Young patients' self-reported fear compared to professionals' assessments during invasive and non-invasive dental visits: a prospective, longitudinal study

Parenting Styles and Sedation Efficacy in Pediatric Dental Care; A Study in Uncooperative Children Aged 4 to 6 Years: Structural Equation Modeling Approach

Background

Behavioral problems in children contribute significantly to non-compliance and lack of cooperation with dentists.This study aimed to assess the impact of parenting styles on the success of conscious sedation with midazolam in uncooperative children aged 4 to 6 years.

Methods

This short-term longitudinal study included ninety-six children aged 4-6 years who were classified as uncooperative according to the Frankl Behavior Rating Scale (Frankl I, II), requiring pulp treatment and Stainless-Steel Crown (SSC) restoration. Midazolam was orally administered at 0.25 mg/kg. Parenting Styles and Dimensions Questionnaire (PSDQ), Strengths and Difficulties Questionnaire (SDQ), and Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Treatment began at least thirty minutes post-drug administration. Vital signs were monitored using a pulse oximeter. Sedation effectiveness was assessed with the Houpt scale at local anesthesia injection (T0), cavity preparation (T1), restoration (T2), and treatment conclusion (T3). Statistical analysis used Mann-Whitney U test (P < 0.05).

Results

Most parents (69, 71.9%) had an authoritative parenting style, while 10 (10.4%) were authoritarian, and 17 (17.7%) were permissive. Authoritative parenting is associated significantly with sedation success (P = 0.001) and reduced dental fear (P = 0.008). Conversely, authoritarian (P = 0.031) and permissive (P = 0.001) parenting styles are associated with sedation failure. Authoritarian parenting is associated positively with increased dental fear (P = 0.001). No significant association was found between permissive parenting style and dental fear (P > 0.05). No significant association existed between behavioral problems and parenting styles (P > 0.05). There was no significant association observed between permissive parenting style and dental fear (P = 0.279). Similarly, no significant associations were found between behavioral problems and specific parenting styles: authoritative (P = 0.625), authoritarian (P = 0.050), and permissive (P = 0.522).

Conclusion

Understanding parenting styles aids in predicting conscious sedation success with midazolam and assisting in managing uncooperative children during dental procedures.

Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis

OBJECTIVE

The objective of this review is to determine the global prevalence of dental fear and anxiety (DFA) in early childhood and identify its related factors.

METHODS

The systematic review utilized three common English-language databases (PubMed, EMBASE, and Web of Science). Two independent researchers performed a systematic search to include observational studies on young children published from 2000 to 2023. They extracted information on prevalence of DFA, assessment tools used, study sites, respondents, and children's dental visit experiences.

RESULTS

A total of 2,895 studies were identified, and 25 studies met the inclusion criteria for analysis. The pooled prevalence of DFA among 2- to 6- year-old children was estimated to be 30 % (95 % CI=25, 36). Children without dental visit experience (OR=1.37, 95 % CI=1.18, 1.59) and children with caries experiences (OR=1.18, 95 % CI=1.09, 1.27) had higher odds of experiencing DFA compared to those with dental visit experience or caries-free status. The most commonly used assessment tools in the included studies were the Frankl Behaviour Rating Scale (32 %, 8/25), Children's Fear Survey Schedule-Dental Subscale (20 %, 5/25), and Dental Anxiety Question (20 %, 5/25).

CONCLUSIONS

This systematic review reveals that approximately one-third of young children globally experience DFA. Children who lack dental visit experience or have caries experiences are at increased risk of DFA. Clinicians can use this information to make informed decisions regarding dental care provision for young children.

CLINICAL SIGNIFICANCE

This study provides comprehensive information on the global prevalence of dental fear and anxiety and its associated factors in early childhood. The findings can assist clinicians in understanding and addressing DFA in their dental care approach for young children.

REGISTRATION

PROSPERO (CRD42023446464).