• Article 1

Dental Anxiety in Children

Dental anxiety, also known as dental fear or dental phobia, is condition charac-
terized by nervousness and fear associated with impending dental appointments.
It's estimated that 15-20% of the population, including children, experience
dental anxiety.Children are particularly susceptible to dental anxiety due to var-
ious factors. Negative past experiences with dentists, fear of poor oral hygiene
or additional dental treatments, and a lack of understanding about dental proce-
dures can contribute to anxiety.Common signs and symptoms of dental anxiety
in children, including restlessness, sadness, physical symptoms like flushed
cheeks or sweating, irritability, fainting or dizziness, and even attempts to make
themselves sick to avoid dental appointments.Dental anxiety can lead to avoid-
ance of essential dental care, creating a cycle of worsening oral health and in-
creased anxiety. Addressing dental anxiety early is crucial to prevent this cy-
cle.Building a trusting relationship with a pediatric dentist is the first step in
helping children overcome dental anxiety. It's essential to communicate your
child's fears, and dentists should respond with kindness and understanding.
Modern technology in pediatric dental practices has made procedures less inva-
sive and more comfortable for children. Some dentists offer entertainment op-
tions and rewards to help children relax. In some cases, mild sedatives like
laughing gas can be used for more complex procedures.To address dental anxi-
ety, it's recommended to find a dentist you trust. Reading online reviews, sched-
uling an interview with the dentist, and asking questions about their approach to
children and dental anxiety can help establish trust.Children with dental anxiety
tend to outgrow their fear with age and positive experiences. Early visits to the
dentist can help children become more comfortable with dental care.
In summary, the article emphasizes the importance of addressing dental anxi-
ety in children, providing tips on how to do so, and highlighting the positive im-
pact of early, positive dental experiences on a child's comfort with dental care.

Reference : Pediatric Dental Care of Yukon. (2021). Pdcyukon.com.

https://www.pdcyukon.com/blog/dental-anxiety-in-children
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Article 2
Dental Anxiety in Children: A Review of the Contributing Factors

he article discusses various factors influencing dental anxiety in children and

provides insights into their possible explanations. The review encompasses the
following key factors:
• Age: Younger children tend to exhibit higher dental anxiety, attributed to
fear of the unknown, which diminishes with age. However, contradictory
 findings exist, suggesting no age-related difference or an increase in anxi-
ety with age due to prior painful experiences.
• Gender: Inconsistent evidence regarding gender differences in dental
anxiety exists, with some studies reporting higher anxiety in girls, others in
boys, and some finding no gender-related distinctions. Cultural back-
ground, anxiety scale structures, and willingness to acknowledge anxiety
may contribute to these variations.
• Education and Socioeconomic Status: Children from low socioeco-
nomic backgrounds and less educated families often experience more den-
tal anxiety. However, conflicting studies suggest weak or no associations
between educational levels and anxiety.
• Ethnicity and Culture: Cultural backgrounds impact how anxiety is ex-
pressed. For instance, Arab and African cultures may influence boys to be
brave or exhibit self-control, while Western cultures may allow easier ex-
pression of anxiety.
• Number of Siblings: Dental anxiety is associated with an increased num-
ber of siblings, possibly due to exposure to siblings' dental experiences.
However, some studies suggest conflicting results, such as higher anxiety
in single children or the first-born child.
• Previous General Anaesthesia: Dental treatment under general anaes-
thesia (GA) is linked to increased dental anxiety, but a few studies report
no change in anxiety levels post-GA, possibly due to pre-existing high anx-
iety.
• Dental Caries: The association between dental caries and dental anxiety
varies, with most studies indicating a relationship, but some reporting no
correlation.
• Parental/Maternal Anxiety: Positive associations exist between chil-
dren's dental anxiety and parental, especially maternal, anxiety. However,
some studies find no relationship or suggest the parental impact is limited
to the first dental visit.
• Dental Procedures: Specific procedures influence dental anxiety, with
operative procedures and extractions causing higher anxiety levels. Oral
prophylaxis is associated with lower anxiety.
• Previous Dental and Medical Experiences and Frequency of Dental
Visits: Dental anxiety decreases with more dental visits and experiences.
Negative experiences, infrequent visits, and long intervals between visits
correlate with increased anxiety in some studies, while others report no as-
sociation.
• Clinical Environment: Dental office factors such as drilling sounds, long
waits, and the environment influence dental anxiety. The shape of instru-
ments, smells, and the dentist's attire and gender also play a role.
 • Personal Traits, General Anxiety, and Psychological Status: Dental
anxiety is linked to personal traits, high trait-state and general anxiety, and
psychological status, including psychiatric and depressive disorders.
In conclusion, dental anxiety is a complex, multifactorial phenomenon influ-
enced by various interconnected factors, and differences in study findings may
result from methodological or cultural variations in the investigated popula-
tions. Further research in this area is recommended.

Reference
Alasmari, A. A., Aldossari, G. S., & Aldossary, M. S. (2018). Dental Anxiety in
Children: A Review of the Contributing Factors. JOURNAL of CLINICAL and
DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2018/35081.11379

Article 3
A clinical study of child dental anxiety
The study, utilizing Rachman's fear acquisition theory, investigates dental fear
in 60 children (7–14 years) attending a pediatric dental clinic. Clinically anx-
ious cases (31) and nonanxious cases (29) were identified based on past experi-
ences and current anxiety levels reported by children, parents, and examining
dentists. Conditioning emerged as the primary contributor to dental fear, with
subjective pain and trauma exerting a stronger influence than objective dental
pathology. The conditioning pathway was more pronounced in adults with den-
tal phobia, but findings in children varied. Negative dentist behavior and the
timing of unpleasant events were identified as modulating factors in fear condi-
tioning. Modeling, influenced by maternal anxiety, and the informational path-
way were explored but lacked empirical support. Dispositional factors, such as
general fears and potential gender differences, were considered. The study em-
phasizes the need for a comprehensive assessment, incorporating all pathways
and dentist-assessed anxiety, to better understand childhood dental fear. The re-
search aims to fill existing gaps in knowledge and provides insights for future
studies in this critical area. The study concludes by highlighting the importance
of considering all factors concurrently and involving the examining dentist in
assessing and managing children's anxious behavior during dental appoint-
ments.

Reference
Townend, E., Dimigen, G., & Fung, D. E. (2000). A clinical study of child den-
tal anxiety. Behaviour Research and Therapy, 38(1), 31–46.
https://doi.org/10.1016/s0005-7967(98)00205-8
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NIKITA’S
The study aimed to assess factors influencing dental anxiety in children by sur-
veying 50 participants aged 6 to 10. Utilizing facial image scale (FIS) and the
modified dental anxiety scale, the study correlated anxiety levels with various
factors. Results indicated higher anxiety in females, significant anxiety during
radiographic exams, and the need for behavioral shaping techniques for uncoop-
erative children. Good rapport with the dentist correlated with lower anxiety.
Gender, behavior during diagnosis and radiographic exams, implementation of
behavioral shaping techniques, and dentist-child rapport were identified as in-
fluential factors. However, factors like socioeconomic status, number of dental
visits, type of treatment, sugar consumption, and brushing habits showed no
significant impact on anxiety. The study emphasized the complexity of manag-
ing anxiety in children, highlighting the importance of the dentist's approach,
clinic environment, and use of behavioral techniques. The findings contribute to
understanding the nuanced aspects of dental anxiety in children, guiding dental
practitioners in improving patient management strategies for pediatric dental
care. Additionally, the study underscores the necessity of personalized ap-
proaches, considering individual characteristics and experiences in addressing
dental anxiety in young patients.

Reference
Kothari, S., & Deepa Gurunathan. (2019). Factors influencing anxiety levels in
children undergoing dental treatment in an undergraduate clinic. Journal of
Family Medicine and Primary Care, 8(6), 2036–2036.
https://doi.org/10.4103/jfmpc.jfmpc_229_19
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Factors Associated with Dental Fear and Anxiety in Children Aged 7 to 9 Years
The study aimed to investigate changes in dental fear and anxiety (DFA) in
children aged 7 to 9, identifying associated factors. A cohort study of 160 chil-
dren utilized parental questionnaires, oral examinations, and the Children's Fear
Survey Schedule-Dental Subscale (CFSS-DS). Results showed that 7% had
DFA at age 7, with a mean CFSS-DS of 22.9. At age 9, 8% reported DFA, with
an increased mean of 25.4. Factors associated with DFA development included
parental dental fear, child toothache experience, painful dental treatment, and
caries development. The study suggested a dynamic nature of DFA in growing
individuals, significantly linked to painful symptoms, dental care experiences,
and parental dental fear.
Analysis revealed that 73% of children reporting DFA at age 7 did not report
DFA at age 9, while 7% developed DFA between these ages. The transition
highlighted the complexity of DFA development and its potential attenuation
with age. Specific fears, such as injections and drilling, exhibited changes over
time. The study emphasized the need for psychological preparation for poten-
tially painful dental procedures and suggested cognitive-behavioral therapy as
an intervention.
Despite limitations, such as a non-population-based sample, the longitudinal de-
sign and use of CFSS-DS strengthened the study. The findings underscored the
importance of addressing both oral health and psychological aspects in pediatric
dental care to prevent painful and traumatic experiences, ultimately contributing
to improved patient outcomes.

Reference
Dahlander, A., Fernanda Cunha Soares, Grindefjord, M., & Göran Dahllöf.
(2019). Factors Associated with Dental Fear and Anxiety in Children Aged 7 to
9 Years. Dentistry Journal, 7(3), 68–68. https://doi.org/10.3390/dj7030068
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Anxiety in Children submitted to Dental Appointment
The study aimed to determine anxiety in children during dental treatment and
identify associated factors. The sample included 48 children, caregivers, and
dentistry students. Anxiety was assessed using the modified Venham Picture
Test for children, modified Corah’s dental anxiety scale for caregivers, and
Lipp’s stress symptoms inventory for dentistry students. Results showed that
60.4% of children experienced anxiety, linked to invasive procedures, dental
pain history, bruxism, anxious caregivers, and the stress of the treating dentistry
student. The majority of pediatric patients with anxiety exhibited non-collabora-
tive behavior during dental care, especially during invasive treatments.
The research highlighted the high prevalence of dental anxiety in children, em-
phasizing its potential impact on behavior during dental appointments. Factors
such as previous dental pain and bruxism were associated with child anxiety,
indicating the role of individual characteristics. Additionally, the study revealed
a connection between parental anxiety and child anxiety, reinforcing the influ-
ence of caregivers on a child’s emotional state. Moreover, dentistry students
showing stress symptoms were associated with anxious pediatric patients, em-
phasizing the significance of the professional-patient relationship.
The study emphasized the importance of early diagnosis and intervention for
anxious children. Instruments like the Venham Picture Test were deemed effec-
tive in assessing anxiety in children across different cultures. The findings un-
derscored the need for dentists to understand individual characteristics, commu-
nicate effectively, and establish trust to create a positive dental experience. The
study concluded that addressing anxiety in children during dental treatment re-
quires a comprehensive approach that considers both individual factors and the
emotional state of caregivers and dental professionals.
Reference
Ollé, L., Araujo, C., Casagrande, L., Bento, L., Santos, B., & Dalpian, D.
(2016). Anxiety in Children submitted to Dental Appointment. Pesquisa
Brasileira Em Odontopediatria E Clínica Integrada, 16(1), 167–175.
https://doi.org/10.4034/pboci.2016.161.18
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