Prevalence of Dental Fear and Its Relationship with Oral Health in Children

International Journal of Clinical Preventive Dentistry Volume 9, Number 1, March 2013 Prevalence of Dental Fear and Its Relationship with Oral Health in Children Patcharaphol Samnieng Department of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand Objective: The aims of this cross-sectional study were evaluation the level of the dental fear and assess the relationship between dental fear and oral health status among 12 year-old children in Thailand. Methods: The subjects were 212 children (146 girls and 66 boys), who were 12 year-old, lived in Sukhothai province, Thailand. Subject completed a Children s Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaires. Number of teeth present, decayed and filled teeth, and gingival condition were clinically examined. Children with CFSS-DS 38 were defined as dentally anxious. Results: Dental fear was identified in 50 children (46 girls and 4 boys) (23.6%). The average of the CFSS-DS value was 31.38±10.45. Girls had statistics significant higher mean score of CFSS-DS than boys (p<0.005). Subjects were defined as dentally anxious had higher decayed teeth (1.73±0.28) than those in the normal group (0.86±0.15) (p<0.05). Subjects with dental fear was lower in number of filled teeth (0.98±0.16) than the normal groups (1.22±0.32) (p<0.05). Children with dentally anxious had 48.0% gingivitis with was significant higher than 19.8% gingivitis in the normal groups (p<0.05). Conclusion: Twenty-four percentage of all subjects had dental fear, which was related with decayed, filled teeth and gingival condition. Early intensive prevention and early detection of cause of fear is very important in the solution of the problem. Keywords: dental fear, children, CFSS-DS, Thailand Introduction Dental fear in children has been recognized in many countries as a public health problem (1,2). This problem may lead to neglect of dental care and therefore represents a problem to both dentists and patient alike (2,3). Research has shown that the effects of children s dental fears may well persist into adolescence and, in turn, may lead avoidance of seeking dental care or disruptive behavior during treatment (4). Therefore, it is of great Corresponding author Patcharaphol Samnieng Department of Preventive Dentistry, Faculty of Dentistry, Naresaun University, Phitsanulok, Thailand [65000]. Tel: +66-55-261934, Fax: +66-55-261934, E-mail: patcharaphols@yahoo.com Received October, 24, 2012, Revised March, 5, 2013, Accepted March, 5, 2013 importance that the dental health professional is able to identify children who have dental fear and apply appropriate pediatric management techniques at the earliest age possible (5,6). The etiology of dental fear in children is multifactorial factors. Dental fear has been related to personality, increased general fears, previous painful dental experiences, parental dental fear, age and gender (4,7). The Children s Fear Survey Schedule-Dental Subscale (CFSS-DS) is a well-known psychometric scale that was developed in 1982 for assessing dental fear in children. It has been shown to have good reliability-validity (8,9). CFSS-DS is used to register differences in dental fear between experimental and control groups to select fearful and non-fearful children from a larger reference population and to estimate the prevalence of dental fear in children (9). CFSS-DS has been shown to be better in some situations than other scales such as the Venham Picture Test and the Dental Anxiety Scale (10). Dental fear has been reported to be associated with a range of 1

International Journal of Clinical Preventive Dentistry adverse behavioral and dental health characteristics. Associations between children s dental fear and oral health status have been reported (3,11,12). Studies of children and adults have shown that dental fear is associated with less favorable self-care behavior, avoidance of dental care and also with poorer health outcomes (11). There were no information about dental fear and its relationship with oral health status among Thai children. The aims of this cross-sectional study were evaluation the level of dental fear among 12 year-old schoolchildren and assess the relationship between clinical oral health status and dental fear in Thai children. Material and Methods 1. Subjects The sample comprised 212 children (146 girls and 66 boys) aged 12 years-old, who study at the primary school, Sukhothai, Thailand. All of subjects had dental experience before. Written and verbal informed consent to participate in the study was obtained from all subjects or their relative. 2. Dental fear measurement The CFSS-DS consists of 15 items related to different aspects of dental treatment which were scored as follows: not afraid=1; a little afraid=2; fairly afraid=3; quite afraid=4; very afraid=5. Total score thus ranged from 15-75 (Table 1). Children with CFSS-DS 38 were defined as dentally anxious (13). To obtain a valid instrument for use in Thailand, the CFSS-DS was translated in to Thai by native speaker and then back-translated for Table 1. The children s fear survey schedule-dental subscale (CFSS-DS) Items 1. Dentist 2. Doctors 3. Injections 4. Having somebody examine your mouth 5. Having to open your mouth 6. Having a stranger touch you 7. Having somebody look at you 8. The dentist drilling 9. The sight of the dentist drilling 10. The noise of dentist drilling 11. Having some body put instruments in your mouth 12. Choking 13. Having to go to the hospital 14. People in white uniform 15. Having the dentist clean your teeth quality control. This study was the first time to use the CFSS-DS for Thai children, the pilot study were tested and modified. To fit the conditions of dental procedures in Thailand, the items Having the nurse clean your teeth was changed to Having the dentist clean your teeth (5). The questionnaire was completed by children before dental examination. 3. Clinical dental examination The children were assessed the clinical dental examination procedures recommended by the World Health Organization. The number of teeth present, Decayed, Missing and Filled Teeth (DMFT) index was used. For gingival examination was evaluated the gingivitis criteria (Bright red or red-purple gingival appearance) (14). 4. Statistical analyses Data management and analyses were conducted using SPSS 17. Chi-square test, t-tests, and Pearson correlation were used in statistical analysis. ANOVA was performed to test for group differences in the CFSS-DS scores for children in the dental fear between genders. ANCOVA were used for the relationship between dental fear and oral health status, dental fear as dependent variables, oral health status (number of teeth present, number of decayed, filled teeth and gingivitis) as independent variables, gender and oral health behavior were adjusted. Results Dental fear was identified in 50 children (46 girls and 4 boys) (23.6%). The average of the CFSS-DS value was 31.38±10.45. Girls had statistics significant higher mean score of CFSS-DS than boys (p<0.05). Oral health status and oral health behavior of subjects were showed in Table 2. There were no significant in number of teeth present, decayed and filled teeth and also no significant different between boys and girls about toothbrush behaviors. In this study showed that girls had more gingival problems than boys (p<0.05). Table 2. Dental fear, oral health status and oral health behaviors of subjects Girls (n=73) CFSS-DS (mean±sd) 33.18±10.62* 27.39±8.98* Teeth present (mean±sd) 27.23±1.46 27.30±1.44 Decayed teeth (mean±sd) Filled teeth (mean±sd) Gingivitis (%) Brushing twice/day (%) 1.23±1.25 1.05±1.59 35.6* 86.3 0.69±1.07 1.34±1.08 6.1* 84.8 *p<0.05. Boys (n=33) Total (n=106) 31.38±10.45 27.26±1.45 1.06±1.04 1.08±1.45 26.4 85.8 2 Vol. 9, No. 1, March 2013

Patcharaphol Samnieng:Dental Fear in Children Table 3. Mean scores and standard deviation of DFSS-DS Items Girls Boys Total 1. Dentist 2. Doctors 3. Injections 4. Having somebody examine your mouth 5. Having to open your mouth 6. Having a stranger touch you 7. Having somebody look at you 8. The dentist drilling 9. The sight of the dentist drilling 10. The noise of dentist drilling 11. Having some body put instruments in your mouth 12. Choking 13. Having to go to the hospital 14. People in white uniform 15. Having the dentist clean your teeth 1.59±0.75 1.97±0.97 2.67±1.14* 1.68±0.78* 1.52±0.73 2.76±1.22 2.52±1.11 2.55±1.14 2.41±1.16 2.52±1.12* 2.95±1.15* 2.73±1.20* 1.93±1.26 1.64±0.96 1.90±1.04* 1.42±0.75 1.64±0.92 2.19±1.10* 1.33±0.54* 1.39±0.61 2.27±1.23 2.12±1.08 2.21±1.11 2.33±1.11 2.00±1.11* 2.30±1.13* 2.00±1.03* 1.73±0.94 1.24±0.56 1.45±1.03* 1.54±0.78 1.87±0.97 2.52±1.15 1.58±0.73 1.48±0.69 2.60±1.24 2.40±1.11 2.44±1.14 2.39±1.14 2.36±1.13 2.75±1.18 2.50±1.19 1.87±1.17 1.52±0.88 1.76±1.06 *p<0.05. Table 4. Relationship between dental fear and oral health status Teeth present (mean±sd) Decayed teeth (mean±sd) Filled teeth (mean±sd) Gingivitis (%) Dentally anxious (CFSS-DS 8) Normal (CFSS-DS 8) 27.25±0.16 27.29±0.30 1.73±0.28* 0.86±0.15* 0.98±0.16* 1.22±0.32* 48.0* 19.8* Adjusted for gender and oral health behaviors. Where *p<0.05. Average values of the answers in CFSS-DS items are given in Table 3. The results showed that girls had statistical significant higher mean fear scores for the Injections, Having somebody examine your mouth, The noise of the dentist drilling, Having somebody put instruments in your mouth, Choking, and Having the dentist clean your teeth than boys (p<0.005). Table 4 showed the relationship between dental fear and oral health status adjusted for gender and oral health behaviors. No significant different in number of teeth present between dentally anxious and normal groups. Subjects were defined as dentally anxious had higher decayed teeth (1.73±0.28) than those in the normal (0.86±0.15) (p<0.05). Subjects with dental fear was lower in number of filled teeth (0.98±0.16) than the normal groups (1.22±0.32) (p<0.05). Subjects with Children with dentally anxious had 48.0% gingivitis significant higher than 19.8% gingivitis in the normal groups (p<0.05). Discussion This study was the first study about dental fear in Thai children, the results showed, the high prevalence of dental fear among 12 years old (23.6%). CFSS-DS scores in the present study was higher than the finding in Finland (22.1%) (15), 9-11 year-old Swedish (23.1%) (13), Netherland (23.2%) (16), but lower than the finding in Canada (for 5-15 year-old Chinese children, (31.9%) (17) and 10-14 year-old Singapore children (30.6%) (1). The results showed that dental fear was public health problem affected poor oral health of children Thai. Fear of dental treatment in children has been recognized as a source of serious health problems and it may persist into adolescence, which may lead to an avoidance of seeing dental care or disruptive behavior during treatment (10). This study showed a little high dental fear scores might be because of the age of subjects. The present study selected 12 years old children, the dental fear was higher among 12- and 15- year-old children than among the younger ones (12). Twelve years-old is the last period of childhood before become adolescence. Experiencing rapid changes in physical appearance, perhaps causing embarrassment and self-consciousness, might be dental fear concerned. This study found that girls were more fearful than boys, consistent form previous study (1,16). Woman may report experiencing dental anxiety more often than men do because of the stereotypical belief that they experience emotions of greater in- IJCPD 3

International Journal of Clinical Preventive Dentistry tensity than men (18). If there is a higher prevalence of dental fear in girls, regardless of its origin, dentists should be alert to the potential for more anxiety in this group. The children were most afraid of injections, Chocking, having somebody put instrument in your mouth, and the noise of dentist drilling in this study confirmed by other cultures (1,5,8,12,16). The most commonly reported source of fear in the present study was fear of specific stimuli (2). The sight of needle and sound of drill were rated approximately as high as the actual sensations associated with their use suggested that the children were conditioned to the sensation (2,11,17). The aetiology of dental fear has been discussed in various aspects, including a general subject s inclination foe anxiety and fears, and a response to certain specific stimulus. The majority of patients tend to associate dental fears with painful experience in childhood (19). This study found that the dental fear significantly related with decayed teeth and gingival conditions. Dental anxiety is likely to be a predictor of dental caries, and may be a risk factor for dental caries incidence (19,20). The previous studies showed the significant correlation between dental fear and DMFS-dmfs scores (11,12,15,18). Subjects with dentally anxious had higher percentage of gingivitis than the normal groups, consistency with the study in USA, reported that subjects with dentally anxious had higher percentage of teeth with calculus and percentage of teeth with bleeding than the not anxious subjects (18). This study found that dental fear was lower in subject with number of filled teeth. More frequent dental checkups may increase the likelihood of detecting caries, thus increasing the number of restorative procedures for a patient. Furthermore, more frequent visits to the dentist may lessen anxiety because the experience becomes more familiar and comfortable to the patient, and early correction of a dental problem is likely to be less traumatic (18). Dental fear is a serious problem which negatively affects the oral health of children and adults. Early detection of the causes of fear is very important in the solution of the problem. The dental health professional is able to identify children who have dental fear and apply appropriate pediatric management techniques at the earliest age possible (5,6). To reduce the level of dental fear among children, attention needs to be paid to use of epidemiologic concepts of clinical risk ascertainment and early intensive preventive efforts such as pit and fissure sealants, routine oral health examination, oral hygiene instructions and parental education. Oral health promotion program for school health activity should be setting for increase knowledge, good attitude for dentist, dental treatment and oral health self-check of children, might be reduces the dental fear problem. However, more studies should be carried out with greater sample sizes and covering larger geographic areas and large age group in Thailand. In conclusion, Twenty-four percentage of all subjects had dental fear, which was related with decayed, filled teeth and gingival condition. Early intensive prevention and early detection of cause of fear is very important in the solution of the problem. Conclusion In conclusion, Twenty-four percentage of all subjects had dental fear, which was related with decayed, filled teeth and gingival condition. Early intensive prevention and early detection of cause of fear is very important in the solution of the problem. 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