Validating the dental subscale of the children's fear survey schedule using Rasch analysis

Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?-a systematic review

PURPOSE

Molar Incisor Hypomineralization (MIH) are first molars with developmental enamel defects and are common findings in many child populations. The porous nature of MIH enamel and the presence of post-eruptive enamel breakdown leads to the presence of hypersensitivity and pain, which is often the patient's main complaint and can result in dental fear and affect the quality of life. The present review aims to summarise the evidence for the ability of MIH to cause problems, such as dental fear and anxiety (DFA) and to summarise the evidence for a possibly negative impact on the oral health-related quality of life (OHRQoL) of MIH affected children and adolescents, in a systematic review.

METHOD

Two searches, (1) MIH AND dental anxiety and (2) MIH AND Quality of life, were performed in MEDLINE/PubMed and Scopus. Selection demands were fulfilling the MIH diagnosis criteria using validated instruments and questionnaires for assessing DFA and OHRQoL, respectively.

RESULTS

After removing duplicates and articles not fulfilling the selection demands, 6 studies concerning MIH and DFA and 8 studies concerning MIH and OHRQoL remained.

CONCLUSION

Children and adolescents with diagnosed MIH did not seem to suffer from increased dental fear and anxiety, but indicated an impaired oral health-related quality of life.

An Introduction to Assessing Dental Fear and Anxiety in Children

Fear and anxiety constitute an important theme in dentistry, especially with children. Anxiety and the fear of pain during dental treatment can lead to avoidance behaviour, which contributes to perpetuating fear and anxiety of dental care. Understanding and assessing dental fear and anxiety in children is important for delivering successful dental care with high satisfaction in this age group. Among the vast assessment method options available today, self-report assessment, parental proxy assessment, observation-based assessment, and physiological assessment are the four major types for dental fear and anxiety in children. Each method has its own merits and limitations. The selection of a method should be based on the objectives, validity, and setting of the assessment. The aim of this paper is to review and discuss the assessment methods for dental fear and anxiety in children.

Validity of the Brazilian version of the Dental Subscale of Children's Fear Survey Schedule

BACKGROUND

Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) is a tool widely used to assess dental fear in children.

AIM

To translate and to verify the psychometric properties, including factor analyses of the Brazilian version of the CFSS-DS (B-CFSS-DS) in two settings.

DESIGN

The CFFS-DS was translated into the Portuguese language. In the first cross-sectional study (dental setting), 128 children (age: 4-12 years) participated. Mothers were interviewed; children's dental fear was assessed through the CFSS-DS and the Venham picture test; and child behaviour was assessed using the Frankl Scale. The second was a longitudinal study, with 103 schoolchildren (age: 4-12 years). Two receiver operating characteristic curves were drawn to establish the cut-off points.

RESULTS

The B-CFSS-DS version showed good internal consistency in dental and school settings (Cronbach's α = 0.88 and 0.77 respectively) and a good test-retest reliability (Weighted Kappa = 0.767), as well as good criterion and discriminant validities. Factor analyses showed four factors.

CONCLUSION

The Brazilian version of the CFSS-DS is a valid tool for dental fear assessment in children aged 4-12 years. Further studies with representative samples should be performed to strengthen the findings of this study, especially in the school setting.

Cognitive Behavioral Therapy for Children with Dental Anxiety: A Randomized Controlled Trial

Dental anxiety affects approximately 9% of children and is associated with poor oral health, pain, and psychosocial problems. The objective of this study was to investigate the efficacy of cognitive behavioral therapy (CBT) for children with dental anxiety in specialist pediatric dentistry. The study used a parallel-group superiority randomized controlled trial design. The primary outcome measure was the behavioral avoidance test; assessors were blind to treatment allocation. Participants were 8 boys and 22 girls 7 to 18 y old (mean ± SD, 10 ± 3.1). Children fulfilling the diagnostic criteria for dental anxiety were randomized to CBT (n = 13) or treatment as usual (n = 17), such as various sedation methods. Psychologists provided 10 h of CBT based on a treatment manual. Treatments were conducted in a naturalistic real-world clinical setting. Assessments were conducted before the treatment, 3 mo after the start of treatment, and at 1-y follow-up. The analyses of the primary outcome measure by repeated-measures analysis of variance and independent t test showed that children receiving CBT made superior, statistically significant improvements at follow-up (16.8 ± 2.4) compared with treatment as usual (11.4 ± 3.1, P < 0.01). A large between-group effect size (Cohen’s d = 1.9) was found. Following treatment, 73% of those in the CBT group managed all stages of the dental procedures included in the behavioral avoidance test compared with 13% in the treatment-as-usual group. Furthermore, 91% in the CBT group compared with 25% in the treatment-as-usual group no longer met the diagnostic criteria for dental anxiety at the 1-y follow-up according to the secondary outcome measure. Measures of dental anxiety and self-efficacy showed larger improvements in the CBT group compared with controls. We conclude that CBT is an efficacious treatment for children and adolescents with dental anxiety and should be made accessible in pediatric dentistry (ClinicalTrials.gov: NCT01798355).

Knowledge transfer statement: The results of this study can be used by decision makers and clinicians when planning to implement evidence-based treatment in pediatric dentistry and give children and adolescents access to methods for treating dental anxiety. The results can also be used by parents of children with dental anxiety when asking dentists to cooperate with psychologists using cognitive behavioral therapy.

Reliability and validity of the Children's Fear Survey Schedule-Dental Subscale for Arabic-speaking children: a cross-sectional study

Background

Early recognition of dental fear is essential for the effective delivery of dental care. This study aimed to test the reliability and validity of the Arabic version of the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS).

Methods

A school-based sample of 1546 children was randomly recruited. The Arabic version of the CFSS-DS was completed by children during class time. The scale was tested for internal consistency and test-retest reliability. To test criterion validity, children’s behavior was assessed using the Frankl scale during dental examination, and results were compared with children’s CFSS-DS scores. To test the scale’s construct validity, scores on “fear of going to the dentist soon” were correlated with CFSS-DS scores. Factor analysis was also used.

Results

The Arabic version of the CFSS-DS showed high reliability regarding both test-retest reliability (intraclass correlation = 0.83, p < 0.001) and internal consistency (Cronbach’s α = 0.88). It showed good criterion validity: children with negative behavior had significantly higher fear scores (t = 13.67, p < 0.001). It also showed moderate construct validity (Spearman’s rho correlation, r = 0.53, p < 0.001). Factor analysis identified the following factors: “fear of invasive dental procedures,” “fear of less invasive dental procedures” and “fear of strangers.”

Conclusion

The Arabic version of the CFSS-DS is a reliable and valid measure of dental fear in Arabic-speaking children. Pediatric dentists and researchers may use this validated version of the CFSS-DS to measure dental fear in Arabic-speaking children.

Psychometric properties of the faces version of the Malay-modified child dental anxiety scale

BACKGROUND

To evaluate the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDASf) Malay version in 5-6 and 9-12 year-old children.

METHODS

The MCDASf was cross culturally adapted from English into Malay. The Malay version was tested for reliability and validity in 3 studies. In the Study 1, to determine test-retest reliability of MCDASf scale, 166 preschool children aged 5-6 years were asked to rank orders five cartoons faces depicting emotions from 'very happy' to 'very sad' faces on two separate occasions 3 weeks apart. A total of 87 other 5-6 year-old children completed the Malay-MCDASf on two separate occasions 3 weeks apart to determine test-retest reliability for Study 2. In study 3, 239 schoolchildren aged 9-12 years completed the Malay-MCDASf and the Malay-Dental Subscale of the Children Fear Survey Schedule (CFSS-DS) at the same sitting to determine the criterion and construct validity.

RESULTS

In study 1, Kendall W test showed a high degree of concordance in ranking the cartoon faces picture cards on each of the 2 occasions (time 1, W = 0.955 and time 2, W = 0.954). The Malay-MCDASf demonstrated moderate test-retest reliability (Intraclass correlation coefficient = 0.63, p <0.001) and acceptable internal consistency for all the 6 items (Cronbach's alpha = 0.77) and 8 items (Cronbach's alpha = 0.73). The highest MCDASf scores were observed for the items 'injection in the gum' and 'tooth taken out' for both age groups. The MCDASf significantly correlated with the CFSS-DS (Pearson r = 0.67, p < 0.001).

CONCLUSIONS

These psychometric findings support for the inclusion of a cartoon faces rating scale to assess child dental anxiety and the Malay-MCDASf is a reliable and valid measure of dental anxiety in 5-12 year-old children.

Reliability and validity of the Chinese version of the Children's Fear Survey Schedule-Dental Subscale

BACKGROUND

The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) is a commonly used questionnaire that measures children's dental fears.

AIM

This study aimed to examine the reliability and validity of the Chinese version of the CFSS-DS.

DESIGN

The CFSS-DS was translated into Chinese and administered to children in a dental office. The sample comprised 206 child patients aged 6-10 years, 42 of whom were selected for test-retest analysis. The behaviors of all 206 children were rated during their dental appointments and compared to their questionnaire results.

RESULTS

The internal consistency (Cronbach's α) was 0.85, and the test-retest reliability (intraclass correlation) was 0.71. The Chinese version of the CFSS-DS showed good criterion validity; children who were uncooperative on the Frankl Scale had higher mean CFSS-DS scores (Z = 5.79). Through factorization, three factors emerged: (1) dental treatment, (2) hospital personnel, and (3) invasive dental procedures. Girls reported more fear than boys (21.79 vs 19.91), and children who had painful dental experiences reported more fear (30.87 vs 20.00).

CONCLUSION

These results suggest that the CFSS-DS is reliable and valid and operates in China as it does in other cultures. Further studies should include school samples to evaluate children who may not go to the dentist.