Anxiety during the dental care of children aged 4 to 6 years over three consecutive visits

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

[1] 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.

[2] 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.

[3] 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.

[4] 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.

[5] 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.

[6] 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).

[7] Geršak G, Drnovšek J. Electrodermal activity patient simulator. PLOS ONE. 2020; 15: e0228949.

[8] Posada-Quintero HF, Chon KH. Innovations in electrodermal activity data collection and signal processing: a systematic review. Sensors. 2020; 20: 479.

[9] 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.

[10] 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.

[11] 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.

[12] 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.

[13] 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.

[14] 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.

[15] 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.

[16] 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.

[17] 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.

[18] 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.

[19] 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.

[20] 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.

[21] 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.