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Background and Prevalence of Dental Fear and Anxiety

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Abstract

We have all experienced anxiety and fear at some point in our lives; however, we sometimes still find it difficult to understand other people’s fears if these are different to our own. This can be a challenge for dental professionals who treat anxious children and who may struggle to understand their patient’s fear reactions. It is, however, incredibly important that members of the dental team have a clear understanding of why children experience dental anxiety, and the impact this type of anxiety may have on their patient’s thoughts, feelings and behaviours. This will enable dental professionals to develop empathy with their patients. Understanding the patient’s perspective is an important first step in developing patient-centred treatment plans. Therefore, this chapter aims to promote understanding of the different types of anxiety and fear responses which can be experienced by children, the prevalence of childhood dental anxiety and the factors which may play an important role in the development and maintenance of children’s dental anxiety.

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References

  1. Craske MG. Functions of fear versus anxiety. Origins of phobias and anxiety. 1st ed. Oxford: Elsevier; 2003. p. 21–31.

    Book  Google Scholar 

  2. Lang PJ. Fear reduction and fear behavior: Problems in treating a construct. Research in psychotherapy. Washington, DC: American Psychological Association; 1968. p. 90–102.

    Google Scholar 

  3. Armfield JM. How do we measure dental fear and what are we measuring anyway? Oral Health & Prev Dent. 2010;8:107–15.

    Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  5. Barlow DH. Fear, anxiety and theories of emotion. Anxiety and its disorders. 2nd ed. New York: Guilford Press; 2002. p. 37–63.

    Google Scholar 

  6. Barlow DH. Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. Am Psychol. 2000;55:1247–63.

    Article  PubMed  Google Scholar 

  7. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2007;17:391–406.

    Article  Google Scholar 

  8. De Jongh A, Oosterink FM, Kieffer JM, et al. The structure of common fears: comparing three different models. Am J Psychol. 2011;124:141–9.

    Article  PubMed  Google Scholar 

  9. Carrillo-Diaz M, Crego A, Romero-Maroto M. The influence of gender on the relationship between dental anxiety and oral health-related emotional well-being. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2013;23:180–7.

    Article  Google Scholar 

  10. Klingberg G, Berggren U, Carlsson SG, et al. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci. 1995;103:405–12.

    Article  PubMed  Google Scholar 

  11. Townend E, Dimigen G, Fung D. A clinical study of child dental anxiety. Behav Res Ther. 2000;38:31–46.

    Article  PubMed  Google Scholar 

  12. Nuttall NM, Gilbert A, Morris J. Children’s dental anxiety in the United Kingdom in 2003. J Dent. 2008;36:857–60.

    Article  PubMed  Google Scholar 

  13. Wogelius P, Poulsen S. Associations between dental anxiety, dental treatment due to toothache, and missed dental appointments among six to eight-year-old Danish children: a cross-sectional study. Acta Odontol Scand. 2005;63:179–82.

    Article  PubMed  Google Scholar 

  14. Ramos-Jorge J, Marques LS, Homem MA, et al. Degree of dental anxiety in children with and without toothache: prospective assessment. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2013;23:125–30.

    Article  Google Scholar 

  15. Krikken JB, Veerkamp JS. Child rearing styles, dental anxiety and disruptive behaviour; an exploratory study. Eur Arch Paediatr Dent Off J Eur Acad Paediatr Dent. 2008;9(Suppl):23–8.

    Google Scholar 

  16. Wigen TI, Skaret E, Wang NJ. Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2009;19:431–7.

    Article  Google Scholar 

  17. Klingberg G, Vannas Lofqvist L, Bjarnason S, et al. Dental behavior management problems in Swedish children. Community Dent Oral Epidemiol. 1994;22:201–5.

    Article  PubMed  Google Scholar 

  18. Hallberg U, Camling E, Zickert I, et al. Dental appointment no-shows: why do some parents fail to take their children to the dentist? Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2008;18:27–34.

    Google Scholar 

  19. Moore R, Brodsgaard I. Dentists’ perceived stress and its relation to perceptions about anxious patients. Community Dent Oral Epidemiol. 2001;29:73–80.

    Article  PubMed  Google Scholar 

  20. Weinstein P. Child-Centred child management in a changing world. Eur Archiv Paediatr Dent. 2008;9:6–10.

    Article  Google Scholar 

  21. Hill KB, Hainsworth JM, Burke FJ, et al.. Evaluation of dentists’ perceived needs regarding treatment of the anxious patient. Br Dent J. 2008;204:E13; discussion 442–3.

    Google Scholar 

  22. Harris RV, Pender SM, Merry A, et al. Unravelling referral paths relating to the dental care of children: a study in Liverpool. Prim Dent Care. 2008;15:45–52.

    Article  PubMed  Google Scholar 

  23. ten Berge M, Veerkamp JS, Hoogstraten J, et al. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol. 2002;30:101–7.

    Article  PubMed  Google Scholar 

  24. Wogelius P, Poulsen S, Sorensen HT. Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children. Acta Odontol Scand. 2003;61:178–83.

    Article  PubMed  Google Scholar 

  25. Taani DQ, El-Qaderi SS, Abu Alhaija ES. Dental anxiety in children and its relationship to dental caries and gingival condition. Int J Dent Hyg. 2005;3:83–7.

    Article  PubMed  Google Scholar 

  26. Lee CY, Chang YY, Huang ST. Prevalence of dental anxiety among 5- to 8-year-old Taiwanese children. J Public Health Dent. 2007;67:36–41.

    Article  PubMed  Google Scholar 

  27. Locker D, Shapiro D, Liddell A. Who is dentally anxious? Concordance between measures of dental anxiety. Community Dent Oral Epidemiol. 1996;24:346–50.

    Article  PubMed  Google Scholar 

  28. Humphris GM, Morrison T, Lindsay SJ. The modified dental anxiety scale: validation and United Kingdom norms. Community Dent Health. 1995;12:143–50.

    PubMed  Google Scholar 

  29. Health and Social Care Information Centre. Children’s dental health survey 2013 report 1: attitudes, behaviours and children’s dental health: Health and Social Care Information Centre; 2015. Available from: http://www.hscic.gov.uk/catalogue/PUB17137/CDHS2013-Report1-Attitudes-and-Behaviours.pdf.

  30. Gullone E. The development of normal fear: a century of research. Clin Psychol Rev. 2000;20:429–51.

    Article  PubMed  Google Scholar 

  31. Freeman RE. Dental anxiety: a multifactorial aetiology. Br Dent J. 1985;159:406–8.

    Article  PubMed  Google Scholar 

  32. Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23:295–301.

    Article  PubMed  Google Scholar 

  33. Rachman S. The conditioning theory of fear-acquisition: a critical examination. Behav Res Ther. 1977;15:375–87.

    Article  PubMed  Google Scholar 

  34. de Jongh A, Muris P, ter Horst G, Duyx MP. Acquisition and maintenance of dental anxiety: the role of conditioning experiences and cognitive factors. Behav Res Ther. 1995;33(2):205–10.

    Google Scholar 

  35. de Jongh A, Aartman IH, Brand N. Trauma-related phenomena in anxious dental patients. Community Dent Oral Epidemiol. 2003;31:52–8.

    Article  PubMed  Google Scholar 

  36. Locker D, Liddell A, Shapiro D. Diagnostic categories of dental anxiety: a population-based study. Behav Res Ther. 1999;37:25–37.

    Article  PubMed  Google Scholar 

  37. Kent G. Memory of dental pain. Pain. 1985;21:187–94.

    Article  PubMed  Google Scholar 

  38. Davey GCL. Classic conditioning and the acquisition of human fears and phobias. Adv Behav Res. 1992;14:29–66.

    Article  Google Scholar 

  39. Ten Berge M, Veerkamp JS, Hoogstraten J. The etiology of childhood dental fear: the role of dental and conditioning experiences. J Anxiety Disord. 2002;16:321–9.

    Article  PubMed  Google Scholar 

  40. Bandura A. Social learning through imitation. Nebraska Symposium on Motivation, 1962. Oxford, England: Univer. Nebraska Press; 1962. p. 211–74.

    Google Scholar 

  41. Themessl-Huber M, Freeman R, Humphris G, et al. Empirical evidence of the relationship between parental and child dental fear: a structured review and meta-analysis. Int J Paediatr Dent. 2010;20:83–101.

    Article  PubMed  Google Scholar 

  42. Themessl-Huber M, Freeman R, Humphris G, et al. Empirical evidence of the relationship between parental and child dental fear: a structured review and meta-analysis. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2010;20:83–101.

    Article  Google Scholar 

  43. Bedi R, Sutcliffe P, Donnan PT, et al. The prevalence of dental anxiety in a group of 13- and 14-year-old Scottish children. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 1992;2:17–24.

    Article  Google Scholar 

  44. Mineka S, Zinbarg R. A contemporary learning theory perspective on the etiology of anxiety disorders: it’s not what you thought it was. Am Psychol. 2006;61:10–26.

    Article  PubMed  Google Scholar 

  45. Bernson JM, Elfstrom ML, Hakeberg M. Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns. Eur J Oral Sci. 2013;121:270–6.

    Article  PubMed  Google Scholar 

  46. Vika M, Skaret E, Raadal M, et al. Fear of blood, injury, and injections, and its relationship to dental anxiety and probability of avoiding dental treatment among 18-year-olds in Norway. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2008;18:163–9.

    Article  Google Scholar 

  47. Ray J, Boman UW, Bodin L, et al. Heritability of dental fear. J Dent Res. 2010;89:297–301.

    Article  PubMed  Google Scholar 

  48. Weiner AA, Sheehan DV, Jones KJ. Dental anxiety – the development of a measurement model. Acta Psychiatr Scand. 1986;73:559–65.

    Article  PubMed  Google Scholar 

  49. Klingberg G, Broberg AG. Temperament and child dental fear. Pediatr Dent. 1998;20:237–43.

    PubMed  Google Scholar 

  50. ten Berge M, Veerkamp JS, Hoogstraten J, et al. Behavioural and emotional problems in children referred to a centre for special dental care. Community Dent Oral Epidemiol. 1999;27:181–6.

    Article  PubMed  Google Scholar 

  51. Locker D, Poulton R, Thomson WM. Psychological disorders and dental anxiety in a young adult population. Community Dent Oral Epidemiol. 2001;29:456–63.

    Article  PubMed  Google Scholar 

  52. Versloot J, Veerkamp J, Hoogstraten J. Dental anxiety and psychological functioning in children: its relationship with behaviour during treatment. Eur Arch Paediatr Dent Off J Eur Acad Paediatr Dent. 2008;9(Suppl 1):36–40.

    Article  Google Scholar 

  53. Stenebrand A, Wide Boman U, Hakeberg M. Dental anxiety and symptoms of general anxiety and depression in 15-year-olds. Int J Dent Hyg. 2013;11:99–104.

    Article  PubMed  Google Scholar 

  54. Stenebrand A, Wide Boman U, Hakeberg M. General fearfulness, attitudes to dental care, and dental anxiety in adolescents. Eur J Oral Sci. 2013;121:252–7.

    Article  PubMed  Google Scholar 

  55. Chellappah NK, Vignehsa H, Milgrom P, et al. Prevalence of dental anxiety and fear in children in Singapore. Community Dent Oral Epidemiol. 1990;18:269–71.

    Article  PubMed  Google Scholar 

  56. Burnham JJ, Gullone E. The Fear Survey Schedule for Children–II: a psychometric investigation with American data. Behav Res Ther. 1997;35(2):165–73.

    Google Scholar 

  57. Klingberg G, Berggren U, Noren JG. Dental fear in an urban Swedish child population: prevalence and concomitant factors. Community Dent Health. 1994;11:208–14.

    PubMed  Google Scholar 

  58. Dogan MC, Seydaoglu G, Uguz S, et al. The effect of age, gender and socio-economic factors on perceived dental anxiety determined by a modified scale in children. Oral Health Prev Dent. 2006;4:235–41.

    PubMed  Google Scholar 

  59. Majstorovic M, Veerkamp JS. Developmental changes in dental anxiety in a normative population of Dutch children. Eur Arch Paediatr Dent Off J Eur Acad Paediatr Dent. 2005;6:30–4.

    Google Scholar 

  60. Majstorovic M, Skrinjaric T, Szirovicza L, et al. Dental anxiety in relation to emotional and behavioral problems in Croatian adolescents. Coll Antropol. 2007;31:573–8.

    PubMed  Google Scholar 

  61. Nakai Y, Hirakawa T, Milgrom P, et al. The children’s fear survey schedule-dental subscale in Japan. Community Dent Oral Epidemiol. 2005;33:196–204.

    Article  PubMed  Google Scholar 

  62. Alvesalo I, Murtomaa H, Milgrom P, et al. The dental fear survey schedule: a study with Finnish children. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 1993;3:193–8.

    Article  Google Scholar 

  63. Nicolas E, Bessadet M, Collado V, et al. Factors affecting dental fear in French children aged 5-12 years. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2010;20:366–73.

    Article  Google Scholar 

  64. Rantavuori K, Lahti S, Hausen H, et al. Dental fear and oral health and family characteristics of Finnish children. Acta Odontol Scand. 2004;62:207–13.

    Article  PubMed  Google Scholar 

  65. Locker D, Liddell A, Dempster L, et al. Age of onset of dental anxiety. J Dent Res. 1999;78:790–6.

    Article  PubMed  Google Scholar 

  66. Poulton R, Waldie KE, Thomson WM, et al. Determinants of early- vs late-onset dental fear in a longitudinal-epidemiological study. Behav Res Ther. 2001;39:777–85.

    Article  PubMed  Google Scholar 

  67. Kendell PC. Childhood coping: Avoiding a lifetime of anxiety. Behav Chang. 1992;9:1–8.

    Article  Google Scholar 

  68. de Jongh A, ter Horst G. What do anxious patients think? An exploratory investigation of anxious dental patients’ thoughts. Community Dent Oral Epidemiol. 1993;21:221–3.

    Article  PubMed  Google Scholar 

  69. Williams C, Garland A. A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Adv Psychiatr Treat. 2002;8:172–9.

    Article  Google Scholar 

  70. Ost LG, Clark DM. Cognitive behavioural therapy: principles, procedures and evidence-base. In: Ost LG, Skaret E, editors. Cognitive behavioural therapy for dental anxiety and phobia. 1st ed. Malaysia: Wiley-Blackwell; 2013. p. 91–108.

    Chapter  Google Scholar 

  71. Kent G, Gibbons R. Self-efficacy and the control of anxious cognitions. J Behav Ther Exp Psychiatry. 1987;18:33–40.

    Article  PubMed  Google Scholar 

  72. Armfield JM, Slade GD, Spencer AJ. Cognitive vulnerability and dental fear. BMC Oral Health. 2008;8:2.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Beck AT, Clark DA. An information processing model of anxiety: Automatic and strategic processes. Behav Res Ther. 1997;35:49–58.

    Google Scholar 

  74. Armfield JM. Cognitive vulnerability: A model of the etiology of fear. Clin Psychol Rev. 2006;26:746–68.

    Google Scholar 

  75. Beck AT, Haigh EA. Advances in cognitive theory and therapy: The generic cognitive model. Annu Rev Clin Psychol. 2014;10:1–24.

    Google Scholar 

  76. Willumsen T, Haukebo K, Raadal M. Aetiology of dental phobia. In: Ost LG, Skaret E, editors. Cognitive behavioural therapy for dental phobia and anxiety. 1st ed. Malaysia: Wiley-Blackwell; 2013. p. 45–61.

    Chapter  Google Scholar 

  77. Berggren U, Meynert G. Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc (1939). 1984;109:247–51.

    Article  Google Scholar 

  78. Smith PA, Freeman R. Remembering and repeating childhood dental treatment experiences: parents, their children, and barriers to dental care. Int J Paediatr Dent Br Paedod Soc Int Assoc Dent Child. 2010;20:50–8.

    Article  Google Scholar 

  79. Zhou Y, Cameron E, Forbes G, et al. Systematic review of the effect of dental staff behaviour on child dental patient anxiety and behaviour. Patient Educ Couns. 2011;85:4–13.

    Article  PubMed  Google Scholar 

  80. Jones L. Validation and randomized control trial of the e-SAID, a computerized paediatric dental patient request form, to intervene in dental anxiety. Child Care Health Dev. 2015;41:620–5.

    Article  PubMed  Google Scholar 

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Morgan, A.G., Porritt, J. (2017). Background and Prevalence of Dental Fear and Anxiety. In: Campbell, C. (eds) Dental Fear and Anxiety in Pediatric Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-48729-8_1

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