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.     

Dental fear and oral health and family characteristics of Finnish children

Objectives: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. Methods: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle‐sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Results: Dental fear was higher among 12‐ and 15‐year‐old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12‐year‐olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six‐ and 12‐year‐olds who had experienced caries were more likely to report dental fear than were caries‐free children. Among 6‐year‐olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Conclusions: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.     

口服咪达唑仑治疗牙科恐惧症儿童的临床疗效观察

目的对牙科恐惧症儿童实施口服咪达唑仑镇静下的口腔治疗,评估治疗的安全性、有效性及其影响因素。方法选择在口腔科就诊的Frankl量表评分为1的有不良牙科治疗经历的30例患儿为研究对象,共进行了46人次的口服咪达唑仑（0.5～1.0 mg·kg-1）镇静下治疗。治疗时,记录患儿的心率、血氧饱和度、治疗内容及持续时间等。采用Houpt量表评估患儿治疗完成情况,治疗结束24 h后电话回访不良反应。结果46人次治疗中,患儿的生命体征平稳、安全,37人次（80.4％）完成了既定治疗,9人次（19.6％）镇静效果不理想,仅完成部分治疗。烦躁不安是术后最常见的不良反应。3岁以上儿童的治疗成功率高于3岁及以下儿童,性别、剂量和治疗内容与治疗成功率无关。结论口服咪达唑仑治疗牙科恐惧症儿童是一种安全有效的方法,3岁以上儿童的治疗效果较好。     

Confirming the factor structure of modified CFSS-DS in Finnish children at different ages

Abstract

Objective. The aims were to determine whether means of different fear-related items were similar in 1998 and 2001 and to find a common factor structure of the modified CFSS-DS for children at different ages. Materials and methods: Independent random samples of 6-, 9-, 12- and 15-year olds were drawn in two cities in 1998 and 2001 (n = 180 per age group from each city). The study group in 2001 comprised 282, 265, 281 and 234 subjects aged 6, 9, 12 and 15 years, respectively. Each child received a modified CFSS-DS form to be filled out at home. Mean scores of different fear-related items were reported for each age group for both data sets. Confirmatory factor analyses (CFA) were performed to test whether the three factor structures revealed for 6-, 9- and 12–15-year olds in 1998 fitted the 2001 data. Multiple group CFA was used to test for the equivalence of the factorial structure across age groups (configural invariance). Results. The age-specific patterns of the means for individual fear-related items in 2001 corresponded to the mean values for 1998. When age-specific factor structures were tested separately for each age group, the factor structure for 9-year-olds was, in general, the best-fitting overall structure. The factor structure had a good fit for all age groups, but the loadings differed at different ages. Conclusions. The modified CFSS-DS provides consistent factor structures for children at different ages and reflects the changes in manifestations of dental fear during growth.     

牙科畏惧症的构成因子及其在牙病治疗前后的差异

目的：考察牙科畏惧症(DF)的构成因子及其在牙病治疗前后的的差别。方法：自编DF量表(1)entalFear Inventory，DFI)，用DFI在治疗前后测试了250名患者。结果：DFI的因子分析验证了5个DF因子，即医务人员畏惧，器械畏惧，卫生条件畏惧，经历畏惧，疗效畏惧。对于DFI各测度的性别与就诊前后的二因素方差分析显示，性别因素的主效应不显著，而就诊前后因素的主效应非常显著。结论：DFI的有效性和可靠性可以接受，DFI能够反映DF及其临床变化。     

提高护理水平 预防儿童牙科畏惧症

目的探讨有效的护理措施在儿童配合牙科治疗中的作用。方法采用牙科畏惧症(DF)的评价标准进行分级,针对患儿的具体情况,采用一些护理措施。结果577例患儿有575例得到了不同程度的治疗,配合率达到99.6%。结论有效的护理措施能提高患儿在牙科中的配合率及治疗效果。     

Dental fear, regularity of dental attendance and subjective evaluation of dental erosion in women with eating disorders

This questionnaire study, with a response rate of 53%, examined self-induced vomiting, erosions and dental attendance in women with eating disorders (EDs) as well as dental fear and its effect on attendance and communication with the dentist. A survey of 371 responding women with EDs, who were recruited from a self-help organization, revealed that dental fear was higher in women with EDs compared to the general population. Dental fear was present in 32.1% of women with EDs, and very high dental fear was present in 16.5% of women with EDs. Of those with very high dental fear, 32.3% had not visited a dental clinic at all in the preceding 2 yr, and 43.5% only initiated contact when they had symptoms. Self-induced vomiting was especially frequent in women with bulimia nervosa (87.9%) and in those with more than one ED (the 'mixed group') (80.6%). Among those with self-induced vomiting, 45.3% thought that they had erosions, although only 28.4% had erosions diagnosed by a dentist. Of women with EDs, 61.4% failed to disclose their condition. High dental fear did not affect willingness to disclose the ED. We conclude that dentists should examine ED patients carefully for dental erosions. Moreover, they should realize that most ED patients avoid disclosing their disorder and that dental fear further complicates dental treatment in these patients.     

Prevalence of dental anxiety and fear in children in Singapore

505 primary school children in Singapore aged 10-14 were surveyed regarding fear of the dentist. Sixty-eight children were classified as having high fear, giving a sex and race adjusted population prevalence rate of 177 fearful children per 1000 population. Females were 2.64 times more fearful than males. There were no significant racial differences in the prevalence rate. Children with high state anxiety are almost three times as likely to report dental fear as those with low state anxiety. Children with trait anxiety scores above the population mean were just as likely as those reporting below the mean to be fearful. Access to dental care is an important intervening variable in dental fear.     

儿童牙科畏惧症调查研究

目的　探讨儿童牙科畏惧症(dentalfear,DF)发病情况及其相关因素。方法　采用Venham临床焦虑及合作行为级别评定量表对2 0 5例牙病患儿进行调查及统计分析。结果　不同年龄、不同性别儿童DF发病率无统计学差异,不同居住地、母亲文化程度不同、牙科经历不同、口腔卫生状况不同的儿童DF发病率有统计学差异。结论　直接不良的牙科经历是儿童DF发生的主要原因。牙科医生除熟练掌握专业知识以减少操作中患儿的痛苦外,熟悉并充分运用儿童心理学知识,改善牙科就诊环境,加强儿童口腔卫生知识的宣传教育,对减少和减轻儿童牙科畏惧症的发生有积极的意义。     

Dental fear treatment: comparison of a video training procedure and clinical rehearsals

Abstract – Two types of fear desensitization, video training, and clinical rehearsals, were evaluated using psychometric tests, behavioral measures, and interviews for a group of 68 dental fear patients with high and low general trait anxiety. After treatment, a visual analogue scale (VAS) also tested the degree of perceived anxiety before going off to an unknown dentist. Results indicated no significant differences in dental fear reduction effects of the two types of desensitization. However, both treatments showed significant and meaningful effects when compared with a group of 75 dental fear patients on a waiting list who were also tested once at the beginning of the waiting period and again after 6 months. Only high general anxiety subjects resisted desensitization and failed standardized dental treatment tests. Exit interviews revealed that both groups named securing/accepting personnel, conversations about their fears and relaxation, in that order, as the most important factors in their dental fear reduction. Psychometric trust scores confirmed this. VAS scores showed a significant increase in fear level about the next dentist, also indicating trust as a major factor in reducing dental fear. Suggestions are made about which patient conditions can affect the choice of either of these training methods.     

Gender differences in reported dental fear and fear of dental pain

Objectives: Gender differences in dental fear have been of increasing interest among clinicians and researchers. The objectives of this study were to assess: (i) gender differences in reports of global dental fear, global fear of dental pain, and specific fear of dental pain; (ii) how the wording of questions about specific fear of dental pain influences a subjective report, and (iii) the interactions between gender differences and wording effects in the reports of specific fear of dental pain. Methods: A telephonic survey of 504 adult Floridians was conducted in 2004. Data collected included six measures of specific fear of dental pain, one measure of global fear of dental pain, one measure of global dental fear, and demographic information. Results: Women were more likely to report global dental fear, global fear of dental pain, and specific fear of dental pain than men, and both women and men were more likely to report ‘dread’ of dental pain than ‘fear’ of dental pain. Conclusions: Our findings suggest that: (i) there are gender differences in reports of dental fear and fear of dental pain; and (ii) both men and women are more willing to express their fearful feelings regarding dentistry using a more socially acceptable term.     

Exploring the associations between somatization and dental fear and dental visiting

While somatization has been investigated as an important variable in relation to excessive health-service utilization, its role in relation to dental visiting and dental fear has received limited attention. It was hypothesized that an excessive focus on physical symptoms might lead somatizers to experience dental treatment as more traumatic, resulting in greater dental fear. The aims of this study were to determine whether somatization was associated with dental fear, reduced dental visiting, and symptomatic visiting. Questionnaire data were collected from 5,806 dentate Finnish adults, with somatization measured using 12 items from the Symptom Check List (SCL-90). Dental fear was measured using a single-item question and dental visiting was assessed by questions relating to time since last dental visit and the usual reason for dental visiting. Multinomial logistic regression analyses indicated that somatization has a statistically significant positive association with both dental fear and symptomatic dental visiting after controlling for age, gender, and education. However, the association between dental-visiting frequency and somatization was not statistically significant. The results were consistent with the hypothesized role of somatization in the development of dental fear. Further investigation of how somatization is related to dental fear and dental-service utilization appears warranted.     

儿童牙科畏惧症的临床分析

目的探讨儿童气质特征与牙科畏惧症（DF）之间的关系,了解DF儿童的气质特点。方法用中国学龄前儿童气质量表（CPTS）对254例4～6岁首次接受牙科治疗的儿童进行气质测查,用Frankl行为分级法进行DF评定,对所得结果进行统计学分析。结果254例患儿中有104例为不畏惧,80例为畏惧,70例为高度畏惧,DF发生率为59.06%。此年龄段男女的DF发生率无统计学差异（P>0.05）。不畏惧、畏惧、高度畏惧3组患儿的气质类型构成不同,差异有统计学意义（P<0.05）。经方差分析,3组患儿在适应性和心境两个气质维度得分上有统计学差异,进一步行两两比较,高度畏惧组得分高于不畏惧组（P<0.05）;其他气质维度得分3组间无统计学差异（P>0.05）。结论儿童牙科畏惧症的发生与儿童本身的气质有关,适应缓慢、心境消极可能发展为儿童DF的危险因子。     

父母牙科焦虑诱导儿童牙科畏惧症行为的影响

目的:观察父母牙科焦虑(parental dental anxiety,PDA)在对儿童牙科畏惧症(child dentalfear,CDF)行为诱导中的作用。方法:240例同时伴有CDF和PDA的家庭,按照儿童年龄进行分层随机分组。实验组CDF在实施诱导前首先进行家长PDA的行为诱导。对照组仅对CDF实施行为诱导。结果:对PDA的诱导可有效促进CDF的行为诱导效果,与对照组相比具有统计学意义(P<0.05)。结论:对伴随家长PDA的CDF诱导过程中,父母(家长)PDA的行为诱导具有重要作用。     

Psychometric measures of dental fear

Abstract Four psychometric scales: Corah Dental Anxiety Scale (CDAS), a modified version of the Geer Fear Scale (GFS), the Health Locus of Control Scale (HLCS), and a Mood Adjective Check List (MACL), were studied with regard to their implications for dental fear. Swedish versions given to groups of fearful and non-fearful dental patients as well as non-patients showed satisfactory metric properties. Mean scores obtained were in most cases similar to those reported for original American versions, even though some indications of cultural differences were observed. The scales seem to reflect important aspects of dental fear, and they represent a valuable methodology in research on etiology and treatment of dental fear.     

基于环境听觉管理的舒适化治疗策略在儿童牙科畏惧症中的应用效果研究

摘要：目的    探讨基于环境听觉管理的舒适化治疗策略在儿童牙科畏惧症中的应用效果。方法    选择2021年7—8月于武汉大学口腔医院儿童口腔科就诊需行口腔治疗的3 ~ 10岁牙科畏惧症患儿60例,随机分为试验组和对照组,每组各30例。对照组仅进行行为管理,试验组在行为管理基础上采用环境听觉管理（佩戴无线智能耳机聆听音乐或音乐故事）。采用儿童畏惧调查-牙科分量表（CFSS-DS）和Venham临床焦虑与合作行为级别评定量表（以下简称“Venham量表”）评估两组患儿治疗前后的焦虑畏惧水平和临床合作情况。结果    在治疗后,两组患儿CFSS-DS评分较治疗前均显著下降,且试验组患儿CFSS-DS评分和Venham量表评级均显著低于对照组,差异均有统计学意义（均P < 0.05）。此外,试验组患儿的临床合作率显著高于对照组,差异有统计学意义（P < 0.05）。结论    基于环境听觉管理的舒适化治疗策略能够有效缓解儿童的牙科畏惧症状和焦虑水平,提高就诊的依从性和配合度,有望为开展儿童口腔舒适化治疗提供新的思路和参考。