Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children

Abstract

Background This study assessed anticipatory dental anxiety levels among 8- to 12-year-old children based on subjective and physiological measures and their correlation. The variations in anxiety based on sex, age, temperament, and academic performance were evaluated. Methods An observational study was conducted in 60 children recruited from the waiting room over a 6-month period. The operator recorded subjective anxiety in the children using a novel visual facial anxiety scale. The operator also noted the demographic details and child's temperament using the nine dimensions of the Thomas and Chess criteria, and graded children as “easy,” “slow to warm-up,” and “difficult.” The academic performance of the children was graded (parental ratings) on a five-point Likert scale. Physiological variables (heartrate [HR], oxygen saturation[SpO 2 ], and blood pressure [BP]) were recorded by another evaluator. The correlation between anxiety levels and physiological variables was also assessed. The effects of age, sex, temperament, and academic performance on anxiety were evaluated. Results The study included 60 children aged 8–12 years, including 36 boys and 24 girls. Seventy percent of children had mild to moderate levels of pre-extraction anxiety, while 30% of children demonstrated high anxiety. A significant positive correlation was noted between anxiety levels and HR (r s = 0.477, P < 0.001 * ) and systolic BP (r s = 0.294, P < 0.05), while a significant but inverse correlation was observed with SpO 2 (r s = −0.40, P < 0.05). Anxiety did not influence diastolic BP. Children with difficult temperament and poor academic performance had significantly higher anxiety. Conclusion A high percentage (70%) of children aged 8–12 years had mild to moderate anxiety prior to the extraction procedure. Increased HR, systolic BP, and reduced SpO 2 were significantly associated with high levels of anticipatory dental anxiety. Pre-extraction anxiety was significantly related to the temperament and scholastic performance.

Association of Age and Temperamental Traits with Children’s Behaviour during Dental Treatment

“…In this study, a higher activity trait was observed in younger children, while sociability was lower; both characteristics had an influence on negative behaviour and explain their lower adaptation towards dental treatment. Another study reported that 8-12-year-old children with difficult temperaments presented greater anxiety at the dental office, along with the presence of negative behaviour [22].…”

Preoperative Anxiety Impact on Anesthetic and Analgesic Use

“…The role of preoperative anxiety in postoperative delirium remains a topic of debate. Some studies have suggested that preoperative anxiety serves as a predictive factor for postoperative delirium [14,32,33], whereas the majority of research findings indicate no significant association between preoperative anxiety and postoperative delirium in elderly patients [12][13][14]. Consequently, further investigations focusing on the relationship between preoperative anxiety and postoperative delirium are warranted.…”

“…Objective approaches encompass both indirect and direct evaluations of anxiety levels, involving the estimation of sympathoadrenal system activation and the measurement of stress hormones, respectively [29,32]. Numerous studies have demonstrated that elevated preoperative anxiety levels are associated with increased heart rate, blood pressure, plasma cortisol, and catecholamine levels, alongside a reduction in heart rate variability and oxygen saturation [29,33]. For instance, a study conducted by Balasubramaniyan N. et al in 2016 revealed that hypertensive patients undergoing dental procedures experienced significant elevations in heart rate and systolic blood pressure due to preoperative anxiety.…”

Preoperative anxiety: An important, but neglected issue

“…An increase in heart rate, blood pressure,plasma cortisol andcatecholamines values, as well as a decrease in heart rate variability and oxygensaturation, were described as consequencesof higher levels of preoperative anxiety. (22)(23)(24) For instance, a study by Balasubramaniyan N. et al from 2016 investigated the association of cardiovascular alterations and anxiety in 80 hypertensive patients undergoing dental procedures. The authors demonstrated that high-level preoperative anxiety is associated with significant increases in heart rate and systolic blood pressure.…”