Dental Anxiety: Prevalence in children and adolescents

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There is some uncertainty around the use of the terms dental fear, dental anxiety, and dental phobia in the literature with these terms often being used interchangeably. Dental fear is considered a normal emotional reaction to specific threatening stimuli in relation to the dental situation, while dental anxiety is considered a state of apprehension, that something dreadful is going to happen in relation to dental treatment. Dental phobia (DP) corresponds to an intense fear that interferes with the individual’s functioning and distinguishing this from dental fear can be challenging for dentists as phobia is a clinical diagnosis. Estimates of dental anxiety children and adolescents range from 5.7- 20.2% and a large number of tools are available for measurement e.g. the Dental Fear Survey (DFS), the Venham Picture Test (VPT), Modified Child Dental Scale (MCDAS) and its faces version (MCDASf).

The main aim of this review was to describe the global prevalence of dental anxiety in children and adolescents.

Methods

Searches were conducted in the Medline/PubMed, Embase, Web of Science, CINHAL, Scopus, PsychINFO, LILACS, OpenGrey and CAPES Thesis Databases with no restrictions on language. This was supplemented by hand searches of the journals; Community Dentistry and Oral Epidemiology, International Journal of Paediatric Dentistry, Paediatric Dentistry, Journal of Dentistry for Children, Journal of Dental Research and Journal of the American Dental Association between 2010 and 2018. Observational studies assessing the prevalence of dental anxiety in children and adolescents published between 1985 and 2020 were considered.  The primary outcome was overall dental anxiety, with prevalence by age as a secondary outcome. Two reviewers independently selected studies and extracted data. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data’ checklist. Data were pooled and random effects meta-analyses conducted.

Results

  • 50 studies reported in 57 papers were included.
  • Studies from 21 countries were included; Bosnia and Herzegovina, Brazil, Canada, China, England, Greece, India, Iran, Italy, Kuwait, Nepal, the Netherlands, Norway, Romania, Saudi Arabia, Scotland, Serbian, Singapore, Spain, Sweden and the USA.
  • None of the included studies was considered to be of high methodological quality.
  • Pooled estimates for dental anxiety prevalence are shown in the table below.
Dental Anxiety No. of Studies Pooled prevalence (95%CI)
All studies 50 23.9% (20.4 to 27.3)
Preschool children 7 36.5% (23.8 to 49.2)
School Children 25 25.8% (19.5 to 32.1
Adolescents 7 13.3% (9.5 to 17.0
  • With the exception of preschool children there was little difference in pooled anxiety level using different sampling strategies.
  Pooled prevalence (95%CI)
  Representative sample Convenience sample
Preschool children 23.4% (21.8 to 25.0) 42.4% (15.3 to 69.5)
School Children 27.6% (15.9 to 39.4) 22.6% (15.1 to 30.1),
Adolescents 11.2% (3.6 to 18.8) 19.1% (16.2 to 22.0
  • The scale used to assess dental anxiety was shown to influence pooled prevalence in preschool and adolescents.

Conclusions

The authors concluded: –

Dental anxiety is a frequent problem in 3‐ to 18‐year‐olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

Comments

The authors have undertaken an extensive database search covering three and a half decades. With the exception of 4 cohort studies all the included studies were of cross-sectional design and used non-random sampling strategies. Consequently, the authors advise caution when extrapolating to other populations. The authors highlight the range of instruments used to measure dental anxiety noting that not all the instruments tap into the same constructs. This and the fact that cut-off points for determining dental anxiety are often arbitrarily determined need to be taken into consideration when interpreting the reviews findings.   This review only included instruments for dental anxiety assessment that had their psychometric properties previously tested in the age group in which they are intended to be applied a key point for future studies in this area.  The available studies were of low quality so the authors suggest that future research on this topic should from the STROBE Initiative recommendations.

Links

Primary Paper

Grisolia, BM, dos Santos, APP, D’Hyppolito, IM, Buchanan, H, Hill, K, Heloisa Oliveira, B. Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta‐analyses. Int J Paediatr Dent. 2020; 00: 1– 16. https://doi.org/10.1111/ipd.12712

Review protocol on PROSPERO

Other references

Dental Elf – 10th Jun 2019

Distraction techniques for managing dental anxiety in children and adolescents

Dental Elf – 28th Sep 2018

Audiovisual distraction for dental anxiety in children?

Dental Elf – 24th Jul 2018

Dental anxiety in paediatric patients: Is cognitive behavioural therapy effective?

 

 

 

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