gender, education, nicotine dependence, perceived stress, subjective dental health pain during cleanings, and past-year dental cleaning visit for inclusion in the multivariable model. In step one of the multivariable model (F_{(2, 406)} = 6.98, ΔR² = 0.033, <i>p</i> = .001), female gender and lower education were significantly related to the IDAF-C; in step two (F_{(7, 401)} = 21.32, ΔR² = 0.238, <i>p</i> &lt; .001), greater perceived stress (b = 0.07, SE = 0.02, <i>p</i> &lt; .001), greater pain level (b = 0.14, SE = 0.02, <i>p</i> &lt; .001), poorer subjective dental health (b = 0.16, SE = 0.07, <i>p =</i> .03), and higher nicotine dependence (b = 0.05, SE = 0.02, <i>p</i> = .024) were significantly associated with higher IDAF-C scores, while gender and education were not-significant.</p> Conclusions <p>Gender and education accounted for a small portion of the association with IDAF-C, while malleable factors such as pain during cleanings, subjective dental health, nicotine dependence, and perceived stress accounted for a larger proportion of the variance, having the potential to guide future intervention development.</p> Clinical trial registration <p>This research was funded by the National Institute for Dental and Craniofacial Research (NIDCR; B. Borrelli, PI. 5UH3DE028866); ClinicalTrials.gov (Identifier NCT04524533)</p>