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Background/purpose Patients with periodontal disease have higher dental fear levels, which may have negative effects on their clinical outcome during scaling and root planing (SRP). The present study used the new classification of periodontitis and validated questionnaires to assess the relationship among dental fear, SRP pain and periodontal status. Materials and methods A total of 120 periodontitis patients were enrolled and staging according to the new classification of periodontitis. SRP was performed, and the visual analog scale (VAS) to assess pain was used with every patient after treatment. Questionnaires, including Corah's Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and short-form Dental Anxiety Inventory (S-DAI) were implemented from the first attendance and subsequent visits after 6 months. The patients were grouped by DAS scores. The statistical analysis was performed using T-test, chi-square, Pearson and Spearman correlative analysis. Results Compared to pre-SRP treatment, the dental fear level on DFS was decreased in the posttreatment period for all periodontitis stages. There were no statistically significant differences in S-DAI and DAS between pretreatment and posttreatment periods in stage I and II; meanwhile, there were statistically differences in stage III and IV. The correlation among periodontitis stages, VAS and dental fear level was significant. The proportion of high periodontitis stages was increased in high dental fear group. Conclusion SRP can reduce dental fear levels in all periodontitis stages, especially in stage III and IV. Correlations exist among periodontal status, dental fear and SRP pain. High dental fear is associated with poor periodontal status.

Background Painful pokes, buzzing drills, uncomfortable pressure, foreign tastes, and disturbing noises are all events that a child can experience in a single dental appointment. Each event has the potential to trigger dental fear and anxiety in pediatric patients. Dental fear and anxiety are common for children and can lead to the neglect of dental care into adulthood. Many behavioral interventions currently in practice focus on immediate behavior changes rather than long-term psychosocial well-being of children. Objective The purpose of this paper was to review the literature of pediatric dental fear and anxiety and provide reasoning for child life specialist intervention in the pediatric dental clinic. Results Rooted in developmental theory, child life specialists advocate for the psychosocial care of children in various healthcare environments, including dental clinics. Child life specialists work to minimize pediatric fear and anxiety using various strategies, including psychological preparation. Psychological preparation is accomplished by the provision of developmentally appropriate education, therapeutic or medical play, and preparation books. Conclusions Further research is needed to establish the effectiveness of child life specialist intervention, such as psychological preparation, in pediatric dentistry at reducing pediatric dental fear and anxiety.

Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.

(1) Background: The present study aimed to examine the psychometric properties of the Persian adaptation of the Modified Dental Anxiety Scale (MDAS) in Iranian adolescents. (2) Methods: Adolescents with a mean age of 15.10 (n = 3197, 47.1% males) were recruited from Qazvin city of Iran using a stratified cluster random sampling technique. All children completed the five-item Persian MDAS and information related to background characteristics. Psychometric testing was conducted using classical test theory (CTT) and Rasch models. For CTT, an item-total correlation of &gt, 0.4 was considered satisfactory while for Rasch analysis, infit and outfit mean squares (Mnsq) ranging from 0.5–1.5 were considered satisfactory. Confirmatory Factor Analysis (CFA) was conducted to confirm the unidimensional structure of MDAS using various fit indices. Differential item functioning (DIF) was evaluated based on gender and time since last dental visit. Moreover, latent class analysis (LCA) was used to classify the participants into different levels of dental fear based on their pattern of responses. Both item level reliability using Cronbachs alpha (α) and test-reliability using intraclass correlation coefficients were evaluated. (3) Results: Item-total correlations ranged from 0.69–0.78, infit MnSq ranged from 0.80 to 1.11 and the range of outfit MnSq was 0.84–1.10. The data confirmed a one-factor structure of MDAS with satisfactory fit indices. DIF analysis indicated that the scale was interpreted similarly across the genders and time since dental visit groups. LCA analysis identified three levels, low, moderate and high levels of dental anxiety. The groups with moderate and high levels of dental anxiety had more females (44.6% and 36.7%) than the group with low level of dental anxiety (18.8%, p &lt, 0.001). α of the total scale was 0.89 and item test-retest reliability ranged from 0.72–0.86. (4) Conclusions: The Persian MDAS was unidimensional with satisfactory psychometric properties evaluated using both CTT and Rasch analysis among Iranian adolescents. The scale was stable across the genders and individuals with different dental visiting patterns. The Persian MDAS also demonstrated excellent reliability.

Introduction: Anxiety is the state of feeling nervous or worried that something bad is going to happen. Dental anxiety is defined as a patient’s response to stress that is associated with a dental procedure. The aim of our study is to investigate the anxiety status of dental patients visiting Orthodontic department at Nobel Medical College Teaching Hospital, Biratnagar. Materials and Method: Total 80 ongoing orthodontic patients (M =21 F=59) who completed modified Dental Anxiety Scale questionnaire were included in the study. Result: Majority of patients (65%) had moderate anxiety where as 25% had mild anxiety and around 9% had severe to extreme anxiety. Patients’ age and education level had significant association with the level of dental anxiety. Conclusion: Dental anxiety in orthodontic patients is unavoidable but needs appropriate counseling. Orthodontist’s role is crucial in bridging the gap between patients’ perception towards orthodontic treatment and the actual treatment.

AIM The current study aims to address the patient's dental anxiety (DA) And dental fear (DF) under the treatment of a general practitioner (GP) among different parameters. MATERIALS AND METHODS The cross-sectional study included 500 patients recruited from different clinics in Jazan, Saudi Arabia. Data were collected through a questionnaire-based form consisting of three parts; the first part was personal and demographic questions whereas the second and third parts were a modified dental anxiety scale (MDAS) and a dental fear survey (DFS) to measure DA and DF among patients. Spearman's correlation was used to measure the relation between DA and DF as well as Chi-square tests and logistic regression analyses for analyzing the effect of each variable on DA and DF. RESULTS All patients fulfilled their eligibility criteria. A high percentage was found in moderate anxiety (36.8%) as well as in moderate fear (46.2%) among different anxiety and fear scales. The association between DA and DF was positively significant (p

Muhammad Nazir,1 Khalid S Almulhim,2 Ziyad AlDaamah,3 Salman Bubshait,3 Mohammed Sallout,3 Salman AlGhamdi,3 Jehan Alhumaid1 1Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia; 2Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia; 3College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi ArabiaCorrespondence: Muhammad Nazir Tel +966-543569615Email manazir@iau.edu.saPurpose: Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia.Materials and Methods: Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June–July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information.Results: The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear.Conclusion: Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.Keywords: dental anxiety, emergency treatment, dental visits, pandemic

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.

Background Drama and role play can be unlisted as methods to allow children to view problems from a range of different perspectives that may differ from their own experience. Application of drama technique to assess the cause of dental fear and anxiety in a school setting is novel. Aim The aim of this study was to engage primary school children in the core investigation via participatory arts methodologies, namely, process drama to gain understanding of the causes of dental anxiety. Design Sixty-three children, aged 7–10 years from three primary schools participated in this study. A 90-min drama workshop was carried in each school. The children were encouraged to identify the causes of dental anxiety using key concepts from process drama. The sessions were audio-recorded and transcribed. Results Four key concepts emerged: (1) fear of the unknown; (2) unpleasant sensory experience; (3) society’s perception and portrayal of the dentist; and (4) learnt negative associations with the dentist. Within each four key concepts, two sub-themes were identified. Conclusions Role-playing and use of drama are a novel application and can reveal a considerable amount of information from the child’s perspective on the cause of dental fear and anxiety.

Aim To assess schoolchildren's feelings and attitudes towards dentists and their potential impact on oral health. Materials and methods 7902 schoolchildren (12 and 15 years old) attending public and private schools completed a questionnaire that assessed their feeling and attitude toward dentists. DMFT and CPI indices were used to assess dental caries and periodontal diseases respectively according to the World Health Organization method and criteria. Results 79.7% of all schoolchildren who participated in this study had been to the dentist. 24.7% reported that they are afraid of dental visits, pain being the main reason for this disturbing feeling (88, 2%). Of the children, 81.4% preferred a female dentist; 82.3% preferred a dentist with a colored coat and 80.3% favored a renovated dental facility. 91.1% of the children are irritated by the noises in the dental clinic. The mean DMFT and CPI scores were significantly higher in patients with dental fear, and in patients who never had a dental visit. Conclusion Meeting patient's perceptions and preferences regarding their dentist may help to reduce the potential dental anxiety and thus ensure the delivery of a high-quality dental treatment leading to better oral health status. Clinical relevance Patient perception about dentists is affected by a series of factors related to the dentist, the patient, and the dental clinic. Patients who experience the worst perceptions of dental professional tend not to seek dental care, which leads to a bad oral health status, hence the importance of further studies in this area to improve such perceptions, and promote attitudinal changes toward positive health-seeking behavior.

Background The purpose was to analyse the associations between dental and trait anxiety, fear of COVID-19 and the duration and frequency of spontaneous hand-to-face contact (self-contact). Methods A cross-sectional design was carried out with 128 adult patients from four dental clinics in Madrid, during the confinement, from March 15 to May 15. The patients’ movements in the waiting room were monitored with Microsoft Kinect Software, also completed the Trait anxiety subscale of the STAI, the COVID-19 Fear and the S-DAI questionnaire. Results Associations were observed between the duration and frequency of facial, mask and eye contact with trait anxiety and dental fear was determined only by the frequency of this self-contact. Trait anxiety is associated with dental anxiety and with fear of COVID-19. Although facial self-contact is higher in women, it also rises in men as dental fear increases. Moreover, dental anxiety is a good predictor of trait anxiety and the incidence of facial self-contact. Conclusions Understanding the possible associations between biopsychosocial factors, such as trait anxiety, dental anxiety and self-contact is important. It may help to prevent the spread of COVID-19 in the population as well as enabling the formulation of effective interventions to improve oral health care through the implementation of dental care programmes.

Background: Dental fear and anxiety (DFA) is considered the main reason of dental negligence which can lead to detrimental oral health as well as overall health including psychological well-being and quality of life in an individual. Aims: The present trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education. Materials and Methods: The present study was an original survey and questionnaire trial, which was distributed to the 82 dentists. The collected data were subjected to statistical evaluation and the results were formulated. Results: Educating and motivating subjects was found to be effective by 62.19% (n = 51) of dentists followed by successive approximation, and muscle relaxation was considered highly ineffective by one responder (1.21%). Music and reduced waiting time in the clinic appeared to be the most effective strategy as responded by 56.09% (n = 46) of dentists. Attempting treatment in various visits than a single seems to be a highly ineffective technique by 4 dentists (4.87%). Conclusion: Within its limitation, the study showed that the application of various behavior modification techniques can be effective in alleviating DFA in adult patients.

Introduction: Dental fear and anxiety pose a significant problem for the practice of dentistry, especially in children. Therefore, it is necessary to identify and quantify this anxiety, to implement, and to monitor the effectiveness of treatment interventions. Materials and Methods: A cross-sectional study was conducted on children in the age group of 3–14 years. The children who had sound health and visited outpatient department of a Dental College, Lucknow, India with their parents for dental care were considered for study purposes. Children’s dental fear and anxiety were measured by using three scales. Result: Out of the total 220 respondents, 118 (53.6%) were males and 102 (46.4%) females. The outcome of the study showed that the dental fear among children was 13.3%, 22.9%, 7.8%, respectively, in existence measured by the three scales, viz., (a) facial image scale (FIS), (b) dental fear scale (DFS), and (c) children’s fear survey schedule-dental subscale (CFSS-DS). About 70.2% of the children showed Frankl’s behavior rating of 3, i.e. positive. Conclusion: Dental fear and anxiety are the most common problems of children and because of this, they are afraid of undergoing any dental treatment. By using the above scale, we can know about those factors which can enhance their fear so that we can modify our treatment approach. Altering in a treatment modality not only leads the children to get the treatment done easily but also removes the fear for dental treatment in the future.

In children, dental fear is not only associated with fear of pain or invasive procedures, but it is also correlated with separation from parents or confronting unfamiliar people or environments. The Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) was developed to evaluate dental fear in children, and this scale is now used across the world for evaluating dental fear. The aim of this study was to evaluate dental fear in children between 7–11 years of age and to find out the association between caries and fear of dental treatment. A total of 300 subjects of both sexes were enrolled in the study. Prior to the oral examination, all patients’ attendants were informed about the study, and the subjects were asked to fill in a questionnaire regarding the CFSS-DS scale. The data obtained through the questionnaires were analyzed using the Chi-Square test. Fear scores were highest for “injections” (3.91±0.17), “dentist drilling” (3.91±0.10) and “choking” (3.65±0.82). It was also observed that subjects who had already visited a dental clinic or those who were familiar with the dental environment at an early stage of life were less anxious than patients who were receiving dental treatment for the first time. In this study, we found that female subjects were more anxious in comparison to male patients. Once the child’s fear is identified, the dentist can use various behavior modification techniques to eliminate fear, explain the steps, and use the instruments accordingly until fear has vanished.

O medo e a ansiedade odontológica surgem por diversos fatores, entre eles, a exposição à experiências traumáticas anteriores com envolvimento de agulhas, injeções e instrumentos que possam causar incômodo. Os pacientes ansiosos tendem a adiar consultas, evitam os tratamentos odontológicos e só se dispõe às visitas ao dentista quando aparecem sintomas dolorosos, logo o tratamento tardio tende a ser mais invasivo causando ainda mais prejuízo emocional ao paciente, consequente agravo a tal sentimento e, por sua vez, origina um ciclo vicioso no qual evitar o tratamento agrava ainda mais a condição de saúde bucal. Cabe aos profissionais da Odontologia identificar a ansiedade nos pacientes e fazer uso de recursos de manejo dessa ansiedade de modo a possibilitar um tratamento odontológico eficaz e com menor prejuízo emocional ao paciente. Com este estudo pretende-se avaliar por meio de uma revisão integrativa de literatura, a importância do estudo da Psicologia pelo profissional da Odontologia e expor algumas técnicas de enfrentamento da ansiedade odontológica, com base em evidências científicas.

Lifestyle modifications, work pressure, stress may lead to adverse habits like smoking, drinking and tobacco chewing. These habits may lead to poor oral health. Not only poor oral health may also lead to dental fear and dental anxiety. Self-administered questionnaires were designed based on knowledge, attitude and practice. The questionnaire was distributed through an online platform. The study population included people belonging to the age group of 18-24 age groups. The participants were explained about the purpose of the study in detail. The questions were carefully studied and the participants marked the corresponding answers. The data were collected and statistically analysed using SPSS software. Results were collected as an ordinal data and reported that smoking and alcohol causes increased dental fear which leads to poor oral health and some anxiety management techniques should be employed by dental practitioners to make the procedures in a simple way. For a satisfactory dental treatment and good oral health status, the state of mind of the patient is very important and it is influenced by many factors, including smoking and alcohol use. The aim of the study is to evaluate whether students are aware that the increased level of dental fear and anxiety is associated with smoking and alcohol use.

Background: Virtual Reality (VR) immerses children in a simulated environment and diverts their attention away from Dental Fear and anxiety (DFA). Likewise, Positive Pre-Visit Imagery (PPVI) intervention serves as a psychological preparation vehicle for the Local Anaesthesia (LA) injection in an attractive approach. Aim: this study aimed to investigate the effect of VR distraction versus PPVI intervention on children's DFA during LA injection. Design: A quasi-experimental study was conducted at Pedo-dentist Clinic, Dental Center, Alexandria. A sample of 90 children aged from 4-6 years were observed for their anxious behaviors in the waiting room. Participants randomly received routine unit care, VR distraction, or PPVI intervention, and their fear and anxious behavioral responses were quantified during LA injection. Findings: Majority of the VR group (83.3%) and 46.7% of the PPVI group experienced mild fear levels during dental LA injection compared to none of the children in the control group. Regarding children's anxiety, 36.7% of the VR group and 10.0% of the PPVI group were relaxed during the LA injection, while 43.3% of children in the control group were out-of-contact during the injection procedure. Conclusion: Both VR distraction and PPVI intervention showed positive effects and had excellent potential as evidence-based interventions for minimizing children's DFA during LA injection

В современном обществе страх перед посещением стоматолога испытывает почти треть всего населения. В данной статье речь пойдет о детском страхе. На различных этапах своего развития ребёнок испытывает разны страхи. Наиболее «легкий» способ справиться со страхами и беспокойством, выбираемый ребёнком, стремление избежать источника страха. В данной статье обработаны и проанализированы данные по обращаемости детей в детскую стоматологическую поликлинику с разными степенями страха перед посещением стоматолога, освещены основные причины появления страха, пути его преодоления.

BACKGROUND: The relationship between dental anxiety and mucosal wound healing, especially the inflammatory response, has not been well studied. This study aimed to examine the relationship between anxiety prior to dental treatment and short-term inflammation following impacted mandibular third molar (IMTM) surgery. METHODS: Fifty-nine patients who required IMTM surgery were recruited for this study. Sample demographics (gender, age) and surgical extent (Pederson classification, duration) were collected. Psychological stress towards surgery was assessed by the Dental Fear Survey (DFS). All surgeries were conducted according to an identical surgical protocol and all patients were given the same medical prescription. Correlations between short-term inflammation (swelling and trismus after 2 days) and DFS, demographics and surgical extent were statistically analysed. RESULTS: The results showed that patients with a higher DFS score demonstrated more severe swelling (s = 0.36, P = 0.016) and trismus (s = 0.37, P = 0.008) 2 days after surgery. In addition, more severe trismus occurred following more difficult surgery (s = 0.29, P = 0.016) or that with a longer duration (s = 0.21, P = 0.081). Neither gender nor age showed any significant relationship with swelling or trismus. CONCLUSION: Short-term inflammatory response following IMTM surgery correlated with the preoperative dental anxiety and this correlation was independent of gender and surgical extent.

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.

The fear of the dentist, dental anxiety and dental phobia continue to concern the medical world, seeking to elucidate the causes, calculate the prevalence and its implications on the oral health of the population, as well as identify the most effective methods to combat it. The survey included 208 patients, who were treated and investigated, in the period 2018-2019. The questionnaire consisted of 15 questions, structured in 3 sections: socio-demographic data, oral hygiene habits and past experience, during dental treatment, with analysis of dental anxiety, using modified MDAS. The mean value of MDAS in the study group was 11.7 ± 4. Most of the respondents (80%) had medium or low dental anxiety. High levels of anxiety were observed in 20% of patients, including 12% with dental phobia. A statistically significant correlation was found between the mean values of the MDAS and sex (p = 0.030), age (p

High dental anxiety is a major barrier to accessing dental care and has been found to be experienced to a greater extent in the homeless population. No studies have investigated the extent and nature of dental anxiety in Australians experiencing homelessness and was the aim of this study. Participants were recruited from four not-for-profit organisations in inner Brisbane using convenience and snowball sampling. The Dental Anxiety Questionnaire (DAQ) and the Index of Dental Anxiety and Fear (IDAF-4C+ ) questionnaire and oral health screening were completed by people experiencing homelessness in Brisbane, Australia, and compared to population norms. Descriptive statistics were calculated, and non-overlapping confidence intervals considered significantly different. The majority of the participants (n = 66) were male, a current smoker, unemployed and living in government supported housing. Most of the participants rated their oral health as poor/fair (n = 46, 71.9%) and their oral function as good or higher (n = 34, 53.1%). Using the single-item DAQ, 28.2% (n = 19) of people experiencing homelessness had high dental anxiety, compared to 16% of the general Australian population. The mean summed IDAF-4C+ fear module score was 18.02 (CI 15.60-20.43), which was significantly higher than the Australian population (µ = 14.40, CI 13.93-14.86). The highest mean score in the IDAF-4C+ stimulus module was feeling embarrassed or ashamed as anxiety inducing (µ = 2.27, CI 1.89-2.64) and was significantly different from the general Australian population (µ = 1.40, CI 1.33-1.47). The poorer overall self-rated oral health by the homeless population may induce feelings of embarrassment or shame, highlighting the differing psychosocial aspect to dental anxiety experienced by this population. Managing dental anxiety is needed to improve accessing to dental care for this population. Multidisciplinary care from social workers, mental health workers and dental practitioners may be beneficial in managing fear.

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.

Introduction: Dental anxiety is common and causes symptomatic use of oral health services. Objectives: The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety. Methods: A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking. Results: Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (β = −0.75, P < .001, for MDAS total score; β = −0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (β = −1.08, P < .001) and treatment-related dental anxiety (β = −0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (β = −0.217, P < .026) and women (β = −0.498, P < .001). Conclusion: Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080). Knowledge Transfer Statement: Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

Play is an inseparable part of childhood and can act as a mode through which children can be desensitized toward dental treatment. Aim To assess and compare the efficacy of bubble breath play therapy (BBPT) and tell-show-do (TSD) technique in the dental management of anxious/fearful children. Materials and methods Forty-eight children aged 6-8 years were randomly divided into group I: BBPT and group II: TSD. The effectiveness of the BBPT and TSD technique in reducing anxiety/fear in children was assessed pretreatment, during, and posttreatment evaluation of the child's anxiety levels using finger pulse oximeter and Venham's anxiety and behavior rating scale. All children underwent rotary restorative treatment. Results The mean pulse rate in the BBPT and TSD group was 106.96 mm Hg and 102.25 mm Hg, respectively, at baseline. A decrease in the pulse rate was observed in both the groups after the application of behavior modification strategies. However, after the dental treatment, the mean pulse rate slightly increased in the BBPT group, while it showed a further improvement in the TSD group. Conclusion The BBPT acts as a distraction and can be considered to enhance rapport between the dentist and children during dental treatment. Clinical significance Application of appropriate strategies to allay dental fear in children is essential to provide quality dental treatment and build a positive attitude toward oral health.

Introduction: Dental fear or dental phobia is caused by previous unpleasant dental experiences and pain. It can result in delaying or avoiding dental visits. Most often it leads to individuals avoiding visiting the dentist until physical pain completely impairs the quality of life. Objectives: Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current. The main aim of this study was to examine whether the TENS device affects the reduction of anxiety and fear during dental procedures. Material and Methods: The study was conducted on a sample of 125 respondents, aged 9-14 years. Statistical significance of differences between pre- and post-treatment results on all applied measuring instruments was verified by the t-test for dependent samples. The calculation was performed for all respondents and individually for the three observed groups. The Children`s Fear Survey Schedule – Dental Subscale test was used to assess anxiety and fear. Results: The results on the CFSS-DS scale in all subjects did not differ statistically significantly before and after treatment (p > 0.05). The results on the CFSS-DS scale in subjects who received TENS were statistically significantly different before and after treatment (p < 0.01). The results on the CFSSDS scale in subjects who received local anesthesia were statistically significantly different before and after treatment (p < 0.05). Conclusion: The TENS device had an anxiolytic effect after the first visit.

Introduction: Dental fear and anxiety poses a significant problem in child patient management as such patients are more likely to avoid or delay seeking dental treatment, cancel dental appointments, and are considered to be the main barrier for successful completion of the dental treatment. Thus, early recognition and management of dental fear are imperative and the key to deliver effective dental treatment to the child patient. Aim: The aim of this study was to evaluate dental fear among children aged 4–12 years and parental anxiety using validated assessment scales. Methods: The study was conducted on 288 children who visited the Department of Pedodontics and Preventive Dentistry at Post Graduate Institute of Dental Sciences, Rohtak. The dental fear among children was measured using validated dental fear assessment scales, i.e., facial image scale and Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Parental anxiety was assessed using Norman Corah's Dental Anxiety Scale (C-DAS). Children dental fear was compared with parental anxiety. The factors associated with dental fear (age, gender, parent gender, previous dental experience, socioeconomic status, and background area), and also, the first dental visit age was assessed. Results: A total of 288 children showed CFSS-DS of 25.36 ± 6.130, 105 were girls (36.5%) and 183 were boys (63.5%) with CFSS-DS of 25.56 ± 6.102 and 25.25 ± 6.160, respectively. This showed that there were no significant differences in fear between boys and girls. According to the facial image scale, 0.3% of children were reported to have dental fear. Parental anxiety showed C-DAS of 7.53 ± 4.674, 163 were female (56.6%) and 125 were male (43.4%) with C-DAS 9.53 ± 5.183 and 4.94 ± 1.852, respectively. Conclusion: Parental anxiety was not associated with children's dental fear. Among factors, age, previous dental experience, and socioeconomic status were associated with children's dental fear. The most common first dental visit age among the three groups was 5 years.

The short form of the Fear of Dental Pain Questionnaire (s-FDPQ) is a validated measure developed to screen patients for their fear of pain associated with dental procedures. As there is a high prevalence of dental fear/anxiety in Chinese adults, the primary aim of our study was to translate the s-FDPQ into standard Mandarin and explore its reliability and validity with Chinese adults. The second aim of our study was to explore fear of dental pain (FDP) scores in relation to dental attendance, anxiety and gender. We translated the s-FDPQ using the forward-backward method. It was completed by 480 Chinese adults alongside the Modified Dental Anxiety Scale (MDAS; Chinese version) to test convergent validity. 109 participants completed the s-FDPQ again 14 days later to evaluate test-retest reliability. The Chinese s-FDPQ (s-CFDPQ) was internally consistent (alpha = 0.87) and demonstrated convergent validity (r = 0.73 when correlated with the MDAS). Test-retest reliability was good (ICC = 0.86). Individuals who had never attended the dentist (22%) had higher FDP scores than those that had, even if they were not dentally anxious. Also, females reported higher FDP scores (p < 0.001). These findings suggest that the s-CFDPQ is a reliable and valid measure for assessing fear of dental pain in Chinese adults. The s-CFDPQ could allow quick identification of individuals who are fearful of dental pain who may require specialist attention.

We evaluated gender-specific associations of two dimensions of dental anxiety (anticipatory and treatment-related dental anxiety) with three dimensions of alexithymia: difficulty in identifying feelings, difficulty in describing feelings, and externally oriented thinking. The sample comprised 2558 parents from the general population participating in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale and alexithymia with the 20-item Toronto Alexithymia Scale. Associations between dental anxiety and alexithymia dimensions were modelled using linear regression analysis adjusting for general anxiety and depressive symptoms, age, and education. Structural equation modeling assessed their interrelationships. In women, anticipatory dental anxiety was associated only with difficulty in identifying feelings, but treatment-related dental anxiety was associated with difficulty in identifying feelings, difficulty in describing feelings, and externally oriented thinking. In men, anticipatory dental anxiety was associated with only externally oriented thinking, whereas treatment-related dental anxiety was associated with difficulty in describing feelings, and with externally oriented thinking. Structural equation modelling showed that difficulty in identifying feelings was associated with anticipatory and treatment-related dental anxiety in women, whereas in men, only difficulty in describing feelings was associated with both types of dental anxiety. Anticipatory and treatment-related dental anxiety have different associations with alexithymia dimensions.

Objective: To determine the relationship of transmission of COVID-19 virus knowledge with dental care during a pandemic . Material and Methods: Online questionnaire using Google forms distributed through social media (WhatsApp groups, Facebook, line groups) using a combination of convenience and snowball sampling. The level of knowledge about coronavirus transmission was measured using a questionnaire consisting of 5 statement items. This questionnaire uses the Guttman scale with 3 response and anxiety categories for dental care as measured using a modified questionnaire from the Dental Fear Survey. This questionnaire consisted of 9 question items using a Likert scale. Results: 285 respondents came from WhatsApp media users (89.9%) with an average age of 29.91 years. Respondents who experienced "dental health problems" during the pandemic were 44.7%. The knowledge of respondents about the transmission of the COVID-19 virus in dental care was 79.9% and the knowledge of the fear of caring during the pandemic period was 31.85% afraid. Statistical analysis showed a significant relationship between knowledge about transmission of the COVID-19 virus and fear of dental care (rs=0.388, p

The aim was to analyze perceptions of oral health in adults who have been exposed to child sexual abuse. Eleven participants (10 women), 19 to 56 y of age, who had experienced sexual abuse as children were purposively selected and interviewed in-depth. The participants were encouraged to describe how they perceived the effect of the sexual abuse on their oral health as adults. The interviews were recorded digitally and transcribed verbatim. The collected material was analyzed according to qualitative content analysis. The theme “challenging conditions for maintaining oral health” was identified, comprising 2 categories: first, “the emotional significance,” with the subcategories 1) emotional barriers and 2) powerful relief, and second, “the obstacles to oral health,” with the subcategories 1) daily self-care with complications and 2) dental appointments with difficulties. The findings indicate that the experience of sexual abuse during childhood can have a negative impact on oral care in adulthood. The informants stated that oral health was of utmost importance but also associated with strong emotions. There were obstacles to maintenance of oral health that were difficult to surmount.Knowledge Transfer Statement:The study provides access to the attitudes of survivors of child sexual abuse regarding oral health and the needs and obstacles that they experience. This is important knowledge for dental professionals to optimize dental care.

Introduction Emergency dental services are an important establishment for accessing immediate care for patients with acute odontogenic conditions, some of which are potentially life-threatening. The city of Zagreb has been providing this type of service free of charge for the past 15 years to its citizens and the citizens of Zagreb’s county. In the past years, there has been a graduate increase of patients attending our clinics, specifically, an average of 20329 patients has attended every year for the past three years. This type of service is unique in the sense that it is accessible to anyone during workday nights (from 10 pm to 6 am), weekends and public holidays (24/7). Description of policy context and objective As an objective, this service has the intention to provide urgent care for patients experiencing a dental emergency in situations when patients have no access to their family dentist. This gives our City’s citizens a sense of confidence and safety in the integrated healthcare system and is often the last resort for patients who for any reason have obstacles in receiving dental care. The obstacles vary from incompatible working hours, low income to lack of confidence in treatment or dental fear and anxiety. This kind of medical service is important for an integrated healthcare system since dental services are often fragmented and have long waiting lists. Patients, therefore, can find themselves in an uneasy situation if an emergency occurs. Targeted population The city of Zagreb and its metropolitan area has 1,088,841 citizens. A substantial influx of citizens of other counties seeking work and living within the city has contributed to its growth, which is only expected to continue into the future. The service is provided through three dental offices positioned in the west, east and center/south part of the city, to make access to service easier and a total of seven dental teams are employed. Highlights Due to the high numbers of patients frequenting our service we can say that there is an obvious need for emergency dentistry and our service is often the only resort for patients with acute dental conditions. In the year 2018 alone, there was a total of 22,201 patients who visited and had 59.858 procedures done. Financing comes mostly from the local municipality (The city of Zagreb) and part from the Croatian Health Insurance Fund. By providing emergency care the risk of serious and possibly life-threatening complications which require expensive hospitalization is decreased since most emergency procedures can be done with smaller patient discomfort. Comments on transferability This service design can be transferred to other municipalities who aim to decrease the seriousness and severity of dental emergencies and the costs that they can cause. This would be useful for areas with a shortage of dentists and specialists in various fields of dentistry, which is often seen in rural areas. Conclusions Emergency dentistry should be accessible to anyone in an integrated system considering the various obstacles for receiving dental care, and shouldn’t rely on hospital admissions.

Background. The aim of the present study is to compare the dental anxiety levels between two outpatient clinics. Methods. Two hundred and seventy patients treated in two different clinics of minor oral surgery and dental extraction polyclinic in the Dental Faculty of Eskisehir Osmangazi University were included in the study. The impacted third molar surgery group and conventional dental extraction group consisted of 101 and 169 patients, respectively. The Modified Dental Anxiety Scale (MDAS) and Dental Fear Scale (DFS) were used to measure anxiety levels in patients treated in both clinics. Tests were made in an isolated room preoperatively. The differences in anxiety levels according to education status and gender were also evaluated. Results. The impacted third molar surgery group showed a significant increase in dental anxiety measured with DFS questionnaire ( p < 0.05 ). However, MDAS revealed that there was no difference between anxiety levels between the impacted third molar surgery and conventional dental extraction groups ( p > 0.05 ). There was also no difference in anxiety levels between patients with different education status ( p > 0.05 ). Female patients demonstrated higher levels of anxiety in both MDAS and DFS indexes ( p < 0.05 ). Conclusion. Dental anxiety may be higher in patients treated with impacted third molar surgery compared with conventional dental extraction. The education status of patients may not affect dental anxiety. Female patients may show increased levels of dental anxiety in conventional dental and impacted third molar extractions.

Background Dental fear and anxiety still pose the most common factors proposed for the child’s negative behavior in the dental operatory. Intelligence has an impact on the children’s communication, feelings, and responsiveness to dental situations. The benefits of parental presence on reinforcing the child’s behavior during dental treatment are still debatable. This study aimed to assess the effect of parental active versus parental passive presence techniques on the overall behavior of preschool children with different intelligence levels. Methods This randomized controlled trial was conducted from December 2017 to August 2019. It recruited 150 healthy children, 3–6-year-old, with no history of previous dental pain/treatment, and intelligence quotient level of 70– ≤ 110 stratified into 3 equal groups (high, average, low). In the first visit, each IQ group was randomly divided into test (PAP) and control (PPP) groups. In the second visit, dental fear was assessed before preventive intervention, the test groups were then managed using parental active presence technique, while the control groups were managed using parental passive presence technique. The overall behavior was assessed at the end of the visit. Data was analyzed using Chi-square test and logistic regression analysis. Results The parental active presence technique had significant effect on children with high and low intelligence quotients. There were significantly higher odds of positive behavior in high than low intelligence quotient children, (OR 4.08, 95% CI 1.43, 11.67, P = 0.01). The parental active presence technique had significantly higher odds of positive behavior than the parental passive presence technique, (OR 4.08, 95% CI 1.71, 9.76, P = 0.002). Conclusions The parental active presence technique had positively influenced the children’s overall behavior irrespective of their intelligence levels. This trial was retrospectively registered, trial identifier number: NCT04580316, 8/11/2020.

AIM The aim of this systematic review and meta-analysis was to evaluate the association between sense of coherence (SOC) and dental fear/dental anxiety. METHODS Computerized searches were performed in six databases. Gray literature and manual searches were also conducted. Study selection, risk of bias assessment, and meta-analyses were performed. The results of meta-analyses were reported in odds ratio (OR), mean difference (MD), and confidence interval (CI). RESULTS After removing duplicates, 131 references were retrieved and the full texts of 12 were evaluated. Nine references met the eligibility criteria and were included. The results of meta-analyses demonstrated that individuals with a weaker SOC had a score in the dental anxiety/dental fear scale 6.04 times higher than individuals with a stronger SOC (OR = 6.04, CI = 2.62-13.91). Individuals with no dental anxiety/dental fear had a mean score of the SOC scale higher than individuals with dental anxiety/dental fear (MD = 5.39, CI = 2.21-8.56). Sensitivity analysis demonstrated that the result of a higher mean score of the SOC scale among individuals with no dental anxiety/dental fear remained (MD = 7.38, CI = 3.79-10.98). Risk of bias ranged from low to high. The certainty of evidence was very low. CONCLUSION Individuals with stronger SOC have lower levels of dental fear/dental anxiety.

Introduction: The aetiological factors of dental fear include negative information, witnessing or having a bad experience, and negative conditions related to periodontal treatment. Modified Dental Anxiety Scale Nepali version, is one of the tools used in epidemiological studies to measure dental anxiety in adults. The objective was to find out the prevalence of anxiety among dental patients visiting for periodontal therapy in a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted among patients visiting for periodontal therapy from November 2020 to January 2021 at a tertiary care dental hospital. Ethical clearance from Institutional Review Committee (Reference no. 0311202001) was taken before the study. Convenient sampling was done. A standard questionnaire for dental anxiety was used for data collection after receiving informed consent from the participants. Data were entered and analyzed in Microsoft Excel Sheet. Descriptive data are presented as means, standard deviations, frequencies, and percentages. Results: Among a total of 311 participants visiting for periodontal therapy, 297 (95.49%) (92.57-97.42 at 95% Confidence Interval) were having anxiety. Among total patients, 113 (36.33%) were fairly anxious, 111 (35.69%) were slightly anxious, 62 (19.94%) very anxious and 11 (3.54%) were extremely anxious. Majority of males 54 (17.36%) were slightly anxious while most females 67 (21.54%) were fairly anxious. Mean Modified Dental Anxiety Scale-Nepali score of all the participants was 11.59±3.808. Extreme dental anxiety was observed in 11 (3.54%) participants 7 (2.25%) females; 4 (1.29%) males. Conclusions: The prevalence of anxiety among patients visiting for periodontal therapy in this study was found to be higher compared to other studies done in similar settings.

Background Dental fear is associated with the experience of prior dental treatment and avoidance of dental visits. It remains unclear if individuals show an intention of avoidance (IA) towards treatments that they have not received (i.e., non-experienced dental treatment). The study aims to investigated (a) if individuals showed an increased fear and IA to non-experienced, compared to experienced dental treatment, and (b) if fear and IA to non-experienced treatment is associated with dental anxiety. Methods Fear/IA of 12 common conditions of dental treatment of 402 adults were investigated. If subjects have experienced the condition, fear and IA were assessed based on subjects’ prior experience (i.e., ExpFear/ExpIA). If they have not experienced the condition, fear and IA were assessed based on their anticipation (i.e., NExpFear/NExpIA). Trait dental anxiety was assessed using the Index of Dental Anxiety and Fear (IDAF-4C+). Results (A) NExpFear and NExpIA were significantly higher than ExpFear and ExpIA, respectively. (B) The IDAF-4C+ scores are positively correlated with NExpFear/NExpIA and negatively correlated with the magnification of fear (i.e., the discrepancy in the fear/IA of non-experienced vs. experienced conditions). (C) The condition ‘extraction of a wisdom tooth’ and ‘root canal treatment’ showed the highest ratings on NExpFear. Conclusions Individuals may develop a high degree of fear and IA of the treatment they have not received. Trait dental anxiety plays a key role in the fear of non-experienced treatment.

Objective: Dental fear is a common phenomenon in children and parents can have a key role in the development of child's dental anxiety. There is moderate evidence to support the relationship between the parental general health and children’s dental fear. The aim of this study was to investigate the relationship between dental fear and cooperation of children during dental treatment with the general health of parents.Methods: This cross-sectional descriptive study was done on 130 children aged 6 to 12 at the Department of Pediatric Dentistry, Guilan University of Medical Sciences from May to September 2020.The personality traits and general health of parents were assessed by using the General Health Questionnaire (GHQ-28). The Frankl's behavior rating scale and Children's Fear Survey Schedule Dental Subscale (CFSS-DS) were used to respectively assess the degree of cooperation during dental practices and children’s dental fear. Statistical approaches included T-test, Chi-square and Pearson Linear correlation. A significant level of differences was taken as P0.001).Conclusion: There was not relationship between parent's general health with children's dental fear and cooperation.

Objective: Molar incisor hypomineralization (MIH), a quite common condition in pediatric dentistry, whose treatment might seem complicated, manifests itself with severe dental anxiety and fear that can cause behavioral problems. Although dental fear is seen in almost all cases, it is believed that dental fear will increase as the severity of MIH increases. This study evaluates the relationship between MIH severity and dental fear. Material and Methods: Children Fear Survey Schedule-Dental Subscale (CFSS-DS) was used to measure dental fear in 58 (51.79%) children whose teeth suffered from mild, moderate or severe MIH and 54 (48.21%) children with healthy teeth. Scores between 1 (not afraid at all) and 5 (very afraid) were given according to the responses. Each question was evaluated separately in order to obtain the total score. Results: Children with severe MIH who participated in the study were proved to be more afraid of the dentists, drill sounds, injections, placement of instruments in the mouth, choking and going to the hospital; and there was a statistically significant difference (p

Aim: To investigate the level of dental fear in middle childhood and the impact of various personal and social factors that contribute to developing dental fear. Materials and methods: The study included sixty-seven 6-12-year-old children and their parents, randomly selected while receiving their treatment at the Department of Pediatric Dentistry, Plovdiv. A modified version of Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS) was used to assess the dental fear of each patient. An interview was conducted with the parents to gather information about patient’s gender and age, parent’s dental anxiety (Corah’s dental anxiety scale-DAS) and pre-appointment preparation of children. Results: The results show that the mean of CFSS-DS for children is 30.28±1.17. Concerning the age and gender the comparison between groups of patients with different levels of dental fear demonstrate no significant difference (p>0.05). 60.6%±0.49 of parents prepare their children themselves for the future dental visit and 39.4%±0.49 rely on the dentists to do it. The analysis shows that parent’s dental anxiety and pre-appointment preparation are not associated with the level of dental fear of their children (p>0.05). Conclusions: In middle childhood the majority of children show no or low level of dental fear. The personal and social factors we studied are not determinant risk factors for 6-12-year-old children to develop dental fear.

Introdução: A prevalência estimada de extremo medo e ansiedade dentária é de 40% na população adulta. O medo expresso pelo paciente do dentista raramente é usado na prática clínica para avaliar as preocupações do paciente. Objetivos: O presente estudo foi realizado para identificar os fatores de risco associados ao medo do dentista e a frequência de visitas ao consultório odontológico. Metodologia: O estudo incluiu 98 indivíduos que visitaram uma clínica odontológica da Universidade Federal do Amazonas. O medo dentário foi medido: (Qual o seu medo de visitar o dentista? A. De modo algum, b. Pouco c. Muito). Os dados demográficos foram coletados com base na Escala Hospitalar de Ansiedade e Depressão (HAD), enquanto o medo dentário foi avaliado pelo Questionário de Medo Dental (CMD). Essas avaliações foram feitas antes da realização do tratamento odontológico. Resultados: Os resultados revelaram que quatro dimensões do TMC foram consideradas: A. cuidados acidentais, b. atitude do dentista, c. negligência e d. organização. Somente as dimensões de atitude do dentista (OR = 2,4 (IC95%: 1,1-5,4); p = 0,02) e negligência (OR = 5,3 (IC95%: 2,0- 13,1); p = 0,0001), juntamente com o os níveis de ansiedade (OR = 1,3 (IC95%: 1,3-1,7); p = 0,01) foram associados independentemente à presença de medo dentário. Nenhuma das variáveis esteve associada à frequência de visitas ao dentista. Conclusões: Os resultados revelaram ainda que as dimensões de atitude e ansiedade do dentista estavam associadas ao medo de visitar o dentista. Palavras Chave: Medo, Ansiedade, Dentista, Escala de Depressão

BACKGROUND: Dental fear/anxiety are associated with numerous negative outcomes. State dental fear is known to be transmitted from parents to their children in the dental setting, but it is not known how trait fear/anxiety might be shared between parents and offspring long-term, and especially for adolescents. AIM: This study aimed to: (a) compare dental fear levels of adolescents and their parents; (b) predict adolescent dental fear based on demographic variables, fear of pain, and parental dental fear; and, (c) determine relative contributions of mothers’ and fathers’ dental fear to adolescent fear. DESIGN: In this cross-sectional study, the Dental Fear Survey and Fear of Pain Questionnaire-9 were administered to 350 adolescents (age range 11–17) and 515 of their parents, with t-test and ANOVA used to calculate between-group differences; multiple linear regression was used to predict adolescent fear from parent fear. RESULTS: Adolescents’ dental fear was predicted by their own fear of pain and their parents’ dental fear, but not their parents’ fear of pain nor their own age or gender. When considered together, fathers’ but not mothers’ dental fear predicted adolescents’ dental fear. CONCLUSIONS: Parents’ fears/anxieties about dentistry are associated with adolescents’ dental fear in a manner suggestive of intergenerational transmission.

Purpose The sound of dental treatments can evoke anxiety in some dental patients. While women have shown greater dental anxiety than men, little is known about the gender differences in the perception of dental sounds. The purpose of this preliminary study was to evaluate differences in the perception of dental sounds according to the level of dental fear and gender. Patients and methods Based on the level of dental fear, 69 adults (39 women, 30 men; average age, 28.1±8.1 years) were categorized into four groups. Three types of sounds were presented to participants: two sounds associated with dental treatment and a neutral sound. All participants rated their emotional reaction to each sound on a visual analog scale. Results Significant differences were observed for ratings of valence and disgust for a dental drilling sound among the four groups (p=0.007 and 0.004, respectively). Female participants in the dental fear group rated the dental drilling sound as more negative and disgusting than did female participants in the control group (p=0.002 for both ratings). However, no significant differences were found in ratings between males in the dental fear and control groups. Conclusion Perception of dental sounds appears to differ by level of dental fear and by gender. Considering these differences may contribute to reducing fear in dental patients.

Dental fear and anxiety (DFA) serves as significant problem in child patient management as it leads to greater prevalence and increased severity of the disease associated with delayed dental visits. Therefore, it is necessary to effectively predict children dental behaviour and identify children at risk of Behaviour Management problems. Study of factors influencing DFA and its association with behaviour in children during first dental visit. The study included 209 children (5-14 years). DFA levels were assessed using 3 standardised questionnaires i.e. Facial Image Scale (FIS), Dental Anxiety Scale (DAS), Children’s Fear Survey Schedule – Dental Subscale (CFSS-DS). The behaviour of the child was then assessed using Frankl’s Behaviour Rating Scale (FBRS). The data were analysed, and a correlation was established between DFA and behaviour using statistical analysis. Presence of DFA according to FIS is 13.4%, according to DAS is 15.2% and according to CFSS-DS is 17.7%. Maximum participants showed positive behaviour (81.8%) according to FBRS. Factors causing maximum Dental anxiety according to DAS was anticipation of treatment (26.30%) and factor which caused maximum dental fear according to CFSS-DS was injections (45.4%). There is association between DFA and behaviour in children during first dental visit. This study will help assess the factors which lead to dental fear and anxiety in children and also find a correlation between dental fear and anxiety and behaviour management problems which can help the Paedodontist to predict various behaviour management problems and to avoid the factors which lead to them before the initiation of the dental treatment. This can lead to a decrease in the fear and anxiety levels of children which will further lead to better treatment and in turn better case management.

Background: Child dental anxiety can be related to poor oral hygiene, along with more missing and decayed teeth. Information on the origin of dental fear and uncooperative behavior in pediatric dentistry is important for behavior management strategy. A limited number of studies have investigated the effects of environmental factors comparatively. Accordingly, the present study aimed to evaluate dental anxiety in children who referred to Hamadan Dental School with respect to such environmental factors during 2018-2019. Methods: In this cross-sectional study, the level of child dental anxiety was evaluated by the Modified Child Dental Anxiety Scale (MCDAS) and Venham picture test (VPT). The study was conducted on 121 children aged 9-12 years old and the obtained data were statistically analyzed with SPSS 20. In addition, analytical methods such as t test, Freedman test, and independent t test (α=0.05), as well as one-way ANOVA, Kruskal-Wallis, and Mann-Whitney were utilized for analyzing the data. Finally, the correlation between the two questionnaires was measured using the Pearson test. Results: Tooth extraction and injection in the gum were operated with the highest level of anxiety. The relationship between MCDAS and VPT scores was significant. According to the MCDAS score, having a dental experience was the only factor that was significantly related to child dental anxiety. Based on the VPT score, gender, dental experience, clinic type, and mother’s education level were the variables with a significant relationship with the child dental score. Conclusions: In general, aggressive dental treatment such as tooth extraction and restoration should be avoided in the first visit of children. The level of dental anxiety among female children was higher compared to male children, therefore, female children need more attention in this regard. Eventually, mothers’ awareness of dental and oral hygiene also plays an important role in reducing the dental anxiety of their children.

This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child’s behaviour. The aim was to investigate which factors directly interfere with child’s behaviour regardless of the order of sequential dental visits. In this prospective longitudinal study, children aged 7–12 years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children’s non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits. Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7–12 years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour. The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children’s behaviour aged 7–12 years.

Objective To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment. Methods Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively. Results Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies. Conclusion There is a very low certainty of evidence that DT can be effective in managing children's/adolescents' dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well-executed RCTs are needed.

Objectives Dental utilization is an important determinant of oral health and well‐being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north‐central Appalachia, USA, a region where oral health disparities are profound. Methods This study used household‐based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north‐central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best‐fitting predictor model for dental utilization among adult family members. Results On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3‐year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). Conclusions Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care‐related anxiety and fear predicted dental care utilization in north‐central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual‐level fatalistic beliefs and oral health values may affect utilization of routine oral health care.

Objectives The aim of this longitudinal study was to investigate causal pathways among as well as interrelationships between changes in dental fear and dental attendance in a nationally representative sample of adult Finns aged 19 years or older in 2000, with 11 years of follow-up. Methods Data from the Health 2000 and 2011 Surveys (BRIF8901) in Finland were used. The Health 2000 survey used a stratified two-stage cluster sampling design (N=9742). Of the participants in 2000, 7964 were eligible and invited to participate in 2011. Of the participants in 2011 (n=5806), 3,631 (63%) responded to both dental fear and attendance questions in both years. Both fear and attendance were assessed using single questions and dichotomized. The background variables included were age, gender and education. Path analysis and logistic regression models were used. Results Dental fear led to nonhabitual use of dental services rather than vice versa (-0.07 to 0.04 vs. 0.00). When confounders were considered, in both age groups (29-39 years and 40+ years) an increase in fear predicted nonhabitual dental attendance. This association was stronger among the younger age group (OR = 4.91) than among those aged 40 years and older (OR = 2.88). Among the younger age group, improved dental fear decreased the risk of nonhabitual dental attendance (OR = 0.16), while among older age group, stable fear increased the risk of nonhabitual dental attendance (OR = 2.33). Conclusions Dental fear causes nonhabitual dental attendance, and decreasing dental fear increases habitual attendance. Oral health personnel should adapt measures to prevent and treat dental fear.