Concordance of Fathers and Mothers in the Assessment of Their 5-Year-Old Child's Dental Fear.

The aim of this study was to evaluate the concordance of parents' assessments of their child's dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children's Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother-father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen's Kappa coefficients were used in the analyses. The concordance of parents' assessments was poor (Kappa range 0.072-0.258). The majority of parents replied "No Experience" to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child's fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent's assessment, and whether or not the child has experience with the question asked should also be considered.

Two-Year Trajectories of Dental Anxiety in Parents and Their Association with Parents' and Children's Oral Healthcare Procedures in FinnBrain Birth Cohort Study.

We aimed to identify parents' dental anxiety trajectories and the association of the trajectories with the number of parents' and their children's oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers' trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers' trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures.

Gender differences in the association between malocclusion traits and oral health-related quality of life in Finnish adults.

We aimed to evaluate the gender-specific associations of malocclusion traits with oral health-related quality of life (OHRQoL) among Finnish adults. Data were obtained from the Health 2000 Survey, Finland. Included participants (n = 3993) were ≥30 years old with OHRQoL and occlusion data. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14). OHIP-14 severity mean score, prevalence of impacts, and means of seven dimensions were outcomes. Explanatory variables were any malocclusion trait, increased overjet, negative overjet, open bite, deep bite, and crossbite/scissor bite. Logistic (prevalence) and cumulative (severity) regression models were adjusted for age, decayed teeth, deep periodontal pocket, occluding pairs, orthodontic treatment, and self-perceived health. Gender modified the association between any malocclusion trait and OHRQoL, with the association being stronger in females. Females without any malocclusion trait (OR = 1.62, 95% CI = 1.14-2.28) or without crossbite/scissor bite (OR = 1.68, 95% CI = 1.16-2.43) had better OHRQoL (lower prevalence) than those with malocclusions. Males without increased overjet (OR 1.50, 95% CI = 1.04-2.17) had lower mean OHIP-14 severity score than males with increased overjet, after adjustments. The association between psychological and physical disability and malocclusion traits was different between males and females. Gender differences in the impact of malocclusion traits should be considered when assessing orthodontic treatment need.

Concurrent changes in dental anxiety and smoking in parents of the FinnBrain Birth Cohort Study.

We evaluated associations between changes in dental anxiety and tobacco use, adjusted for general anxiety and depressive symptoms. The FinnBrain Birth Cohort Study data, collected at gestational weeks 14 and 34 and at 3 months postpartum, were used. Questionnaires included the Modified Dental Anxiety Scale (MDAS), the Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Symptom Checklist-90 (SCL). Smoking was categorized as "stable non-smoking", "started smoking", "quit smoking", and "stable smoking". Changes in smoking and dental anxiety were evaluated "during pregnancy" (i.e., from gestational week 14 to gestational week 34) in 2442 women and 1346 men and "after pregnancy" (i.e., from gestational week 34 to 3 months postpartum) in 2008 women and 1095 men. Changes were evaluated in three smoking categories (stable non-smoking, fluctuating, and stable smoking), using data from all three time-points (1979 women and 1049 men). Modeling used repeated measures analysis of covariance. Stable smoking mothers had statistically significantly higher levels of dental anxiety (mean MDAS 12.3-12.6) than non-smoking mothers (mean MDAS 10.1-10.7) or mothers who smoked at some point during pregnancy (mean MDAS 10.8-11.5). A similar tendency was observed in fathers. However, no systematic change in dental anxiety by changes in smoking habits was observed. Those smoking during pregnancy and with high dental anxiety may need special support for smoking cessation.

Associations between temperament dimensions and dental anxiety in parents of the FinnBrain Birth Cohort Study.

We evaluated associations between dental anxiety and four temperament dimensions: effortful control, extraversion/surgency, negative affect and orienting sensitivity among 2558 parents in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale, and temperament with the Adult Temperament Questionnaire. Associations between dental anxiety and temperament dimensions were modelled using linear and logistic (cut-off ≥ 19 for high dental anxiety) regression analyses adjusting for general anxiety and depressive symptoms, age and education. In women and men, dental anxiety was positively associated with negative affect (women ß = 1.10; 95%CI 1.06-1.15; men ß = 1.11; 95%CI 1.05-1.18) and negatively associated with effortful control (women ß = 0.95; 95% CI0.92-0.99, men ß = 0.90; 95% CI 0.85-0.95). In women, extraversion/surgency was also positively associated with dental anxiety (ß = 1.04; 95%CI 1.00-1.08). For high dental anxiety, negative affect in women (OR = 2.00; 95%CI 1.31-3.06) and men (OR = 5.21; 95%CI 1.72-15.83) and for extraversion/surgency in women (OR = 1.50; 95%CI 1.01-1.47) associated positively with dental anxiety, but for effortful control, the association was not statistically significant. Dentists should understand that temperament dimensions affect the risk for dental anxiety more strongly than general anxiety or depressive symptoms. Dimensions negative affect and extraversion/surgency may increase and effortful control decrease the risk.

Gender-specific associations between the dimensions of alexithymia personality trait and dental anxiety in parents of the FinnBrain Birth Cohort Study.

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.

Hair Cortisol Concentrations Are Associated with Dental Anxiety during Pregnancy.

Dental anxiety (DA) and hair cortisol concentrations (HCC) are associated with psychological symptoms and vary during pregnancy. We aimed to examine the association between HCC and DA at two points of pregnancy. Participants were pregnant mothers (n = 533) drawn from the FinnBrain Birth Cohort Study donating a hair sample at gestational week (gwk) 24 (n = 442) and/or at delivery (n = 176) and completed questionnaires on DA. Two groups, HCC1 and HCC2, treated as separate in the analyses, were formed according to the hair sample donation time i.e., gwk24 and delivery. 85 subjects were included in both groups. MDAS, EPDS, and SCL-90 were used to measure DA, depressive and anxiety symptoms, respectively, at gwk14 for the HCC1 group and gwk34 for the HCC2 group. The association between DA and HCC was studied with a binary logistic regression model, adjusted for anxiety and depressive symptoms, age, BMI, and smoking status. Individuals with high DA had lower HCC levels at gwk24 (OR = 0.548; 95% CI = 0.35-0.86; p = 0.009), but the association was not statistically significant at the delivery (OR = 0.611; 95% CI = 0.28-1.33; p = 0.216). The independent association between HCC and DA in pregnant women suggests that long-term cortisol levels could play a role in the endogenous etiology of DA. Further studies are however, needed.

Changes in dental fear and its relations to anxiety and depression in the FinnBrain Birth Cohort Study.

This study aimed to: (i) evaluate short-term changes in dental fear during a 9-month period among women and men, and (ii) evaluate whether the course and magnitude of changes in dental fear were associated with changes in depression and anxiety. The longitudinal data of the FinnBrain Birth Cohort Study were used. Out of 3808 women and 2623 men, 1984 women and 1082 men filled in the Modified Dental Anxiety Scale (MDAS) at gestational weeks 14 and 34, and 3 months after childbirth. Other questionnaires used were the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Symptom Checklist-90. All scales were analyzed as sum scores. The MDAS was also trichotomized to assess the stability of dental fear. Statistical significances of the changes in dental fear, depression, and general anxiety were evaluated using repeated-measures Friedman tests. Correlation coefficients were used to describe the associations between measures (Spearman) and their changes (Pearson). Dental fear more often increased than decreased, but for the majority it was stable. On average, dental fear, depression, and anxiety symptoms correlated throughout the study. The correlations tended to be stronger with depressive symptoms. However, the relationships between changes in dental fear, depression, and anxiety were not systematic.

Association of depression and anxiety with different aspects of dental anxiety in pregnant mothers and their partners.

OBJECTIVES: The aim was to confirm the factor structure of Modified Dental Anxiety Scale (MDAS) and to investigate whether the association of these factors with general anxiety and depression varied across gender. METHODS: The FinnBrain Birth Cohort Study (www.finnbrain.fi) data from the first collection point at gestational week 14 were used. Of the invited participants (n = 5790), 3808 (66%) expectant mothers and 2623 fathers or other partners of the mother agreed to participate, and 3095 (81.3%) mothers and 2011 (76.7%) fathers returned the self-report questionnaire. Dental anxiety was measured with the MDAS, general anxiety symptoms with Symptom Checklist-90 (anxiety subscale) and depressive symptoms with the Edinburgh Postnatal Depression Scale. Multiple group confirmatory factor analysis (MGCFA) was conducted to test the equivalence of the factor structure and multiple group SEM (MGSEM) to test the configural invariance (unconstrained model) and metric invariance (structural weights model), across genders. RESULTS: Of those consenting, 3022 (98%) women and 1935 (96%) men answered the MDAS. The MGCFA indicated good convergent validity for the two-factor model for MDAS, but somewhat low discriminant validity (factors demonstrated 72% shared variance). The MDAS items loaded clearly higher for the assigned factor than to the other factor (differences in loadings >0.2), indicating that the 2-factor model has merit. According to the final MGSEM model, anxiety symptoms were directly related to anticipatory dental anxiety, but not to treatment-related dental anxiety. CONCLUSIONS: When assessing dental anxiety with MDAS, considering also its two factors may help clinicians in understanding the nature of patient's dental anxiety.

Pressure pain sensitivity is associated with dental fear in adults in middle age: Findings from the Northern Finland 1966 birth cohort study.

INTRODUCTION: Dental fear is a prevalent problem leading to severe deterioration of oral health and health-related quality of life. Despite the knowledge that dental fear is closely linked to painful experience, the association between pain sensitivity and dental fear remains unclear. This study was designed to evaluate this association with validated measures of dental fear and pressure pain sensitivity in a cohort population. METHODS: The study population consisted of a subpopulation of the Northern Finland Birth Cohort 1966. At the age of 46 years, 1736 participants completed the valid and reliable Modified Dental Anxiety Scale (MDAS) and participated in a clinical examination, where their nonorofacial pressure pain sensitivity was evaluated by validated pressure pain threshold (PPT) and tolerance (PPTo) measurements. Gender-specific Tobit regressions were performed to analyse this association adjusted for smoking and depressive and anxiety symptoms. RESULTS: Women with moderate dental fear had 5% (31.3 kPa; P < 0.05), and women with high dental fear had 7% (42.9 kPa; n.s.) lower pressure pain threshold than women with low dental fear. Women with moderate dental fear had 4% (35.4 kPa; P < 0.05) and women with high dental fear had 9% (82.7 kPa; P < 0.01) lower pressure pain tolerance than women with low dental fear. Men with moderate and high dental fear had 3% lower pressure pain tolerance (35.4 kPa; P < 0.05 and 29.6 kPa; n.s., respectively) than men with low dental fear, whereas the associations with pain threshold were not statistically significant. Among women, both anticipatory and treatment-related dental fears were associated with pain threshold and pain tolerance. Among men, pain threshold was associated with treatment-related dental fear only and the associations with pain tolerance were not statistically significant. CONCLUSIONS: Nonorofacial pressure pain threshold and tolerance appeared to be lower in participants with dental fear, which emphasizes the role of pain sensitivity in dental fear.

Short-term longitudinal changes in adult dental fear.

This study aimed to evaluate (i) longitudinal fluctuations and considerable changes in adult fear at five data-collection points during a 2.5-yr period and (ii) the stability of symptoms of depression in dental fear-change groups. Pilot data from the FinnBrain Birth Cohort study, of 254 families expecting a baby, were used. Data-collection points (DCPs) were: 18-20 and 32-34 gestational weeks; and 3, 12, and 24 months after delivery. At baseline, 119 women and 85 men completed the Modified Dental Anxiety Scale (MDAS) questionnaire. At all DCPs, 57 (48%) women and 35 (41%) men completed MDAS. Depression was measured using the Edinburgh Postnatal Depression Scale. Changes in MDAS were analyzed using general linear modelling for repeated measures. Stability of dental fear was assessed using dichotomized MDAS scores. Dental fear among women decreased statistically significantly in late pregnancy and increased thereafter. Among men, dental fear tended to increase in late pregnancy and decreased afterwards. Depression scores varied in high and fluctuating fear groups but the differences diminished towards the last DCP. Dental fear among adults experiencing a major life event does not seem to be stable. Clinicians should take this into account. The mechanisms behind these changes need further research.

A longitudinal study of changes and associations in dental fear in parent/adolescent dyads.

BACKGROUND: Dental fear seems to fluctuate, but concordance of changes in dental fears between parent/adolescent dyads has not been reported. AIM: To study longitudinally the associations between adolescent and parental dental fears and their changes. DESIGN: Adolescents and parents reported their dental fear independently of each other when adolescents were between 11-12 and 15-16-year-olds. Eight hundred and seventeen eligible parent/adolescent dyads were included in the analyses. Dental fear was measured with a single question using five response alternatives. Associations between adolescent and parental dental fears and their changes were analysed using χ2 tests and correlation coefficients. RESULTS: Prevalence of dental fear remained rather similar during the study. There was a positive association between adolescent and parental dental fears in early adolescence (P < 0.001) but at middle adolescence only among parent/girl dyads (P = 0.007 for girls, P = 0.341 for boys). Changes in dental fear among parent/adolescent dyads did not correlate statistically significantly. Difference between girls' and boys' change in dental fear was statistically significant (P = 0.001). Dental fear increased more often among girls than among boys. Boys had stable low/no dental fear more often than girls did. CONCLUSION: Adolescents' and parents' dental fears seemingly change independently of each other.

Dental fear and previous childhood traumatic experiences, life events, and parental bonding.

We aimed to determine whether adult dental fear is associated with traumas, life events, and perceived parental bonding. Pilot data for the FinnBrain Cohort study were used. Of the 254 families expecting a baby, 80% agreed to participate. At 32-34 wk of pregnancy, 125 women and 81 men completed a Modified Dental Anxiety Scale questionnaire and were included in this study. Other instruments used were the Trauma and Distress Scale (TADS), the Life Event Checklist, and the Parental Bonding Index. All scales were analyzed as summated rating scale scores. Associations between dental fear, TADS domains, and life events were evaluated using Spearman correlation coefficients. The association between dental fear and parental bonding was evaluated using the Kruskal-Wallis test. Among women, dental fear did not correlate with trauma measures, but among men dental fear correlated with emotional neglect and abuse. Dental fear correlated positively with the number of life events among women. Life events and dental fear did not correlate among men. Dental fear was not associated with parental bonding among women or men. The association between traumas, life events, and dental fear seems to be different in women and men.

Individual changes in dental fear among children and parents: a longitudinal study.

OBJECTIVE: The aim was to study longitudinal changes in dental fear among children and one of their parents separately for girls, boys, mothers and fathers over a 3.5-year period. MATERIALS AND METHODS: 11-12-year-old children in Pori, Finland (n = 1691) and one of their parents were invited to participate in this longitudinal study. Dental fear was measured in 2001, 2003 and 2005 when the children were 11-12, 13-14 and 15-16-years-old, respectively. The participants were asked if they were afraid of dental care (1 = 'not afraid', 2 = 'slightly afraid', 3 = 'afraid to some degree', 4 = 'quite afraid', 5 = 'very afraid' and 6 = 'I don't know'). The participants' gender was also registered. Mean values of the change scores were studied. Prevalence and incidence of dental fear and changes in dichotomized dental fear (responses 4-5 = high dental fear and responses 1-3 = low dental fear) were studied using cross-tabulations and Cochran's Q test. RESULTS: Overall, the prevalence of dental fear slightly increased and female preponderance in dental fear became more evident during the follow-up. Of the mothers and children with high dental fear at the baseline, 24% and 56%, respectively, reported not to be fearful at the end of the follow-up. CONCLUSIONS: Dental fear seems to be more stable in adulthood than in childhood. Thus, it might be better to intervene in dental fear during childhood rather than during adulthood.

The significance of previous invasive and orthodontic treatment experiences on children's dental fear.

OBJECTIVES: The aim was to find out if children who have gone through orthodontic and invasive treatment have less dental fear than children who have experienced only invasive treatment or no treatment at all. MATERIALS AND METHODS: The data consisted of 910 9- to 15-year-old children from Jyväskylä and Kuopio, Finland. A questionnaire was used that contained 11 dental fear-related questions and family member's dental fear and questions on oral health habits and family characteristics. Information on treatment procedures from three preceding years was collected from patient records. To study the association between dental fear and treatment experiences, analysis of variance, and multiple logistic regression analyses were performed. RESULTS: Dental fear was found more often in children who had experiences of orthodontic treatment experiences and invasive treatment than in children with invasive treatment only or no treatment experiences at all. LIMITATIONS: Different orthodontic treatment experiences were not analysed individually, and the study was retrospective. CONCLUSION: Familiarization to dental treatment via orthodontic procedures does not necessarily decrease dental fear among children.

Changes over time in adult dental fear and correlation to depression and anxiety: a cohort study of pregnant mothers and fathers.

We aimed to evaluate (i) changes in dental fear over time during pregnancy and after delivery among mothers and fathers and (ii) whether these changes inter-relate to changes in depression and anxiety. Longitudinal pilot data for the FinnBrain Cohort study were used. Of 254 pregnant families, 80% agreed to participate and 60% returned questionnaires at the first data-collection point. After three data-collection points [weeks 18-20 and 32-34 of pregnancy (H18-20 and H32-34, respectively), and 3 months after childbirth], 99 mothers and 74 fathers had filled out at least two out of three Modified Dental Anxiety Scale questionnaires and were included in this study. Other questionnaires used were the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Inventory, and the Pregnancy Related Anxiety Questionnaire. All scales were analyzed as sum scores. Among mothers, dental fear decreased during late pregnancy and increased slightly after childbirth, but no statistically significant correlations between dental fear and depression or anxiety, except for fear of giving birth, were found. Among fathers dental fear increased and was correlated with depression and anxiety. Dental fear seems to fluctuate among women during pregnancy and could be affected by hormonal changes.

Confirming the factor structure of modified CFSS-DS in Finnish children at different ages.

OBJECTIVE: The aims were to determine whether means of different fear-related items were similar in 1998 and 2001 and to find a common factor structure of the modified CFSS-DS for children at different ages. MATERIALS AND METHODS: Independent random samples of 6-, 9-, 12- and 15-year olds were drawn in two cities in 1998 and 2001 (n = 180 per age group from each city). The study group in 2001 comprised 282, 265, 281 and 234 subjects aged 6, 9, 12 and 15 years, respectively. Each child received a modified CFSS-DS form to be filled out at home. Mean scores of different fear-related items were reported for each age group for both data sets. Confirmatory factor analyses (CFA) were performed to test whether the three factor structures revealed for 6-, 9- and 12-15-year olds in 1998 fitted the 2001 data. Multiple group CFA was used to test for the equivalence of the factorial structure across age groups (configural invariance). RESULTS: The age-specific patterns of the means for individual fear-related items in 2001 corresponded to the mean values for 1998. When age-specific factor structures were tested separately for each age group, the factor structure for 9-year-olds was, in general, the best-fitting overall structure. The factor structure had a good fit for all age groups, but the loadings differed at different ages. CONCLUSIONS: The modified CFSS-DS provides consistent factor structures for children at different ages and reflects the changes in manifestations of dental fear during growth.

Can parents and children evaluate each other's dental fear?

The aim of this study was to determine whether parents and their 11-16-yr-old children can evaluate each other's dental fear. At baseline the participants were 11-12-yr-old children from the Finnish Cities of Pori (n = 1,691) and Rauma (n = 807), and one of their parents. The children and their parents were asked if they or their family members were afraid of dental care. Fears were assessed using single 5-point Likert-scale questions that included a 'do not know' option. Children and parents answered the questionnaire independently of each other. Background variables were the child's and their parent's gender. Parents' and children's knowledge of each other's dental fear was evaluated with kappa statistics and with sensitivity and specificity statistics using dichotomized fear variables. All kappa values were < 0.42. When dental fear among children and parents was evaluated, all sensitivities varied between 0.10 and 0.39, and all specificities varied between 0.93 and 0.99. Evaluating dental fear among fearful children and parents, the sensitivities varied between 0.17 and 0.50 and the specificities varied between 0.85 and 0.94, respectively. Parents and children could not recognize each other's dental fear. Therefore, parents and children cannot be used as reliable proxies for determining each other's dental fear.

Factors associated with different measures of dental fear among children at different ages.

PURPOSE: This study's purpose was to determine the associations between 4 dental fear measures and treatment procedures, oral habits, and family characteristics at different ages. METHODS: Independent random samples of 6-, 9-, 12-, and 15-year-olds were drawn in 2 cities (N=180 per age group from both cities). The study group comprised 270, 283, 311, and 293 subjects who were 6, 9, 12, and 15 years old, respectively. The total inclusion rate was 80%. The data concerning dental treatment procedures during the 3 preceding years were collected from patient records. Four measures (treatment of dental decay, attending dentist, general dental fear, and peak value for dental fear) were drawn from the questionnaire, including 11 fear-related questions (a modified children's dental fear survey schedule). Oral health habits and family characteristics were also recorded. Age-specific logistic regression analyses were performed using different fear measures as dependent variables. RESULTS: The relationship between child's dental fear (CDF) and oral health habits, family characteristics, and earlier treatment procedures differed among different ages, even when the same CDF measure was used as the dependent variable. CONCLUSIONS: When evaluating children's dental fear, dentists should understand that CDF-related factors vary at different ages and according to the fear type.

Dental fear of Finnish children in the light of different measures of dental fear.

OBJECTIVES: The aims were: (1) to examine the construct and reliability of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) among children of different ages and (2) to compare the correlations between fear measured with the modified CFSS-DS, the "peak value for dental fear" (PV), and "fear of dental treatment in general" (GF). METHODS: The study sample consisted of 302, 299, 314, and 297 children aged 6, 9, 12, and 15 years, respectively. Each child received a questionnaire to be filled out at home. An explorative factor analysis with varimax rotation was performed for eight items taken from the CFSS-DS and questions on fear of pain and suction used in the mouth. For further age-specific analyses, mean values were calculated for the sum of items that loaded >0.5 on each factor. The correlations between these values and PV and GF were studied. RESULTS: The questionnaire was reliable. Two factors were revealed for each age: "treatment of dental decay" (TDD), which included fears related to invasive treatment, and "attending the dentist" (AD), which included fears related to dental visits in general. TDD explained over 50% of the variance, except among 9-year-olds. TDD mean values were higher among older children than among younger ones and correlated more strongly with PV than with GF. AD mean values were higher among younger children than among older ones and correlated more strongly with GF than with PV. CONCLUSION: The factor structures were fairly similar but the correlations between fear measures differed among children of different ages.