An Introduction to Assessing Dental Fear and Anxiety in Children

Madeline Jun Yu Yon, Kitty Jieyi Chen, Sherry Shiqian Gao, Duangporn Duangthip, Edward Chin Man Lo, Chun Hung Chu, Madeline Jun Yu Yon, Kitty Jieyi Chen, Sherry Shiqian Gao, Duangporn Duangthip, Edward Chin Man Lo, Chun Hung Chu

Abstract

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.

Keywords: assessment; children; dental anxiety; dental fear.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Leal S.C., Abreu D.M.M., Frencken J.E. Dental anxiety and pain related to art. J. Appl. Oral Sci. Rev. FOB. 2009;17:84–88. doi: 10.1590/S1678-77572009000700015.
    1. Cambridge English Dictionary: Meanings & Definitions. [(accessed on 7 February 2020)]; Available online: .
    1. Miller A.A. Psychological considerations in dentistry. J. Am. Dent. Assoc. 1970;81:941–948. doi: 10.14219/jada.archive.1970.0347.
    1. Armfield J.M. Cognitive vulnerability: A model of the etiology of fear. Clin. Psychol. Rev. 2006;26:746–768. doi: 10.1016/j.cpr.2006.03.007.
    1. Aminabadi N.A., Ghoreishizadeh A., Ghoreishizadeh M., Oskouei S.G. Can drawing be considered a projective measure for children’s distress in paediatric dentistry? Int. J. Paediatr. Dent. 2011;21:1–12. doi: 10.1111/j.1365-263X.2010.01072.x.
    1. Venham L.L., Gaulin-Kremer E. A self-report measure of situational anxiety for young children. Pediatr. Dent. 1979;1:91–96.
    1. American Psychiatric Association . In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington V.A., editor. American Psychiatric Pub; Washington, DC, USA: 2013.
    1. Armfield J.M. How do we measure dental fear and what are we measuring anyway? Oral Health Prev. Dent. 2010;8:107–115.
    1. Porritt J., Buchanan H., Hall M., Gilchrist F., Marshman Z. Assessing children’s dental anxiety: A systematic review of current measures. Community Dent. Oral Epidemiol. 2013;41:130–142. doi: 10.1111/j.1600-0528.2012.00740.x.
    1. Asl A.N., Shokravi M., Jamali Z., Shirazi S. Barriers and drawbacks of the assessment of dental fear, dental anxiety and dental phobia in children: A critical literature review. J. Clin. Pediatr. Dent. 2017;41:399–423. doi: 10.17796/1053-4628-41.6.1.
    1. Stouthard M.E.A., Mellenbergh G.J., Hoogstraten J. Assessment of dental anxiety: A facet approach. Anxiety Stress Coping. 1993;6:89–105. doi: 10.1080/10615809308248372.
    1. Gustafsson A., Arnrup K., Broberg A.G., Bodin L., Berggren U. 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) Community Dent. Oral Epidemiol. 2010;38:256–266. doi: 10.1111/j.1600-0528.2009.00521.x.
    1. Wong M.L.W., Lai S.H.F., Wong H.M., Yang Y.X., Yiu C.K.Y. Dental anxiety in Hong Kong preschool children: Prevalence and associated factors. Adv. Pediatr. Res. 2017;4:10.
    1. Klingberg G., Hwang C.P. Children’s dental fear picture test (CDFP): A projective test for the assessment of child dental fear. ASDC J. Dent. Child. 1994;61:89–96.
    1. Kilinc G., Akay A., Eden E., Sevinc N., Ellidokuz H. Evaluation of children’s dental anxiety levels at a kindergarten and at a dental clinic. Braz. Oral Res. 2016;30 doi: 10.1590/1807-3107BOR-2016.vol30.0072.
    1. Sheskin R.B., Klein H., Lowental U. Assessment of children’s anxiety throughout dental treatment by their drawings. ASDC J. Dent. Child. 1982;49:99–106.
    1. Krikken J.B., van Wijk A.J., ten Cate J.M., Veerkamp J.S. Measuring dental fear using the CFSS-DS. Do children and parents agree? Int. J. Paediatr. Dent. 2013;23:94–100. doi: 10.1111/j.1365-263X.2012.01228.x.
    1. Krikken J.B., Vanwijk A.J., Tencate J.M., Veerkamp J.S. Child dental anxiety, parental rearing style and dental history reported by parents. Eur. J. Paediatr. Dent. 2013;14:258–262.
    1. Milgrom P., Jie Z., Yang Z., Tay K.M. Cross-cultural validity of a parent’s version of the dental fear survey schedule for children in Chinese. Behav. Res. Ther. 1994;32:131–135. doi: 10.1016/0005-7967(94)90094-9.
    1. Ten Berge M., Hoogstraten J., Veerkamp J.S.J., Prins P.J.M. The dental subscale of the children’s fear survey schedule: A factor analytic study in the Netherlands. Community Dent. Oral Epidemiol. 1998;26:340–343. doi: 10.1111/j.1600-0528.1998.tb01970.x.
    1. Rantavuori K., Lahti S., Seppa L., Hausen H. Dental fear of Finnish children in the light of different measures of dental fear. Acta Odontol. Scand. 2005;63:239–244. doi: 10.1080/00016350510019856.
    1. Luoto A., Tolvanen M., Rantavuori K., Pohjola V., Lahti S. Can parents and children evaluate each other’s dental fear? Eur. J. Oral Sci. 2010;118:254–258. doi: 10.1111/j.1600-0722.2010.00727.x.
    1. Nelson T.M., Huebner C.E., Kim A.S., Scott J.M. Parent, dentist, and independent rater assessment of child distress during preventive dental visits. J. Dent. Child. (Chicago) 2016;83:71–77.
    1. Carson P., Freeman R. Assessing child dental anxiety: The validity of clinical observations. Int. J. Paediatr. Dent. 1997;7:171–176. doi: 10.1046/j.1365-263X.1997.00235.x.
    1. Klein U., Manangkil R., DeWitt P. Parents’ ability to assess dental fear in their six- to 10-year-old children. Pediatr. Dent. 2015;37:436–441.
    1. Venham L.L., Gaulin-Kremer E., Munster E., Bengston-Audia D., Cohan J. Interval rating scales for children’s dental anxiety and uncooperative behavior. Pediatr. Dent. 1980;2:195–202.
    1. Sharma A., Tyagi R. Behavior assessment of children in dental settings: A retrospective study. Int. J. Clin. Pediatr. Dent. 2011;4:35–39.
    1. Shinohara S., Nomura Y., Shingyouchi K., Takase A., Ide M., Moriyasu K., Idaira Y., Takahashi T., Yamada Y., Aoyagi Y., et al. Structural relationship of child behavior and its evaluation during dental treatment. J. Oral Sci. 2005;47:91–96. doi: 10.2334/josnusd.47.91.
    1. Melamed B.G., Weinstein D., Katin-Borland M., Hawes R. Reduction of fear-related dental management problems with use of filmed modeling. J. Am. Dent. Assoc. 1975;90:822–826. doi: 10.14219/jada.archive.1975.0151.
    1. Hosey M.T., Blinkhorn A.S. An evaluation of four methods of assessing the behaviour of anxious child dental patients. Int. J. Paediatr. Dent. 1995;5:87–95. doi: 10.1111/j.1365-263X.1995.tb00170.x.
    1. Aminabadi N.A., Sohrabi A., Oskouei S.G., Aghaee S., Jamali Z., Ghojazadeh M. Design and preliminary validation of the verbal skill scale in the dental setting: An anxiety scale for children. Pediatr. Dent. 2013;35:E43–E48.
    1. Shinohara S., Nomura Y., Ide M., Idaira Y., Moriyasu K., Takahashi T., Takano F., Ikeda T., Ohno K., Asada Y. The classification of the children by their behavior for the dental treatment using cluster analysis. Pediatr. Dent. J. 2005;15:191–194. doi: 10.1016/S0917-2394(05)70052-5.
    1. Aartman I.H.A., van Everdingen T., Hoogstraten J., Schuurs A.H.B. Appraisal of behavioral measurement techniques for assessing dental anxiety and fear in children: A review. J. Psychopathol. Behav. Assess. 1996;18:153–171. doi: 10.1007/BF02229114.
    1. Veerkamp J.S., Gruythuysen R.J., van Amerongen W.E., Hoogstraten J., Weerheijm K.L. Dentist’s ratings of child dental-patients’ anxiety. Community Dent. Oral Epidemiol. 1995;23:356–359. doi: 10.1111/j.1600-0528.1995.tb00262.x.
    1. Salas Huamani J.R., Barbosa T.D.S., de Freitas C.N., de Sousa K.G., Gavião M.B.D., Leal S.C., Mialhe F.L., Castelo P.M. Assessment of anxiety and stress markers in children submitted to educational strategies and ART-restoration: A randomized clinical trial. Arch. Oral Biol. 2019;97:191–197. doi: 10.1016/j.archoralbio.2018.10.032.
    1. Uehara N., Takagi Y., Miwa Z., Sugimoto K. Objective assessment of internal stress in children during dental treatment by analysis of autonomic nervous activity. Int. J. Paediatr. Dent. 2012;22:331–341. doi: 10.1111/j.1365-263X.2011.01202.x.
    1. Mitsuhata C., Ohara Y., Tachikake M., Iwamoto Y., Kozai K. Effectiveness of salivary chromogranin A as a stress index in young children during dental treatment. Pediatr. Dent. J. 2012;22:163–169. doi: 10.1016/S0917-2394(12)70267-7.
    1. Aartman I.H.A., Van Everdingen T., Hoogstraten J., Schuurs A.H.B. Self-report measurements of dental anxiety and fear in children: A critical assessment. J. Dent. Child. 1998;65:252–258.
    1. McGrath P.A. Measurement issues in research on dental fears and anxiety. Anesth. Prog. 1986;33:43–46.
    1. Alwin N.P., Murray J.J., Britton P.G. An assessment of dental anxiety in children. Br. Dent. J. 1991;171:201–207. doi: 10.1038/sj.bdj.4807661.
    1. Nelson T.M., Xu Z. Pediatric dental sedation: Challenges and opportunities. Clin. Cosmet. Investig. Dent. 2015;7:97–106. doi: 10.2147/CCIDE.S64250.
    1. Locker D., Liddell A., Dempster L., Shapiro D. Age of onset of dental anxiety. J. Dent. Res. 1999;78:790–796. doi: 10.1177/00220345990780031201.
    1. Sadana G., Grover R., Mehra M., Gupta S., Kaur J., Sadana S. A novel Chotta Bheem-Chutki scale for dental anxiety determination in children. J. Int. Soc. Prev. Community Dent. 2016;6:200–205.
    1. Lu J.X., Yu D.S., Luo W., Xiao X.F., Zhao W. Development of Chinese version of children’s fear survey schedule-dental subscale. Zhonghua Kou Qiang Yi Xue Za Zhi. 2011;46:218–221.
    1. Shindova M., Belcheva A., Mateva N. Factors in dental environment related to development of child dental fear and parent-child agreement on its evaluation. Int. Sci. On-Line J. Sci. Technol. Med Biol. Stud. Clin. Stud. Soc. Med. Health Care. 2014;4:91–95.
    1. Nakai Y., Hirakawa T., Milgrom P., Coolidge T., Heima M., Mori Y., Ishihara C., Yakushiji N., Yoshida T., Shimono T. The children’s fear survey schedule-dental subscale in Japan. Community Dent. Oral Epidemiol. 2005;33:196–204. doi: 10.1111/j.1600-0528.2005.00211.x.
    1. Lee C.Y., Chang Y.Y., Huang S.T. Higher-order exploratory factor analysis of the dental subscale of children’s fear survey schedule in a Taiwanese population. Community Dent. Health. 2009;26:183–187.
    1. Esa R., Hashim N.A., Ayob Y., Yusof Z.Y. Psychometric properties of the faces version of the malay-modified child dental anxiety scale. BMC Oral Health. 2015;15:28. doi: 10.1186/s12903-015-0013-y.
    1. Ma L., Wang M., Jing Q., Zhao J., Wan K., Xu Q. Reliability and validity of the Chinese version of the children’s fear survey schedule-dental subscale. Int. J. Paediatr. Dent. 2015;25:110–116. doi: 10.1111/ipd.12106.
    1. Lopes D., Arnrup K., Robertson A., Lundgren J. Validating the dental subscale of the children’s fear survey schedule using Rasch analysis. Eur. J. Oral Sci. 2013;121:277–282. doi: 10.1111/eos.12040.
    1. Buchanan H. Development of a computerised dental anxiety scale for children: Validation and reliability. Br. Dent. J. 2005;199:359–362. doi: 10.1038/sj.bdj.4812694. discussion 351, quiz 372.
    1. Buchanan H. Assessing dental anxiety in children: The revised smiley faces program. Child Care Health Dev. 2010;36:534–538. doi: 10.1111/j.1365-2214.2009.01033.x.
    1. Buchanan H., Niven N. Validation of a facial image scale to assess child dental anxiety. Int. J. Paediatr. Dent. 2002;12:47–52.
    1. Humphris G.M., Milsom K., Tickle M., Holbrook H., Blinkhorn A. A new dental anxiety scale for 5-year-old children (DA5): Description and concurrent validity. Health Educ. J. 2002;61:5–19. doi: 10.1177/001789690206100102.

Source: PubMed

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