Dental anxiety in children and its relationship to dental caries and gingival condition

The aim of this study was to determine the levels of dental anxiety, dental caries and gingivitis among 12–15‐year‐old schoolchildren, in Irbid Governorate/northern Jordan, and to evaluate the correlation between these variables. Two schools were selected by a simple random method from each of the five geographic areas in Irbid Governorate. All children (1021), from the 10 selected schools, who participated in this study completed a questionnaire modified from Kleinknecht's Dental Fear Survey (DFS questionnaire). Children underwent oral examination for dental caries and gingival condition, using Decayed, Missing and Filled Teeth (DMFT) Index and Löe and Silness Gingival Index (GI), respectively. Results of this survey showed that the prevalence of low to moderate ‘general dental fear’ among the study population was 43% while that of ‘high dental fear’ was 10%. The self‐reported ‘general fear of dental treatment’ was higher among girls than boys. Fear of specific stimuli (pain) was the most common source of dental fear. The sight and sensation of the anaesthetic needle and the sight, sound and sensation of the drill were rated the most fear‐eliciting stimuli. The mean DMFT (2.89) and GI (1.80) of boys was not significantly different from the DMFT (3.37) and GI (1.53) of girls (P > 0.05). Spearman's correlation test demonstrated no association between ‘general dental fear’ and dental caries (r = 0.06) or gingivitis (r = 0.007).     

Dental fear among a young adult Saudian population

AIMS: To assess the prevalence of dental fear and reasons for irregular dental attendance among young adult university students; to describe the gender distribution of the dentally anxious population according to the perceived origins or sources of fear; to identify the time of fear development and preference for anaesthesia or sedation before dental treatment. METHOD: A questionnaire incorporating the Dental Fear Scale (DFS) with items related to sources of dental fear stimuli, together with the preference of anaesthesia or sedation before dental treatment and other characteristics. Approximately 500 questionnaires were distributed among Saudian undergraduate students. RESULTS: 368 questionnaires were completed and presented for statistical analysis. The sight and sensation of anaesthetic needles and the sight, sound and sensation of the drill were rated the most fear-eliciting stimuli. Also, females tended to be more anxious than males. Increased heart rate was the most common reported physiological response to fear resulting from dental treatment. The overall level of fear of dental work among the studied population was found to be about 39%.'Lack of time' and 'no need for treatment' were found to be the main reasons for irregular dental visits. Fear of pain and trauma were the major perceived sources of reported fear reactions and were developed mainly during childhood. About 63% of the subjects preferred to have local anaesthesia before dental treatment to prevent or ameliorate dental fear.     

Relationship of socioeconomic background to oral hygiene, gingival status, and dental caries in children.

OBJECTIVE: The aim of this study was to assess the relationship between socioeconomic status and oral hygiene, gingival condition, and dental caries among 12- to 15-year-old children. METHOD AND MATERIALS: Poor children of low-to-moderate socioeconomic status (n = 674) attending 10 public schools were chosen randomly from each of the five geographic areas in Irbid, Jordan. Rich children of high socioeconomic status (n = 347) attending 10 private schools were also included. Schoolchildren were examined for oral hygiene, gingival condition, and dental caries. RESULTS: Significantly higher proportions of children attending public schools had bleeding on brushing and calculus. Mean plaque and gingival scores were higher in public school children than in private school children, but the difference was not statistically significant. The public school children had higher overall scores for decayed, missing, or filled teeth and surfaces as well as higher scores for decayed teeth and surfaces, but there was no statistically significant difference between groups. However, children attending private schools had significantly more missing and filled teeth and surfaces. CONCLUSION: The findings for oral hygiene, gingival status, and dental caries were worse, but not significantly worse, among poor children than they were among rich children. Therefore, dental health education is recommended for both socioeconomic groups.     

Dental anxiety and regularity of dental attendance in younger adults

Dental anxiety constitutes a major problem for patients and dental care providers alike. The aim of this study was to examine the relationship between dental anxiety and regularity of dental attendance among young adults. A random sample of 15 course directors (1:50) was asked to participate in the study. Of these, only 10 course-directors agreed to handout the 500 questionnaires. All undergraduate students who participated in this study were asked to complete a questionnaire modified from Dental Fear Survey (DFS) questionnaire and 368 (73.6%) filled forms were returned for statistical analysis. The results showed that only 20.9% were regular dental attendee while the majority (79.1%) were irregular attendee. The reasons given for irregular attendance were 'lack of time' (36%), 'treatment not needed' (34.1%), 'fear from dentist' (13.3%) and 'cost' (16.6%). The sight and sensation of the injection and sight, sound, and sensation of the drill were the most common fear-eliciting stimuli. Increased heart rate was the commonest reported physiological response. Females had higher mean ratings, therefore tended to be more anxious than males. Dental anxiety represented by the mean responses to the items, was found to be higher in irregular dental attendee than regular attendee. In conclusion, this suggests that dental anxiety may affect the seeking of dental care, therefore to be taken into account when training dental care providers.     

The prevalence of dental anxiety in a group of 13- and 14-year-old Scottish children

The aim of this study was to determine the prevalence of dental anxiety reported by a group of 13- and 14-year-old children, and to explore the relationships between dental anxiety and general fear, social class, gender, size of family, length of time since the last dental appointment, and the number of people known by the child to be afraid of visiting the dentist. A group of 1103 children from eight schools took part in the study, which was completed in 1989. The children (mean age 14.0 years, SD 0.35) completed a structured questionnaire containing the Corah Dental Anxiety Scale (CDAS) and the Geer Fear Scale (GFS). The prevalence of high dental anxiety (CDAS greater than = 15) was 7.1%. High dental anxiety was associated with gender (girls having higher levels of anxiety than boys) and with social class as defined by father's occupation (lower social class groups having higher dental anxiety). Injection was the dental procedure most highly correlated with CDAS in children with a high dental anxiety, closely followed by 'drilling' and 'tooth scaling'. A high level of general fear (GFS) was associated with a high level of dental anxiety. Despite this, 64% of those with high dental anxiety had a low general fear. Two factors were useful predictors of high dental anxiety: the length of time since the last visit to the dentist and the number of people known by the child to be afraid of going to the dentist.     

Age of first dental visit and predictors for oral healthcare utilisation in preschool children

Purpose: To assess the age the of the first dental visit and the association of self-perceived oral health, socioeconomic and clinical indicators with healthcare utilisation in Brazilian preschool children. Materials and Methods: An epidemiological survey with 455 5- to 59-month-old children was conducted on National Children's Vaccination Day in Santa Maria, RS, Brazil. Data about age and reasons for the first dental visit, healthcare utilisation, socioeconomic status and self-perceived oral health were collected by means of a parental semi-structured questionnaire. Calibrated examiners evaluated the prevalence of dental caries (WHO) and dental trauma. The assessment of the association used Poisson regression models (prevalence ratio; 95% confidence interval [CI]). Results: A total of 24.2% (95% CI: 20.3% to 28.4%) of the study sample had already had a first dental visit. Older children, those with dental caries and dental trauma and whose mothers had a higher level of education were more likely to have gone to the dentist. Children of low socioeconomic status were more likely to have visited public than private healthcare services. The reasons for the first dental visit were associated with clinical indicators of the sample. The distribution of utilisation of the types of oral healthcare services (public or private) varied across the socioeconomic groups. Non-white children with dental caries and dental trauma tended to visit a dentist only for treatment reasons. Conclusion: Socioeconomic and clinical indicators are associated with the use of dental services, indicating the need for strategies to promote public health and reorientation of services that facilitate dental access for preschool children.     

The effectiveness of school dental screening: dental attendance and treatment of those screened positive

OBJECTIVE: To determine dental attendance and treatment outcomes following two models of dental screening. DESIGN: An observational prospective cohort study. SETTING: Infant, primary and junior schools in the North West of England. SUBJECTS: Children aged six to nine years at the start of the study. INTERVENTIONS: Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screening. MAIN OUTCOME MEASURES: Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth. RESULTS: In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. CONCLUSION: School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.     

Dental erosion among 12-14 year old school children in Khartoum: a pilot study

OBJECTIVES: To investigate dental erosion among 12-14 year old Sudanese school children and evaluate the associated risk factors. BASIC RESEARCH DESIGN: Cross sectional survey in secondary schools in Khartoum city, Sudan. METHOD AND PARTICIPANTS: A sample of 157 school children was obtained from both private and public schools. Erosion on the labial and palatal surfaces of maxillary incisors was measured by criterion based on the Smith and Knight Tooth Wear Index. Dietary intake and other related factors were assessed using a questionnaire. RESULTS: The overall erosion prevalence in this group was 66.9%, of which 45.2% was mild and 21.7% was moderate erosion. A strong association was found between erosion and private schooling (higher socioeconomic groups), carbonated drinks, herbal hibiscus drink and traditional acidic food consumption. CONCLUSION: There was a high prevalence of dental erosion among Sudanese school children which was mild to moderate in severity and was strongly associated with acidic dietary intake     

Dental caries experience and use of dental services among preschool children in Ajman, UAE

OBJECTIVE: The aim of this study was to estimate the prevalence and severity of dental caries in the primary dentition of young children in Ajman, UAE, and investigate its association with sociodemographic characteristics and use of dental services. METHODS: A cluster-sampling approach was used to randomly select children aged 5 or 6 years who were enrolled in public or private schools. Clinical examinations for caries were conducted by a single examiner using World Health Organization criteria. Parents completed questionnaires seeking information on socioeconomic background and dental service utilization. Zero-inflated negative binomial (ZINB) regression modelling was used to identify risk markers and risk indicators for caries experience. RESULTS: The prevalence of dental caries in the sample was high 76.1%. The average dmfs score 10.2. Caries severity was greater among older children and among male children of less educated mothers. Emirati (local) children had higher caries severity than others. Children who had higher level of caries visited the dentist more frequently than other children whose visits were for check-up only. CONCLUSIONS: Dental caries prevalence and severity in young children in Ajman are high, and socioeconomic characteristics and dental utilization are important determinants of their dental caries experience. There is an urgent need for oral health programmes targeted at the treatment and underlying causes of dental caries in these children.     

The Children's Fear Survey Schedule-Dental Subscale in Japan

OBJECTIVES: The aims of this research are to examine the reliability and validity of the Japanese version of the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS), and to examine the responses of children in the dental setting and in the community. METHODS: The CFSS-DS was translated into Japanese and administered to three samples. The first sample comprised 134 child patients aged 8-15 years, of whom 100 were assigned for test-retest analysis, and the behavior of the remaining 34 additional children were rated during their dental appointments, and compared with their questionnaire results. A second sample of 532 child patients aged 8-15 years, completed the CFSS-DS and also one additional item measuring fear of returning to the dentist. A third sample of 1250 school children aged 8-15 years was surveyed using the CFSS-DS and the additional item measuring fear of returning to the dentist. RESULTS: The Japanese version of the CFSS-DS showed good internal consistency (alpha=0.91) and test-retest reliability (r=0.90), as well as good criterion validity assessed by the relationship with actual child behavior (r(s)=0.51). It also showed good construct validity assessed by correlation with willingness to return to the dentist. Fear levels were higher in the school sample than in the clinic sample (27.7 versus 24.6). Girls reported more fear than boys (26.2 versus 23.2 in the clinic sample, and 30.7 versus 24.8 in the school sample). Injections, choking, having a stranger touch them, and drilling were the most common fears. Factor analyses demonstrated a factor pattern similar to the results found in other cultures. CONCLUSION: The results suggest that the CFSS-DS is reliable and valid and operates in Japan as it does in other cultures.     

Fear of injections and report of negative dentist behavior among Caucasian American and Taiwanese adults from dental school clinics

Abstract Fear of injections and reports of negative dentist behavior and associations with dental anxiety and avoidance of treatment were explored among 951 adults from denial school clinics in Iowa City, Iowa and Taipei. Taiwan. Use and fear of anesthetic injections and negative dentist behavior were assessed by written questionnaire to test associations with demographics, overall dental anxiety (Dental Anxiety Scale or “DAS”) and utilization behaviors. Frequency and logistic regression analyses showed that use of dental anesthetics for routine treatment was much greater overall among Caucasian Americans than Taiwanese, as was fear of injections. Taiwanese and Americans with high dental anxiety (DAS 12) had similar high fear of injections, but inspite of similar fears about dental drilling, high anxiety Taiwanese reported using much less local anesthesia for routine treatments than did high anxiety Americans. Report of condescending remarks to patients (“put downs”) by dentists was mainly an American phenomenon associated with high dental anxiety. Avoidance of appointment making was high for persons afraid of injections and for Americans reporting negative dentist behavior. Avoidance was highest in subjects with high dental anxiety. That predominant characteristics or etiologies of dental anxiety can differ by cultural differences in dental health care systems, dentist beliefs and/or expectations of patients within those systems was discussed in relation to the literature.     

Association Between Socioeconomic Factors and Dental Erosion in Brazilian Schoolchildren

Objective: The aim of this study was to evaluate if a higher socioeconomic status is a potential risk factor for dental erosion in 6‐ to 12‐year‐old Brazilian schoolchildren. Methods: A sample of 983 children was drawn from 36 schools. A questionnaire was applied to determine socioeconomic background. Clinical exams for dental erosion were carried out by one trained and calibrated examiner considering location, severity, and surface area affected. Chi‐square tests and multivariate analysis were carried out. Results: Dental erosion was detected in 196 children (19.9 percent). From this total, 61.8 percent of the lesions were found in the primary dentition and 38.2 percent in the permanent dentition. The palatal surface was the most affected. Higher prevalence was observed in males (P = 0.005). Dental erosion was more prevalent in private school children than in public school children (P = 0.029). Also, dental erosion was prevalent in children from families with higher income (21.3 percent) than in children from low‐income families (13.5 percent) without significant difference (P > 0.05). A higher prevalence of erosion was observed in those children whose parents had a high education level (22.7 percent, P = 0.05). Conclusions: The data suggest a high prevalence of dental erosion across this age span. Dental erosion seems to occur most often in primary dentition of boys who attended private schools and whose mothers have a high educational status.     

Dental fear of Finnish children in the light of different measures of dental fear

OBJECTIVES: The aims were: (1) to examine the construct and reliability of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) among children of different ages and (2) to compare the correlations between fear measured with the modified CFSS-DS, the "peak value for dental fear" (PV), and "fear of dental treatment in general" (GF). METHODS: The study sample consisted of 302, 299, 314, and 297 children aged 6, 9, 12, and 15 years, respectively. Each child received a questionnaire to be filled out at home. An explorative factor analysis with varimax rotation was performed for eight items taken from the CFSS-DS and questions on fear of pain and suction used in the mouth. For further age-specific analyses, mean values were calculated for the sum of items that loaded >0.5 on each factor. The correlations between these values and PV and GF were studied. RESULTS: The questionnaire was reliable. Two factors were revealed for each age: "treatment of dental decay" (TDD), which included fears related to invasive treatment, and "attending the dentist" (AD), which included fears related to dental visits in general. TDD explained over 50% of the variance, except among 9-year-olds. TDD mean values were higher among older children than among younger ones and correlated more strongly with PV than with GF. AD mean values were higher among younger children than among older ones and correlated more strongly with GF than with PV. CONCLUSION: The factor structures were fairly similar but the correlations between fear measures differed among children of different ages.     

Assessing child dental anxiety: the validity of clinical observations

For children there are few validated psychometric measures of dental anxiety. The study reported here aims to examine the validity of using clinical observations as a measure of child dental fear. 100 children consecutively attending a community clinic were asked to complete the validated Child Fear Survey Schedule (CFSS). After the dental examination both dental nurse and dentist separately assessed the subject's dental fear using a checklist based on the CFSS schedule. High agreement was found between the child, the dentist and dental nurse respectively and principal components analysis suggested that a dual nature of anticipatory dental anxiety existed in children. The findings of this work suggest that clinical observations may be a valid means of assessing child dental anxiety status.     

Effectiveness of the school dental screening programme in stimulating dental attendance for children in need of treatment in Northern Ireland

The school dental screening programme has been in existence from the beginning of the 20th century yet its value in encouraging attendance among children with a dental health need is not fully established. OBJECTIVE: To evaluate the effectiveness of school dental screening in promoting dental attendance among children with a treatment need and to examine the relative importance of screening, social class and other factors in dental attendance. METHODS: Sixty-four participating schools were assigned to study and control groups using a stratified, blocked randomisation technique. The study group children received the standard school dental screening and the dental attendance of those with a positive screening result was assessed after 2 months by means of a questionnaire issued to the children's parents. The control group children were not, at this stage, screened, yet their parents received the same questionnaire assessing dental attendance over the 2-month period. However, only questionnaires from control group children who had a positive result at a subsequent screening were retained for analysis. RESULTS: A total of 2,321 children were screened, with 980 having a positive result. The mean dmft of those screening positive was 4.85. In all, 664 completed questionnaires were returned, giving a response rate of 67.8%. Dental attendance was reported among 45.5% of the study group (n=352) in the 2 months following screening. In the same period, 27.6% of the control group (n=312) claimed attendance. The effect was found to be significant among the high employed group (P<0.01) and the unemployed group (P<0.05). CONCLUSION: School dental screening was capable of stimulating dental attendance. The strong effect among the lowest socio-economic group shows that school dental screening may be used to decrease dental health inequalities.     

Association between dental fear and dental attendance among adults in Finland

OBJECTIVE: Our aim was to evaluate the association between dental attendance and dental fear while considering the simultaneous effects of perceived oral health and treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. MATERIAL AND METHODS: The two-stage stratified cluster sample (n=8028) represented Finnish adults aged 30 years and older. The response rate to this nationwide sample was 88%. Dental fear was measured with the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analyses were used to determine the association between dental fear and dental attendance, including the following independent variables: perceived oral health, perceived treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. RESULTS: Among all ages, except 30 to 34-year-olds, irregular attenders were more likely to be very afraid of visiting a dentist than regular attenders were. The association was stronger the older the age group. Only age modified the association between dental fear and attendance. Irregular dental attendance can be attributed to high dental fear (etiologic fraction among exposed) in 41% of cases. CONCLUSION: Reducing dental fear would increase the number of regular attenders, especially among older age groups. Individuals for whom oral health services have been provided regularly since childhood seem to continue to use these services regularly despite high dental fear.     

Dental caries prevalence in relation to socioeconomic status of nursery school children in Goiâania-GO, Brazil

Abstract The study was carried out to assess dental caries in the primary dentition of pre-school children in Goiânia-GO, Brazil, and to assess the influence of socio-economic status. The study population comprised 0–6-yr-old pre-school children (n=2267) attending public (low SES children) and private (higher SES children) nursery schools. Mean dmft and percent caries-free were 0.09 (96.4%) at 1 year and younger, 0.40 (87.3%) at 2, 1.14 (69.9%) at 3, 2.18 (49.5%) at 4. 3.18 (36.1%) at 5, and 3.94 (29.4%) at age 6 years respectively. Caries prevalence was higher in those attending public nursery school than in those attending private schools (P<0.05). Amongst children from public nursery schools the highest dmf component was untreated decay while in private nurseries it was filled teeth. The results indicate that social inequalities exist, which influence denial caries experience. It was concluded that oral health programmes for pre-school children emphasizing preventive measures and dental health education should be developed mainly in areas of social deprivation.     

Dental school finances: current status

Total expenditures and revenues of 58 US dental school were derived from reports of the ADA Division of Educational Measurements. These financial data were studied by type of dental school (public, state-related private, and private) and by expenditure/revenue categories. Dental schools showed little diversity in expenditures: most were directed toward instruction; few were directed toward research or continuing education. Several distinctive patterns among the three types of dental schools in revenues were observed. Two configurations emerged: public and state-related private dental schools receive more than 75% of their revenues from government and tuition, and private dental schools, more than 50%.