Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children

Aim.  The aim of this study was to explore associations between avoidance behaviour and dental anxiety in both parents and children and caries experience in 5-year-old children. It was hypothesised that parents' dental avoidance behaviour and dental anxiety were related to dental caries in 5-year-old children.
Design.  Data were collected from dental records and by clinical and radiographic examination of 523 children. The parents completed a questionnaire regarding education, national background, dental anxiety, dental attendance, and behaviour management problems. Bivariate and multivariate logistic regression was conducted.
Results.  Children having one or more missed dental appointments (OR = 4.7), child behaviour management problems (OR = 3.3), child dental anxiety (OR = 3.1), and parents avoiding dental care (OR = 2.1) were bivariately associated with caries experience at the age of 5 years. In multivariate logistic regression, having one or more missed dental appointments (OR = 4.0) and child behaviour management problems (OR = 2.4) were indicators for dental caries in 5-year-old children, when controlling for parents education and national origin.
Conclusion.  Parents that avoid bringing their child to scheduled dental appointments and previous experiences of behaviour management problems for the child indicated risk for dental caries in 5-year-old children.     

Trajectories of dental anxiety in a birth cohort

Abstract – Objective: To examine predictors of dental anxiety trajectories in a longitudinal study of New Zealanders. Methods:  Prospective study of a complete birth cohort born in 1972/73 in Dunedin, New Zealand, with dental anxiety scale (DAS) scores and dental utilization determined at ages 15, 18, 26 and 32 years. Personality traits were assessed at a superfactor and (more fine‐grained) subscale level via the Multidimensional Personality Questionnaire at age 18 years. Group‐based trajectory analysis was used to identify dental anxiety trajectories. Results:  DAS scores from at least three assessments were available for 828 participants. Six dental anxiety trajectories were observed: stable nonanxious low (39.6%); stable nonanxious medium (37.9%); recovery (1.6%); adult‐onset anxious (7.7%); stable anxious (7.2%) and adolescent‐onset anxious (5.9%). Multivariate analysis showed that males and those with higher DMFS at age 15 years were more likely to be in the stable nonanxious low trajectory group. Membership of the stable nonanxious medium group was predicted by the dental caries experience at age 15 years. Participants who had lost one or more teeth between ages 26 and 32 years had almost twice the relative risk for membership of the adult‐onset anxious group. Personality traits predicted group membership. Specifically, high scorers (via median split) on the ‘stress reaction’ subscale had over twice the risk of being in the stable anxious group; low scorers on the traditionalism subscale were more likely to be members of the recovery trajectory group; and high scorers on the ‘social closeness’ subscale had half the risk of being in the stable anxious group. Dental caries experience at age 5 years was also a predictor for the stable anxious group. Membership of the late‐adolescent‐onset anxious group was predicted by higher dental caries experience by age 15 years, but none of the other predictors was significant. Conclusion:  Six discrete trajectories of dental anxiety have been observed. Some trajectories (totalling more than 90% of the cohort) had clear associations with external influences, but others were more strongly associated with characteristics such as personality traits. A mix of both influences was observed with only the stable anxious dental anxiety trajectory.     

Children choosing between general anaesthesia or inhalation sedation for dental extractions: the effect on dental anxiety

Summary. Aim. To compare the levels of dental anxiety experienced by children having dental extractions using general anaesthesia (GA) with those having extractions using local anaesthesia and inhalation sedation (IHS) when offered a programmed choice between the two techniques prior to treatment.
Design . Structured interview with child at pre-treatment and at one week (approximately) follow up.
Setting . Community: primary health care centre.
Subjects . Children aged 9–15 years referred to a local NHS Trust dental clinic ( n  = 88).
Intervention . Child and parent provided with information about IHS and its benefits over GA for the assistance in tolerating extraction of teeth and provided with a choice of procedure.
Main outcome measure . An eight question modified child dental anxiety scale.
Results . Full information was received from 76 children giving an 86% response rate. Post-operative dental anxiety was lower in children who had chosen (with their parent) IHS in comparison to those who had chosen general anaesthesia ( P < 0·05). Dental anxiety remained unchanged in the group who chose to have their extractions under GA.
Conclusion . Children and their parents who select IHS as opposed to GA to assist in extractions demonstrate less psychological distress.     

Dental anxiety among survivors of childhood cancer: a cross-sectional study

Background.   Childhood cancer survivors may have experienced a high number of invasive medical and dental procedures which are known to be risk factors for dental anxiety.
Aim.  The aim of this study was to examine the prevalence of dental anxiety among children who have survived cancer.
Design.  In a cross-sectional study, we examined 51 6- to 14-year-old children who had been treated for cancer at Aalborg Hospital, and 192 children without cancer. All children answered the Dental Subscale of the Children's Fear Survey Schedule. Dental anxiety was defined as a dental anxiety score exceeding the mean dental anxiety score + 1 standard deviation for the children without cancer.
Results.  Children with cancer did not have an increased prevalence of dental anxiety compared with children without cancer: the prevalence ratio was 0.41 [95% confidence interval (CI): 0.10–1.24]. The mean dental anxiety score was 23.1 (95% CI: 21.2–25.0) among children who had been treated for cancer, and 24.7 (95% CI: 23.4–26.0) among children without cancer (mean difference: 1.6; 95% CI: 1.1–4.3).
Conclusion.  Cancer and cancer treatment during childhood were not associated with an increased risk of dental anxiety in this population.     

Oral lesions and dental caries status in perinatally HIV-infected children in Northern Thailand

Summary. Objective. To describe the prevalence of oral lesions and dental caries status in perinatally HIV-infected children.
Design. A cross-sectional study.
Setting. Paediatric HIV outpatient department at the Nakornping Provincial Hospital, Chiang Mai, Thailand.
Patients and methods. Forty children with perinatal HIV infection, from early infancy to 12 years of age, were included in the study. These children were examined for oral lesions and dental caries. A number of children receiving antifungal and antiretroviral (ART) therapy were recorded.
Results. The mean DMFT and DMFS scores were both 2·1 (SD = 2·3). The dft and dfs scores were 4·1 (SD = 5·0) and 10·9 (SD = 14·8), respectively. A total of 57·5% of the children had one or more oral lesions. Oral candidiasis and hairy leukoplakia were the most common oral lesions. Only 12·5% of children had received ART. A total of 22·5% of the children had a history of receiving antifungal therapy.
Conclusions. Oral lesions and dental caries were relatively high in this study. Consequently, treatment and prevention for oral lesions and dental caries are inevitably required for children with HIV infection in Northern Thailand. Furthermore, ART should be made available for all HIV-infected children to decrease the prevalence of HIV-associated oral lesions.     

Oral health programme for preschool children: a prospective, controlled study

Background.  New perspectives are needed for oral health programmes (OHPs). The aim was to evaluate the preventive effect of a risk-based OHP in comparison with a traditional programme.
Design.  An age cohort of 794 Finnish children, 446 in the intervention group and 348 in the control group, was followed from 18 months to 5 years of age. The children were screened for mutans streptococci (MS) in the dental biofilm. The main outcome measure was the proportion of children with dental caries (decayed, missing, or filled primary teeth > 0) at the age of 5 years. The intervention, targeted to MS-positive subjects in the intervention group only, was based on repeated health education to the caretakers and xylitol lozenges for the child. Dental hygienists carried out the programme.
Results.  OHP was effective in white-collar families [numbers needed to treat (NNT) = 3, 95% CI 2–11]. Factors significantly associated with caries at 5 years were MS colonization at 18 months, occupation of caretaker, but also gender when incipient carious lesions were included in the index.
Conclusion.  Early risk-based OHP, targeted to the families of MS-positive children, can reduce the risk for caries in white-collar families. For blue-collar families, different kinds of methods in caries prevention and support are needed.     

Everyday- and dental-pain experiences in healthy Swedish 8–19 year olds: an epidemiological study

Background.  Very little is known about children's everyday pains and dental treatment pains. A child's gender, age, and level of dental anxiety are factors that could interplay with the perception of pain and are thus worth studying.
Aim.  The objectives of this study were to investigate the frequency and reported intensity levels of children's everyday- and dental-pain experiences, and to study the reported pains in relation to gender, age, and dental anxiety.
Design.  Three hundred and sixty-eight consecutive patients (8–19 years, mean age 13.5 years) from three different Public Dental Service were recruited. Pain ratings were obtained using McGrath's Children's Pain Inventory list and some additional items. Dental anxiety was estimated by the Dental Anxiety Scale.
Results.  Most frequently experienced everyday pains were headache and tummy/stomach ache. Among dental treatment events, dental injection was reported to be most often ranked as painful, and more frequently by girls. Both dental and everyday pains were rated higher grouping children with high dental anxiety.
Conclusions.  The frequency of pain experiences are the same in Swedish children as in other populations. There is a relation between dental anxiety and the perception of pain.     

The relationship between bone age, chronological age and dental age in children with isolated growth hormone deficiency

Aim . To relate dental age and bone age to chronological age in a group of children with isolated growth hormone deficiency (GHD).
Design . A group of 25 children between the ages of 6 and 18 years, diagnosed as having GHD were studied. Of these, 16 were male and nine were female, undergoing replacement therapy with growth hormone (GH) over 2·5 years. Dental age (DA) was estimated from orthopantograms (Haavicko Methods) and compared to bone age (BA) by Greulich and Pyle Standards, and chronological age (CA).
Results . CA versus BA – there was a statistically significant difference of 1·52 years between the average chronological age and bone age ( t  = 5·61, P < 0·001). CA versus DA – there was a statistically significant difference of 0·92 years between the average chronological age and dental age ( t  = 3·93, P < 0·001). BA versus DA – statistically nonsignificant differences were found between the average bone age and dental age ( t  = –0·60, P  = 0·10).
Conclusion . After 2·5 years of therapy with growth hormone both DA and BA showed a significant delay compared to CA. Despite the fact that some catch-up occurs in speed of growth there is no evidence from the children in our study that might support the occurrence of a similar speed-up in dental age.     

Relationship between needle phobia and dental anxiety

PURPOSE: This cross-sectional study aimed to explain the nature of needle phobia and its relationship in dental phobic children with evidence on age-related differences. METHODS: The study used 2,865 patients (52% boys, 48% girls), 4 to 11 years old (mean=7.18 years). The patient sample included randomly selected patients (N=2,153) and an anxious group of children (N=712). Children were divided into 3 age groups (4-6, 7-9, and 10-11 years). The Children Fear Survey Schedule--Dental Subscale (CFSS-DS) was used to assess age-related needle phobia (CFSS-DS question 3) and dental anxiety. Children were arranged into 3 anxiety groups (cutoffs=scores of 25 and 37). Children who scored >37 were considered needle-phobic. Statistical analysis was performed using Statistics for Windows 10. RESULTS: Needle phobia progressively decreases with increasing age (19% of 4- to 6-year-old vs 11% of 10- to 11-year-old needle phobics; P< or =05). Stepwise regression analysis revealed needle phobia does not primarily seem to be related to dental anxiety. Other aspects, like having had someone examine the mouth and the dentist drilling, contribute the most to dental anxiety in both low- and high-anxiety children. Fear of doctors is more specific for high-anxiety children (P < or =05). A significant age-related difference regarding needle phobia is found between children ages 4 to 6 and 7 to 9 and between children ages 4 to 6 and 10 to 11 (P < or =001). CONCLUSIONS: Needle phobia is age related, but should be considered a separate phenomenon. It is not specific for dental anxiety and is related to other painful treatment.     

The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial

Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental patient anxiety levels: a cluster randomized-controlled trial. Community Dent Oral Epidemiol 2010; 38: 83–87. © 2009 John Wiley & Sons A/S   Abstract – 
Objectives:  To review the effect of lavender scent on anticipatory anxiety in dental participants.
Methods:  In a cluster randomized-controlled trial, patients' ( N  = 340) anxiety was assessed while waiting for a scheduled dental appointment, either under the odor of lavender or with no odor. Current anxiety, assessed by the brief State Trait Anxiety Indicator (STAI-6), and generalized dental anxiety, assessed by the Modified Dental Anxiety Scale (MDAS) were examined.
Results:  Analyses of variance ( anova s) showed that although both groups showed similar, moderate levels of generalized dental anxiety (MDAS F _(1,338) = 2.17, P  > 0.05) the lavender group reported significantly lower current anxiety (STAI: F _(1,338) = 74.69, P  < 0.001) than the control group.
Conclusions:  Although anxiety about future dental visits seems to be unaffected, lavender scent reduces state anxiety in dental patients.     

Vegetarianism and dental fluorosis among children in a high fluoride area of northern Tanzania

Objective . The purpose of this study was to compare the prevalence and severity of dental fluorosis among vegetarian and nonvegetarian children and adolescents living in an area where dental fluorosis is endemic.
Design . An analytical cross-sectional retrospective study.
Sample and methods . Children ( n  = 165) aged 6–18 years, from five schools in Arusha town were examined. The children had a life-long exposure to drinking water with 3·6 mg F/litre. The severity of dental fluorosis was assessed using the Thylstrup & Fejerskov Index (TFI).
Results . In the vegetarian group ( n  = 24), the prevalence of dental fluorosis (TFI score 1) was 67%, while 21% had severe fluorosis (TFI score 5). In the nonvegetarian group ( n  = 141) the prevalence of fluorosis and severe fluorosis was 95% and 35%, respectively. In bi-variate correlation analyses age, vegetarianism and a series of other factors related to childhood nutrition (meals per day, the use of home-made porridge, the use of fish, etc.) were significantly associated with the tooth prevalence of dental fluorosis (TPF, P < 0·05). Stepwise multiple linear regression analyses explained 30% of the variance in TPF; age 15% points and vegetarianism 13% points. Multiple logistic regression analysis showed that the risk of developing dental fluorosis was seven times higher among nonvegetarians than among vegetarians.
Conclusion . The significantly lower prevalence and severity of dental fluorosis among the vegetarian group compared to the nonvegetarians would seem to be related to diet.     

Parental perspectives on preterm children's oral health behaviour and experience of dental care during preschool and early school years

Background.  Children born preterm (PT) have medical conditions and impairments that may affect their oral health.
Hypothesis.  Our hypothesis for the study was that PT children display more dental behaviour management problems (BMPs) and less favourable oral health behaviour than controls (C).
Methods.  Parents of 153 PT children and 153 C children were interviewed regarding the children's oral health behaviour and experience of dental care on two occasions, 2 years apart. The interviews concerned the preschool period and the early school years, respectively.
Results.  BMPs were more common in PT children of preschool age, but not during the early school years. Regarding oral health behaviour, there were no differences between the groups, except that PT children had more problems with toothbrushing than C children in the preschool period, in spite of the fact that the PT group reported more medical health problems and more anxious behaviour and indications of cognitive problems than the C group.
Conclusions.  Children born PT exhibit several risk factors for both BMP and impaired oral health. It is essential that this group of patients is identified early and receives special attention from the dental services.     

Dental behavioural management problems and dental caries prevalence in 3- to 6-year-old Swedish children born preterm

Background.   Today, most children born preterm survive without major impairments. But high frequencies of cognitive and behavioural difficulties arise. Studies on dental behavioural management problems (DBMP) in these children are lacking. In addition, studies on caries prevalence are few and inconclusive.
Aim.   This study aims to compare the frequency of behavioural problems and poor compliance with dental treatment in preschool children born preterm with those born full-term. The prevalence of caries was also studied.
Methods.   The study group included 187 children born between 23 and 32 weeks of gestation. The control group constituted full-term children matched by age, sex, immigrant background, and dental operator. DBMP, number of dental visits, missed appointments, and caries between ages 3 and 6 were noted.
Results.   At age 3, but not at age 6, the prevalence of DBMP at clinical examinations was significantly higher in preterm children compared with the control group. Of the children who received dental treatments during preschool years, preterm children displayed significantly more DBMP. No significant difference in dental visits or in caries prevalence was found. Preterm children, however, missed significantly more dental appointments.
Conclusion.   Children born preterm display a higher prevalence of DBMP at dental examinations and treatments during preschool years.     

Dental caries and changes in dental anxiety in late adolescence

Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13 + were identied as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was signicantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a signicant predictor of dental caries experience, and may be a risk factor for dental caries incidence.     

Dental maturation of 18th and 19th century British children using Demirjian's method

Aim . To compare dental age with chronological age in a group of children born approximately 200 years ago and a group of modern children.
Methods . Dental maturation of 15 skeletal remains (range 3·0–15·1 years) of London children of known age-at-death was compared to an age and sex matched control group of contemporary children ( n  = 30). The method of Demirjian, Goldstein and Tanner (1973, 1976, 1978) was used to assess maturity.
Results . The difference between dental age (DA) and chronological age (CA) for both groups was not significant, suggesting similar maturation over 200 years, however, many of the younger children from Spitalfields were dentally delayed. Several of the younger individuals from both groups had a dental age less than the lowest limit of this scale (2·5 years), highlighting one pitfall of this method.
Conclusion . These results suggest that this method is not entirely suitable for younger children.     

Dental caries prevalence and dental health behaviour in HIV infected children

Objectives . To determine dental caries prevalence in a group of HIV positive children and their reported dental health behaviour.
Design . Standardized epidemiological dental examination and structured interview.
Setting . Paediatric HIV outpatient department in a South London hospital.
Study population . HIV-positive children attending the above outpatient clinic over a 6-month period (30 subjects) and parents (20 informants).
Methods . Epidemiological examination of children was undertaken by one trained and calibrated examiner to determine caries prevalence using dmft/DMFT. Parents were interviewed to obtain information on their children's dental health behaviour: tooth-brushing, diet, fluoride; oral medication and dental attendance were explored.
Results . Sixty-three per cent ( n  = 19) of children had dental caries experience, much of it untreated. Mean dmft/DMFT was 4·4. Sixty per cent ( n  = 18) of all children presented with active or untreated caries and the care index for those at/under age 5 years was low (10%). Unfavourable dental health behaviour included: consumption of nonmilk extrinsic sugars at night, use of sugar-based medications, low fluoride intake, late commencement of toothbrushing and poor dental attendance. Dental health was not considered a priority for many of these children. Parents did not necessarily disclose their child's HIV status on dental attendance.
Conclusion . Caries prevalence was high, much of the disease untreated, and unfavourable dental health behaviour, including the use of sugar-based medicines was common. HIV infected children should be considered a high caries risk and receive appropriate dental care, in terms of both treatment and preventive services, following confirmation of seropositivity.     

Preventive dental utilization for Medicaid-enrolled children in Iowa identified with intellectual and/or developmental disability

Objectives: To compare preventive dental utilization for children with intellectual and/or developmental disability (IDD) and those without IDD and to identify factors associated with dental utilization.
Methods: We analyzed Iowa Medicaid dental claims submitted during calendar year (CY) 2005 for a cohort of children ages 3-17 who were eligible for Medicaid for at least 11 months in CY 2005 ( n  = 107,605). A protocol for identifying IDD children was developed by a group of dentists and physicians with clinical experience in treating children with disabilities. Utilization rates were compared for the two groups. Crude and covariate-adjusted odds ratios were estimated using conditional logistic regression modeling.
Results: A significantly higher proportion of non-IDD children received preventive care than those identified as IDD (48.6 percent versus 46.1 percent; P  < 0.001). However, the final model revealed no statistically significant difference between the two groups. Factors such as older age, not residing in a dental Health Professional Shortage Area, interaction with the medical system, and family characteristics increased one's likelihood of receiving preventive dental care.
Conclusion: Although IDD children face additional barriers to receiving dental care and may be at greater risk for dental disease, they utilize preventive dental services at the same rate as non-IDD children. Clinical and policy efforts should focus on ensuring that all Medicaid-enrolled children receive need-appropriate levels of preventive dental care.     

The clinically related predictors of dental fear in Taiwanese children

Background. Dental fear has been singled out as one of the most troublesome problems facing paediatric dentistry today. Children with dental fear may avoid visiting dentists; therefore, their oral health protection is often compromised. However, the aetiology of dental fear is still not entirely understood. Objective. This study investigated the dental visiting habit, the previous dental experiences, the conditioning pathway, and the clinically related predictors of dental fear in children. Design. The dental history of 247 children (2–10 years old) was obtained when they came to a dental clinic for treatment. The level of dental fear in these children was assessed using the Children's Fear Survey Schedule–Dental Subscale (CFSS-DS). Observers rated the clinically anxious responses and uncooperative behaviour towards dental treatment in these children. Three stepwise regression analyses were performed to determine significant predictors of CFSS-DS score, clinically anxious responses, and uncooperative behaviour of children, respectively. Results. We found that the CFSS-DS score and clinical anxiety have different predictors, but age ≤ 3.99 years old and cooperativeness in the first dental visit were important predictors for both the CFSS-DS score and the clinical anxiety. Furthermore, the other predictors of the CFSS-DS score were maternal dental fear, unbearable pain during the first dental visit, and visiting dentists in a regular dental clinic; the other predictors of clinical anxiety were first-born, regular dentist, and CFSS-DS score. Finally, the only significant predictor for uncooperative behaviour was clinical anxiety. Conclusion. Children's dental fear and their anxious response during dental treatment were dynamic processes that consisted of many different factors. The direct conditioning of subjective experience of pain was more important than the objective pathway of child dental fear, and the indirect conditioning does not seem influential in this study sample.     

The Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ): a measure of severity of exposure to distressing dental events

To understand the development of dental anxiety better and to identify those at increased risk of developing dental anxiety, the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ) was developed. The aim of the current study was to determine the psychometric properties (i.e. factor structure, reliability, and validity) of the LOE-DEQ and to determine its suitability as an additional screening instrument for dentally anxious patients. Five different samples were used: (i) highly dentally anxious patients ( n  = 119); (ii) general dental patients ( n  = 480); (iii) students ( n  = 186); (iv) psychiatric outpatients ( n  = 17); and (v) oral surgery patients ( n  = 34). Results of the factor analysis revealed a four-factor solution. The LOE-DEQ has sufficient internal consistency (Cronbach's alpha values ranging from 0.69 to 0.85) and satisfactory test–retest reliability (intraclass correlation coefficient = 0.78). The results further suggest that this instrument has adequate discriminant, concurrent, and predictive validity. It is concluded that the LOE-DEQ is a useful tool for assessing patients' background in terms of previous exposure to distressing dental events, which is considered a vulnerability factor in the development of dental anxiety.     

An evaluation of the PALS after treatment modelling intervention to reduce dental anxiety in child dental patients

Aim.  The aim of this study was to assess the effectiveness of the passivity to activity through live symbolic (PALS) after treatment modelling intervention to reduce child dental anxiety.
Methods.  A convenience sample of consecutive 5- to 10-year-old dental patients were randomly assigned to intervention or control groups. Self-reported child dental anxiety was assessed at the start of each visit. At the end of each visit, children in the intervention group were introduced to a glove puppet, which acted as the PALS model. The intervention group children re-enacted the treatment they had just received on the puppet's teeth. At the end of each visit, the control children received motivational rewards only. The change in dental anxiety scores was examined by t -tests and analysis of covariance.
Results.  The final analysis included 27 intervention children and 26 control children. For the intervention group, there were no statistically significant changes in dental anxiety over a course of treatment, between first and second preventive visits, between first and second invasive treatment visits, or between first attendance and subsequent recall attendance. For the control group, a statistically significant decrease in dental anxiety was observed between the first and second invasive dental treatment visits.
Conclusion.  The PALS after treatment modelling intervention was ineffective in reducing child dental anxiety.