Validity of the Brazilian version of the Dental Subscale of Children's Fear Survey Schedule

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.

Prevalence of Dental Fear and Its Association with Oral Health Status Among School Children in Bosnia and Herzegovina: A Cross-Sectional Study

Background and Objective: This study aimed to examine the prevalence of dental fear among schoolchildren in Bosnia and Herzegovina, analyze the distribution of dental anxiety by gender, age, and place of residence in relation to perceived sources of fear, and evaluate its association with oral health status. Materials and Methods: The sample included 355 schoolchildren between the ages of 12 and 15. Data were gathered using a self-assessment questionnaire, a brief clinical oral examination, and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Results: Clinical examinations showed that 87.61% of the children had dental caries, with a mean DMFT score of 3.75 (SD = 2.93). The prevalence of dental caries was significantly higher in the older group compared to the younger group (p < 0.01). Dental fear was present in 21.7% of the children, with a mean total CFSS-DS score of 27.50 (SD = 13.85). The most feared aspect among the children was "Choking" (73.8%), followed by "Injections" (63.7%) and "The noise of the dentist drilling" (52.1%). Children with dental fear had a significantly greater number of decayed and missing teeth, higher DMFT scores, and poorer gingival health and oral hygiene compared to those without dental fear (p < 0.01), even after adjusting for sociodemographic factors. Conclusions: The study found a moderate level of dental fear among Bosnian schoolchildren, with younger children and those from urban areas showing more fear of injections. It also showed a consistent link between dental anxiety and clinical factors such as caries, gum disease, and oral hygiene, even after adjusting for sociodemographic factors.

Pathways to dental fear from childhood to adolescence: A 10-year cohort study

BACKGROUND

Dental fear affects children's oral health; there is, however, no evidence regarding the pathways linking possible predictors for its occurrence.

AIM

This study aimed at exploring the direct and indirect effects of sociodemographic, clinical, behavioural and psychosocial factors on the development of dental fear in schoolchildren over time.

DESIGN

This is a prospective cohort study, with 10 years of follow-up. The first assessment started in 2010 (T1) with a sample of 639 children aged 1-5 years from Southern Brazil. For this study, the follow-up (T2) of these individuals was performed in 2020. Dental fear was assessed at T2 using the Brazilian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Socio-economic, demographic, psychosocial and oral health measures were collected in both assessments. A structural equation model was performed to assess the direct and indirect pathways among variables at T1 and T2 to predict the CFSS-DS scores at T2.

RESULTS

Of the 639 children, 429 were re-evaluated at T2. Higher levels of untreated dental caries, younger individuals, dental visits for nonroutine reasons and low sense of coherence at T2 directly impacted dental fear at T2. Considering the indirect effects, the presence of dental caries and low household income at T1 indirectly impacted higher levels of dental fear over 10 years via dental caries at follow-up.

CONCLUSION

Our findings suggest that socio-economic, demographic, clinical, psychosocial and behavioural conditions can influence dental fear from childhood to adolescence.

Association of dental hypersensitivity and anxiety in children with molar-incisor hypomineralisation (MIH)

AIM

The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH.

METHODS

For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS).

RESULTS

MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age.

CONCLUSION

No association was found between dental fear and dental hypersensitivity in children with MIH.

The relationship between temperament and dental fear and anxiety: a systematic review

OBJECTIVE

To investigate the relationship between temperament traits and dental fear and anxiety (DFA) in children and adolescents by the means of a systematic review (PROSPERO #CRD42020207578).

METHODS

The PEO (Population, Exposure, and Outcome) strategy was followed using children and adolescents as the population, temperament as the exposure, and DFA as the outcome. A systematic search for observational studies (cross-sectional, case-control, and cohort) without restrictions on year or language of publication was performed in seven databases (PubMed, Web of Science, Scopus, Lilacs, Embase, Cochrane, and PsycINFO) in September 2021. Grey literature search was performed in OpenGrey, Google Scholar, and in the reference list of included studies. Study selection, data extraction, and risk of bias assessment were carried out independently by two reviewers. The Fowkes and Fulton Critical Assessment Guideline was used to assess methodological quality of each study included. The GRADE approach was performed to determine the certainty of evidence of relationship between temperament traits.

RESULTS

This study recovered 1362 articles, of which 12 were included. Despite the high heterogeneity of methodological aspects, qualitative synthesis by subgroups showed a positive association/correlation between emotionality, neuroticism, and shyness with DFA in children and adolescents. Different subgroups analysis showed similar results. Eight studies were classified as having low methodological quality.

CONCLUSION

The main shortcoming of the included studies is the high risk of bias and a very low certainty of evidence. Within its limitations, children and adolescents with a temperament-like emotionality/neuroticism and shyness are more likely to present higher DFA.

The effect of socioeconomic aspects and dental history on pediatric patients' dental anxiety

This study aimed to characterize the profile of dental anxiety in pediatric patients, identifying the effect exerted by socioeconomic factors using dental data. A cross-sectional study design with a sample of 120 children aged 7-12 years old was used. Data relating to anxiety levels prior to dental care, socioeconomic aspects (family income, education level, child's school type), and child's dental history (previous dental appointments, previous treatment, caries experience) were collected. Additionally, participants completed the Brazilian version of the Children's Fear Survey Schedule- Dental Subscale (B-CFSS-DS) to assess dental anxiety. Descriptive analyses, chi-squared (X 2 ) tests, and Mann-Whitney U tests were performed, with a significance level of 5%. A total of 51 boys (42.5%) and 69 girls (57.5%) were included. There was no significant difference in dental anxiety between them. However, younger children had higher mean B-CFSS-DS scores (p = 0.036, Mann-Whitney). A higher prevalence of dental anxiety was found in participants from low-income families (p = 0.012, X 2 ) and in patients who did not receive endodontic treatment (p=0.034, X 2 ). Higher mean B-CFSS-DS scores were also observed in participants who did not receive endodontic treatment (p=0.001, Mann-Whitney) compared with those that did receive endodontic treatment. No relationship was found between education level, patient school type, first dental appointment, caries experience, and dental anxiety data. Younger children presented a profile of greater dental anxiety. Socioeconomic factors and dental data exerted some effect on dental anxiety, where children from low-income families and those not subjected to endodontic treatment displayed higher rates of dental anxiety.

Evaluating pain, fear, anxiety or stress/distress using children's drawings in paediatric dentistry: a scoping review

PURPOSE

The aim of this study was to systematically review the literature to answer the question: Can children's drawings represent a helping tool so the dentist can better understand the children's pain, fear, anxiety or stress/distress and their perception concerning the dentist and/or dental treatment?

METHODS

A scoping review was done. Cochrane Library, EMBASE, LILACS, LIVIVO, PsycINFO, PubMed, Scopus, Web of Science, and Grey literature was searched. Cross-sectional, quasi-experimental and qualitative studies in which patients were children and adolescents were included. Two authors independently selected studies to extract data and evaluate methodological quality by using Joanna Briggs Institute tools. Data collected included: characteristics of the studies, drawing evaluation/scales, main results and conclusion.

RESULTS

Out of 1037 papers were identified in search, 25 studies verified the emotional state and the children's perceptions regarding dental environment and the dentist and were included in the narrative synthesis. The spontaneous drawings were useful to identify the children's emotions. Drawings might be considered a helping tool to identify children and adolescents' perception in relation to dental treatment. Few studies used validated instruments. There were methodological disparities among studies.

CONCLUSIONS

The drawings can be considered a useful tool in identifying children's pain, fear, anxiety or stress/distress and perceptions about the dentist and/or dental treatment. Future studies with standardized analysis of the drawings are recommended. Code https://doi.org/10.17605/OSF.IO/U5BJH . "Retrospectively registered".

The Use of a Dental Storybook as a Dental Anxiety Reduction Medium among Pediatric Patients: A Randomized Controlled Clinical Trial

This randomized clinical trial aimed to evaluate the effectiveness of a specially designed dental storybook in reducing dental anxiety among children. Eighty-eight children (6−8 years old) were randomly divided into two groups: the intervention group (received the storybook) and the control group (did not receive the storybook). Three dental visits (screening, examination and cleaning, and treatment) were provided for each child. Anxiety was assessed following each visit using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Venham clinical anxiety scale (VCAS). The behavior was assessed using the Frankl’s Behavior Rating Scale (FBRS). The intervention group showed significantly lower anxiety and more cooperative behavior during treatment than the control group (p < 0.0001). The intervention group showed a significant decrease in anxiety scores and more cooperative behavior across time according to the CFSS-DS (p = 0.001) and Frankl behavior scale OR = 3.22, 95% CI 1.18−8.76. Multivariate models found that using the storybook was a significant independent factor in reducing anxiety and improving behavior after controlling for sex, previous visits, family income, and mother’s education. In conclusion, the dental storybook can decrease children’s dental anxiety and improve their behavior during dental treatment.

Turkish version of the faces version of the Modified Child Dental Anxiety Scale (MCDASf): translation, reliability, and validity

OBJECTIVES

To cross-culturally adapt of MCDAS_f into Turkish and to evaluate reliability and validity of the Turkish version of MCDAS_f using explorative factor analysis (EFA), confirmatory factor analysis (CFA), and receiver operating characteristic (ROC) analysis to form a less time consuming and easy to understand tool for measuring dental anxiety.

MATERIALS AND METHODS

A total of 300 children (174 females, 126 males) aged 6-12 years who were recruited at the Department of Paediatric Dentistry in RTEU at the first visit participated in the present study. For the internal consistency reliability, Cronbach's alpha was calculated. Intraclass correlation coefficients (ICCs) were calculated for test-retest reliability (n=67). Construct validity was determined by comparing with the Venham Picture Test (VPT). The factor structure was examined using EFA. CFA was used for dimensionality. The cut-off points of the Turkish version of MCDAS_f were plotted using a ROC curve.

RESULTS

The Turkish version of MCDAS_f showed high internal consistency (0.703) and an excellent ICC value (0.827). Good correlations were found between the global scores of MCDAS_f and VPT (r=0.632). Three factors were identified from EFA and verified with CFA. Discriminant validity was supported by high scores of females and younger children (p<0.05). The cut-off point was assigned as >24.50. The area under the ROC curve (AUC) was 0.921 (95% CI: 0.873-0.969).

CONCLUSIONS

The Turkish version of the MCDAS_f is a reliable and valid scale that satisfied psychometric properties.

CLINICAL RELEVANCE

The Turkish version of MCDAS_f is a usable tool for the measurement of dental anxiety among Turkish speaking children.

Is dental anxiety associated with the behavior of sedated children?

The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

Prevalence and risk factors of children's dental anxiety in China: a longitudinal study

OBJECTIVES

Dental anxiety remains widespread among children, may continue into adulthood and affect their oral health-related quality of life and clinical management. The aim of the study was to explore the trend of children's dental anxiety over time and potential risk factors.

DESIGN

Longitudinal study.

METHODS

Children aged between 5 and 12 years were investigated with the Chinese version of face version of Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and Frankl Behavior Rating scale from 2008 to 2017, and influential factors were explored.

RESULTS

Clinical data were available from 1061 children, including 533 (50.2%) male participants and 528 (49.8%) female participants. The total CFSS-DS scores ranged from 16 to 66, with a mean of 24.8±10.3. The prevalence of dental anxiety is 11.59%. No significant differences in total CFSS-DS scores between girls and boys were found. According to the Frankl scale, 238 children were allocated to the uncooperative group and the remaining 823 children were allocated to the cooperative group. Scores of CFSS-DS were negatively correlated with the clinical behaviour level of Frankl. Children aged 11-12 years old had significantly decreased scores compared with other age groups, and there was a decline in the scores of the group aged 8-10 years old over time. The factor analysis divided 15 items of CFSS-DS into four factors, and the total scores of 'less invasive oral procedures' items belonging to factor III decreased significantly over time in the group aged 8-10 years old.

CONCLUSIONS

Age is a significant determinant for children's dental anxiety, and dental anxiety outcomes have improved for Chinese children aged 8-10 years. This study is one of the few reports on changes of children's dental anxiety in a new era of information, but the results may be extrapolated to other populations with caution.