Understanding Dental Fear and Anxiety in Children

Background.
Dental fear and anxiety (DFA) assessment using standardised self-report questionnaires could improve patient care, facilitate communication, and reduce occupational stressors for dental professionals. However, existing measures have conceptual limitations and barriers to clinical utilisation.

Aim.
To further the understanding of DFA assessment in paediatric dental patients.

Method.
Firstly, a cross-sectional study was conducted to determine a profile of paediatric dental patients referred with DFA. Additionally, child mental health and health-related quality of life were assessed. Next, a qualitative approach was used to explore children’s DFA experiences using a Cognitive Behavioural Therapy (CBT) framework. The findings informed the development on a new child centred DFA measure (Porritt et al. 2018). Subsequently, a web-based version of this measure for use on mobile smart devices was designed and tested.

Results.
In Study 1, the profile of 100 children aged 11-16 years found most were female, White ethnicity, and lived in areas with high deprivation (61%, 85%, and 50% respectively). Participants had a range of self-reported DFA severity scores. Most did not have additional psychological difficulties and reported levels of impacts on daily living consistent with community samples. In Study 2, semi-structured interviews were conducted with 13 children aged 11-16 years. The thoughts, feelings, physical symptoms, and behaviours described were characteristic of changes associated with fears and anxieties. In Study 3, 107 children aged 9-16 years participated in the design and/or testing of the web-application. Mode of questionnaire delivery did not affect data equivalence or completeness, or time taken to complete responses. Both questionnaire versions had high acceptability, with no participant preference reported.

Discussion.
DFA is a multidimensional experience for children. Further research is needed into the factors that influence children’s self-reporting of DFA using standardised questionnaires. The functionality offered by web-applications on mobile smart devices has considerable potential for DFA assessment.