Smartphone application for dental anxiety in adolescents


Dental anxiety is a common problem (Dental Elf – 7th Oct 2020) that can cause problems with the delivery of dental care. While a number of smartphone applications have been developed for health education and prevention only a small number have been tested for dental anxiety. The e-SAID (Survey of Anxiety and Information for Dentists), a quiz of 25 questions has been developed for this purpose. The eSAID has been translated into Portuguese and developed into a smartphone application (App) named FALE containing 14 questions on the patient’s dental anxiety, feelings, coping preferences, and requests regarding dental care.

The aim of this trial was to investigate the effects of the FALE App on dental anxiety, communication, cooperation, and satisfaction among adolescent patients.


Brazilian adolescents aged 10–19years, literate in Portuguese, able to use a smartphone were stratified by age (10–14 and 15–19 years) and sex and randomised by a researcher with no clinical involvement in the trial. Patients were instructed to use the App while in the waiting room before their dental care and at the end of the appointment.  Patients in the control group used a version of the FALE App that only included the first question about their level of dental anxiety. The primary study outcome was dental anxiety. Secondary outcomes included adolescent cooperation during dental care a secondary outcome assessed by a psychologist using the Frankl Behaviour Scale and patients and clinician assessment of the App, care, communication and co-operation.


  • 184 patients (92 test group ,92 controls) were randomised.
  • Dental care was provided by 79 dental students.
  • A statistically significant difference in anxiety levels were seen in the test group compared with the controls. Levels of anxiety before and after the intervention are shown in the table below.
  Test group n (%) Control group n (%)
Number 92 92
Anxiety level before 21 (22.8%) 19 (20.7%)
Anxiety level after 6 (6.5%) 17 (18.5%)
  • Levels of dental anxiety were similar in males and females at baseline and following the intervention with no difference in the level of improvements between male or female patients.
  • A difference in anxiety levels was seen for 10-14yr olds but not 15-19 yr olds.
  • The clinicians and psychologist reported very high level of adolescent cooperation, with no difference between the groups.
  • Clinicians and adolescents rated the level of communication during care as very good.


The authors concluded: –

the FALE App effectively reduced dental anxiety before the appointment in the test group. Moreover, the App improved the adolescents’ satisfaction both with the treatment and dental students who assisted them. The dental students considered it very useful to receive the report with the patient’s information before the appointment. The App, however, had no impact on the evaluation of communication, as well as on cooperation during the consultation.


This trial was registered on the platform and aimed to follow the Consolidated Standards of Reporting Trials (CONSORT) guidelines. An initial sample size calculation of 130 (65 per group) was amended to 184 (92 per group based on preliminary data. Block randomisation was undertaken using different block sizes. Both test and control group used the App with the control group only being able to respond to the first question on two occasions following a one-minute pause.

The findings indicate that the FALE App did reduce levels of dental anxiety in the control group and improve satisfaction with treatment and clinicians. Although high levels of co-operation with treatment were seen in both groups. The authors’ note that the e-SAID on which the App is based has shown good in reducing anxiety in two other studies ( Jones L, 2015; Yee R, et al 2017) and it would be interesting to see additional studies to see if the findings can be reproduced in other settings.

Primary Paper

Mayer TMAS, Maior GBS, da Costa NP, do Nascimento MG, Colares V. Effectiveness of a smartphone application on dental anxiety in adolescents: A randomized controlled trial. Int J Paediatr Dent. 2023 Feb 25. doi: 10.1111/ipd.13064. Epub ahead of print. PMID: 36840438.

Study registration on www.ClinicalTrials

The FALE App source code can be obtained from the GitHub address (


Other references.

Dental Elf – 7th Oct 2020

Dental Anxiety: Prevalence in children and adolescents

Dental Elf – 10th Jun 2019

Distraction techniques for managing dental anxiety in children and adolescents


Jones L. Validation and randomized control trial of the e-SAID, a computerized paediatric dental patient request form, to intervene in dental anxiety. Child Care Health Dev. 2015 Jul;41(4):620-5. doi: 10.1111/cch.12200. Epub 2014 Oct 6. PMID: 25287626.

Yee R, Jones LM, Hosey MT. What the child “SAID” to the dentist: A UK randomized controlled trial. Child Care Health Dev. 2017 Nov;43(6):926-932. doi: 10.1111/cch.12510. Epub 2017 Aug 30. PMID: 28857237.

Picture Credits

Photo by Jonas Leupe on Unsplash



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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