This investigation explored strategies to cope with dental treatment used by fearful adult patients undergoing regular dental care and those with phobic avoidance. A newly constructed 20-item questionnaire entitled The Dental Coping Strategy Questionnaire (DCSQ-20) was distributed consecutively to 171 individuals with self- and dentist-reported high dental fear, of whom 77 had dental phobic avoidance and were attending a dental fear clinic and 94 were undergoing regular care at one of three different public dental clinics. The level of dental fear was high in both groups, but significantly higher among avoidant individuals. Several of the DCSQ-20 items showed statistically significant differences between groups. Factor analysis of the DCSQ-20 yielded a four-factor solution explaining 52% of the total variance. The factors were labelled (i) 'self-efficacy statements', (ii) 'self distraction and distancing', (iii) 'catastrophizing', and (iv) 'praying and despair'. The DCSQ-20 displayed sound psychometric properties, and the reliability (Cronbach's alpha) for the factors was between 0.68-0.78. Factors (iii) and (iv) correlated significantly with dental anxiety and were rated significantly higher among individuals with phobic avoidance. In a logistic regression analysis, gender, dental anxiety, and three of the four factors (i, iii, iv) were predictive of regularity vs. phobic avoidance of dental care.