Dental Anxiety Reduction in A Young Population: Risk Indicators Running Title- Evaluation of DA Among Children

Dental fear is a response to a known danger, anxiety is a response to an  unknown danger. The global prevalence is 6-13 %. It has a multi-factorial etiology.¹ DFA is a term that describes all sorts of fears and anxieties related to dentistry. The clinic ambiance, environment, support staff along with parental and peer pressure serve as contributing factor for dental anxiety. ^2,3

 

Literature reveals that the prevalence of dental anxiety is 12.6 % in Russia, 13.5 % in France, 12.5 % in Canada and 30 % in China. Dental fear and anxiety can lead poor oral health, due to non utilization of the services.⁴

 

Several associated factors contribute towards the etiology of dental anxiety. Since dental fear and anxiety are mostly subjective in nature, it can easily succumb to peer pressure and influence. Children are subjected to the development of imaginary fears that add up to the stressful scenario. A pediatric dentist has a major role to play in such a situation, to intervene at the right time and motivate and mould them to come out of dental anxiety. Thus he can pave the way to stride towards an anxiety free future society. ^5.6

 

The present study was aimed to evaluate the prevalence of dental anxiety and to identify the contributing factors for dental anxiety.

Target population were children who visited the dental office. Study design was cross-sectional in nature.

 

Subjects

Sample size calculation

Based on the previous Indian studies, the prevalence of dental anxiety varied between 20-50%.By keeping an error margin of + or – 5 % and a confidence interval of 95%, the sample size was calculated .Thereby 110 children were recruited by simple randomization method.

 

Inclusion criteria

Children within  school age groups were included.

 

Exclusion criteria

Children with major debilitating disorders and physically challenged children were excluded from the study.

 

Sampling Technique

Multi stage sampling technique

 

Data collection

Patient demographics along with dental anxiety status was recorded by way of personal interview through customized structured questionnaire.

 

Data Recording

Clinical examination was done by a single examiner in the OP premises. Inter and intra-examiner reproducibility was assessed with the help of kappa statistics. K=0.87 for inter and 0.95 for intra examiner reproducibility was found.

 

Statistical Analysis

Data were analyzed using SPSS version 20.(IBM, India). Chi-square test was used to compare the qualitative data, to find out the statistical significance. Strength of association was also computed. The level of significance was set at P < 0.05.

 

For independent association with outcome multivariate logistic regression was used.

 

Variables that showed only significant associations were included in logistic regression models (Stata Corp, Chicago. USA) was used to assess the independent effect of these co-variates on the prevalence of dental anxiety.

Total number of children who were recruited were 110, which had a break up of 60 males and 50 females.

 

Results based on the gender distribution pattern

Table 1 in our study depicted the gender wise distribution pattern of children. The number of males with dental anxiety were more than females. The percentage was also higher in males-54.5

 

Table 1: Depicted the gender wise distribution pattern of children

 

Results based on the age distribution pattern

Table 2 in our study depicted the age- wise distribution pattern of children. There were more number of children in the 10-14 age group.

 

Table 2: Depicted the age wise distribution pattern of children

 

Results based on the logistic regression risk indicators

Table 3 in our study depicted showed the logistic regression risk indicators. The variables –y axis chosen were age with odds ratio, standard error, P-value and confidence interval. The variables- X axis chosen were parents, peers, modeling, educational posters, relatives and friends.

 

Table 3: Depicted the logistic regression risk indicators

 

Inter and intra-examiner reproducibility was assessed with the help of kappa statistics. K=0.87 for inter and 0.95 for intra examiner reproducibility was found.

The present study was undertaken in the Department of Pediatric Dentistry, with the aim to find out the prevalence of dental anxiety among school aged children. Total number of children who were recruited were 110, which had a break up of males and females.

 

Table 1 in our study depicted the gender wise distribution pattern of children

 

This is in accordance with similar studies done by  Scarpelli AC  ^6-12 et al based on

 

Psychometric properties of the Brazilian version of the early childhood oral health impact scale.

 

Table 2 in our study showed the depicted the age- wise distribution pattern of children. This is in accordance with similar studies done by Dailey YM et al ^13-17 based on  The use of dental anxiety questionnaires: a survey of a group of UK dental practitioners.           

       

Table 3 in our study depicted showed the logistic regression risk indicators across the variables of parents, peers, modeling, educational posters, relatives and friends. This is in accordance with similar studies done by Corah NL^18-24 et al based Development of an interval scale of anxiety response.

 

Logistic regression is used to obtain odds ratio in the presence of more than one explanatory variable. The response variable is binomial. Each variable has an impact on the odds ratio. It analyzes the relationship of a dependent variable over an independent variable. Regression is the assumption of linearity between dependent variable over an independent variable. This is in accordance with similar studies done by Agras .S et al ^25-29 based on the prevalence of dental fear and avoidance.

 

Clinical examination was done by a single examiner in the OP premises. Inter and intra-examiner reproducibility was assessed with the help of kappa statistics. K=0.87 for inter and 0.95 for intra examiner reproducibility was found. This is in accordance with similar studies done by Armfield JM et al ^{30, 31}

 

Parents play an important part in their child’s dental anxiety as the child imbibes their emotions directly. Due to the incorporation of imaginary fears the children’s behavior patterns are enhanced and reinforced towards positive or negative side. Peers, friends and relatives have a crucial role to play, since they have the same cognitive growth.

 

Modeling adds support, since it is a live demonstration. When they witness another child undergoing the same treatment in the same dental scenario, they are convinced the right way, to develop a right attitude towards dental treatment.

 

Educational posters add support by way of witnessing the pictures of dental procedures being performed, thus harnessing the child’s emotional state of mind and perspectives.

 

Hence or study revealed that children’s behavior can be modified towards betterment and utmost positivity with such approaches.

 

Limitations

Since the age ranges and sample sizes were small the findings could not be generalized

The present study concludes that identifying the barriers of dental anxiety will help in reducing dental anxiety in children.

 

Clinical Implications

Similar studies such as this with more multivariate factor analysis will help us to explore and evaluate further more on this aspect in order to inculcate more positive behavioral attitudes.

 

Ethical Clearance: This study was a short project. Hence IEC could not be obtained, ethical issues were appropriately addressed as follows

1.      Anonymity of subjects was ensured.

2.      No pressure was exerted on the subjects to participate in the study and participation was completely voluntary.

3.      Confidentiality of data was ensured. It was saved in password protected systems which had access only to investigators.

 

DECLARATION OF INTERESTS: The authors declare no conflicts of interest.

 

FUNDING: No funding was acquired for this study

1.      Venham, L. L. “The Effect of Mother’s Presence on Child’s Response to Dental Treatment.” ASDC Journal of Dentistry for Children, vol. 46, no. 3, 1979, pp. 219–225.

2.      Humphris, G. M., et al. “Preliminary Validation and Reliability of the Modified Child Dental Anxiety Scale.” Psychological Reports, vol. 83, no. 3 suppl., Dec. 1998, pp. 1179–1186.

3.      Buchanan, Hilary, and Nicola Niven. “Validation of a Facial Image Scale to Assess Child Dental Anxiety.” International Journal of Paediatric Dentistry, vol. 12, no. 1, Jan. 2002, pp. 47–52.

4.      Buchanan, Hilary. “Development of a Computerised Dental Anxiety Scale for Children: Validation and Reliability.” British Dental Journal, vol. 199, no. 6, Sept. 2005, pp. 359–362.

5.      Bhat, S. G., and R. Sivaram. “Psychometric Properties of the Malayalam Version of ECOHIS.” Journal of Indian Society of Pedodontics and Preventive Dentistry, vol. 33, no. 3, 2015, p. 234.

6.      Scarpelli, Ana Cláudia, et al. “Psychometric Properties of the Brazilian Version of the Early Childhood Oral Health Impact Scale (B-ECOHIS).” BMC Oral Health, vol. 11, no. 1, Dec. 2011, pp. 1–11.

7.      Martins-Júnior, Paulo Antônio, et al. “Validation of the Brazilian Version of the Early Childhood Oral Health Impact Scale (ECOHIS).” Cadernos de Saúde Pública, vol. 28, no. 2, Feb. 2012, pp. 367–374.

8.      Peker, Kubra, et al. “Cross-Cultural Adaptation and Preliminary Validation of the Turkish Version of the Early Childhood Oral Health Impact Scale among 5–6-Year-Old Children.” Health and Quality of Life Outcomes, vol. 9, no. 1, Dec. 2011, pp. 1–8.

9.      Barbosa, Tatiana S., and Maria Beatriz D. Gavião. “Oral Health-Related Quality of Life in Children: Part III. Is There Agreement between Parents in Rating Their Children’s Oral Health-Related Quality of Life? A Systematic Review.” International Journal of Dental Hygiene, vol. 6, no. 2, May 2008, pp. 108–113.

10.   Pahel, Brett T., et al. “Parental Perceptions of Children’s Oral Health: The Early Childhood Oral Health Impact Scale (ECOHIS).” Health and Quality of Life Outcomes, vol. 5, no. 1, Dec. 2007, pp. 1–10.

11.   Ayer, William A. Psychology and Dentistry: Mental Health Aspects of Patient Care. Psychology Press, 2005.

12.   Mostofsky, David I., et al. Behavioral Dentistry. Wiley-Blackwell, 2006.

13.   Dailey, Y. M., et al. “The Use of Dental Anxiety Questionnaires: A Survey of a Group of UK Dental Practitioners.” British Dental Journal, vol. 190, no. 8, Apr. 2001, pp. 450–453.

14.   Bowling, Ann. Measuring Health: A Review of Quality of Life Measurement Scales. Open University Press, 1991.

15.   Newton, Tim J., and David J. Buck. “Anxiety and Pain Measures in Dentistry: A Guide to Their Quality and Application.” Journal of the American Dental Association, vol. 131, no. 10, Oct. 2000, pp. 1449–1457.

16.   McGrath, Patrick A. “Measurement Issues in Research on Dental Fears and Anxiety.” Anesthesia Progress, vol. 33, no. 1, Jan. 1986, pp. 43–46.

17.   Folayan, Morenike O., and Emmanuel E. Idehen. “Factors Influencing the Use of Behavioural Management Techniques during Child Management by Dentists.” Journal of Clinical Pediatric Dentistry, vol. 28, no. 2, 2005, pp. 155–161.

18.   Corah, Norman L., et al. “Development of an Interval Scale of Anxiety Response.” Anesthesia Progress, vol. 33, no. 5, Sept. 1986, pp. 220–223.

19.   Ramos-Jorge, Maria Letícia, et al. “Degree of Dental Anxiety in Children with and without Toothache: A Prospective Assessment.” International Journal of Paediatric Dentistry, 2012.

20.   Corah, Norman L., et al. “Assessment of a Dental Anxiety Scale.” Journal of the American Dental Association, vol. 97, 1978, pp. 616–619.

21.   Locker, David, et al. “Age of Onset of Dental Anxiety.” Journal of Dental Research, vol. 78, 1999, pp. 790–796.

22.   STROBE Statement. www.strobe-statement.org/fileadmin/Strobe/uploads/checklists/STROBE_checklist_v4_combined_Plos_Medicine.pdf. Accessed 2026.

23.   Stecki, Andrew J., and Prajokta Ray. “Stress Biomarkers in Biological Fluids and Their Point-of-Use Detection.” 2018.

24.   Pohjola, Ville, et al. “Association between Dental Fear and Dental Attendance among Adults in Finland.” Acta Odontologica Scandinavica, vol. 65, no. 4, 2007, pp. 224–230.

25.   Agras, Stewart, et al. “The Epidemiology of Common Fears and Phobia.” Comprehensive Psychiatry, vol. 10, no. 2, 1969, pp. 151–156.

26.   Gatchel, Robert J., et al. “The Prevalence of Dental Fear and Avoidance: A Recent Survey Study.” Journal of the American Dental Association, vol. 107, no. 4, 1983, pp. 609–610.

27.   Al Absi, Mustafa, and Paul D. Rokke. “Can Anxiety Help Us Tolerate Pain?” Pain, vol. 46, no. 1, 1991, pp. 43–51.

28.   Eli, Ilana. “Dental Anxiety: A Cause for Possible Misdiagnosis of Tooth Vitality.” International Endodontic Journal, vol. 26, no. 4, 1993, pp. 251–253.

29.   Van Wijk, Arjen J., and Johannes Hoogstraten. “The Fear of Dental Pain Questionnaire: Construction and Validity.” European Journal of Oral Sciences, vol. 111, no. 1, 2003, pp. 12–18.

30.   Armfield, Jason M., et al. “Dental Fear in Australia: Who’s Afraid of the Dentist?” Australian Dental Journal, vol. 51, no. 1, 2006, pp. 78–85.

31.   Dikshit, Pratiksha, et al. “Evaluation of Dental Anxiety in Parents Accompanying Their Children for Dental Treatment.” Orthodontic Journal of Nepal, vol. 3, no. 1, Dec. 2013, pp. 47–52.