A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age

Tickle, Martin; Jones, Clare; Buchannan, Katie; Milsom, K M; Blinkhorn, Anthony; Humphris, Gerry

doi:10.1111/j.1365-263x.2009.00976.x

Cited by 67 publications

(92 citation statements)

References 27 publications

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“…17 Like all other existing scales, it includes only the most commonly feared items such as injection, drill and tooth extraction. There may be issues with how patients perceive the faces relate to their anxiety status, with evidence to suggest that face numbers 1, 2, and 3 may be seen as a relaxed response, while faces 4 and 5 an anxious response; 30 perhaps introducing bias in favour of a relaxed response when considering outcomes for MCDAS and MCDASf.…”

Section: Assessment Of the Clinical Implicationsmentioning

confidence: 99%

Evidence-based dentistry: analysis of dental anxiety scales for children

2012

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Section: Assessment Of the Clinical Implicationsmentioning

confidence: 99%

Evidence-based dentistry: analysis of dental anxiety scales for children

2012

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“…Extractions performed under GA have a negative impact on young children and their families, 28 and there is a strong association between a history of dental extraction at a young age and the development of dental anxiety, 29 which can continue to affect individuals in later life. 30 Children who develop caries active in early childhood are likely to have a high risk of the disease into adolescence.…”

Section: Impact Of the Diseasementioning

confidence: 99%

A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial

Tickle

O’Neill

Donaldson

et al. 2016

Health Technol Assess

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BackgroundDental caries is the most common disease of childhood. The NHS guidelines promote preventative care in dental practices, particularly for young children. However, the cost-effectiveness of this policy has not been established.ObjectiveTo measure the effects and costs of a composite fluoride intervention designed to prevent caries in young children attending dental services.DesignThe study was a two-arm, parallel-group, randomised controlled trial, with an allocation ratio of 1 : 1. Randomisation was by clinical trials unit, using randomised permuted blocks. Children/families were not blinded; however, outcome assessment was blinded to group assessment.SettingThe study took place in 22 NHS dental practices in Northern Ireland, UK.ParticipantsThe study participants were children aged 2–3 years, who were caries free at baseline.InterventionsThe intervention was composite in nature, comprising a varnish containing 22,600 parts per million (p.p.m.) fluoride, a toothbrush and a 50-ml tube of toothpaste containing 1450 p.p.m. fluoride; plus standardised, evidence-based prevention advice provided at 6-monthly intervals over 3 years. The control group received the prevention advice alone.Main outcome measuresThe primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were the number of decayed, missing or filled tooth surfaces in primary dentition (dmfs) in caries-active children, the number of episodes of pain, the number of extracted teeth and the costs of care. Adverse reactions (ARs) were recorded.ResultsA total of 1248 children (624 randomised to each group) were recruited and 1096 (549 in the intervention group and 547 in the control group) were included in the final analyses. A total of 87% of the intervention children and 85% of control children attended every 6-month visit (p = 0.77). In total, 187 (34%) children in the intervention group converted to caries active, compared with 213 (39%) in the control group [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.64 to 1.04;p = 0.11]. The mean number of tooth surfaces affected by caries was 7.2 in the intervention group, compared with 9.6 in the control group (p = 0.007). There was no significant difference in the number of episodes of pain between groups (p = 0.81). However, 164 out of the total of 400 (41%) children who converted to caries active reported toothache, compared with 62 out of 696 (9%) caries-free children (OR 7.1 95% CI 5.1 to 9.9;p < 0.001). There was no statistically significant difference in the number of teeth extracted in caries-active children (p = 0.95). Ten children in the intervention group had ARs of a minor nature. The average direct dental care cost was £155.74 for the intervention group and £48.21 for the control group over 3 years (p < 0.05). The mean cost per carious surface avoided over the 3 years was estimated at £251.00.LimitationsThe usual limitations of a trial such as generalisability and understanding the underlying reasons for the outcomes apply. There is no mean willingness-to-pay threshold available to enable assessment of value for money.ConclusionsA statistically significant effect could not be demonstrated for the primary outcome. Once caries develop, pain is likely. There was a statistically significant difference in dmfs in caries-active children in favour of the intervention. Although adequately powered, the effect size of the intervention was small and of questionable clinical and economic benefit.Future workFuture work should assess the caries prevention effects of interventions to reduce sugar consumption at the population and individual levels. Interventions designed to arrest the disease once it is established need to be developed and tested in practice.Trial registrationCurrent Controlled Trials ISRCTN36180119 and EudraCT 2009-010725-39.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 71. See the NIHR Journals Library website for further project information.

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“…These findings agree with the present study where most children cited noninvasive procedures as the ones they liked most during dental treatment. Tickle et al 2 also showed that a history of extractions and asymptomatic dental visits were significantly associated with anxiety, suggesting that the etiology of dental anxiety in children is multifactorial.…”

mentioning

confidence: 99%

“…The false image of torture in the dentist chair seems to occupy the imagination of many children that arrive at dental offices with this pre-established concept and resist conditioning mechanisms. It is therefore important to make sure that children feel comfortable during their dental visit and consequently have a positive experience [1][2][3] . Negative experiences are difficult to overcome, especially when they were the child's first impression of dental care 1,4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…Besides that, the results of the present study indicate the need for strategies designed to promote constant asymptomatic visits to the dentist at an early age. Dental professionals need to understand the etiology of dental anxiety in children and its development over time in order to provide a more effective care to their patients and therefore, to minimize the risk of developing anxiety 2 . Employing scales that measure fear, as Children's Fear Survey Schedule -Dental Subscale, the dentist may recognize which item(s) of the scale reported by the child were related to a particular fear.…”

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Perception of dental care among children

et al. 2017

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Children that come to dental offices with fear and anxiety usually tend to resist conditioning mechanisms. Aim: To evaluate children's perception of dental treatment and to identify the factors influencing this perception. Methods: For this study, we selected a random sample of 100 children of both genders aged 3 to 12, treated at the Department of Dentistry of a University (Group I) and at a Children's Hospital (Group II). A structured questionnaire about the child's perception about dental care was applied and the children were asked to draw a picture of this topic. Results: Most children expressed a positive perception in the questionnaire and in the drawings (93.8%). This positive perception was more accentuated in Group I (94%) and in children aged 3 to 5 years (100%), particularly in girls (78%). The main cause of fear was the use of needles (42.4%). Many children (24.2%) reported to prefer the noninvasive procedures. Conclusions: A positive perception of dental treatment was observed in most children. Therefore, dental pediatricians must be aware of the children's perception for establishing a better conditioning.

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A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age

Abstract: Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.

Cited by 67 publications

References 27 publications

Evidence-based dentistry: analysis of dental anxiety scales for children

Evidence-based dentistry: analysis of dental anxiety scales for children

A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial

Perception of dental care among children

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