Evaluation of dental anxiety in children in relation to children’s emotional intelligence, parenting styles, and parents’ dental anxiety

1. Introduction

Dental anxiety is a serious issue for paediatric dentists because of its strong association with many behavioural management problems [1]. The development of dental anxiety has a multifactorial and poorly understood aetiology. Among the causes, the most common source is direct conditioning. However, not all children who have negative dental experiences develop dental anxiety. Parents play a significant role in teaching their children how to cope with fearful situations [2]. The impact of parental dental anxiety on children’s dental anxiety remains a controversial topic among researchers. While some studies have reported a direct relationship, others have not been able to confirm this finding [3, 4, 5]. This could be due to other psychological factors, such as temperament, attachment, and psychological disorders, which play significant roles in the development of dental anxiety [6, 7, 8].

Many factors, such as cognitive ability, the ability to use different coping strategies to assist with anxious feelings, and the social adaptability skills that children use to respond to ordinary or daily experiences, can affect a child’s response in a dental setting [9]. Furthermore, emotional intelligence provides new fundamental insights and a critical clinical understanding of children’s emotional and behavioural outcomes. Emotional intelligence refers to a person’s ability to understand, generate, and regulate their emotions and is one of the theories of intelligence that expands the concept of intelligence to better address the complexities of a person’s interactions with their environment [10]. It is defined as “the ability to monitor one’s own and others’ emotions, discriminate among them, and use this information to guide one’s thinking and actions” [11]. In addition to the ability to regulate emotions to cope effectively with daily demands, the ability to motivate oneself to achieve personal goals and create a positive impact also falls within the scope of emotional intelligence [12]. The emotional quotient (EQ) is a self-reported measure of emotional and social behaviour that provides an estimate of a person’s underlying emotional and social intelligence [13]. Given that EQ is an influential factor, an assessment of a child’s anxiety and behaviour in the dental setting with a focus on the subscales of emotional intelligence can highlight problematic areas of emotional regulation in the child, which may aid in the formulation of an emotion-based behavioural management strategy. Such strategies are suitable for capitalising on early interventions to regulate children’s emotion-related behaviours during dental treatments and potentially averting the emergence of certain behavioural problems [14].

Parenting styles provide a framework for the psychosocial development of children and shape their behaviours [15]. Baumrind identified three primary parenting styles: authoritative, authoritarian and permissive [16]. This classification of parenting styles serves as a valuable tool for investigating the impact of parenting on various issues related to a child’s development. While some researchers have reported a relationship between parenting styles and dental fear in children, others have been unable to correlate parenting styles with dental anxiety [17, 18]. Given the limited evidence gathered from a small number of studies, the relationships between parenting styles and children’s dental fear and anxiety remain uncertain. In this study, we therefore aimed to examine the correlations between children’s dental fear and anxiety and the subscales of emotional intelligence, parental dental anxiety, and parenting styles.

2. Materials and methods

3. Results

4. Discussion

In this study, correlations between the levels of dental anxiety in children and their sociodemographic variables, their total emotional intelligence (including its subscales), their families’ levels of dental anxiety, and the parenting styles in their families were evaluated.

Interest in the relationships between emotional intelligence and health and well-being is increasing. Emotional intelligence is thought to be related to health behaviours and to lead to better interactions with healthcare professionals, which may thereby increase the tendency to seek help and adhere to advice [25]. In this study, a statistically significant negative correlation was found between the children’s total emotional intelligence levels and degrees of dental anxiety, which is consistent with the findings of a study conducted by Aminabadi et al. [14]. Our finding demonstrates that children with high emotional intelligence have lower levels of dental anxiety related to dental procedures. The general mood subscale of the EQ-i (YV) refers to an individual’s optimism and positive outlook on events [26]. In this study, although not statistically significant, a negative correlation was found between general mood and levels of dental anxiety. This result indicates that having an optimistic and positive outlook before a dental procedure may have the effect of reducing dental anxiety levels. Understanding how dental fear and anxiety develop or are learned in children is crucial for reducing these fears. Most psychology scholars believe that fears are learned. Different pathways for learning fear, such as direct conditioning or indirect learning through modelling, have been identified [27].

Indirect learning assumes that individuals can learn by observing the behaviours of others and the outcomes of those behaviours [27, 28]. Children’s responses to dental procedures may be influenced by factors such as culture, parenting style, age, cognitive level, anxiety and fear, reactions to strangers, social expectations, and temperament [29, 30, 31]. The attitudes of parents during dental procedures can be considered a modelling process in which children imitate adult models in the development of dental fear and anxiety [32]. Parents, especially if they have had negative experiences with dentists themselves, play a significant role in how a child behaves during a dental appointment. As such, an anxious or fearful parent can negatively impact a child’s behaviour in the dental clinic [33]. Furthermore, parents may have a specific cognitive style for coping with pain, which may in turn affect the responses of their children to their own pain experiences [34]. Studies have reported a significant relationship between parents and children’s dental anxiety [32, 35, 36]. In our study, in line with the literature, a statistically significant positive correlation was found between the levels of dental anxiety in the parents and those in their children.

When examining the relationship between parenting style and children’s dental anxiety, we concluded that there is no correlation between these variables, which is similar to the results of Krikken et al. [18, 37]. This suggests that parenting style does not have an effect on the aetiology of children’s anxiety related to dental treatments. We therefore purport that the use of effective behaviour guidance techniques by dentists could lead to increased acceptance rates of planned dental treatments by children.

Age is one of the factors that has an immense impact on the presence of anxiety among children. Younger children are more likely to be affected by fear of the unknown and to have separation anxiety [38, 39]. Contrary to what is commonly indicated in the literature, we found a positive correlation between increasing age and the anxiety levels of the children in our study. We attribute this finding to the fact that with increasing age, children may have higher attention and cognitive levels and may associate their own experiences with the negative experiences of their family members.

It is difficult to find a study in the literature that is without limitations. The most significant limitation in our study was the evaluation of a small sample of 95 participants. However, considering the high prevalence of oral and dental health issues and early childhood caries, the likelihood of finding children aged 7–12 years without any dental treatment experience is low. Additionally, the child self-report scale used to determine emotional intelligence and its subscales is suitable for children over the age of 7. The status of children younger than 7 years, who are more likely to lack dental treatment experience, could therefore not be assessed.

5. Conclusions

On the basis of the results obtained in this study, we concluded that children with higher overall EQ levels generally exhibit lower levels of dental anxiety. Furthermore, we observed that children with high scores on the emotional intelligence subscale of optimism and positive outlook, which is included in the general mood scale, tend to have lower levels of dental anxiety. As children age, their cognitive levels increase, which appears to be associated with a rise in dental anxiety levels. We believe that this is partly due to children learning indirectly from the experiences of the people in their immediate environment. Indeed, our findings showed that the anxiety levels of the children positively correlated with those of their families. Conducting more comprehensive studies on this topic will increase the success of behaviour guidance techniques that dentists can employ with their paediatric patients.

Abbreviations

CDAS, Corah’s Dental Anxiety Scale; EQ, Emotional Quotient; MCDAS(f), facial version of the Modified Child Dental Anxiety Scale; EQ-i (YV), Bar-On Emotional Intelligence Scale-Child and Adolescent Form Scale; ANOVA, Analysis of Variance.

Availability of data and materials

Data from the study are available from the corresponding author upon request.

Author contributions

OCD and NS—designed the research study, analyzed the data. OCD—performed the research work. NS—provided help and advice for the writing of the manuscript. All the authors contributed to editorial changes in the manuscript. All the authors read and approved the final manuscript.

Ethics approval and consent to participate

The research protocol was submitted and approved by the Ethics Committee of Medicine and Health Sciences at Muğla Sıtkı Koçman University (Protocol No: 230090 and September 2023). All parents and children older than 7 years and younger than 12 years who were eligible for inclusion were asked to provide informed consent to participate in the study.

Acknowledgment

Not applicable.

Funding

This research received no external funding.

Conflict of interest

The authors declare no conflict of interest.