Anxiety during the dental care of children aged 4 to 6 years over three consecutive visits
1Department of Pediatric Dentistry, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, 9112102 Jerusalem, Israel
DOI: 10.22514/jocpd.2023.084 Vol.47,Issue 6,November 2023 pp.100-105
Submitted: 01 April 2023 Accepted: 20 June 2023
Published: 03 November 2023
Managing the anxiety of children during dental care is a major aspect of a pediatric dentist’s work. Only a sparse body of literature is available regarding anxiety during dental care over consecutive visits. The purpose of the study was to investigate anxiety over three consecutive visits for pediatric dental treatment using an electrodermal activity (EDA) device. We also investigated how patient age, gender, the type of dental care performed and previous dental experience, exerted effect on anxiety.This was an observational cohort study. Anxiety was assessed during treatment, using an EDA device. We also recorded Frankl’s behavior rating, previous dental experience, behavior guidance technique, heart rate and the type of dental care. Our cohort included 30 healthy children aged 4–6 years who needed dental care over at least three visits. Frankl scale scores, EDA values and heart rate did not differ significantly between visits. Behavior and anxiety during treatment did not differ significantly according to gender and age. At the second visit, the Frankl score was higher in children who received pulp treatments and crowns than those who received restorations (p = 0.012). At the third visit, children who received pulp treatments and crowns had higher heart rates than those who received restorations (p = 0.011). Heart rate was significantly higher in children who had negative dental experiences when compared to those with positive experiences (p = 0.030). The levels of anxiety in children aged 4–6 years did not change significantly over three consecutive dental treatments. Therefore, varied and meticulous behavior management methods should be maintained throughout consecutive visits.
Dental anxiety; Pediatric dental care; Child behavior; Consecutive visits
Avia Fux-Noy,Raneen Zeineh,Aviv Shmueli,Elinor Halperson,Diana Ram,Moti Moskovitz. Anxiety during the dental care of children aged 4 to 6 years over three consecutive visits. Journal of Clinical Pediatric Dentistry. 2023. 47(6);100-105.
 Alsadat FA, El-Housseiny AA, Alamoudi NM, Elderwi DA, Ainosa AM, Dardeer FM. Dental fear in primary school children and its relation to dental caries. Nigerian Journal of Clinical Practice. 2018; 21: 1454–1460.
 Zhu M, Yu H, Xie B, Li H, He Q, Li H, et al. Experiential learning for children’s dental anxiety: a cluster randomized trial. BMC Oral Health. 2020; 20: 216.
 Yon MJY, Chen KJ, Gao SS, Duangthip D, Lo ECM, Chu CH. Dental fear and anxiety of kindergarten children in Hong Kong: a cross-sectional study. International Journal of Environmental Research and Public Health. 2020; 17: 2827.
 Ramos-Jorge J, Marques LS, Homem MA, Paiva SM, Ferreira MC, Oliveira Ferreira F, et al. Degree of dental anxiety in children with and without toothache: prospective assessment. International Journal of Paediatric Dentistry. 2013; 23: 125–130.
 Bagchi A, Lahiri B, Jalaluddin M, Kumar G, Das S, Dhull KS. Quantification and measurement of changes in anxiety level in preschool children and their mothers through multiple-visit dental treatment. Journal of International Society of Preventive & Community Dentistry. 2017; 7: 125–130.
 Rank RCIC, Rank MS, Correa MSNP, Vilela JER, Ogawa WN. Dental anxiety and behavior in young children undergoing different distraction techniques. 2017. Available at: https://www.redalyc.org/articulo.oa?id=63749543066 (Accessed: 31 March 2023).
 Geršak G, Drnovšek J. Electrodermal activity patient simulator. PLOS ONE. 2020; 15: e0228949.
 Posada-Quintero HF, Chon KH. Innovations in electrodermal activity data collection and signal processing: a systematic review. Sensors. 2020; 20: 479.
 Shapiro M, Sgan-Cohen HD, Parush S, Melmed RN. Influence of adapted environment on the anxiety of medically treated children with developmental disability. The Journal of Pediatrics. 2009; 154: 546–550.
 Shapiro M, Melmed RN, Sgan-Cohen HD, Eli I, Parush S. Behavioural and physiological effect of dental environment sensory adaptation on children’s dental anxiety. European Journal of Oral Sciences. 2007; 115: 479–483.
 Yon MJY, Chen KJ, Gao SS, Duangthip D, Lo ECM, Chu CH. An introduction to assessing dental fear and anxiety in children. Healthcare. 2020; 8: 86.
 Alshoraim MA, El-Housseiny AA, Farsi NM, Felemban OM, Alamoudi NM, Alandejani AA. Effects of child characteristics and dental history on dental fear: cross-sectional study. BMC Oral Health. 2018; 18: 33.
 Lima DSM, Barreto KA, Rank RCIC, Vilela JER, Corrêa MSNP, Colares V. Does previous dental care experience make the child less anxious? An evaluation of anxiety and fear of pain. European Archives of Paediatric Dentistry. 2021; 22: 139–143.
 Blumer S, Costa L, Peretz B. Success of dental treatment under behavior management sedation and general anesthesia. Journal of Clinical Pediatric Dentistry. 2019; 43: 413–416.
 Veerkamp JSJ, Wright GZ. Children’s behavior in the dental office. In Wright GZ and Kupietzky A (eds). Behavior Management in Dentistry for Children (pp. 23–34). 2nd edn. John Wiley & Sons Inc: Ames. 2014.
 Jain A, Suprabha BS, Shenoy R, Rao A. Association of temperament with dental anxiety and behaviour of the preschool child during the initial dental visit. European Journal of Oral Science. 2019; 127: 147–155.
 Katsouda M, Coolidge T, Simos G, Kotsanos N, Arapostathis KN. Gagging and cooperation in 4–12-year-old children over a series of dental appointments. European Archives of Paediatric Dentistry. 2021; 22: 937–946.
 Ashkenazi M, Blumer S, Eli I. Post-operative pain and use of analgesic agent in children following intrasulcular anesthesia and various operative procedures. British Dental Journal. 2007; 202: E13; discussion 276–277.
 Fux-Noy A, Bendahan Y, Ungar E, Shmueli A, Halperson E, Ram D, et al. Does preoperative paracetamol reduce pain after dental treatment? A randomized controlled double-blind study. Quintessence International. 2020; 51: 732–740.
 Goettems ML, Zborowski EJ, Costa FD, Costa VP, Torriani DD. Nonpharmacologic intervention on the prevention of pain and anxiety during pediatric dental care: a systematic review. Academic Pediatrics. 2017; 17: 110–119.
 Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/fear, sensory over-responsivity, and oral Health behaviors and outcomes: a conceptual model. International Journal of Environmental Research and Public Health. 2022; 19: 2380.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.
Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.
Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.
JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.