Applying the Cognitive Vulnerability Model to the analysis of cognitive and family influences on children's dental fear

The RMS-Pictorial Scale: cross-cultural adaptation and validation for Brazilian children and adolescents

PURPOSE

The aim of this study is to perform the cross-cultural adaptation and validation of the RMS-Pictorial Scale (RMS-PS) for use with Brazilian children and adolescents.

METHODS

The RMS-PS was developed to measure self-perceived dental anxiety in children. The photographs of Brazilian children reproducing the faces of the original scale were taken and discussed by a Committee of Experts. The first step was to produce four versions of the scale (a white girl, a black girl, a white boy, and a black boy) to guarantee the representativeness of the population. The scale was tested in two pre-tests before the definition of the final version of each one. An original form (5 faces) for 7-14-year-old children and adolescents a short form (3 faces) for 4-6-year-old children were developed. Sixty children and adolescents (mean age = 7.67) responded to the RMS-PS, the Facial Image Scale (FIS) and the Children's Fear Survey Scale-Dental Subscale (CFSS-DS). Statistical analyses included a descriptive analysis, the Intraclass Correlation Coefficients (ICC), the Spearman correlation, and the Mann-Whitney test.

RESULTS

Test-retest reliability showed a good correlation for the children's self-reporting of the B-RMS-PS across the two-week interval (ICC = 0.791; 95% CI 0.673-0.870). Convergent validity was confirmed by the correlation between the B-RMS-PS and the FIS (r = 0.524, p < 0.001). The children with proxy-report dental anxiety had greater B-RMS-PS scores than those without anxiety (p = 0.010) supporting discriminant validity.

CONCLUSION

The B-RMS-PS showed good psychometric characteristics, being reliable and valid to be used with Brazilian children and adolescents.

Psychological Intrusion - An Overlooked Aspect of Dental Fear

Dental fear/anxiety is a widely recognised problem affecting a large proportion of the population. It can result in avoidance and/or difficulty accepting dental care. We believe that psychological intrusion may play a role in the aetiology and maintenance of dental fear for at least some individuals. In this narrative review we will take a developmental perspective in order to understand its impact across the lifespan. We will consider the nature of 'self,' parenting styles, the details of intrusive parenting or parental psychological control, and briefly touch upon child temperament and parental anxiety. Finally, we draw together the supporting (largely unrecognised) evidence available in the dental literature. We illustrate the paper with clinical examples and discuss possibly effective ways of addressing the problem. We conclude that psychological intrusion appears to play an important role in dental fear, for at least some individuals, and we call for detailed research into the extent and exact nature of the problem. A simple means of identifying individuals who are vulnerable to psychological intrusion would be useful for dentists.

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.

A mediation analysis study: The influence of mothers' dental anxiety on children's dental utilization among low-income African Americans

OBJECTIVES

The aim of this study was to test a hypothesized mediation model to explain associations between mothers' dental anxiety and children's dental utilization through the mothers' own dental utilization.

METHODS

Two hundred and fourteen low-income African American mothers with young children (age 31-59 months) completed a study questionnaire which assessed (i) mothers' dental anxiety; (ii) mothers' dental utilization (seeing a dentist at least once a year) and (iii) children's dental utilization (at least one non-study-related dental visit during the 36-month study period). The hypothesized mediation model consisted of these three elements with both a direct path from mothers' dental anxiety to children's dental utilization and an indirect path from mothers' dental anxiety to children's dental utilization through mothers' dental utilization. Mediation analysis with bootstrapping was conducted to test the hypothesized model.

RESULTS

The mediation analysis indicated significant total effect of mothers' dental anxiety on children's dental utilization. The standardized total effect of mothers' anxiety on children's dental utilization was -0.172 (SE=.084, P=.041), and the standardized indirect effect of mothers' anxiety on children's dental utilization mediated by mothers' dental utilization was -0.069 (SE=.039, P=.076). The direct effect from mothers' anxiety to children's dental utilization was not statistically significant (P=.261) after adjusting for the mothers' dental utilization.

CONCLUSIONS

In this low-income African American sample, there was a trend for mothers' dental anxiety to be associated with children's dental utilization indirectly through mothers' own dental utilization, while the direct influence of mothers' dental anxiety on children's dental utilization was not seen. This suggests that mothers' dental utilization might explain how mothers' dental anxiety impacts children's early dental utilization.

Dental fear and expected effectiveness of destructive coping as predictors of children's uncooperative intentions in dental settings

AIM

To explore the mechanisms by which some children select disruptive behaviours to cope with stressful dental events. In particular, the relationships between dental fear, expected effectiveness of destructive coping, and intentions of displaying uncooperative behaviours were analysed.

DESIGN

Participants were 170 children who filled out a questionnaire survey. Descriptive statistics by gender and group age as well as comparisons of means were calculated. Spearman's rho correlation coefficients and binary logistic regression analysis were used to test hypotheses of the relationships among variables.

RESULTS

Both dental fear and the expected effectiveness of destructive coping strategies were significantly associated with children's uncooperative intentions at the dentist. In addition, children who strongly endorsed the effectiveness of destructive coping strategies had a higher probability of uncooperative intentions as dental fear increased. In contrast, this relationship was not statistically significant among children who did not expect negative behaviours to be effective.

CONCLUSIONS

Children's expectations about the effectiveness of destructive coping behaviours can help explain variations in the use of these strategies in stressful dental situations. Dental fear as well as children's inadequate expectancies about coping alternatives should be explored and targeted to prevent and modify uncooperative behaviour intentions at the dentist.

From public mental health to community oral health: the impact of dental anxiety and fear on dental status

Dental fear is a widely experienced problem. Through a “vicious cycle dynamic,” fear of dental treatment, lower use of dental services, and oral health diseases reinforce each other. Research on the antecedents of dental anxiety could help to break this cycle, providing useful knowledge to design effective community programs aimed at preventing dental fear and its oral health-related consequences. In this regard, frameworks that analyze the interplay between cognitive and psychosocial determinants of fear, such as the Cognitive Vulnerability Model, are promising. The onset of dental fear often occurs in childhood, so focusing on the child population could greatly contribute to understanding dental fear mechanisms and prevent this problem extending into adulthood. Not only can public mental health contribute to population health, but also community dentistry programs can help to prevent dental fear. Regular dental visits seem to act in a prophylactic way, with dental professionals playing an important role in the regulation of the patients’ anxiety-related responses. Both public mental health and community dentistry could therefore benefit from a multidisciplinary approach to dental fear and oral health.