Prevalence of dental anxiety among 5- to 8-year-old Taiwanese children

Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis

BACKGROUND

Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12.

METHOD

A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses.

RESULT

A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children.

CONCLUSIONS

The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.

Possible Risk Factors for Dental Fear and Anxiety in Children Who Suffered Traumatic Dental Injury

BACKGROUND

Children who undergo painful experiences such as traumatic dental injury (TDI) during their early years are more likely to be at an increased risk of developing dental fear and anxiety (DFA). The purpose of this study was to identify potential risk factors for DFA of these children.

METHODS

The study participants were 220 parents/caregivers and their children who experienced TDI. Their socio-demographic backgrounds were investigated with the modified WHO Oral Health Questionnaire for Children that included questions about parents' knowledge and attitudes, while the DFA level was determined using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Simplified Oral Hygiene Index (OHI-S Index) was used to assess oral hygiene status.

RESULTS

The confirmed risk factors are parental knowledge, female gender, and degree of oral hygiene and pain in the last three months, while age, type of TDI, presence of soft-tissue injury, and number of subjective complaints were not confirmed. The overall model predicted approximately 54% of variance in DFA, R2 = 0.545, F (4.215) = 64.28 p < 0.001.

CONCLUSIONS

These findings emphasise the importance of addressing pain management, improving oral hygiene, and enhancing parental knowledge to mitigate DFA in children with TDIs.

Does Dental Fear in Children Predict Untreated Dental Caries? An Analytical Cross-Sectional Study

Despite free health care services in Saudi Arabia, the prevalence of caries in children is substantially greater in comparison to other high-income countries. Dental fear in children may be an important issue that needs attention. Therefore, the aim was to investigate the role of dental fear in predicting untreated dental caries in schoolchildren. This analytical cross-sectional study included children aged 8–10 years residing in Saudi Arabia. Dental status via oral examinations was surveyed with the WHO standardized chart and the Children Fear Survey Schedule—Dental Subscale was used to score dental fear. Descriptive, binary, and multivariable logistic regression analyses were performed to report the findings at 5% statistical significance. Overall, there were 798 schoolchildren with an average fear score of 36. Nearly 70.4% reported fear of someone examining their mouth. About 76.9% had at least one carious tooth in their oral cavity. Children with dental fear were 1.8 times (OR = 1.80; 95% CI = 1.26, 2.56) more likely to have at least one untreated carious tooth in their oral cavity than those who did not express fear during oral examinations and dental procedures. Thus, the current study concludes that fear of dentists and dental treatment procedures successfully predicts untreated carious teeth in schoolchildren.

Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses

BACKGROUND

Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time.

AIM

To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence.

DESIGN

Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879).

RESULTS

Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents.

CONCLUSION

DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

Prevalence of Dental Fear and Anxiety among Russian Children of Different Ages: The Cross-Sectional Study

OBJECTIVE

 Children's dental fear may lead to an avoidance of seeking dental care or disruptive behavior during treatment. The study was aimed to evaluate the prevalence and scores of dental fear and anxiety (DFA) among Russian children of different ages with an experience of dental treatment.

MATERIALS AND METHODS

 The cross-sectional study included 371 children aged 2 to 17 years. Study participants were divided into three groups according to their age: 112 "preschool children" aged 2 to 5 years, 137 "school children" aged 6 to 11 years, and 122 "adolescents" aged 12 to 18 years. The questionnaires were distributed at reception areas of the dental clinic to parents of children aged 2 to 5 years and to the older children themselves.

STATISTICAL ANALYSIS

Data analysis was performed using SPSS version 15.0. The parametric tests were used (one-way ANOVA, Student's t-test, and Pearson's correlation) because of the expected sample of more than 100 observations. The chi-square test was used for categorical variables.

RESULTS

The data have shown that 93.8% of the Russian child population visiting dental offices suffer mostly from moderate (11.85) levels of DFA. DFA was more often revealed in girls and among the youngest children aged 2 to 5 years.

CONCLUSIONS

 According to the obtained results, children were more afraid of "tooth drilling" and an "injection of local anesthetic" than other factors mentioned in the questionnaires. Fear of dental treatment is common among Russian children, and the factors associated with it differ with the gender and age of the child.

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.

Reliability and Validity of Scales for Assessing Child Dental Fear and Anxiety

Introduction

Children with high dental anxiety display uncooperative behavior during dental procedures. Different self-assessment questionnaires are in use to estimate the prevalence of dental fear and anxiety (DFA) in children but they need to be tested for reliability and validity in different populations.

Objectives

The aim of this study was to test the reliability and validity of two scales for the assessment of child dental fear and anxiety in a sample of Croatian children.

Material and Methods

The sample comprised 202 pairs consisting of children and their mothers (97 boys and 105 girls) aged 5 - 12 years. Two scales were used to assess children's DFA: the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale - face version (MCDAS-f). The Corah's Dental Anxiety Scale (CDAS) was used in the sample of children's mothers. The average scores of cooperative children and children with behavior management problem (BMP) were compared.

Results

Cooperative children displayed significantly lower CFSS-DS scores than children with BMP (M = 28. 46 vs. M = 39. 36; P < 0.001). The average MCDAS-f score was significantly higher in children with BMP than in cooperative children (M = 28. 07 vs. 20. 01; P < 0.001). The CFSS-DS showed high internal consistency (Cronbach's α = 0. 90), while internal consistency of MCDAS-f was good (α = 0. 73). The maternal CDAS showed good internal consistency (α = 0, 89). The correlations with other self-report measurements of DFS show good validity of all scales. The correlations between CFSS-DS and MCDAS-f were highly significant (r = 0.482; P < 0. 01) as well as the correlations of CFSS-DS and MCDAS-f with CDAS scores (r = 0.223; P < 0. 01 and r = 0.198; P < 0. 01, respectively.

Conclusion

The obtained results suggest that both the CFSS-DS scale and the MCDAS-f scale are reliable and valid scales for measuring dental fear and anxiety in children in a sample of Croatian children. The MCDAS-f scale has shown slightly lower internal consistency but it is suitable for use in young children. In addition, the MCDAS-f scale is simple to administer.

[Dental anxiety in preschool children: How helpful are behavioral control management strategies?]

Dental anxiety in preschool children: How helpful are behavioral control management strategies? Abstract. Objective: Dental anxiety is a frequent problem in the dental treatment of young children. Control management methods are widely used in pediatric dental care as coping strategies. This study compares two control management strategies regarding their reduction of dental anxiety and treatment success. Method: A group of 60 preschool children with known dental fear in their medical history underwent professional dental cleaning in which the Tell-Show-Do Method (TSDM) was applied. Patients were randomized into two groups according to the controlling method employed: (1) limited controlling method (L-K) and (2) standardized controlling method (S-K). The efficacy of the two control methods was tested using pulse rate as an objective measure of anxiety and self-rating as a subjective indicator. Results: Both the S-K and the L-K condition showed a significant reduction in pulse rate, and there was no difference in physiological arousal and treatment success. However, independent of the group disposition, there was a noticeable increase in pulse rate in children after TSDM. Conclusion: The results of this study indicate that even limited options for controlling dental treatment do not lead to greater burdens on the children in question with dental anxiety. However, further studies are necessary to investigate the use of control methods independent of TSDM.

Assessing the behavior management problems during the first dental visit of preschool children using a doll placement test

CONTEXT

Assessing dental anxiety as a predictor of the likely behavior of the child in the dental operatory is of paramount importance for a clinician to render quality care.

AIM

This study aims to correlate the dental anxiety of preschool children as shown during the doll placement test with that of their behavioral patterns during the first dental visit.

SETTINGS AND DESIGN

This cross-sectional study was conducted between the ages of 3-7 years.

MATERIALS AND METHODS

During their first dental visit, the background variables were elicited from parent/guardian at the reception desk. Later at the play area, the child was given a set of dolls representing dentist, child, and mother to place them in a model dental office having a dental chair. The child was then taken for the initial oral examination, during which the behavior of the child was rated using Frankl's Behavior Rating Scale. The data collected were analyzed using Chi-square test and binary regression analysis.

RESULTS

The observed association between the doll placement pattern and the behavior of the patient during dental treatment was statistically significant (P < 0.001). The binary regression analysis showed that the child's unpleasant previous medical and parent's unpleasant dental experiences had higher odds favoring uncooperative behavior (46.63 and 41.93, respectively).

CONCLUSIONS

The child's behavior on the dental chair is associated with the doll placement pattern, which is also influenced by experiences of the child during his/her encounter with the medical doctor and previous dental experiences of their parents.

Effect of Three Behavior Guidance Techniques on Anxiety Indicators of Children Undergoing Diagnosis and Preventive Dental Care

Objective(s): To assess the effect of three behavior guidance techniques on anxiety indicators of children undergoing diagnosis and preventive dental care. Study Design: Sixty-three subjects (7-9 years) were divided into three groups as per the behavior guidance technique namely tell-show-do, live and filmed modeling (using Tablet Computer) to receive diagnostic (Oral examination & radiographic assessment using intraoral periapical radiographs) and preventive dental care (Oral prophylaxis and topical fluoride application). Anxiety indicators-Facial Image Scale (FIS) scores and heart rate were recorded before, during and after diagnosis/preventive treatment. Three-way repeated measures ANOVA with post-hoc analysis was performed at significance of p-value < 0.05. Results: There was a statistically significant difference in the anxiety indicators of children under the influence of different behavior guidance approaches undergoing diagnosis/preventive treatments except for mean heart rate of children while oral examination. Multiple comparison results reveal that the mean FIS scores and heart rate of children with modeling techniques were significantly better as compared to tell-show-do technique with no significant difference between the two modeling techniques. Conclusion: This study suggests that the modeling techniques (filmed and live) seem to be an efficient behavioral guidance approach for children aged 7-9 years undergoing routine diagnosis and preventive dental care as compared to tell-show-do technique.

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.

Barriers and Drawbacks of the Assessment of Dental Fear, Dental Anxiety and Dental Phobia in Children: A Critical Literature Review

OBJECTIVE

Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry.

STUDY DESIGN

A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children.

RESULTS

104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia.

CONCLUSION

The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.

Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia

OBJECTIVES

Dental anxiety level has been previously associated with oral health status. Since general anesthesia (GA) allows dental treatments to be performed in anxious children with a high number of caries, we aimed to evaluate the dental anxiety levels of these children before and after dental treatments performed under GA.

MATERIALS AND METHODS

Thirty-eight children with high anxiety aged between 35 and 72 months who required multiple dental treatments to be performed under GA were included in the study. Frankl's Behavior Rating Scale, sitting patterns, Facial Image Scale, and Children's Fear Survey Schedule-Dental Subscale (completed by the children's parents) were recorded before and after the dental treatments performed under GA. Pre-treatment and post-treatment biochemical parameters, including cortisol, alpha-amylase, and chromogranin A levels, in saliva and serum samples were also evaluated.

RESULTS

The psychometric scales showed a statistically significant reduction in the post-treatment dental anxiety levels of the children compared with the pre-treatment anxiety levels. Additionally, the biochemical parameters measured in the serum and whole saliva samples showed a decrease after treatments performed under GA.

CONCLUSIONS

Our study results suggest that performing dental treatments under GA can reduce the dental anxiety levels of children with a high number of caries.

A Cross-sectional Study to assess the Perception of Psychosocial Elements among Pediatric Patients visiting Dental Clinics

INTRODUCTION

Children with high dental fear and perception usually encounter high prevalence of dental caries. Data showed that individuals with dental fear will probably defer dental appointments which may result in the formation of a setup of an endless loop of dental fear. Present study was aimed to assess different psycho-social parameters among pediatric patients visiting dental clinics.

MATERIALS AND METHODS

In the present cross-sectional study, the data of 200 schoolchildren were collected and analyzed by means of a questionnaire. Evaluation of the oral health status was done by experienced pedodontists. All the answers were recorded and analyzed by Statistical Package for the Social Sciences (SPSS) software.

RESULTS

Nearly 120 were regular attendees while remaining 80 were found to be irregular attendees. Significant difference was observed while comparing the decayed, missing, and filled teeth (DMFT) index, decayed teeth, dental fear, cognitive vulnerability, and dental prevention belief between the regular and irregular group. Significant correlation was observed between higher number of decayed teeth and increasing level of dental fear.

CONCLUSION

Various psychosocial parameters, by affecting the dental visits, are associated with outcome of oral health measures.

CLINICAL SIGNIFICANCE

Special attention should be paid to the pediatric patients with such kind of behavior so that their psy-chosocial attitude could be modified in favor of dental treatment.

State, trait, and dental anxiety in caregivers of individuals with disabilities

PURPOSE

The aim of this study was to compare state anxiety, trait anxiety, and dental anxiety in caregivers of patients with special needs and caregivers of pediatric patients without special needs at dental clinics.

MATERIALS AND METHODS

A quantitative, cross-sectional study was conducted. Data were collected using a semistructured questionnaire. All respondents were older than 18 years of age. Individuals with cognitive impairment and those taking anxiolytics, antidepressants, or sleep-inducing medication were excluded from the study. The sample consisted of 55 caregivers of patients with special needs and 55 caregivers of pediatric dental patients. A questionnaire was administered to determine the sociodemographic profile of the patients based on the 2015 Brazilian Economic Classification Criteria. Anxiety regarding dental treatment was measured using the dental anxiety scale. The state-trait anxiety inventory was used to identify state and trait anxiety levels.

RESULTS

Caregivers of individuals with disabilities had a similar level of anxiety as caregivers of pediatric dental patients. Most caregivers of individuals with disabilities were mothers with an older age and a greater frequency of trait anxiety, especially when these mothers had health problems. State anxiety was associated with a lower education level.

CONCLUSIONS

Higher dental anxiety levels were found among caregivers with a higher level of trait anxiety, independently of the type of patient to which care was given.

Protocol for a feasibility study of a self-help cognitive behavioural therapy resource for the reduction of dental anxiety in young people

Background

Childhood dental anxiety is very common, with 10–20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term. The reduction of dental anxiety through the use of effective psychological techniques is, therefore, of high importance. However, there is a lack of high-quality research investigating the impact of cognitive behavioural therapy (CBT) approaches when applied to young people’s dental anxiety.

Methods/design

The first part of the study will develop a profile of dentally anxious young people using a prospective questionnaire sent to a consecutive sample of 100 young people referred to the Paediatric Dentistry Department, Charles Clifford Dental Hospital, in Sheffield. The second part will involve interviewing a purposive sample of 15–20 dental team members on their perceptions of a CBT self-help resource for dental anxiety, their opinions on whether they might use such a resource with patients, and their willingness to recruit participants to a future randomised controlled trial (RCT) to evaluate the resource. The third part of the study will investigate the most appropriate outcome measures to include in a trial, the acceptability of the resource, and retention and completion rates of treatment with a sample of 60 dentally anxious young people using the CBT resource.

Discussion

This study will provide information on the profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource. It will gain the perceptions of dental care team members of guided self-help CBT for dental anxiety in young people and their willingness to recruit participants to a trial. Acceptability of the resource to participants and retention and completion rates will also be investigated to inform a future RCT.

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.

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.

Dental fear and anxiety in children and adolescents: qualitative study using YouTube

Background

Dental fear and anxiety (DFA) refers to the fear of and anxiety towards going to the dentist. It exists in a considerable proportion of children and adolescents and is a major dilemma in pediatric dental practice. As an Internet social medium with increasing popularity, the video-sharing website YouTube offers a useful data source for understanding health behaviors and perceptions of the public.

Objective

Using YouTube as a platform, this qualitative study aimed to examine the manifestations, impacts, and origins of DFA in children and adolescents from the public’s perspective.

Methods

To retrieve relevant information, we searched YouTube using the keywords “dental fear”, “dental anxiety”, and “dental phobia”. Videos in English expressing a layperson’s views or experience on children’s or adolescent’s DFA were selected for this study. A video was excluded if it had poor audiovisual quality, was irrelevant, was pure advertisement or entertainment, or contained only the views of professionals. After the screen, we transcribed 27 videos involving 32 children and adolescents, which were reviewed by a panel of 3 investigators, including a layperson with no formal dental training. Inductive thematic analysis was applied for coding and interpreting the data.

Results

The videos revealed multiple manifestations and impacts of DFA, including immediate physical reactions (eg, crying, screaming, and shivering), psychological responses (eg, worry, upset, panic, helplessness, insecurity, resentment, and hatred), and uncooperativeness in dental treatment. Testimonials from children, adolescents, and their parents suggested diverse origins of DFA, namely personal experience (eg, irregular dental visits and influence of parents or peers), dentists and dental auxiliaries (eg, bad manner, lack of clinical skills, and improper work ethic), dental settings (eg, dental chair and sounds), and dental procedures (eg, injections, pain, discomfort, and aesthetic concerns).

Conclusions

This qualitative study suggests that DFA in children and adolescents has multifaceted manifestations, impacts, and origins, some of which only became apparent when using Internet social media. Our findings support the value of infodemiological studies using Internet social media to gain a better understanding of health issues.

Physiologic and behavioral effects of papoose board on anxiety in dental patients with special needs

BACKGROUND/PURPOSE

Anxiety induced by dental treatment can become a serious problem, especially for patients with special needs. Application of deep touch pressure, which is a sensory adaptation technique, may ameliorate anxiety in disabled patients. However, few empiric studies have investigated the possible links between the clinical effects of deep touch pressure and its behavioral and physiologic aspects. Equally little progress has been made concerning theoretical development. The current study is a crossover intervention trial to investigate the behavioral and physiological effects of deep touch pressure for participants receiving dental treatment.

METHODS

Nineteen disabled participants, who were retrospectively subclassified for positive trend or negative trend, were recruited to receive the papoose board as an application of deep touch pressure. Quantitative analyses of behavioral assessments and physiological measurements, including electrodermal activity and heart rate variability, were conducted. We sought to understand the modulation of the autonomic nervous system and the orchestration of sympathetic and parasympathetic (PsNS) nervous systems.

RESULTS

Behavioral assessments reported that higher levels of anxiety were induced by the dental treatment for participants with both groups of positive and negative trends. Although no significant differences were found in the SNS activity, physiologic responses indicated that significantly changes of PsNS activity were observed under the stress condition (dental treatment) when deep touch pressure intervention was applied, especially for participants in the group of positive trend.

CONCLUSION

Our results suggest that the PsNS activation plays a critical role in the process of ANS modulation. This study provides not only physiologic evidence for the modulation effects of deep touch pressure on stressful conditions in dental environments but also the evidence that the application of papoose board, as a sensory adaptation technique, is not harmful for dental patients with special needs.

Validating a measure of children's monitoring-blunting coping styles in dental situations

The monitoring-blunting theory of coping suggests that when faced with a threatening situation, individuals can respond by either monitoring or avoiding (blunting) threatening information. The current study sought to validate a scale of children's preferences for monitoring or blunting in dental situations (the Monitoring Blunting Dental Scale or MBDS). The psychometric characteristics of the scale were assessed in a sample of 240 New Zealand children aged 11-13. Reliability was adequate for both monitoring (α = 0.74) and blunting (α = 0.76) subscale scores. Convergent validity was indicated by strong correlations (>0.6) between the measure's subscales and those of a related scale, although discriminant validity with respect to dental anxiety was problematic for the blunting subscale. Exploratory factor analysis supported a two-factor monitoring-blunting model, although confirmatory factor analysis indicated reasonable but imperfect fit for this model, SBχ²(251) = 510.7, p < 0.001, RMSEA = 0.066. We reflect on conceptual issues which may underlie the difficulties experienced here and elsewhere in developing psychometrically sound measures of Miller's blunting construct and suggest that the monitoring subscale of the study scale may be most useful to other researchers.

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.

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 < or = 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.

Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors

OBJECTIVES

The objectives of this article were to examine the literature published from 1982 to 2006 and to evaluate prevalence of dental fear and anxiety (DFA) and dental behaviour management problems (DBMP) in children and adolescents, and their relationships to age, sex, general anxiety, temperament, and general behavioural problems.

METHODS

A broad search of the PubMed database was performed using three combinations of search terms.

RESULTS

A large proportion of the identified articles could not be used for the review owing to inadequate endpoints, measures or poor study design. Thirty-two papers of acceptable quality were identified and reviewed. The prevalence of both DFA and DBMP were estimated to 9%, with a decrease in prevalence with age. DFA/DBMP were more frequent in girls. DFA/DBMP were related to general fear and both internalizing and externalizing behavioural problems, although these relationships were not clear-cut. Temperament was related to both DFA and DBMP but with different temperamental characteristics, while general behavioural problems mainly correlated with DBMP.

CONCLUSIONS

DFA/DBMP are common, and several psychological factors are associated with the development of these problems. In order to better understand these relationships, a number of issues concerning design of research and measurement of DFA/DBMP have to be dealt with.