Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children

The aim of this study was to estimate the prevalence of dental anxiety among 6 to 8-year-old Danish children using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and behavior management problems. The study was designed as a population-based cross-sectional survey of children attending the municipal dental service in four municipalities in the county of North Jutland, Denmark. In 2001, the CFSS-DS questionnaire was mailed to the parents of all children born in 1993, 1994, and 1995 (parents of 1666 children) in 4 municipalities. Data on behavior management problems were collected from the children's dental records held by the municipal dental service. Questionnaires were returned from 1281 (76.9%) parents. The prevalence of dental anxiety (i.e. CFSS-DS > or = 38) was 5.7% (95% CI: 4.6% 7.1%), and the median CFSS-DS score was 22 (1st quartile 19; 3rd quartile 27). A history of behavior management problems was observed in 37.2% (95% CI: 33.3%-41.1%) of all children who had had dental treatment, but more often in children with dental anxiety.     

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.     

Stressful situations for toddlers: indications for dental anxiety?

The present study was undertaken to examine if daily anxiety-provoking situations can predict dental anxiety in a toddler. Parents of 73 toddlers were sent 2 questionnaires: 1) the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS), and 2) the Inventory of Stressful Situations (ISS), a list of 16 questions developed to assess anxiety in daily stressful situations. This investigation was repeated one year later. Forty-eight parents completed all questionnaires. Results show a clear correlation between daily stressful situations at the age of 3 and dental anxiety at the age of 3 (r = .62, p < 0.01, two-tailed) and at the age of 4 (r = .49, p < 0.01, two-tailed). Regression analyses revealed that the ISS at the age of 3 predicted dental anxiety at the age of four; however, it did not contribute additionally if the CFSS-DS score at the age of three was included. CONCLUSION: Daily anxiety-provoking situations in 3-year-old children may be related to dental anxiety at the age of 4.     

Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale

BACKGROUND: A new version of the Modified Child Dental Anxiety Scale (MCDAS) was formed by adding a faces rating scale to the original numeric form. AIMS: To describe the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDAS(f)), and to provide normative data for dental anxiety for children using the MCDAS(f). DESIGN: To determine the test-retest reliability, 287 schoolchildren aged 8-10 years completed the MCDAS(f) on two separate occasions 17 weeks apart. To determine the criterion validity, 207 schoolchildren aged 10-12 years completed the MCDAS(f) and the CFSS-DS at the same sitting. Construct validity was assessed using a cohort of 206 consecutive child dental patients and their parents. RESULTS: The MCDAS(f) showed good test-retest reliability (intraclass correlation coefficient = 0.80) and internal consistency (Cronbach's alpha = 0.82). The MCDAS(f) significantly correlated with the CFSS-DS (r = 0.80, P < 0.001). Dental anxiety assessed using the MCDAS(f) was related to the dmft (t = -2.17, P = 0.03), DMFT (t = -4.19, P < 0.001), and dental general anaesthetic experience (t = -4.46, P < 0.01). The mean MCDAS(f) score for the normative sample (n = 475) was 19.81 (95% CI: 19.20, 20.43). CONCLUSIONS: The MCDAS(f) is a reliable and valid measure of dental anxiety in children aged 8-12 years.     

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.     

Developmental changes in dental anxiety in a normative population of Dutch children.

AIM: The aim of this study was to ascertain age and gender related differences that contribute to dental anxiety and to find relations with early onset of child dental anxiety in a population of 4-11 years old Dutch children. MATERIALS AND METHODS: The study was conducted among 2,865 patients (48.2% girls) aged between 4 and 11 years old. The sample included a normative (n = 2,153) and an anxious group of children (n = 712), who were referred to the Special Dental Care Clinic in Amsterdam because of manifested dental phobia. Children were divided into three age groups (4-6, 7-9 and 10-11 years). Dental anxiety was assessed using the Children Fear Survey Schedule-Dental Subscale. Three levels of dental anxiety were used: low (CFSS-DS = 15-25), moderate (CFSS-DS = 26-36) and high (CFSS-DS above 37). Only children with CFSS-DS scores above 37 were considered dentally phobic. STATISTICS: Statistical analysis was performed in Statistics for Windows 10. RESULTS: In the total group a significantly higher level of dental anxiety was found among girls (p = 0.004; t = -3.262). There was a considerably lower number of dentally phobic boys (7.1%) and girls (9.2%) in the older group compared with the younger (51.8%, 52.8% respectively). One way Anova results revealed a statistically significant age related difference between the oldest and the youngest as well as the middle-aged groups (p < 0.001, p = 0.001). In general dental anxiety was explained better in the younger than in the older group. The regression analysis accounted for a higher percentage of the explained variance. CONCLUSIONS: The study confirmed the highest level of dental anxiety was present at 4 years of age and an overall decrease in dental anxiety occurred as children became older. In different age groups, dental anxiety seems to be related to different aspects of dentistry, indicating the causes shift from simple initial stimuli to more complex events.     

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.     

Prevalence of dental fear and its relationship with primary dental caries in 7-year-old-children

BackgroundChild's dental fear has been reported as one of the reasons that increase, aggravate dental diseases and facilitate other oral diseases. This study is aimed to describe the type and prevalence of dental fear and to assess the relationship between cavities of primary teeth and dental fear in 7-year-old children at Phulam Primary School, Hanoi.MethodsThe sample comprised of 132 children aged 7 years. The questionnaire examined the profile of participants and assessed their dental fear using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Children have “dental fear” when the total CFSS-DS score is greater than or equal to 38. By contrast, those without dental fear gain the total point which is less than 38. After completing the questionnaire, a dental examination was undertaken according to the International Caries Detection and Assessment System (ICDAS).ResultsThe prevalence of dental fear was 34.85%. Fear scores were highest for “Dentist drilling” (2.92 ± 1.47) and “Injections” (2.87 ± 1.53). In the univariate analysis, the odds of girls having dental fear were approximately equal to boys (OR = 0.98, 95% CI = ?0.75-0.70). The odds of only children having dental fear were 1.6 times higher than others, but there were not significant. Dental fear was found to be no associated to sex, birth order and primary dental caries (p > 0.05).ConclusionOur findings demonstrated the status of 7-year-old children's dental fear at Phulam primary school, and found that primary dental caries had no correlation with child dental fear score.     

Oral health, dental anxiety, and behavior management problems in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The aim of this study was to investigate whether children with ADHD have a higher caries prevalence, a higher degree of dental anxiety, or more dental behavior management problems (BMP) than children of a control group. Twenty-five children with ADHD and a control group of 58 children, all aged 11 yr, were included in the study. The children underwent a clinical dental examination, and bitewing radiographs were taken. The parents completed the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS). Dental records from the subjects were obtained, and data regarding notes on behavior management problems (BMP) of the children when between 3 and 10 yr of age were compiled. Compared with controls, children with ADHD had significantly higher decayed, missing or filled surfaces (DMFS) (2.0 ± 3.0 vs. 1.0 ± 1.5) and significantly higher decayed surfaces (DS) (1.7 ± 3.6 vs. 0.5 ± 0.9). Differences between the groups regarding CFSS-DS scores were non-significant. In the ADHD group, the prevalence of BMP increased when the children were between 7 and 9 yr of age. In conclusion, children with ADHD exhibited a higher caries prevalence, did not exhibit a higher degree of dental anxiety, and had more BMP than children of a control group.     

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。     

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.     

Caries experience and oral hygiene status of blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia.

OBJECTIVE: To determine the caries experience and oral hygiene status in blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia. METHOD: All (N=218) the 6-7-year-old and 11-12-year-old blind, deaf and mentally retarded female children registered with the Presidency of Girls' Education schools in Riyadh were examined for dental caries and oral hygiene in a dental operatory setting. RESULTS: All (100%) the blind 6-7-year-old had caries with a mean dmft score of 6.58 (SD 2.02). The caries prevalence in blind 11-12-year-olds was 88.2% with a mean DMFT score of 3.89 (SD 2.67). Among 6-7-year-old blind children 8.3 %, and in 11-12-year-old blind children 29.4% had good oral hygiene. The caries prevalence in deaf 6-7-year-olds was 95.7% with a mean dmft score of 7.35 (SD 3.51). The caries prevalence in 11-12-year-old deaf children was 93% with a mean DMFT of 5.12 (SD 3.45). Less than one-fifth (17.4%) of the 6-7-year-old deaf children and only 7.0% of 11-12-year-old deaf children had good oral hygiene. The caries prevalence in mentally retarded 6-7-year-old was 93.9% with a mean dmft of 8.00 (SD 4.1). All the mentally retarded 11-12-year-old had carious teeth with a mean DMFT score of 5.81 (SD 2.95). Only 3.1% of the mentally retarded 6-7-year-old and none of the mentally retarded 11-12-year-olds had good oral hygiene. CONCLUSIONS: Caries prevalence and severity in all the three groups of female special children were very high, and the number of children with good oral hygiene was very low.     

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。     

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.     

Dental Discomfort Questionnaire: predicting toothache in preverbal children.

AIM: In the present study the value of the Dental Discomfort Questionnaire in predicting toothache in young children is analysed. METHODS: The Dental Discomfort Questionnaire (DDQ-8; Cronbach's alpha 0.75) was completed by parents on behalf of their children (N=99; mean age 47 months). Half of the children were referred to a special dental care centre and the other half were controls from a day care centre. RESULTS: The behaviours from the DDQ-8 appeared to be more often present in those children with decayed teeth and toothache than in those without decayed teeth or toothache. A score of 3 or higher on the DDQ-8 seemed the best cut-off point to predict toothache in children. The receiver operating characteristic curve (ROC) showed that the DDQ-8 has predictive value for toothache. STATISTICS: The validity of the DDQ-8 was expressed as sensitivity, specificity and positive predictive value and negative predictive value. The DDQ's ability to discriminate between patients with and without toothache was estimated by the area under the ROC area of the questionnaire. CONCLUSIONS: The DDQ-8 could be helpful for parents, non-dental healthcare workers and researchers in predicting the existence of toothache in preverbal children.     

A review of the oral health status in Syria

AIM: To estimate the prevalence and severity of dental caries and periodontal diseases in Syria and to determine possible secular changes in the last two decades. METHODS: Epidemiological studies performed between 1980-1999, using the WHO criteria for dental caries and the CPITN criteria for periodontal diseases in Syria were retrieved and reviewed. RESULTS: The caries experience of 5-year-old children was high (dmft of 4.7-5.2). The estimated DMFT score of 12-year-old Syrian children was 1.9-2.3. A secular change of the caries experience in the last two decades was not apparent. The amount of untreated caries lesions was high and had not changed substantially in the last two decades. The D component comprised 72-90% of the DMFT of 12-15-year-old children and 26-30% of the DMFT of 35-44-year-old Syrians. The majority of 15-24-year-olds, and more than 80% of the 35-44-year-olds had calculus. Despite the widespread and chronic existence of calculus, only 3-11% of the 35-44-year-old persons had one or more deep periodontal pockets. CONCLUSION: The caries experience in Syria is moderately low and does not seem to have changed in the last two decades. The increased output of graduate dentists in the last decade has not changed the large amount of untreated caries lesions. In Syria, where the prevalence of unmet (caries) treatment needs is high, regular removal of calculus (scaling) for the sake of preventing periodontal pockets should not have a high priority in the oral health services.     

Prevalence of dental caries among 5-13-year-old children of Mangalore city

A study of prevalence of dental caries was undertaken in 5-13-year-old children from Mangalore city. A total of 524 children were examined. The sample consisted of 193, 160, and 171 children in the 5-7, 8-10 and 11-13 years of age group, respectively. Dental caries was examined visually and observations were recorded. Silness and L phie plaque index, L phie and Silness gingival index were used to record the periodontal status. The prevalence of dental caries was highest in 5-7-year-age group compared to 8-10 years and 11-13 years age groups. The increasing prevalence of dental caries needs dental health programmes, which target the specific segments of the population.     

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.     

Prevalence of dental caries and toothbrushing habits among preschool children in Khartoum State,Sudan

Background: Dental caries in preschool children remains a major dental public health problem and affects significant numbers of children in developed and developing countries. The incidence is increasing in developing countries, such as Sudan, because of lifestyle changes, absence of oral health-preventive services and inadequate access to oral health care. Objectives: This study assessed the prevalence of dental caries and toothbrushing habits among 3- to 5-year-old preschool children in Khartoum State, Sudan, and described the correlation between the mean decayed, missing and filled tooth (dmft) score for primary teeth with toothbrushing and sugar consumption. Materials and Methods: The subjects were 553 preschool children with their mothers/guardians, selected by random sampling from the kindergartens of the seven localities of Khartoum State, Sudan. Data were obtained through clinical examination using a modified World Health Organization (WHO) examination data-capture sheet and through structured administered interviews with mothers/guardians. Results: The prevalence of dental caries was 52.4%, with a mean dmft score of 2.3. There was an increase in the dmft scores with increasing age. The frequency of children who brushed their teeth regularly at least once a day was high (83.4%), lower dmft scores were associated with starting toothbrushing earlier in life and with increased frequency of brushing per day. Eating sugar-containing food was significantly associated with dmft score. Conclusions: The prevalence of dental caries was found to be high among 3- to 5-year-old preschool children, and caries experience increased with age. This was mostly associated with sugar consumption and therefore calls for educational interventions to control sugar intake. The toothbrushing habit is well established in Khartoum State, Sudan, as a large number of children were found to be brushing their teeth regularly. No significant association was found between feeding habits and dmft score.Key words: Dental caries, preschool children, dmft, toothbrushing