不同年龄重度婴幼儿龋治疗时机选择分析

目的:探讨急性、非急性期就诊对不同年龄幼儿牙科焦虑的影响,完善针对焦虑儿童的行为管理。方法:选取3～7岁初次就诊,乳磨牙龋坏儿童192人。每年龄组48人,分别分为实验组、对照组。实验组为急性期就诊患儿,对照组为非急性期患儿。CFSS-DS量表评估患儿治疗前、后及复诊畏惧程度;Venham量表评估初、复诊就诊行为变化。数据进行统计学分析。结果:全年龄段实验组患儿治疗前后CFSS-DS量表评分差值比较,有统计学意义(P＜0.05),对照组无统计学意义。全年龄段实验组患儿初、复诊就诊行为Venham量表评分差值比较,有统计学意义(P＜0.05);对照组无统计学意义。结论:恰当治疗可稳定或改善患儿牙科焦虑,随年龄增长急性期就诊患儿焦虑程度改善更显著。     

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目的    探讨心理行为诱导对牙科畏惧症（dental anxiety, DA）患儿的临床疗效。方法    对2009年2月至2010年7月在济南市口腔医院门诊就诊的398例3～12 岁口腔疾患儿童,采用儿童焦虑调查表-牙科分量表（children’s fear survey schedule-dental subscale, CFSS-DS ）进行分析比较,并将筛选出的316例DA 患儿随机分为试验组和对照组。试验组在进行常规口腔治疗的同时,采用心理行为诱导;对照组仅进行常规口腔治疗。结果      试验组治疗后,DA 程度明显下降（P＜0.01）,男孩DA 程度的下降较女孩更显著（P＜0.05）。结论    心理行为诱导治疗DA患儿效果明显,有利于提高临床治疗效率与治疗质量。     

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目的 评价笑气/氧气吸入镇静技术辅助牙科畏惧症患儿口腔治疗的疗效.方法 选择2009年10月至2011年6月来济南市口腔医院就诊,有紧张恐惧情绪,无法完成常规条件下口腔治疗的患儿64例,随机分为试验组和对照组,每组32例.试验组患儿在应用笑气/氧气吸入镇静技术下进行口腔治疗,对照组患儿仅在心理行为诱导下进行口腔治疗.对比两组患儿临床治疗效果及主观焦虑水平与就诊行为改善程度.结果 两组患儿治疗有效率分别为87.5％和62.5％,差异有统计学意义(P＜0.05).治疗后两组患儿儿童畏惧调查表-牙科分量表(CFSS-DS)平均得分和Venham临床焦虑及合作行为级别评分均降低,试验组下降更明显(P＜0.05).结论 笑气/氧气吸入镇静技术能够有效缓解患儿就诊中的焦虑恐惧情绪、改善其就诊行为表现,提高患儿口腔治疗的合作性.     

低龄儿童龋治疗时机的选择

目的：评价严重龋损乳磨牙治疗时机选择对儿童牙科畏惧程度和就诊行为的影响。方法：实验组为临床症状明显、主动初诊3～6岁患儿144例。对照组为口腔检查中发现无自觉症状乳磨牙龋病3～6岁患儿144例。用中文改良儿童牙科焦虑面部表情量表（MCDASf）评估患儿初次治疗前、治疗后及1周复诊时的主观畏惧状况;Venham 临床焦虑与合作行为评定量表评估初次就诊时与复诊时患儿临床就诊行为。对数据进行统计学分析。结果：实验组治疗后、复诊时 MCDASf 评分较治疗前均下降（P ＜0．05）。对照组治疗后、复诊时 MCDASf 评分较治疗前无明显变化（P ＞0．05）。实验组患儿治疗前后 MCDASf评分差值大于对照组（P ＜0．05）。复诊时2组患儿 Venham 评分级别一致（P ＞0．05）。实验组患儿就诊行为改善比对照组明显（P ＜0．05）。结论：对低龄儿童严重龋损非急性期患牙即时诊治可缓解牙科畏惧症。     

学龄前儿童参与治疗在牙科诊疗中的作用研究`

目的　探讨学龄前儿童参与疾病治疗在牙科诊疗中的作用。方法 选取2017年6月~2018年6月来我院口腔门诊首次就诊并需要复诊的3~6岁学龄前儿童90例为研究对象,根据随机数字法分为实验组和对照组,每组各45例。每次就诊对照组给予常规干预,实验组除常规干预措施外,让患儿参与疾病治疗。首诊和复诊治疗结束后采用CFSS-DS量表、Frankl量表和Houpt行为量表对两组患儿牙科畏惧程度、治疗依从性和治疗完成情况进行评定并比较其统计差异。结果 实验组复诊率为93.33%,高于对照组（77.78%）,差异具有统计学意义（?2=4.406,P<0.05）。实施参与疾病治疗的实验组患儿首诊和复诊CFSS-DS评分均低于对照组,Frankl治疗依从性和Houpt治疗完成情况均优于对照组,两组比较均具有统计学差异（P均<0.05）。和首诊比较,复诊后实验组患儿CFSS-DS评分降低,Frankl治疗依从性提高,差异具有统计学意义（P均<0.05）,但Houpt行为量表评定结果没有统计学差异（P>0.05）。结论 实施学龄前儿童参与疾病治疗能缓解患儿牙科畏惧程度,提高就诊率和治疗依从性。     

心理指导对牙科畏惧症患儿的影响

目的观察心理指导对牙科畏惧症患儿的影响，为探寻治疗牙科畏惧症患儿的策略提供依据。方法牙科畏惧症患儿317例，随机分为试验组177例和对照组140例，试验组在口腔治疗前、中、后进行心理指导，对照组不进行心理指导，口腔治疗结束后应用Frank临床行为分级评定量表判断其畏惧程度。结果试验组在心理指导前后Frankl行为分级变化情况有统计学意义（P〈0．01）。结论心理指导对改善牙科畏惧症患儿在口腔治疗中的畏惧程度有良好的效果。     

中外儿童口腔治疗焦虑行为的对比

目的：比较美国佛罗里达大学口腔医学院（university of florida college of dentistry,UFCD）儿童牙科和中国解放军总医院（301医院）（301 general hospital of PLA China）儿童牙病科就诊儿童的恐惧心理,以改进管理儿童患者就诊行为的方法。方法：选取2006—09—2007—08在UFCD就诊儿童150例,2007—11—2008—03在解放军301医院儿童牙科就诊儿童270例,采用儿童畏惧调查表一牙科分量表（children＇s fear survey schedule—dental subscale,CFSS-DS）调查儿童牙科畏惧情况,所得数据进行统计学分析。结果：CFSS平均得分≥2．5者,UFCD为19．7％,301医院为27．2％;两地区6岁前儿童DF值均明显高于6岁后儿童（P〈0．05）;301医院女性DF值明显低于男性（P〈0．05）,UFCD则无显著差异;与治疗无关的恐惧,UFCD为32％,301医院为39％;两地区家长对治疗恐惧经历均明显影响患儿牙科畏惧症（DF）的发生（P〈0．05）。结论：父母不良的牙科经历是患儿DF发生的主要因素。年龄,性别也一定程度上影响儿童DF发生。     

240例儿童牙科畏惧症的临床初步分析

目的：调查儿童患者牙科畏惧症的发生情况及影响因素。方法：采用改良的儿童畏惧调查量表-牙科分量表（CFSS-DS）和行为分级法对240例儿童牙病患者进行调查及统计分析,比较不同分组因素下儿童患者畏惧水平。结果：CFSS-DS平均评分值为15.78±3.90。240例患儿的术前评分值在年龄、性别、看牙经历、母亲文化程度、口腔卫生和精神状态方面有影响,其中年龄、看牙经历、母亲文化程度、口腔卫生这几方面有显著性差异（P〈0.05）,性别和精神状态无显著性差异。患儿的畏惧率为75.83%,术中行为分级受患儿年龄、性别、看牙经历、母亲文化程度、口腔卫生和精神状态方面有影响,其中年龄、看牙经历、母亲文化程度、口腔卫生和精神状态这五方面有显著性差异（P〈0.05）。结论：了解不同因素下患儿术前和术中的畏惧情况,以期将儿童DF降到最低程度,提高诊疗质量,更好地维护儿童的口腔状况。     

改良儿童牙科焦虑面部表情量表中文版的研制与评价

目的 进行改良儿童牙科焦虑面部表情量表(a face version of the modified child dental anxiety scale,MCDASf)中文版的研制,评价MCDASf中文版的信度和效度,为该量表在我国的应用提供理论依据.方法 按照心理测量学中量表的跨文化适应程序对MCDASf量表英文版进行翻译、回译和文化调试,建立MCDASf中文版.选取250名幼儿园及小学的大于4岁且小于12岁儿童间隔3周前后两次填写的MCDASf量表,检测MCDASf中文版的信度.在北京大学口腔医学院·口腔医院第一门诊部临床抽取大于4岁且小于12岁就诊儿童248名,治疗前填写MCDASf中文版和改良中文版儿童畏惧调查表-牙科分量表,同时根据国内学者修订的Venham临床焦虑与合作行为级别评定量表对这些儿童口腔诊疗行为进行分级,以验证中文MCDASf量表的效度,及儿童焦虑水平与就诊行为之间的关系.结果 信度检测同时完成两次测评的为245人,量表填表完整率98.0％ (245/250);效度检测共有246名有效完成了MCDASf中文版量表的填写,量表填表完整率为99.2％ (246/248).该量表内部一致性克龙巴赫α系数(Cronbach's α coefficient)为0.814,重测信度为0.907.MCDASf中文版量表得分与改良中文版儿童畏惧调查表-牙科分量表的得分、与儿童Venham临床行为分级间均存在显著相关关系,相关系数分别为0.843、0.675(P＜0.01).结论 MCDASf中文版量表具有良好的信度、效度,可以作为儿童口腔临床测量儿童焦虑程度的一种较好的简单自评工具.     

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。     

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??Objective    To explore the application and curative effect of music therapy in relieving children dental fear??CDF??. Methods    A total of 128 first-visit-dental children??aged 4 - 10 years???? who were classified as CDF by children′ s fear survey schedule-dental subscale??CFSS-DS????were included in the study. The children were randomly selected to accept music therapy and behavior management??64 children??experiment group????and behavior management only ??64 children??control group??. Heart rate??blood pressure and oxygen saturation were recorded before??during and after treatment as well as before return visit??and anxiety level was evaluated by Venham anxiety and cooperative behavior scale. Results    Sixty planned treatments were completed satisfactorily in experimental group??but only 56 children completed treatment in control group. In the process of treatment??heart rate variation in experimental group was significantly less than the control group. In the experimental group??the heart rate in operation was not significantly increased??but the postoperative rate was significantly lower than that before treatment??the intraoperative and postoperative heart rate was significantly faster than preoperative rate in the experiment group. Except for children with Venham grade of 4??other children’s heart rate decreased significantly after initial visits and before subsequent visits in experiment group. Systolic pressure also showed similar trends. Conclusion    Music therapy is a safe and acceptable way to relieve children dental fear with higher compliance of children.     

An assessment of dental anxiety in children

The aims of this study were to assess child behaviour in a dental surgery and to isolate the variables most closely associated with lack of cooperation by means of a questionnaire/interview. Sixty-five children aged 6-18 years, who had been referred to one dentist because of poor cooperation, formed the study group. Forty-two children of similar age, treated by the same dentist, but referred for reasons other than lack of cooperation, acted as the control. Assessments of anxiety were made independently by a psychologist who used a number of indices, including the Child Manifest Anxiety Scale (CMAS), Melamed's Child Behaviour Rating Scale and the Venham Picture Scale. Fifty-one children in the study group had experienced a general anaesthetic for dental treatment compared with five in the control group (P less than 0.001). Parents of children in the study group could identify specific instances which contributed to fear of dentistry in 75% of cases. The CMAS found no difference between the groups in general anxiety, but anxiety and cooperation ratings made by parent and dentist in the dental surgery showed significant differences between the two groups, as did the results of the Venham Picture Scale.     

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??Objective    To explore synergistic effect of music therapy and nitrous oxide inhalation sedation for child dental fear??CDF??in children with CFSS-DS grade of 4 or above. Methods    A total of 60 children in need of oral treatment??aged 4-10 years??were included in the study??who were classified as severe CDF by children′s fear survey schedule-dental subscale??CFSS-DS??at Department of Pediatric Stomatology in General Hospital of PLA from December 2015 to December 2016. The children were randomly selected to accept music therapy and nitrous oxide inhalation??the experimental group????or nitrous oxide inhalation only??the control group????30 children in each group. Heart rate??blood pressure and oxygen saturation were recorded before treatment??before using nitrous oxide inhalation and during treatment. Sedation onset time??treatment duration and recovery time were also recorded. Results     In the control group??21 children completed treatment??while 9 children stopped the treatment due to fear. In the experimental group??26 completed the treatment while 4 stopped. The onset time of nitrous oxide and duration of operation in the experimental group were significantly less than the control group. In the course of therapy??children in the experimental group possessed emotional homeostasis and good compliance. Their heart rate and systolic pressure in operation were not significantly increased??and even significantly reduced. The diastolic pressure and oxyhemoglobin saturation had no significant change. Conclusion    Nitrous oxide inhalation and synergistic effect of music therapy has significant effects on children with CFSS-DS grade of 4 or above. It can improve patient compliance and is a safe and acceptable approach for behavior management of children with CDF.     

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.     

A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management

OBJECTIVE: The aim of the present study was to determine the validity of subjective anxiety assessment and the outcomes of management of children receiving operative dental treatment. SETTING: The study was conducted at the Departments of Sedation and Child Dental Health, Newcastle Dental Hospital, Newcastle upon Tyne, UK. SUBJECTS AND METHODS: One hundred children and adolescents aged between 8 and 15 years participated in the study. Clinicians subjectively allocated 50 children for treatment with local analgesia alone (low anxiety), and identified 50 children who had the potential to benefit from nitrous oxide and oxygen sedation (high anxiety). Participants then completed the State-Trait Anxiety Inventory for Children (STAIC), the Venham Picture Test (VPT) and the Child Fear Survey Schedule-Dental Subscale (CFSS-DS). A global rating scale classified behaviour during dental treatment. RESULTS: State anxiety and dental fear prior to treatment were significantly higher in children allocated to receive inhalation sedation (P = 0.004 and P = 0.005, respectively). There was no significant difference in trait anxiety or post-treatment state anxiety between the two groups (P = 0.69 and P = 0.06, respectively). Only 11% displayed 'negative' behaviour during treatment: 82% of this group represented those allocated to receive sedation. CONCLUSION: Children receiving inhalation sedation were significantly more anxious prior to treatment than children receiving treatment with local analgesia alone. The findings support the subjective assessment of anxiety in children; however, objective anxiety measures may assist clinicians in identifying specific fears, which may ultimately aid patient management.     

The Dental Subscale of the Childrens Fear Survey Schedule: a factor analytic study in the Netherlands

The Dental Subscale of the Childrens Fear Survey Schedule (CFSSDS) is a well-known instrument for assessing dental fear in children. Previous studies have shown that the scale has acceptable reliability and validity. Factor analysis using scores of a group of Finnish schoolchildren resulted in three factors. No other data on the factor structure have been published. In order to report on the factor structure of the Dutch parental version of the CFSS-DS, the present study was undertaken. Factor analysis using scores from a group of Dutch children ( n =150) demonstrated a factor pattern fairly similar to the results found in the Finnish study. Three factors were found: 1) fear of highly invasive dental procedures, 2) fear of less invasive aspects of treatment and 3) fear of medical aspects. Considering that almost all items load substantially (≥0.20) on more than one factor, it seems that one primary underlying dimension exists: fear of invasive treatment aspects. The CFSS-DS is proposed as a reliable, one-dimensional measure of dental fear.     

Common use of a Fear Survey Schedule for assessment of dental fear among children and adults

BACKGROUND: Little is known about children with dental fear (DF) in a long-term perspective. Measures of DF suitable for use among children, adolescents, and adults would be of value for longitudinal and family studies. AIM: Our aim was to explore the DF subscale of the Children's Fear Survey Schedule (CFSS-DS) in highly fearful adult dental patients. DESIGN: The subjects were 230 adult patients applying for treatment for severe DF at a specialized DF clinic. Questionnaires investigated background data, general fear and DF, and general anxiety and depression. Reference data were obtained from 36 nonfearful patients on a subset of questionnaires. RESULTS: The fearful group reported high levels of DF on all measures and at a level similar to children with severe DF. The DF measures clearly differed between the fearful and reference groups. A factor analysis revealed a three-factor structure (fear of dental treatment, medical treatment, and of strangers and choking), which explained 68% of the variance. CONCLUSION: The CFSS-DS appears suitable for use in studies of adult populations. The results indicated that some areas of DF (physiology, avoidant behaviour, anticipatory anxiety), areas of importance among adult patients, are not assessed by the CFSS-DS. Studies of adults should therefore also include established adult measures of DF.