DENTAL ANXIETY IN

CHILDREN
INTRODUCTION
 DEFINITION
• Dental anxiety (DA) denotes a state of apprehension
that something dreadful is going to happen in
relation to dental treatment and it is coupled with a
sense of loosing control.
 PREVALENCE
• Prevalence – children - 5 to 61%
• Adults - 1 to 52% , inclusive of participant with
both moderate and high dental anxiety.
 ETIOLOGY
1) Age
2) Gender
3) Education and Socioeconomic
Status
4) Ethnicity and Culture
5) Number of Siblings
6) Previous General Anaesthesia
7) Dental Caries
8) Parental/Maternal Anxiety
9) Previous Dental and Medical Experiences and Frequency of Dental
Visits
10)Dental Procedures
11)Clinical Environment
12)Personal Traits, General Anxiety and Psychological Status
 Dental anxiety pathway
• Pavlovian cognitive conditioning
• Informative pathway
• Vicarious conditioning
• Verbal transmission/threat,
• Parental pathway
 CONSEQUENCES OF DENTAL ANXIETY
• Poor oral health, poor oral hygiene and esthetics.
• Eitner et al - increased caries morbidity and DMFS
scores
• Increased use of antibiotics and analgesics.
• Feeling of exhaustion after a dental appointment.
• Negative thoughts, fear, crying, and aggression,
disturbances in sleep and eating patterns
• Dentists include reduced satisfaction with the
treatment
 Assessment of dental anxiety
Global rating scale (GRS) (1965)
• 5=excellent
• 4=very good
• 3=good
• 2=fair
• 1=poor/aborted
Corah’s dental anxiety scale (Corah and
Pantera, 1968)
Modified dental anxiety scale
VENHAM PICTURE TEST
Raghavendra, Madhuri, and Sujata Pictorial Scale for boys.

Raghavendra, Madhuri, and Sujata Pictorial Scale for girls.

VENHAM’S ANXIETY SCALE
FACIAL IMAGE SCALE
 SMILEY FACES PROGRAM

The example of seven faces used as an assessment scale in measuring

children dental anxiety (Buchanan, H., 2005)
ANXIETY THERMOMETER
State – trait anxiety inventory - state
State – trait anxiety inventor - trait
 Modified Child Dental
Anxiety Scale (faces) (MCDASf)
Children’s Fear Survey Schedule- Dental
Subscale (CFSS-DS)
NONPHARMACOLOGIC
MANAGEMENT
DENTAL ENVIRONMENT
• Receptionists, dental nurses,
and dental hygienists
• office atmosphere - soft music
and avoidance of bright lights.
• slightly cooler dental office
• Walls - posters and pictures,
waiting - books and magazines.
• should not be made to wait too
long,
• Aromatherapy
• “Snoezelen” dental
environment
Communication skills, rapport, and trust
building
• Good patient–dentist relationship
• Two-way communication
• patients should be encouraged to
ask questions about the treatment
• Dentists should give all the
necessary complete information
regarding description of the
problem, treatment options, and
preventive procedures
• Nonverbal communications are an
essential skill.
Relaxation techniques
• Jacobsen’s progressive
muscular relaxation
• Autogenic relaxation
• Ost’s applied relaxation
technique
• Brief relaxation or
functional relaxation
therapy
• Deep relaxation or
diaphragmatic breathing
Guided imagery
Biofeedback
Hypnotherapy
Acupuncture
Distraction
Enhancing control
Systematic desensitization
• Positive reinforcement

• Cognitive therapy
Computer-controlled local anesthetic
delivery
 Technological advancements that help
alleviate anxiety in restorative dentistry
• sight (air-turbine drill, needles),
• sounds
• Sensations
• smells
• Atraumatic restorative
treatment, air abrasion
chemomechanical caries
removal
Pharmacological management
CONCLUSION
 REFERENCES
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