Child dental fear as measured with the Dental Subscale of the Children’s Fear Survey Schedule: the impact of referral status and type of informant (child versus parent)

Hypnosis and nitrous oxide impact on the school aged patients' anxiety and cooperation candidate for tooth extraction: A randomized clinical trial

Background

This randomized clinical trial (RCT) investigated whether hypnosis would lead to favorable outcomes in reducing anxiety, enhancing cooperation, and improving physiological responses in school-aged children undergoing tooth extraction compared to nitrous oxide/oxygen (N2O/O2) and conventional behavior guidance (CBG).

Methods

Sixty-six school-aged children (mean age: 7.87 ± 1.18 years) who needed one posterior primary tooth extraction were included. Children with low-to-moderate anxiety were randomly divided into three groups (n = 22 each): hypnosis, N2O/O2, and CBG. Anxiety levels during and after anesthetic injection and tooth extraction were assessed using the Venham Clinical Anxiety Scale (VCAS) and the Venham Picture Test (VPT). Changes in heart rate (HR) and oxygen saturation (SpO2) were monitored. Children's cooperation levels were measured using the Venham Clinical Cooperation Scale (VCCS).

Results

The VPT scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.001). The VCAS scores in the N2O/O2 group were lower than those in the CBG group (p < 0.05) and were comparable to those in the hypnosis group. The VCCS scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.05). HR changes in the N2O/O2 group were significantly lower than in the hypnosis and CBG groups (p < 0.05). No significant difference in pain was observed between the groups the day after the intervention.

Conclusion

N2O/O2 inhalation and hypnosis are effective in reducing self-reported and observed anxiety and improving cooperation levels in pediatric patients during dental extraction. Moreover, the frequency of reported pain was lower in the hypnosis group compared to the other groups.

Concordance of Fathers and Mothers in the Assessment of Their 5-Year-Old Child's Dental Fear

The aim of this study was to evaluate the concordance of parents' assessments of their child's dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children's Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother-father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen's Kappa coefficients were used in the analyses. The concordance of parents' assessments was poor (Kappa range 0.072-0.258). The majority of parents replied "No Experience" to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child's fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent's assessment, and whether or not the child has experience with the question asked should also be considered.

Evaluation of Children's Anxiety Level in Relation to a Dental Visit/Treatment and Their Parents' Dental Fear

The patients' fear of the dentist plays an important role in the everyday life of a dentist. The anxiety level of children in relation to dental treatment/visits and to their parents' dental fear was evaluated in three different centers. Assessments of a modified CFSS-DS (mCFSS-DS) were performed by questionnaire with 60 children and their parents. Children's dmft/DMFT scores, age and gender were evaluated in relation to the parents' perception of their child's anxiety levels. For statistical evaluation, Kruskal-Wallis and Wilcoxon tests as well as Spearman's correlation coefficient (Spearman) were used. The significance level was set at 0.05. There were no significant differences regarding children's mCFSS-DS between the three centers (p = 0.398, Kruskal-Wallis). The parents' mCFSS-DS scores correlated significantly with their children's mCFSS-DS scores (p = 0.004, Spearman). However, the mean mCFSS-DS score of the children was significantly higher than the mean score of parents' perception of their child's anxiety (p = 0.000, Wilcoxon). The age of the child had an influence on the mCFSS-DS score (p = 0.02, Kruskal-Wallis) but neither the children's gender (p = 0.170, Kruskal-Wallis), nor the dmft/DMFT showed an impact (p < 0.725, Spearman). Although a positive correlation was found between the results of the children's and parents' questionnaire, many parents underestimated the anxiety level of their children.

Interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety: a Chinese cross-sectional study

BACKGROUND

Children's dental anxiety is common in dental clinics. This study aimed to determine the interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety and its affecting factors.

METHODS

In this cross-sectional study performed in a dental clinic, primary school students and their mothers were assessed for enrollment eligibility. The Modified Dental Anxiety Scale plus Facial Image Scale (MDAS-FIS) was employed to test both the children's self-reported and their mothers' proxy-reported dental anxiety independently. The interrater agreement was analyzed using percentage agreement and the linear weighted kappa (k) coefficient. Factors affecting children's dental anxiety were analyzed using univariate and multivariate logistic regression models.

RESULTS

One hundred children and their mothers were enrolled. The median ages of the children and mothers were 8.5 and 40.0 years old, respectively, and 38.0% (38/100) of the children were female. The scores of children's self-reported dental anxiety were significantly higher than their mothers' proxy-reported dental anxiety (MDAS-Questions 1-5, all p < 0.05); moreover, there was no agreement between the two groups in terms of all anxiety hierarchies (kappa coefficient = 0.028, p = 0.593). In the univariate model, a total of seven factors (age, gender, maternal anxiety, number of dental visits, mother's presence or absence, oral health status, and having siblings or not) were involved for analysis, and age [every 1-year increase, odds ratio (OR) = 0.661, 95% confidence interval (CI) = 0.514-0.850, p = 0.001], several dental visits (every 1 visit increase, OR = 0.409, 95% CI = 0.190-0.880, p = 0.022), and mother presence (OR = 0.286, 95% CI = 0.114-0.714, p = 0.007) were affecting factors. In the multivariate model, only age (every 1 year increase) and maternal presence were associated with 0.697-fold (95% CI = 0.535-0.908, p = 0.007) and 0.362-fold (95% CI = 0.135-0.967, p = 0.043) decreases in the risk of children's dental anxiety during dental visits and treatment, respectively.

CONCLUSION

There was no significant agreement between elementary school students' self-reported dental anxiety and mothers' proxy ratings of children's dental anxiety, which suggests that self-reported dental anxiety by children should be encouraged and adopted, and the mother's presence during dental visits is strongly recommended.

Dental patient-reported outcomes following traumatic dental injuries and treatment: A narrative review

Dental patient-reported outcomes (dPROs) are self-reported descriptions of a patient's oral health status that are not modified or interpreted by a healthcare professional. Dental patient-reported outcome measures (dPROMs) are objective or subjective measurements used to assess dPROs. In oral healthcare settings, the emphasis on assessing treatment outcomes from the patient's perspective has increased and this is particularly important after traumatic dental injuries (TDIs), as this group of injuries represent the fifth most prevalent disease or condition worldwide. The purpose of this review is to summarize the current use of dPROs and dPROMs in the field of dental traumatology. Oral Health-Related Quality of Life, pain, swelling, aesthetics, function, adverse effects, patient satisfaction, number of clinical visits and trauma-related dental anxiety are the key dPROs following TDIs. Clinicians and researchers should consider the well-being of patients as their top priority and conduct routine evaluations of dPROs using measures that are appropriate, accurate and reflect what is important to the patient. After a TDI, dPROs can assist clinicians and patients to choose the best management option(s) for each individual patient and potentially improve the methodology, design and relevance of clinical studies.

Held still or pressured to receive dental treatment: self-reported histories of children and adolescents treated by non-specialist dentists in Hordaland, Norway

Aim

This study aimed to estimate the prevalence of a self-reported history of restraint in children and adolescents when receiving dental care by non-specialist dentists and to assess differences in dental fear and anxiety (DFA), intra-oral injection fear, and trust in dentists between patients with and without a self-reported history of restraint.

Methods

An electronic cross-sectional survey was distributed to all 9 years old (n = 6686) and 17 years old (n = 6327) in the Public Dental Service in Hordaland County, Norway, in 2019. For statistical evaluation, we generated descriptive statistics and Mann–Whitney U tests.

Results

The response rate ranged between 43.5 and 59.9% for the different questions. The prevalence of a self-reported history of being held still against one’s will during dental treatment and pressured to undergo dental treatment against one’s will was 3.6% and 5.1%, respectively. In general, these patients reported higher DFA, and higher intra-oral injection fear compared with those without such histories of restraint. Patients who had reported being held still against their will during dental treatment had significantly higher distrust in dentists than those who did not report restraint (p < 0.001).

Conclusion

To feel pressured to receive dental treatment and to be held still against one’s will overlap with the concepts of psychological and physical restraint. Patients with a self-reported history of restraint recorded significant differences in DFA, intra-oral injection fear, and trust in dentists compared to those who did not report restraint. Future studies should explore the role that restraint may play in relation to a patient’s DFA, intra-oral injection fear, and trust in dentists.

Patient-self-reported history of restraint among 17-year-olds: a retrospective study of records by non-specialist dentists in the public dental service in Hordaland, Norway

PURPOSE

The primary purposes were to examine dental records of Norwegian adolescents' with and without self-reported history of restraint for information about oral health (DMFT), total scheduled time in the Public Dental Service (PDS) (dental appointments, cancelled and missed appointments), and reluctant behaviour and/or dental fear and anxiety (DFA). Another purpose was to explore their dental records for information recorded by the dentist concerning the use of restraint.

METHODS

Data on patient-self-reported history of restraint and DFA were collected in a population-based cross-sectional survey of 17-year-olds in the PDS in Hordaland, Norway, 2019. Patients were divided into two groups: self-reported restraint group (N1 = 26) and self-reported non-restraint group (N2 = 200). Data on oral health and dental treatment, total scheduled time of the PDS, reluctant behaviour or DFA, and information on the use of restraint were extracted from the dental records written by non-specialist dentists using a pre-set protocol covering the period from 2002 to 2019.

RESULTS

A total of 206 dental records were analysed. Adolescents with self-reported history of restraint (n1 = 18) had higher DMFT and greater descriptions of reluctant behaviour and/or DFA, and total scheduled time compared with the self-reported non-restraint group (n2 = 188). The use of restraint was recorded in the dental records of one patient from the self-reported restraint group and in two patients from the self-reported non-restraint group.

CONCLUSIONS

The adolescents with self-reported history of restraint had higher DMFT, higher scheduled time attending the PDS, and had more descriptions of reluctant behaviour and/or signs of DFA compared with the self-reported non-restraint group. The patient records contained limited information concerning restraint, and there were significant discrepancies between patient-self-reported history of restraint and the recording of restraint by the dentist in the patients' records.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

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.

Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial

OBJECTIVES

To compare treatment time, patients' perceptions during orthodontic treatment, dental fear and side effects, between open and closed surgical exposures in patients with palatally displaced canines (PDCs).

TRIAL DESIGN

Multicentre, randomized controlled trial, with random 1:1 allocation of two parallel groups.

MATERIALS AND METHODS

One hundred and twenty patients from three different orthodontic centres were randomized into one of the two intervention arms, open or closed surgical exposure. Both techniques had mucoperiosteal flaps raised and bone removed above the PDCs. In open exposure, tissue was removed above the canine, and glass ionomer - reaching above soft tissue - was built on the crown. The canine was then left to erupt spontaneously, prior to orthodontic alignment. At closed exposure, a chain was bonded to the canine and orthodontic traction was applied under the mucosa until eruption. Orthodontic alignment of the canines was undertaken after eruption into the oral cavity, with fixed appliances in both groups. All participants were treated according to intention to treat (ITT).

BLINDING

Due to the nature of this trial, only outcome assessors could be blinded to the intervention group.

RESULTS

One hundred and seventeen patients completed the trial. All PDCs were successfully aligned. Total treatment time was equal in the two techniques, mean difference -0.1 months (95% CI -3.2 to 2.9, P = 0.93). The closed group experienced more pain and discomfort during the active orthodontic traction. Dental fear, root resorption and periodontal status did not show any clinically significant differences between the groups.

GENERALIZABILITY

Results of this randomized controlled trial (RCT) can be generalized only to a similar population aged 9-16 years, if exclusion criteria are met.

CONCLUSION

The closed exposure group experienced more pain and discomfort mostly during active orthodontic traction. All other studied outcomes were similar between the two exposure groups.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

Children's dental anxiety (self and proxy reported) and its association with dental behaviour in a postgraduate dental hospital

PURPOSE

Child dental anxiety (CDA) and uncooperative dental behaviour are common. We aimed to assess the prevalence of CDA (self- and proxy- reported) in the United Arab Emirates (UAE) children related to their dental behaviour.

METHODS

Data were collected from 312 questionnaires obtained from 156 parent/child (mean age 9.95 ± 2.17 years) pairs attending a postgraduate dental hospital. Demographics, self/proxy- reported CDA scores via a six-question, five-point Likert scale, of the Modified CDA Scale-faces version (MCDAS-f: where ≥ 19 was severe CDA) and Frankl Behaviour Rating Scale (FBRS) scores were compared and analysed. Chi-square test, Pearson's correlation, Kappa- coefficient, one-way ANOVA and independent t test statistical analysis were used (p < 0.05).

RESULTS

The prevalence of self and proxy severe CDA was 22.4% (n = 35) and 33.3% (n = 52) respectively, with 9% (n = 14) being dentally- uncooperative. In both groups, extractions caused the highest CDA followed by injections and fillings (p < 0.001). The mean scores for self-reported/proxy-reported CDA were 15.02 (± 4.90)/15.70 (± 6.07) respectively. There was a positive linear correlation between self- and proxy- reported CDA scores and a negative linear correlation between self/proxy- reported CDA scores and the FBRS (p < 0.001). Self/proxy concordance of severe anxiety/none-to-moderate- anxiety was fair (68.6%, kappa = 0.23, p = 0.003). Both self/FBRS and proxy/FBRS concordance of severe anxiety/none-to-moderate- anxiety/behaviour was fair (78.8%, kappa = 0.23, p = 0.001) and (71.8%, kappa = 0.22, p < 0.001) respectively.

CONCLUSIONS

Considering the limitations of the present study in a UAE child population sample, the prevalence of CDA from extractions, injections and fillings was 22.4% (self- reported) and 33% (proxy reported). There was fair agreement between child- self and parent- proxy- reported CDA. Increased CDA led to uncooperative dental behaviour.

Dental Fear and Anxiety of Kindergarten Children in Hong Kong: A Cross-Sectional Study

Objectives: The objectives of this cross-sectional study were to investigate the fear level of kindergarten children in the general population during dental outreach in a familiar kindergarten setting, and to explore the factors associated with the dental fear of kindergarten children. Method: Consecutive sampling method was used to select kindergarten children aged 3 to 5 to participate in a questionnaire survey and an outreach service. A behavioural observation type of instrument for dental fear and anxiety assessment-Frankl Behaviour Rating Scale (FBRS)-was chosen to investigate the fear level of the children. Bivariate analyses between various factors and children's dental fear and anxiety were carried out using Chi-square test. Results: A total of 498 children participated in this study. Almost half (46%) of the children have had caries experience, and the mean dmft score was 2.1 ± 3.4. The prevalence of dental caries was 32%, 43%, and 64% in the 3-, 4- and 5-year-olds, respectively. Only 4% of the children scored negatively for dental fear and anxiety (95% CI 2.3%-5.7%). Children at three years of age displayed more dental fear and anxiety than children of older ages, but the difference in dental fear and anxiety among the genders and caries status was not statistically significant. Most of the children (92%) brushed daily, but only 20% of them used toothpaste. Most (85%) of them had never visited the dentist, and over 70% of them were mainly taken care by their parents. High levels of positive and cooperative behaviour and low levels of fear were found in this population. No statistical significance was found between the child's dental fear and any factors except age. Conclusion: Children generally displayed low fear or anxiety levels in a dental outreach consisting of a non-invasive oral examination and preventive treatment in a familiar kindergarten setting. Conducting regular outreach dental services to kindergartens by providing oral examination and simple remineralisation therapies could be a promising strategy to not only control childhood caries, but also manage and reduce dental fear and encourage long term dental attendance in line with the medical model.

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.

A single-centre investigator-blinded randomised parallel-group study protocol to investigate the influence of an acclimatisation appointment on children's behaviour during N2O/O2 sedation as measured by psychological, behavioural and real-time physiological parameters

AIMS AND OBJECTIVES

To describe a study protocol of a randomised control trial (RCT) assessing the effectiveness, in reducing dental anxiety, of an acclimatising nitrous oxide sedation (N₂O) session prior to actual dental treatment with N₂O.

MATERIALS AND METHODS

A single-centre investigator-blinded parallel-group RCT conducted in a postgraduate dental hospital in Dubai, United Arab Emirates (UAE). Anxious children requiring N₂O (aged 5-15 years) will be randomly assigned to; a study group: children who will have a preparatory N₂O trial experience or; a control group: children who will only have N₂O explained to them. Treatment with N₂O for both groups will start at the second visit. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment (using the Modified Child Dental Anxiety Scale faces), behaviour of the child (using Frankl Rating Behaviour Scale) and the acquisition of real-time physiological anxiety-related parameters (using E4^® electronic wrist devices).

RESULTS

The data will be analysed statistically.

DISCUSSION

There is a paucity of research regarding dental N₂O acclimatising appointments. This RCT will supplement existing literature.

CONCLUSIONS

This RCT will report whether prior acclimatising of a child to N₂O sedation is effective, or not, in improving dental treatment behaviour.

Child dental fear and past dental experience: comparison of parents' and children's ratings

PURPOSE

To compare the parental and child versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the parental and child evaluations of the Child's Past Dental Experience (CPDE) in 4- to 12-year-old children in a sample from Greece.

METHODS

537 families (652 children) with 4- to 12-year-old children seeking dental care either at a University paediatric dental clinic (UC) (50.8%) or a paediatric private practice (PP) participated. Parents completed a sociodemographic questionnaire and the parental Greek version of the CFSS-DS, and children independently completed the child's Greek version. All family members answered questions about CPDE. Statistical analyses were based on multilevel models (p < 0.05).

RESULTS

Mothers' and fathers' mean CFSS-DS total scores were not significantly different from each other (p = 0.655), but were significantly higher than the scores of their sons and daughters (p < 0.001), regardless of the child's age. There was a negative association between mother's age and CFSS-DS agreement, but not for fathers. There was poor agreement for CPDE ratings between children and both parents, regardless of gender. Parents' ratings of CPDE were not related to their assessment of their children's dental fear, whilst the children's ratings of their CPDE were significantly related to their current dental fear. Location (UC or PP) had no significant influence on CFSS-DS or CPDE parental-child differences.

CONCLUSIONS

Both parents overestimated their sons' and daughters' dental fear. There was poor agreement on CPDE evaluation between parents and children. Parental CFSS-DS and CPDE evaluations are poor indicators of children's dental fear and prior dental experience.

Agreement between children and parents in rating oral health-related quality of life using the Swedish versions of the short-form Child Perceptions Questionnaire 11-14 and Parental Perceptions Questionnaire

Objective: To explore the agreement between children and parents on children's oral health-related quality of life (OHRQoL) when using the Swedish short forms of CPQ_11-14 and P-CPQ, and to evaluate the impact on agreement of oral health including malocclusion and background characteristics (dental fear, family situation, gender of informant). Material and methods: A total of 257 children and their accompanying parents were asked to fill in the Swedish versions of the short-form CPQ_11-14 and P-CPQ separately in connection with a clinical examination. Results: The participants comprised 247 child-parent pairs: 116 (47%) boys, 131 (53%) girls, 166 (67%) mothers and 81 (33%) fathers. The agreement between the child and parental ratings of the children's OHRQoL was low, with an ICC of 0.22 (95% CI: 0.04-0.37) for the total scale. Conclusions: There was a low agreement between children's and parents' answers. For best care, it is advisable to consider perceptions of both children and parents because they can complement each other in estimating the child's OHRQoL.

A study protocol of a single-center investigator-blinded randomized parallel group study to investigate the effect of an acclimatization visit on children's behavior during inhalational sedation in a United Arab Emirates pediatric dentistry postgraduate setting as measured by the levels of salivary Alpha Amylase and Cortisol

INTRODUCTION

Inhalation sedation is a proven safe method for reducing children's dental anxiety and has been used worldwide for decades. There is controversy regarding the use of acclimatization or familiarization visits for dental sedation treatment pathways for children. This may increase acceptance to the treatment based on desensitization and acclimatization principles underpinning many behavior management techniques. This study aims to identify whether, an inhalation sedation acclimatization visit is effective in reducing the stress level in anxious children as measured by salivary Alpha Amylase and Cortisol levels.

METHODS

The study is a single-center, single blinded, parallel group 2 arm clinical trial. Children in need of inhalation sedation aged 5 to 15 years from September 2019 through March 2020 attending the Postgraduate Pediatric Clinic at the Hamdan Bin Mohammed College of Dental Medicine, in Dubai, will be allocated randomly and equally to either:At the initial visit a salivary sample will be collected at the beginning of the visit and the sedation need score will be recorded using the pediatric indicator of sedation need. Treatment for both groups will commence at the second visit. Salivary samples will be collected 15 minutes before the start of the treatment and 15 minutes after the conclusion of the treatment. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment using Frankl rating behavior scale and physiological anxiety related changes will be recorded using salivary Alpha Amylase and Cortisol levels. Mean changes of physiologic anxiety levels and corresponding 95% confidence intervals will be determined to compare the 2 treatments (sedation with familiarization and sedation without familiarization).

DISCUSSION

This is will be the first study to measure the effect of the acclimatization visit of nitrous oxide inhalation sedation on the level of physiological anxiety and the behavior of the pediatric patients during treatment.

Factors Associated with Dental Fear and Anxiety in Children Aged 7 to 9 Years

The aim was to investigate changes in dental fear and anxiety (DFA) and verify factors associated with DFA in children. A longitudinal cohort study that included 160 children aged 7 years was carried out. A questionnaire was completed by parents at two time points and evaluated the immigrant background, maternal education, whether the child had ever had toothache, and whether the parents had dental fear. The oral clinical examination evaluated decayed, extracted, and filled primary teeth (deft). The children’s fear survey schedule dental subscale (CFSS-DS) was used to assess the dental fear of the children. Multilevel mixed-effects logistic regressions analyses were used. The CFSS-DS found that 7% of the children had dental fear at age 7 and mean CFSS-DS was 22.9. At 9 years of age, 8% reported dental fear and the mean increased to 25.4. Parental dental fear, experience of toothache, and report of painful dental treatment and caries development between 7 and 9 years of age were factors that were significantly related to development of DFA. There was a change in DFA between 7 and 9 years of age. Dental fear and anxiety is a dynamic process in growing individuals and is significantly related to painful symptoms and experiences of dental care as well as parental dental fear.

Patient-reported outcomes associated with different restorative techniques in pediatric dentistry: A systematic review and MTC meta-analysis

BACKGROUND

Despite the increasing number of studies evaluating patient reported outcome measures (PROs), there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective.

AIM

To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes.

DESIGN

Literature searching was carried out on prospective studies indexed in PubMed, Scopus and OpenGrey. A Mixed Treatment Comparisons (MTC) meta-analysis was undertaken considering the results from reviewed studies. Anxiety, pain and quality of life were extracted as mean with standard deviation, percentage of pain, and mean difference of scores with standard deviation, respectively. For direct comparisons, data were combined using a random-effect model. Heterogeneity was assessed with the I2 statistic. For indirect comparisons, fixed and random effects were chosen through comparison of competing models based on the Deviance Information Criteria (DIC). The expected efficacy ranking based on the posterior probabilities of all treatment rankings was also calculated.

RESULTS

An initial search resulted in 4,322 articles, of which 17 were finally selected. Due to unavailability of data, only pain, anxiety and oral health related quality of life (OHRQoL) were statistically analyzed. The difference in means (95% CI) of anxiety between treatments using only hand instruments with or without chemomechanical agents were -5.35 (-6.42 to -4.20) and -5.79 (-7.77 to -3.79) respectively when compared to conventional treatment using rotary instruments and/or local anesthesia. Regarding pain, there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful. No statistical difference was found intragroup nor among treatments for OHRQoL.

CONCLUSIONS

Anxiety and pain are directly related with more invasive restorative treatments. On the other hand, quality of life is not improved regardless of the restorative technique used. Further well-designed prospective studies regarding PROs in children are still necessary.

Dental fear and anxiety in Estonian and Vietnamese schoolchildren: A comparative study of two populations

Dental fear and anxiety (DFA) has the impact on the development of dental caries. Ethnic background and oral health care system may contribute to DFA model. The aim of the study was to compare DFA in relation to dental health between Estonian and Vietnamese schoolchildren and to determine DFA cutoff point for schoolchildren of two countries. The sample comprised 900 schoolchildren (344 from Estonia and 556 from Vietnam). DFA was measured by using 11 fear items of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Dental health was recorded by using the dental caries experience index of mixed dentition (dmft/DMFT). Results showed that the mean score of dmft/DMFT in Estonian and Vietnamese schoolchildren was 5.2 ± 3.1 and 4.1 ± 3.2, respectively. The mean score of 11-item CFSS-DS of Vietnamese schoolchildren (20.8 ± 9.1) was significantly higher compared with Estonian schoolchildren (15.4 ± 4.4, p < 0.001). The DFA cutoff point of 11-item CFSS-DS in Estonian schoolchildren was 17.5, whereas in Vietnamese, it was 24.5. The lower ranking of DFA was significantly associated with Estonian schoolchildren who had more FT (p < 0.001). In conclusion, the level of DFA of schoolchildren was different in Estonia and Vietnam. Vietnamese schoolchildren had higher DFA scores and cutoff point of the modified CFSS-DS than Estonian schoolchildren. The obtained results suggest that DFA in schoolchildren can be related to oral health care system of each country.

Five years' follow-up of dental fear and anxiety, experience of dental care and oral health behaviour in Swedish preterm and full-term adolescents

Background

There is rising concern about how preterm birth affects long-term health later in life. The various effects that preterm birth have on developmental outcomes, cognitive profiles and medical health may also affect levels of cooperation in the dental care situation in addition to general oral health and other oral health-related habits. Oral health is an integral part of one’s general health and well-being; however, less is known about how prematurity affects oral health and other related areas such as dental care, and including dental fear and anxiety (DFA) in individuals during adolescence and adulthood. This is considered of special interest to study, as preterm children during the preschool and school period were reported to have behavioural problems during dental treatments and less than favourable oral hygiene.

Methods

A questionnaire was used of self-report design and structured into behavioural aspects relating to dental treatment, oral health-related factors, and medical health. This questionnaire at 17–19 years of age was a follow-up from 12 to 14 years of age and considered a predictor for planning future dental care for this group of patients. The 145 participating adolescents were all preterm, born between 23 and 32 weeks of gestation and 140 full-term controls, born ≥37 weeks of gestation.

Results

Dental fear and anxiety, oral health behaviour, and intake of sweets and sugary drinks of 17–19-year old adolescents born preterm was comparable to that of the full-term control group. Medical health problems as well as the intake of sweets and sugary drinks increased from the time of early adolescence to late adolescence in both groups.

Conclusions

Preterm as well as full-term adolescents between 17 and 19 years of age are satisfied with their dental care and display low prevalence of dental fear and anxiety (DFA). The findings in this study indicate that adolescents born very preterm and extremely preterm are well prepared for transition to dental care in adult life with expectations of being able to take responsibility for their oral health.

Evidence of pharmacological and non-pharmacological interventions for the management of dental fear in paediatric dentistry: a systematic review protocol

INTRODUCTION

Several techniques have been proposed to manage dental fear/dental anxiety (DFA) in children and adolescents undergoing dental procedures. To our knowledge, no widely available compendium of therapies to manage DFA exists. We propose a study protocol to assess the evidence regarding pharmacological and non-pharmacological interventions to relieve dental anxiety in children and adolescents.

METHODS AND ANALYSIS

In our systematic review, we will include randomised trials, controlled clinical rials and systematic reviews (SRs) of trials that investigated the effects of pharmacological and non-pharmacological interventions to decrease dental anxiety in children and adolescents. We will search the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of Reviews of Effects=, the Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Web of Science for relevant studies. Pairs of review authors will independently review titles, abstracts and full texts identified by the specific literature search and extract data using a standardised data extraction form. For each study, information will be extracted on the study report (eg, author, year of publication), the study design (eg, the methodology and, for SRs, the types and number of studies included), the population characteristics, the intervention(s), the outcome measures and the results. The quality of SRs will be assessed using the A Measurement Tool to Assess Reviews instrument, while the quality of the retrieved trials will be evaluated using the Cochrane Handbook for Systematic Reviews of Interventions criteria.

ETHICS AND DISSEMINATION

Approval from an ethics committee is not required, as no participants will be included. Results will be disseminated through a peer-reviewed publications and conference presentations.

The Relationship Between Dental Trauma, Anxiety and Aggression Behavior in 7 to14 Year old Children in Kosovo

BACKGROUND AND AIM

Dental fear has a negative impact on the treatment outcomes. The aim of this study was to evaluate dental anxiety among children with different measurement scales, with the aim of getting more precise and thorough estimations, as well as correlation between anxiety scale and aggression scale in children with/or without dental trauma.

MATERIAL AND METHODS

The study population include 254 children's experience with dental trauma (59.1% male), and 251 children without dental trauma (46.6% male), between 7 and 14 years old, and their respective parents were evaluated during 2015-2016. Psychometric measures used for this purpose included several questionnaires. The result was tested with the X² test, Student's t-test, one-way ANOVA, and Pearson's correlation coefficient. The Cronbach alpha was used to check the reliability and validity of the measures. The predetermined significance levels were set at 0.05.

RESULTS

All used test has satisfactory reliability and validity of the scale. The mean anxiety score was significantly higher in children with dental trauma. The children with dental trauma had a higher mean aggression scale (OAS). The girls had significantly higher mean anxiety score than boys in all used questionnaires. The mean aggression score was significantly higher for boys than girls in both compared groups (p<0.001). The Odds of the aggressive behavior in children with dental trauma decrease for 0.95 when the value of the mean DVSS-SV scale is increased by one units, and increase for 1.04 when the means anxiety score increased by one units.

CONCLUSION

The mean anxiety score was significantly higher in children with dental trauma, as well as the girls and children who are more afraid of medical interventions (CMFQ). Also the children with dental trauma, and boys had a higher mean aggression scale (OAS).
Significant correlation was found between dental anxiety level and aggressive behavior of children's. The odds of the aggressive behavior increased with increasing of mean score of each anxiety measurement scale, but not significantly, except for S-DAI score.

Reliability, validity and cutoff score of the Intra-Oral Injection Fear scale

BACKGROUND

A proper assessment tool is needed to gain more knowledge about fear of intraoral injections in children.

AIM

The aims of this study were to evaluate the reliability and validity of the novel Intra-Oral Injection Fear scale (IOIF-s) and to establish a cutoff score for a high level of such fear.

METHODS

Data were obtained from two samples of 10- to 16-year-olds in Hordaland, Norway. Sample I, 1460 pupils attending elementary and high schools, provided questionnaire-based data. The survey instruments used were IOIF-s, Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Mutilation Questionnaire for Children (MQ-c) and Injection phobia Scale for Children (IS-c). Sample II was 67 patients, diagnosed with intraoral injection phobia at the Center for Odontophobia, Oral Health Center of Expertise in Western Norway-Hordaland, who provided IOIF-s data.

RESULTS

Cronbach's alpha was 0.95. The IOIF-s discriminated between subjects with and without intraoral injection phobia and was associated with the other survey instruments of similar construct. Principal component analysis revealed a two-component solution, characterized as 'Contact Fear' and 'Distal Fear'. Receiver-operating characteristic (ROC) curve indicated that a cutoff score of 38 was appropriate.

CONCLUSION

The IOIF-s showed satisfying psychometric properties in terms of reliability and validity.

Prevalence of dental anxiety in 10-14 years old children and its implications

Background

The aim of this study was to provide insight on dental fear amongst schoolchildren and evaluate the association between caries experience and fear of dental procedures.

Methods

A sample size of 250 students (both sexes) of ages 10-14 years were enrolled in the study. Before dental examination, each participant was informed about the study and given the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) questionnaire. Children who scored greater than 38 were included in the 'with dental fear' group and those who scored less than 38 were assigned to the 'without dental fear' group. All oral check-ups were carried out on the school premises according to WHO criteria.

Results

There were 105 children (42%) who experienced dental fear. As CFSS-DS scores increased, scores on the Decayed, Missing and Filled Surfaces Index (DMFS) also increased. Scores were highest on "injections" followed by "dentist drill" and "feeling of choking". Children were significantly less anxious about items of dental treatment if they had experienced that particular form of treatment. Female participants were found to be more dentally anxious than the male participants.

Conclusions

The data revealed dental fear in 10-14 years old children and showed that dental fear scores decreased with increase in age and experience.

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.

Sensory Adapted Dental Environments to Enhance Oral Care for Children with Autism Spectrum Disorders: A Randomized Controlled Pilot Study

This pilot and feasibility study examined the impact of a sensory adapted dental environment (SADE) to reduce distress, sensory discomfort, and perception of pain during oral prophylaxis for children with autism spectrum disorder (ASD). Participants were 44 children ages 6-12 (n = 22 typical, n = 22 ASD). In an experimental crossover design, each participant underwent two professional dental cleanings, one in a regular dental environment (RDE) and one in a SADE, administered in a randomized and counterbalanced order 3-4 months apart. Outcomes included measures of physiological anxiety, behavioral distress, pain intensity, and sensory discomfort. Both groups exhibited decreased physiological anxiety and reported lower pain and sensory discomfort in the SADE condition compared to RDE, indicating a beneficial effect of the SADE.

Predicting children's behaviour during dental treatment under oral sedation

AIMS

The primary aim of this study was to assess whether parents' own anxiety and their perception of their child's dental fear and child's general fear can predict preoperatively their child's behaviour during dental treatment under oral sedation. The secondary aim was to assess whether the child's age, gender and ASA classification grade are associated with a child's behaviour under oral sedation.

STUDY DESIGN

Cross-sectional prospective study.

METHODS

The Corah's Dental Anxiety Scale (DAS), Children's Fear Survey Schedule Dental-Subscale (CFSS-DS) and Children's Fear Survey Schedule Short-Form (CFSS-SF) questionnaires were completed by parents of children undergoing dental treatment with oral midazolam. Behaviour was rated by a single clinician using the overall behaviour section of the Houpt-Scale and scores dichotomised into acceptable or unacceptable behaviour. Data were analysed using χ (2), t test and logistic regression analysis.

RESULTS

In total 404 children (215 girls, 53 %) were included, with the mean age of 4.57 years, SD = 1.9. Behaviour was scored as acceptable in 336 (83 %) and unacceptable in 68 (17 %) children.

STATISTICS

The level of a child's dental fear, as perceived by their parent, was significantly associated with the behaviour outcome (p = 0.001). Logistic regression analysis revealed that if the parentally perceived child's dental fear (CFSS-DS) rating was high, the odds of the child exhibiting unacceptable behaviour under oral sedation was two times greater than if their parents scored them a low dental fear rating (OR 2.27, 95 % CI 1.33-3.88, p = 0.003).

CONCLUSIONS

CFSS-DS may be used preoperatively to help predict behaviour outcome when children are treated under oral sedation and facilitate treatment planning.

Longitudinal Changes in Dental Fear and Coping Behavior in Children, Adolescents, and Young Adults with Cleft Lip and/or Cleft Palate

Objective

To determine changes in dental anxiety levels of cleft lip and/or palate (CL/P) children and to explore the role of coping strategies in the development of their dental anxiety.

Design

Prospective study.

Setting

Free University Medical Center Amsterdam.

Patients

A sample of CL/P children (at T1: n = 153, 4 to 18 years, 67 girls; at T2: n = 113, 7 to 21 years, 51 girls). Data were available at both time points for 102 children.

Measures

Dental anxiety and coping strategies were assessed at the start of the study (T1; mean age: 9.8 years, standard deviation 4.1) and 3 years later (T2; mean age: 13.4 years, standard deviation 3.8). These scores were compared to a normative group of Dutch children.

Main Outcome Measure(s)

The severity of dental anxiety was indexed using the Parental Version of the Dental Subscale of the Children's Fear Survey Schedule. Dental coping strategies were assessed with the Dental Cope Questionnaire.

Results

Overall, dental anxiety decreased to a level equal to normative scores of Dutch children. However, 5% of the children became more anxious. At T2, children used significantly fewer coping strategies. Children whose level of dental anxiety increased significantly used more destructive coping strategies than children whose level of dental anxiety decreased significantly or remained stable.

Conclusions

Results suggest that dental anxiety levels of most CL/P children gradually decline over time. Whereas some coping strategies have the potential to be protective, more destructive coping strategies may put children at greater risk for developing and maintaining their dental anxiety.

Dental fear and previous childhood traumatic experiences, life events, and parental bonding

We aimed to determine whether adult dental fear is associated with traumas, life events, and perceived parental bonding. Pilot data for the FinnBrain Cohort study were used. Of the 254 families expecting a baby, 80% agreed to participate. At 32-34 wk of pregnancy, 125 women and 81 men completed a Modified Dental Anxiety Scale questionnaire and were included in this study. Other instruments used were the Trauma and Distress Scale (TADS), the Life Event Checklist, and the Parental Bonding Index. All scales were analyzed as summated rating scale scores. Associations between dental fear, TADS domains, and life events were evaluated using Spearman correlation coefficients. The association between dental fear and parental bonding was evaluated using the Kruskal-Wallis test. Among women, dental fear did not correlate with trauma measures, but among men dental fear correlated with emotional neglect and abuse. Dental fear correlated positively with the number of life events among women. Life events and dental fear did not correlate among men. Dental fear was not associated with parental bonding among women or men. The association between traumas, life events, and dental fear seems to be different in women and men.

Individual changes in dental fear among children and parents: a longitudinal study

OBJECTIVE

The aim was to study longitudinal changes in dental fear among children and one of their parents separately for girls, boys, mothers and fathers over a 3.5-year period.

MATERIALS AND METHODS

11-12-year-old children in Pori, Finland (n = 1691) and one of their parents were invited to participate in this longitudinal study. Dental fear was measured in 2001, 2003 and 2005 when the children were 11-12, 13-14 and 15-16-years-old, respectively. The participants were asked if they were afraid of dental care (1 = 'not afraid', 2 = 'slightly afraid', 3 = 'afraid to some degree', 4 = 'quite afraid', 5 = 'very afraid' and 6 = 'I don't know'). The participants' gender was also registered. Mean values of the change scores were studied. Prevalence and incidence of dental fear and changes in dichotomized dental fear (responses 4-5 = high dental fear and responses 1-3 = low dental fear) were studied using cross-tabulations and Cochran's Q test.

RESULTS

Overall, the prevalence of dental fear slightly increased and female preponderance in dental fear became more evident during the follow-up. Of the mothers and children with high dental fear at the baseline, 24% and 56%, respectively, reported not to be fearful at the end of the follow-up.

CONCLUSIONS

Dental fear seems to be more stable in adulthood than in childhood. Thus, it might be better to intervene in dental fear during childhood rather than during adulthood.

Children's and parents' attitudes towards dentists' appearance, child dental experience and their relationship with dental anxiety

AIM

To evaluate child and parental attitudes towards dentists' appearance, subsequently related to a child's dental experience and their association with child's anxiety levels.

METHODS

402 parent-child pairs were surveyed using interviewer-administered questionnaires at the School Dental Service, Health Promotion Board, Singapore. Standardised pictures of models with different attires, ages, genders and ethnicities were shown to the parent-child pairs. Information on each child's dental experience was obtained. Parental proxy was used to evaluate the children's dental fear levels based on the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS).

RESULTS

Personal protective equipment (PPE) was the attire of choice for both parents and children, followed by the paediatric coat. Formal and informal attire was least preferred by children and parents, respectively. Parents preferred female dentists to treat their child, whereas children preferred a dentist of the same gender (p < 0.001). Parent's and child's preferences for the child's dentist's appearance were shown to be significantly different (p < 0.001). CFSS-DS scores were also significantly associated with the number of previous dental visits (p = 0.002) as well as a history of extractions (p = 0.02), but not with child's demographics, dmft or preference for dentist's appearance (p > 0.05).

CONCLUSION

Regardless of child anxiety levels, the PPE followed by paediatric coats were preferred over other choices of dentists' attire. Children tended to choose a dentist who was of a younger age, and of the same gender and ethnicity as themselves. Parents tended to choose younger, female dentists of the same ethnicity as themselves. Subjective experience of extractions, as well as multiple dental visits appeared to play a more significant role in the development of dental fear than dental caries experience per se.

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

Rasch analysis was used to examine the validity of the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS). Data were collected from parents of children in regular dental care (n = 240) and from parents of children referred to a specialized pediatric dental clinic (n = 200). The Rasch model is a probabilistic model in which estimations are based on the relationship between person ability and item difficulty, and the present study investigated the validity of the CFSS-DS through analysis of person and item fit, dimensionality, ordering of thresholds, local dependency, and differential item functioning. The results show multidimensionality of the original scale, and an adjusted version consisting of six items with good fit to the model is suggested. The adjusted scale makes interval-level analysis possible, and time efficiency and elimination of previously criticized items argue in favor of the adjusted scale.

Measuring dental fear using the CFSS-DS. Do children and parents agree?

BACKGROUND

In most studies, the parental version of the CFSS-DS is used; however, no information is available concerning the extent to which parents are able to report dental fear on behalf of their children.

AIM

This study aims to assess whether parents are accurate reporters of their child's dental fear.

METHODS

The CFSS-DS was filled out by 326 children in a classroom setting and by 167 parents (mostly mothers) at home on behalf of their child. Intraclass correlation coefficients were used as a measure of agreement between both CFSS-DS versions, and reasons for nonagreement were assessed.

RESULTS

Mean CFSS-DS for children was 21.15 (SD = 6.4) and for parents 23.26 (SD = 6.7). The intraclass correlation coefficient was 0.57. After selection of the 73.1% most accurate reporting parents, the ICC was 0.90. In general, parents estimate the dental fear of their children higher than their children do (P ≤ 0.001), whereas parents of high anxious children (HAC) estimate this fear lower, and parents of low anxious children (LAC) estimate this fear higher. Anxious parents (AP) estimate the dental fear of their children significantly higher than nonanxious parents (NAP) (P ≤ 0.001), but the children of AP do not estimate their own dental fear higher than children of NAP.

CONCLUSIONS

In general, parents tend to estimate the dental fear of their children slightly higher than their children.

Treatment outcomes and dental anxiety in 18-year-olds with MIH, comparisons with healthy controls - a longitudinal study

BACKGROUND

In a previous study, 9-year-old children with severe Molar Incisor Hypomineralization (MIH) had undergone dental treatment of their first molars nearly ten times as often as children in a control group. They also showed more management problems (BMP) and fear and anxiety (DFA).

AIM

To assess the long-term outcomes of dental treatments, dental anxiety, and patients' satisfaction in adolescents with MIH.

DESIGN

Sixty-seven patients, identical with those in the baseline study, were studied at age 18-years. The participants answered the Children's Fear Survey Schedule - Dental Subscale the Dental Visit Satisfaction Scale (DVSS). Data were compiled from the dental records concerning dental health, number of restorative treatments and BMP.

RESULTS

Molar Incisor Hypomineralization group had a significantly higher DMFT, and had undergone treatment of their permanent first molars 4.2 times as often as the controls. BMP was still significantly more common in the MIH group. However, DFS was reduced in MIH group and increased in the control groups. The DVSS scores did not differ between the groups. Conclusions.  Patients with severe MIH had a poorer dental health and were still more treatment consuming at age 18-years. However, their dental fear was now at the same level as the controls.

Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists

BACKGROUND. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. AIM. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. DESIGN. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. RESULTS. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. CONCLUSIONS. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety.

Dissimilarity in vulnerability: self-reported symptoms among children with experiences of intimate partner violence

Children with experiences of intimate partner violence (IPV) are at risk. Not all children, however, display symptoms, and differences connected to gender and age have been demonstrated. In this exploratory study, children's own reports of symptoms were used. The 41 recruited children, between 7 and 19 years old, were entered into a group program specially directed toward children with experiences of IPV. These children reported experiencing more symptoms overall when compared with non-exposed children. The relationship to the abuser and children's symptoms related differently for boys and for girls. Girls who had continued contact with the abusive father described more mental health problems than did other girls exposed to IPV and more than did boys with continued contact. Among children with experiences of custody disputes or other judicial processes, age rather than gender was connected to differences in self-reported symptoms. Younger children with experiences of judicial processes reported more mental health problems than did those with no experience.

Significant relationship between parental and child dental fear

DATA SOURCES

The databases CINAHL, EMbase, Medline, PsycINFO, Cochrane/DARE EBM were searched using OVID together with the reference lists of retrieved papers.

STUDY SELECTION

Studies in English and German which investigated the relationship between parental and child dental fear and included children and young people aged 0-19 years were included. Particular emphasis was placed on studies which used established behaviour and anxiety measures to assess parental and child dental anxiety or child behaviour.

DATA EXTRACTION AND SYNTHESIS

A qualitative synthesis of the included studies was conducted with those studies which provided sufficient quantitative estimates of association between parental and child measures to enable transformation into effect sizes being used in a meta-analysis. A random-effects model was used.

RESULTS

Forty-three studies were included from across the six continents. The studies ranged widely with respect to research design, methods used, age of children included and the reported link between parental and child dental fear. The majority of studies confirmed a relationship between parental and child dental fear. This relationship is most evident in children aged 8 years and under. A meta-analysis confirmed an association between parental and child dental fear.

CONCLUSIONS

The narrative synthesis as well as the meta-analysis demonstrate a significant relationship between parental and child dental fear, particularly in children aged 8 years and under.

Can parents and children evaluate each other's dental fear?

The aim of this study was to determine whether parents and their 11-16-yr-old children can evaluate each other's dental fear. At baseline the participants were 11-12-yr-old children from the Finnish Cities of Pori (n = 1,691) and Rauma (n = 807), and one of their parents. The children and their parents were asked if they or their family members were afraid of dental care. Fears were assessed using single 5-point Likert-scale questions that included a 'do not know' option. Children and parents answered the questionnaire independently of each other. Background variables were the child's and their parent's gender. Parents' and children's knowledge of each other's dental fear was evaluated with kappa statistics and with sensitivity and specificity statistics using dichotomized fear variables. All kappa values were < 0.42. When dental fear among children and parents was evaluated, all sensitivities varied between 0.10 and 0.39, and all specificities varied between 0.93 and 0.99. Evaluating dental fear among fearful children and parents, the sensitivities varied between 0.17 and 0.50 and the specificities varied between 0.85 and 0.94, respectively. Parents and children could not recognize each other's dental fear. Therefore, parents and children cannot be used as reliable proxies for determining each other's dental fear.