Association between Dental Fear and Children's Oral Health-Related Quality of Life.

OBJECTIVES: This study aimed to examine the association between both parental dental fear and children's dental fear and its impact on the Oral Health-Related Quality of Life (OHRQoL) of Saudi children in the Eastern Province of Saudi Arabia. METHODS: Data on 93 individuals aged 7-12 years were collected using clinical examination and Arabic-validated questionnaires: the Child Oral Health Impact Profile-Short Form (COHIP-SF19), and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Negative binomial regression analysis was performed to study the association between children's fear and parental dental fear as well as the OHRQoL, while adjusting for certain confounders. RESULTS: Overall, our multivariate analyses showed that children with high dental fear (CFSS-DS ≥ 38, p = 0.027) and a higher percentage of dental caries (p = 0.013) had a significantly lower OHRQoL after adjusting for clinical and socio-demographic factors. Further, parental fear of dentists was significantly associated with children's fear of dentists (p < 0.001). CONCLUSIONS: Our findings demonstrate that children's fear and dental caries are both associated with poorer OHRQoL. Further, parental dental fear about dentists was associated with children's fear of dentists.

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

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

Evaluating Dental Fear and Anxiety in Pediatric Patients Visiting a Private and a Public Dental Hospital in Lahore, Pakistan.

Background One of the biggest hurdles in treating pediatric patients is managing dental fear and anxiety. Some factors that contribute to an increase in dental anxiety are fear of pain, the presence of unknown individuals, a change in the setting of an environment, and separation from parents. Aim The aim of this study was to evaluate dental fear and anxiety in pediatric patients, between the ages of 6 and 12 years, visiting private and public dental hospitals using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Methods A total of 280 children, 140 in a private dental hospital setting and 140 in a public dental hospital setting, were enrolled in this study. The purpose of the study was explained to the accompanying guardian of the patient and written consent was taken. The CFSS-DS was explained verbally in Urdu and the questionnaire was given to guardians alongside the patients which they were asked to fill out following their dental treatment. Result The data obtained from the questionnaires were analyzed using the unpaired t-test. The highest dental fear mean scores and standard deviation in a private dental hospital were for "choking" (3.25 ± 1.21), "the noise of the dentist drilling" (3.24 ± 1.04), and "having somebody put instruments in your mouth" (3.19 ± 1.06), whereas, for a public dental hospital, the highest fear score was recorded in "choking" (3.17 ± 1.69), "injections" (3.07 ± 1.72), and "people in white uniforms" (1.90 ± 1.21). Conclusion The study showed a higher prevalence of dental fear and anxiety in a private dental setting when compared to a public dental setting. Factors responsible for an increase in dental fear need to be assessed for each patient and then treatment given accordingly.

Dental Fear and Anxiety in 9-12 Years Old Children in Clinical Setting in Bosnia and Herzegovina: Normative Values and Types of Informant.

Background: The most commonly used diagnostic tests for evaluation of the dental fear and anxiety (DFA) presence in children were psychometric scales, where interpretation in determining and using of their cut-off scores sometimes was not completely exact. Also, several studies have been conducted where the results were conflicting in terms of who better assessed the DFA presence - the children, their parents, or dentists. Objective: To determine the normative values in the child and parental versions of the Modified version of the CFSS-DS scale (CFSS-DS-mod scale) and to compare the ways in which children, their parents, and the dentist assessed the DFA presence in the dental office. Methods: Survey sample consisted of 200 children aged from 9 to 12 years, whose DFA presence was determined by the CFSS-DS-mod scale. Child parents answered to their version of this scale, and the dentist observed the child behavior in the dental office during the treatment using Venham Anxiety and Behaviour Rating Scales. Results: Parental version of the CFSS-DS-mod scale found to be reliable (Cronbach alpha = 0.955) and valid (67.87% of variance explained) instrument for assessment of the DFA presence in children. Two cut-off scores were determined in a child (37 and 43), as well as in a parental version of CFSS-DS-mod scale (36 and 44), respectively. Dentists assessed the DFA presence in child patients most accurately. Conclusion: The normative values of psychometric instruments should be considered prior to their use. The borderline area of DFA presence should also be taken into account in the future studies. Children could underestimate DFA existence by themselves while interviewing.

Childhood dental fear in children aged 7-11 years old by using the Children's Fear Survey Schedule-Dental Subscale.

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.

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

PURPOSE: To compare the parental and child versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the parental and child evaluations of the Child's Past Dental Experience (CPDE) in 4- to 12-year-old children in a sample from Greece. METHODS: 537 families (652 children) with 4- to 12-year-old children seeking dental care either at a University paediatric dental clinic (UC) (50.8%) or a paediatric private practice (PP) participated. Parents completed a sociodemographic questionnaire and the parental Greek version of the CFSS-DS, and children independently completed the child's Greek version. All family members answered questions about CPDE. Statistical analyses were based on multilevel models (p < 0.05). RESULTS: Mothers' and fathers' mean CFSS-DS total scores were not significantly different from each other (p = 0.655), but were significantly higher than the scores of their sons and daughters (p < 0.001), regardless of the child's age. There was a negative association between mother's age and CFSS-DS agreement, but not for fathers. There was poor agreement for CPDE ratings between children and both parents, regardless of gender. Parents' ratings of CPDE were not related to their assessment of their children's dental fear, whilst the children's ratings of their CPDE were significantly related to their current dental fear. Location (UC or PP) had no significant influence on CFSS-DS or CPDE parental-child differences. CONCLUSIONS: Both parents overestimated their sons' and daughters' dental fear. There was poor agreement on CPDE evaluation between parents and children. Parental CFSS-DS and CPDE evaluations are poor indicators of children's dental fear and prior dental experience.

El Miedo en Relación a la Odontología Uso de la Escala del Miedo Dental / Fear in Relation to Dentistry Using the Dental Fear Scale

La atención odontológica despierta en numerosos pacientes, especialmente en los niños, miedo y ansiedad que pueden originar conductas de rechazo a la misma o dificultar el trabajo del profesional. Para registrar la prevalencia e identificar los miedos más frecuentes en relación a la atención odontológica, se realizó un estudio observacional, descriptivo y longitudinal en un trabajo interdisciplinario con Musicoterapia. Se utilizó la Escala del Miedo (CFSS-DS), Dental Subscale of the Childrens' Fear Survey. Los resultados en un promedio de edades en años 11,41; desvío = 2,80, registraron el 53% en la puntuación 38:39. Corresponde 54.34% al sexo femenino y 45.66% al sexo masculino. El mayor porcentaje de miedo se registró a los 10 años de edad 15.24% y en el sexo femenino 54.34%. En conclusión, registrar y reconocer los miedos dentales ofreció un espacio de reflexión y elaboración de los mismos, con docentes y alumnos de grado, para desarrollar, en un tratamiento interdisciplinario con musicoterapia, estrategias que favorezcan una mejor adherencia de los pacientes al tratamiento odontológico y habilidades inherentes y habilidades sociales inherentes a la relación odontólogo-paciente. El miedo manifiesto a la atención odontológica sin ser resuelto satisfactoriamente puede entorpecer las mejores intenciones del profesional en el desarrollo de su tarea (AU)

Dental fear and its determinants in 7-11-year-old children in Tehran, Iran.

AIM: To assess dental fear and its determinants in 7-11-year-old children. METHODS: In this cross-sectional (descriptive-analytical) study, the standard Persian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire was completed by 240 parent-child (children aged 7-11 years) pairs referred to dental clinics in Tehran city, Iran. Background characteristics were also inquired. RESULTS: An equal number of boys and girls participated in the study. The mean score of fear among the children was 21.66 ± 8.33. The causes of fear among the children were, first, injection, and then, seeing the dentist's drill, choking feeling, and finally, filling the tooth. There was a significant correlation between the scores of children's dental fear and their experience of meeting with the dentist (p = 0.001). The result of the regression test showed that the age of the children (p = 0.022) and high levels of dental fear among their fathers (p < 0.001) was related to high levels of dental fear among the children. CONCLUSIONS: The present children revealed a moderate level of dental fear. Taking children's age into account in behavioural management and challenging father's fear seemed to play a key role to reduce the child's fear and prevent its long-term consequences.

Reliability and Validity of the Modified Version of Children's Fear Survey Schedule-dental Subscale in 9-12 Years Old Schoolchildren in Bosnia and Herzegovina.

BACKGROUND: Dental fear and anxiety (DFA) are present worldwide globally, as well as in children. These psychological clinical entities in its progressive phase lead to avoiding of dentists and dental appointments, and consequtive impairments of oral health. If we ignore these facts, we would have the strenghtening of this relationship in a way of further oral health impairments and lost of dental hard and soft tissues, as well as appearance of dental phobia as the most negative form of psychological reaction to dental stimuli. Original CFSS-DS scale and its modifications, as the most used instruments for evaluation of DFA presence so far, showed various disadvantages. These were the reasons why we wanted to design new psychometric instrument for better evaluation of DFA presence in children compared to evaluation which the existed scales could offer nowadays, in a form of the Modified Version of CFSS-DS scale (CFSS-DS-mod scale). MATERIALS AND METHODS: There were 809 schoolchildren from 8 cities of Bosnia and Herzegovina aged 9-12 years that participated in the study. There was one school per city where the schoolchildren answered to the questions from the CFSS-DS-mod scale. RESULTS: 636 schoolchildren correctly answered to the scale questions. The CFSS-DS-mod scale showed excellent internal consistency reliability values (with Cronbach α>0.9), and also validity results (mostly over 60% of explained variance of obtained results) with two-dimensional concept of DFA presence. CONCLUSION: The CFSS-DS-mod scale represents good psychometric instrument for evaluation of the DFA presence in 9-12 year old schoolchildren in Bosnia and Herzegovina. Some of normative values of this psychometric instrument should be determined, in order to expand its usage in children.

The Reliability and Validity of the Three Modified Versions of the Children's Fear Survey Schedule-Dental Subscale of 9-12 Year Old Children in a Clinical Setting in Bosnia and Herzegovina.

OBJECTIVE: This study sought to obtain a comprehensive, reliable and valid instrument for evaluation of the presence of dental fear and anxiety (DFA) in children, through evaluation of the reliability and validity of three modified versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). MATERIALS AND METHODS: The study sample comprised children aged 9, 10, 11 and 12 years. The first sample group (200 patients) filled in a modified version of the CFSSDS scale, the second sample group (100 patients) filled in a short form of the Dental Fear Survey Schedule, and the third sample group (100 patients) filled in a short version of the CFSS-DS scale, prior to dental treatment, respectively. In order to determine test-retest reliability, the 184 patients from the first sample group filled in the modified version of the CFSS-DS scale again, prior to their next scheduled dental appointment. RESULTS: The modified version of the CFSS-DS scale had the best internal consistency reliability (α=0.907), as well as validity results, compared to the other two instruments used. Test-retest reliability was moderate (Intraclass correlation coefficient: 0.58). CONCLUSIONS: Of the three psychometric instruments used for evaluation of DFA presence in children, the modified version of the CFSS-DS scale showed the most clinically adequate reliability and validity values. This study thus provides a new psychometric instrument that should be considered for clinical use in evaluation of DFA presence in 9-12 year-olds, in a clinical setting sample type of children.

Effects of child characteristics and dental history on dental fear: cross-sectional study.

BACKGROUND: Dental fear (DF) is a challenging problem in dentistry. It is multifactorial in origin and many contributing factors have been identified. The aim of the study was to assess dental fear among 12-15 years old Arabic speaking children in Jeddah, Saudi Arabia and its relation to demographic variables, previous dental experience, and child behaviour. METHODS: In this cross-sectional study, a total of 1522 boys and girls from middle schools in Jeddah, Saudi Arabia participated in this study during the period of 2014 to 2016. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was used to assess DF. A parental questionnaire was used to record the children's previous dental experience. Children were examined for caries and the children's behaviour was assessed during dental examination using Frankl Behaviour Rating Scale. The associations between different variables and the CFSS-DS scores were analysed using t-tests, ANOVA, and multiple linear regression analysis. RESULTS: The response rate of the questionnaires was 78.6%. The mean CFSS-DS score was 25.99 ± 9.3 out of a maximum of 75. Bivariate analysis showed that younger children, girls, and public-school students were significantly more fearful than older children, boys, and private school children, respectively (P < 0.001). Children who showed poor behaviour during dental examination were significantly more fearful than those with good behaviour (P < 0.001). Regression analysis showed that children who had significantly higher scores of dental fear were the children who did not visit the dentist in the past year due to dental fear; who never visited the dentist or those who only visited the dentist on pain; who were reported by parents as crying, screaming, or resistant during their previous dental visit; and those who were described to be in pain during previous dental treatment. Dental caries showed no significant association with DF. CONCLUSIONS: This study confirms that DF is low among 12-15 years old Arabic speaking children in Jeddah, Saudi Arabia. DF is associated with age, gender, school type, irregular patterns of dental visits, painful experiences during previous dental visits and negative behaviours during dental examinations.

Reliability and validity of the Children's Fear Survey Schedule-Dental Subscale for Arabic-speaking children: a cross-sectional study.

BACKGROUND: Early recognition of dental fear is essential for the effective delivery of dental care. This study aimed to test the reliability and validity of the Arabic version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). METHODS: A school-based sample of 1546 children was randomly recruited. The Arabic version of the CFSS-DS was completed by children during class time. The scale was tested for internal consistency and test-retest reliability. To test criterion validity, children's behavior was assessed using the Frankl scale during dental examination, and results were compared with children's CFSS-DS scores. To test the scale's construct validity, scores on "fear of going to the dentist soon" were correlated with CFSS-DS scores. Factor analysis was also used. RESULTS: The Arabic version of the CFSS-DS showed high reliability regarding both test-retest reliability (intraclass correlation = 0.83, p < 0.001) and internal consistency (Cronbach's α = 0.88). It showed good criterion validity: children with negative behavior had significantly higher fear scores (t = 13.67, p < 0.001). It also showed moderate construct validity (Spearman's rho correlation, r = 0.53, p < 0.001). Factor analysis identified the following factors: "fear of invasive dental procedures," "fear of less invasive dental procedures" and "fear of strangers." CONCLUSION: The Arabic version of the CFSS-DS is a reliable and valid measure of dental fear in Arabic-speaking children. Pediatric dentists and researchers may use this validated version of the CFSS-DS to measure dental fear in Arabic-speaking children.

Indicators of dental anxiety in children just prior to treatment.

OBJECTIVES: We evaluated the relationship between child dental anxiety and selected child and parental characteristics. STUDY DESIGN: Children and their parents were interviewed at the New York University, College of Dentistry, Pediatric Dentistry Clinic. The Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) evaluated child self-reported anxiety; the Modified Dental Anxiety Scale (MDAS) measured self-reported parental anxiety when the parent received dental treatment. RESULTS: Ninety-three children and their parents completed the questionnaires. Mean CFSS-DS scores were higher for girls than boys (32.5 vs. 26.3, p=0.003) and for children whose accompanying parents had MDAS scores of 11+ vs. ≥ 11 (32.8 vs. 26.6, p=0.001). There was little difference in mean CFSS-DS scores among those aged 6-10 yrs. vs. 11-14 yrs. (30.1 vs. 29.3). Significant correlations were found between CFSS-DS and both gender (Spearman's rho, rs=0.31) and MDAS scores (rs=0.33), but not between CFSS-DS and child age (rs=-0.05). Controlling simultaneously for gender, MDAS score and child age, a high CFSS-DS score (38+ vs. ≥ 38) was positively associated with girls (ORadj=3.76, 95% CI: 1.13-12.54) and an MDAS score of ≤ 15 vs. ≥ 11 (ORadj=2.50, 0.73-8.54), but weakly and inversely associated with age (ORadj=0.80, 0.25-2.52). CONCLUSION: Child gender and parental anxiety are indicators of child dental anxiety.

Assessment for the children's fear survey schedule-dental subscale.

OBJECTIVES: Child dental fear causes a significant management problem. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) is the most widely used measure of dental fear in children. This study was undertaken to develop and test reliability and validity for the Arabic version of the CFSS-DS. STUDY DESIGN: the English CFSS-DS was translated to Arabic language and its reliability and validity were evaluated by distributing it to 6-12 year old Arabic pediatric dental patients (n=220). Of whom 144 children were assigned for test- retest reliability. To test criterion validity; 44 children were subjected to behavior rating during treatment and compared with their CFSS-DS. Fear of returning to the dentist was evaluated for all the children to test construct validity. RESULTS: the Arabic version of the CFSS-DS showed good internal consistency (alpha = 0.86) and test-retest reliability (0.86, P<0.001). Treatment with or without local anesthesia did not affect the children's behavior or fear scores. Significant correlations were found between total fear scores and both Frankl rating scale (r=-0.54, p<0.001) and willingness to return to the dentist (r=0.50, p<0.001). CONCLUSION: the Arabic version of the CFSS-DS appears to be a reliable and valid method for evaluating child's dental fear in Arabic cultures.

Iranian version of a face version of the Modified Child Dental Anxiety Scale: Transcultural adaptation and reliability analysis.

BACKGROUND: A novel version of the Modified Child Dental Anxiety Scale (MCDAS) was developed by addition of faces rating scale to the original numeric form. The aim of this prospective descriptive study was to perform a transcultural adaptation and reliability analysis of the Iranian version of Faces version of Modified Child Dental Anxiety Scale (MCDAS(f)) and the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). METHODS: To determine the test-retest reliability, 200 school-children aged 8-12 years completed the MCDAS(f) and the CFSS-DS on two separate occasions, 2 weeks apart. To determine the criterion validity, all participants completed two questionnaires at the same sitting. The translated instrument was tested for internal consistency by Cronbach's alpha, inter-item, and item-total correlation coefficients. Correlation between the MCDAS(f) and CFSS-DS mean scores and age were calculated using the Pearson correlation coefficient. RESULTS: The intraclass correlation coefficients ranged from 0.158 to 0.658 (P < 0.01) for the individual items of the MCDAS(f) between the first and the second assessments and also, ranged from 0.350 to 0.677 (P < 0.01) for CFSS-DS. The internal consistencies (Cronbach's alpha) were 0.85 and 0.92 for the MCDAS(f) and CFSS-DS, respectively. The correlation between the MCDAS(f) and CFSS-DS was 0.73 (P < 0.001). The MCDAS(f) and the CFSS-DS scores at the first administration were significantly greater than those of the second. CONCLUSIONS: The MCDAS(f) is a reliable measure of dental anxiety in Iranian children aged 8-12 years, suggestive of good reliability and validity.