An assessment of dental anxiety in children

Abstract

This study was designed to assess why children become fearful of dentistry and what role relative analgesia (RA) plays in reducing a child's fear. The dental literature indicated that dental anxiety could be divided into three major factors: medical/dental, individual and environmental. The psychological literature provided a model of anxiety based upon a conjunction of cognitive and behavioural theories. The subjects were aged between 6 and 18 years, and comprised of 65 experimental subjects (selected from referrals for anxiety and/or noncooperation) and 42 control subjects (matched for age and gender with the experimental group). All subjects were taken from one dentist's case list and were seen by the same dentist. Data were collected in three stages, firstly, from a pre-treatment questionnaire/interview based on the work of Williams et al. (1985) together with the Corah Dental Anxiety Scale (DAS) to measure parent's dental anxiety and the Child Manifest Anxiety Scale (CMAS) to assess children's general anxiety levels. Secondly, video data of children undergoing dental treatment were collected for analysis using the Venham Anxiety Scale, Melamed Child Behaviour Profile and Weinstein Dentist Behaviour Profile. Thirdly, further data were collected after treatment from parents and dentist. This information related to treatment given, measures of how anxious and cooperative the child had been and whether the child had had a GA or RA. The major conclusions reached by this study were, firstly, that dental anxiety is a specific fear (phobia) of potential injury with a postulated temperamental factor, relating to vigilance and pain expectation. Secondly, a short checklist was developed to aid dentists in assessing children at initial examination for potential dental anxiety. Thirdly, no relation between dental fear and the use of RA could be found. Fourthly, dentist behaviour changes in both beneficial and nonbeneficial ways with respect to rising child anxiety levels.