Dental Anxıety in Chıldren: The Obstacle to Successful Dental Treatment

Year 2024, Volume: 11 Issue: 1, 90 - 95, 26.04.2024

Büşra Mutlu Aysun Avşar

https://doi.org/10.15311/selcukdentj.1271549

Abstract

Dental anxiety is defined as intense anxiety about any dental procedure without an obvious source. Dental anxiety in children is closely related to the fear of the unknown and the lack of opportunity to control the treatment. Dental anxiety, which can cause physiological and psychological problems for the physician as well as the child, causes oral and dental health problems by preventing children from coming to their appointments and applying the treatment steps in an ideal way.
The prevalence of anxiety was found to be between 5% and 20.6% in studies conducted with children in different age groups who underwent different dental treatments in various countries. The way children show their dental concerns may vary according to age groups. In children with dental anxiety, increased heart rate, changes in breathing, sweating, abdominal pain, tremor, nausea, dry mouth, crying, restlessness, and distraction are frequently observed during dental treatment. In order to progress and complete the steps of dental treatment, anxiety can be managed non-pharmacologically with pharmacological methods such as sedation and general anesthesia, aromatherapy, music therapy, visual and auditory distraction and hypnosis by watching videos during treatment.
Keywords: Dental anxiety, Dental fear, Child

Keywords

Dental anxiety, Dental fear, Child

Ethical Statement

This article is not the version of a presentation. This article has not been prepared on the basis of a master’s/ doctoral thesis. It is declared that during the preparation process of this study, scientific and ethical principles were followed and all the studies benefited are stated in the bibliography.

Çocuklarda Dental Anksiyete: Başarılı Dental Tedavinin Önündeki Engel

Abstract

ÖZET

Dental anksiyete; her türlü dental işleme karşı kaynağı belli olmaksızın duyulan yoğun endişe olarak tanımlanmaktadır. Çocuklarda dental anksiyete; bilinmeyene karşı duyulan korku ve tedaviyi kontrol etme fırsatının olmamasıyla yakından ilişkilidir. Çocuğun yanısıra hekim için de fizyolojik ve psikolojik problemlere yol açabilen dental anksiyete, çocukların randevularına gelmelerini ve tedavi basamaklarının ideal şekilde uygulanmasını engelleyerek ağız ve diş sağlığı problemlerine neden olmaktadır. Anksiyetenin ve korkunun nörobiyolojisinde rol oynayan en önemli nöroanatomik oluşum amigdaladır. Amigdala potansiyel tehditleri kontrol ederek hipotalamusla yaptığı bağlantılarıyla sempatik sinir sisteminin aktivasyonunu sağlar; merkezi orta beyinle yaptığı bağlantılarıyla da savaş ya da kaç gibi davranışsal savunma yanıtlarını oluşturur.

Çeşitli ülkelerde farklı yaş gruplarındaki farklı dental tedaviler uygulanan çocuklarda yapılan çalışmalarda anksiyete prevalansının %5-%20,6 arasında olduğu saptanmıştır. Çocukların dental kaygılarını gösterme şekilleri yaş gruplarına göre değişebilmektedir. Diş tedavilerinin karşısındaki en yaygın küresel engellerden biri olan dental anksiyeteye neden olan faktörler; dental, çevresel ve bireysel olmak üzere 3 başlıkta gruplandırılabilir.

Dental kaygıya sahip çocuklarda diş tedavisi esnasında kalp hızında artış, nefes almada değişiklik, terleme, karın ağrısı, titreme, mide bulantısı, ağız kuruluğu, ağlama, huzursuzluk, dikkat dağınıklığı sıklıkla görülmektedir. Dental tedavi işlem basamaklarının ilerleyebilmesi ve tamamlanabilmesi için anksiyete, sedasyon ve genel anestezi gibi farmakolojik, aromaterapi, müzik terapisi, tedavi esnasında video izleterek görsel ve işitsel olarak dikkat dağıtma ve hipnoz gibi yöntemlerle nonfarmakolojik olarak yönetilebilmektedir.

Anahtar Sözcükler: dental anksiyete, dental korku, çocuk



ABSTRACT

Dental anxiety is defined as intense anxiety about any dental procedure without an obvious source. Dental anxiety in children is closely related to the fear of the unknown and the lack of opportunity to control the treatment. Dental anxiety, which can cause physiological and psychological problems for the physician as well as the child, causes oral and dental health problems by preventing children from coming to their appointments and applying the treatment steps in an ideal way. The most important neuroanatomical formation that plays a role in the neurobiology of anxiety and fear is the amygdala. By controlling potential threats, the amygdala provides the activation of the sympathetic nervous system with its connections with the hypothalamus; with its connections with the central midbrain, it creates behavioral defense responses such as fight or flight.

The prevalence of anxiety was found to be between 5% and 20.6% in studies conducted with children in different age groups who underwent different dental treatments in various countries. The way children show their dental concerns may vary according to age groups. Factors causing dental anxiety, one of the most common global barriers to dental treatments; can be grouped under 3 headings as dental, environmental and individual.

In children with dental anxiety, increased heart rate, changes in breathing, sweating, abdominal pain, tremor, nausea, dry mouth, crying, restlessness, and distraction are frequently observed during dental treatment. In order to progress and complete the steps of dental treatment, anxiety can be managed non-pharmacologically with pharmacological methods such as sedation and general anesthesia, aromatherapy, music therapy, visual and auditory distraction and hypnosis by watching videos during treatment.

Keywords: dental anxiety, dental fear, child

Keywords

dental anksiyete, dental korku, çocuk

Ethical Statement

Bu makale, sempozyum ya da kongrede sunulan bir tebliğin içeriği geliştirilerek ve kısmen değiştirilerek üretilmemiştir. Bu çalışma, yüksek lisans ya da doktora tezi esas alınarak hazırlanmamıştır. Bu çalışmanın hazırlanma sürecinde bilimsel ve etik ilkelere uyulduğu ve yararlanılan tüm çalışmaların kaynakçada belirtildiği beyan olunur.

References

• 1. Işık E, Taner YI. Çocuk, Ergen ve Erişkinlerde Anksiyete Bozuklukları, 1.Baskı. İstanbul, Golden Print, 2006: 4-5.
• 2. Kvale G, Berggren U, Milgrom P. Dental fear in adults: a meta- analysis of behavioral interventions. Community Dent Oral Epidemiol.2004;32:250-64.
• 3. Chadwick BL. Assessing the anxious patient. Dent Update. 2002;29:448-54.
• 4. Toledano M, Osorio R, Aguilera F, Pegalajar J. Children's dental anxiety: influence of personality and intelligence factors. Int J Paediatr Dent. 1995;5:23-8.
• 5. Rousset C, Lambin M, Manas F. The ethological method as a means for evaluating stress in children two to three years of age during a dental examination. ASDC J Dent Child. 1997;64: 99-106.
• 6. Brick J, Erickson CK Drugs. The Pharmacology of Abuse and Dependence. The Haworth Medical Press 1998;1:119-131.
• 7. Davis M, Rainnie D, Casell M Neurotransmission in the rat amygdala related to fear and anxiety. Trends Neurosci. 1192;7:208-214.
• 8. Carvey PM. Drug Action in the Central Nervous System. New York, Oxford University Press, s.123-150.
• 9. 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. 2007;17: 391-406.
• 10. Skaret E, Soevdsnes EK. The role of the dental hygienist in prevention and treatment of the fearful dental patient. Int J Dent Hyg. 2005;3:2-6.
• 11. Buldur B, Armfield J. Development of the Turkish version of the Index of Dental Anxiety and Fear (IDAF-4C+): Dental anxiety and concomitant factors in pediatric dental patients, The Journal of clinical pediatric dentistry, 2018;42:279-286
• 12. Mağat, G. Necmettin Erbakan Üniversitesi Diş Hekimliği Fakültesi’ne başvuran hastaların dental anksiyete düzeylerinin değerlendirilmesi, Selcuk Dental Journal,2018;5(3):246-252.
• 13. Doğan MC, Seydaoglu G, Uguz S, Inanc BY. The effect of age, gender and socioeconomic factors on perceived dental anxiety determined by a modified scale in children. Oral health & preventive dentistry. 2006;4 (4): 235-41
• 14. Altın KT, Onur ŞG, Yurtseven BD, Altunok Ç, Sandallı N. Ebeveyn dental kaygısının çocukların dental kaygısı üzerine etkileri Yeditepe J Dent, 2019;2:146- 151.
• 15. Bayrak Ş, Şen E, Eğilmez T, Tüloğlu N. Ebeveyn dental kaygısı ve sosyodemografik faktörlerin çocukların dental kaygısı üzerine etkileri. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2010; (3):181-8.8
• 16. De Jongh A, Adair P, Meijerink-Anderson M. Clinical management of dental anxiety: what works for whom? International dental journal 2005;55:73-80
• 17. Alwin NP, Murray J, Britton P. An assessment of dental anxiety in children. Br Dent J. 1991;171(7) :201-207.
• 18. Eli I, Schwartz-Arad D, Baht R, Ben-Tuvim H. Effect of anxiety on the experience of pain in implant insertion. Clinical oral implants research. 2003;14:115-118
• 19. Wogelius P, Poulsen S, Toft Sørensen H. Prevalence of dental anxiety and behavior management problems among six to eight years old danish children. Acta Odontol Scand, 2003;61:178-183
• 20. 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. Int J Paediatr Dent, 2013;23:125-130
• 21. Bergdahl M, Bergdahl J. Temperament and character personality dimensions in patients with dental anxiety. European journal of oral sciences. 2003;111:93-98.
• 22. Önçağ Ö, Çoğulu D. Ailenin sosyoekonomik durumu ve eğitim düzeyinin çocuklarda dental kaygı üzerine etkisi. AU Dis Hek Fak Derg. 2005;1:45-54.
• 23. Stabholz A, Peretz B. Dental anxiety among patients prior to different dental treatments. Int Dent J. 1999;49:90-94.
• 24. Mishra G, Thakur S, Singhal P, Ghosh SN, Chauhan D, Jayam C. Assessment of child behavior in dental operatory in relation to sociodemographic factors, general anxiety, body mass index and role of multi media distraction. J Indian Soc Pedod Prev Dent, 2016;1:34-159.
• 25. Jawdekar A. Child management in clinical dentistry. 1. Baskı. India, Jaypee Brothers Medical Publishers, 2010. p. 46-51.
• 26. Panda A, Garg I, Bhobe AP. Children’s perspective on the dentist’s attire. Int J Paediatr Dent 2014; 24(2): 98-103.
• 27. Kuscu OO, Çaglar E, Kayabasoglu N, Sandalli N. Preferences of dentist’s attire in a group of Istanbul school children related with dental anxiety. Eur Arch Paediatr Dent 2009;10(1): 38-41.
• 28. Gustafsson A, Broberg A, Bodin L, Berggren U, Arnrup K. Dental behaviour management problems: The role of child personal characteristics. Int J Paediatr Dent. 2010;20: 242-253.
• 29. Lee CY, Chang YY, Huang ST. The clinically related predictors of dental fear in taiwanese children. Int J Paediatr Dent. 2008;18:415-422.
• 30. Burnham JJ, Gullone E. The Fear Survey Schedule for Children:A psychometric investigation with American data. Behav Res Ther 1997; 35(2): 165-73
• 31. Klingberg G, Berggren U, Norén JG. Dental fear in an urban Swedish child population: prevalence and concomitant factors. Community Dent Health 1994;11(4): 208-14.
• 32. Dogan MC, Seydaoglu G, Uguz S, Inanc BY. The effect of age, gender and socioeconomic factors on perceived dental anxiety determined by a modified scale in children. Oral Health Prev Dent 2006;4(4):235-41.
• 33. Wogelius P, Poulsen S, Toft Sørensen H. Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children. Acta Odontol Scand 2003;61(3):178-83.
• 34. Milgrom P, Vignehsa H, Weinstein P. Adolescent dental fear and control: Prevalence and theoretical implications. Behav Res Ther. 1992;30(4): 367-73.
• 35. Locker D, Poulton R, Thomson W. Psychological disorders and dental anxiety in a young adult population. Community Dent Oral Epidemiol, 2001;29:456-463.
• 36. Arnrup K, Broberg A, Berggren U, Bodin L. Lack of cooperation in pediatric dentistry-the role of child personality characteristics. Pediatr Dent, 2002;24: 119- 128.
• 37. De Jongh A, Bongaarts G, Vermeule I, Visser K, De Vos P, Makkes P. Blood– injury–injection phobia and dental phobia. Behav Res Ther. 1998;36 (10):971-82.
• 38. Vika M, Skaret E, Raadal M, Öst LG, Kvale G. 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. 2008;18 (3):163-9.
• 39. Berge KG, Agdal ML, Vika M, Skeie MS. High fear of intra-oral injections: prevalence and relationship to dental fear and dental avoidance among 10-to 16-yrold children. Eur J Oral Sci. 2016;124 (6): 572-9.
• 40. Chadwick BL, Hosey MT: Child Taming: How to manage children in dental practice, Quintessence Publishing Co. Ltd, London 2003;2(8),37-46.
• 41. Watson AT, Vısram A. Children’s preoperative anxiety and postoperative behaviour. Paediatr Anaesth 2003;13: 188-204.
• 42. Liddell A, Locker D. Gender and age differences in attitudes to dental pain and dental control. Community dentistry and oral epidemiology. 1997;25:314-318.
• 43. Corah NL. Development of a dental anxiety scale. J Dent Res. 1969;48:596.
• 44. Frankl SN, Shiere FR, Fogels HR. Should the parent remain with the child in the dental operatory? A.S.D.C. J. Dent. Child 1999;2:150-163.
• 45. Klinberg G, Hwang CP. Children’s dental fear picture test (CDFP): Aprojective test for the assessment of child dental fear. A.S.C.D. J. Dent. Child 1994;61:89-96.
• 46. Messer JG. Stress in dental patients undergoing routine procedures. J Dent Res. 1977;56 (4): 362-7
• 47. Myers D, Kramer W, Sullivan R. A study of the heart action of the child dental patient. ASDC J Dent Child. 1972;39 (2): 99.
• 48. Rayen R, Muthu M, Rao CR, Sivakumar N. Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children. Indian J Dent Res. 2006;17 (1):27.
• 49. Johnson JE, Dabbs Jr JM. Enumeration of active sweat glands: A simple physiological indicator of psychological changes. Nursing Research.1967;16 (3):273.
• 50. Sexton J, Mourino A, Brownstein M. Children's behavior in emergency and nonemergency dental situations. J Clin Pediatr Dent. 1993;17 (2): 61-3.
• 51. Schmidt NA. Salivary cortisol testing in children. Issues Compr Pediatr Nurs. 1997; 20 (3): 183-90.
• 52. Balcıoğlu İ, Savrun M. Stres ve Hormonlar. Turkiye Klinikleri Journal of Psychiatry. 2001;2 (1): 43-50.
• 53. Aartman IH, Hoogstraten J, Schuurs AH. Self-report measurements of dental anxiety and fear in children: a critical assessment. ASDC J Dent Child. 1998;65 (4): 252-8, 29-30.
• 54. Eichenbaum I, Dunn N. Projective drawings by children under repeated dental stress. ASDC J Dent Child. 1971;38 (3): 164-73.
• 55. Campbell C. Dental Fear and Anxiety in Pediatric Patients. 1st ed. UK, Springer Int Pub, 2017:35.
• 56. Chapman H, Kirby-Turner N. Visual/verbal analogue scales: examples of brief assessment methods to aid management of child and adult patients in clinical practice. Br Dent J. 2002;193 (8): 447.
• 57. Venham L, Bengston D, Cipes M. Children's response to sequential dental visits. J Dent Res. 1977;56 (5): 454-9.
• 58. Venham L. The effect of mother's presence of child's response to dental treatment. ASDC J Dent Child.1979;46 (3): 219.
• 59. Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc, 1978;97: 816-819.
• 60. Cuthbert M. A screening device: Children at risk for dental fears and management problems. J Dent Child, 1982;49: 432-436.
• 61. Humphris G, Wong H, Lee G. Preliminary validation and reliability of the modified child dental anxiety scale. Psychol Rep, 1998;83: 1179-1186.
• 62. Al-Namankany A, Ashley P, Petrie A. The development of a dental anxiety scale with a cognitive component for children and adolescents. Pediatr Dent. 2012;34: 219-224.
• 63. Howard KE, Freeman R. Reliability and validity of a faces version of the modified child dental anxiety scale. Int J Paediatr Dent, 2007;17: 281-288.
• 64. Mathur, J, Diwanji A, Sarvaiya B, Sharma D. Identifying Dental Anxiety in Children's Drawings and correlating It with Frankl's Behavior Rating Scale, Int J Clin Pediatr Dent. 2017;10(1):24-28.
• 65. Jenkins, B.N, Fortier A, Kaplan H, Mayes C, Kain N. Development of a short version of the modified Yale Preoperative Anxiety Scale, Anesth Analg. 2014;119(3):643-650.
• 66. Yıldırım C, Akgün Ö, Polat G, Ok M, Altun C, Başak F. Assessment of dental fear in Turkish children with the Frankl Behavior Rating Scale and the Sound-Eye-Motor scale, Gulhane Medical Journal. 2016;58:272-276.
• 67. Topalel S, Orekici G, Azizoğlu M. Evaluation of Preoperative Anxiety in Turkish Paediatric Patients and Validity and Reliability of the Turkish Modified Yale Preoperative Anxiety Scale, Turk J Anaesthesiol Reanim. 2020;48(6):484-490.
• 68. Kain ZN, Mayes LC, Cicchetti DV. The Yale preoperative anxiety scale: How does it compare with a 'gold standard'? Anesth Analg. 1997;85:783-8.
• 69. Hatipoğlu, Z., Kırdök, O., Özcengiz, D. Validity and reliability of the Turkish version of the modified Yale Preoperative Anxiety Scale. Turkish Journal of Medical Sciences. 2019;49 (3):730-737.
• 70. O. Vassend. Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. 1993;31: 659.
• 71. Eitner S, Schultze-Mosgau S, Heckmann J, Wichmann M, Holst S.Changes in neurophysiologic parameters in a patient with dental anxiety by hypnosis during surgical treatment. J Oral Rehabil. 2006;33(7):496-500.
• 72. Attar RH, Baghdadi ZD. Comparative efficacy of active and passive distraction during restorative treatment in children using an iPad versus audiovisual eyeglasses: a randomised controlled trial. Eur Arch Paediatr Dent 2015;16(1):8-9.
• 73. Sullivan C, Schneider PE, Musselman RJ, Dummett CJ, Gardiner D. The effect of virtual reality during dental treatment on child anxiety and behavior. ASDC J Dent Child 2000;67:193-6.
• 74. M. Zabirunnisa, J. Gadagi, P. Gadde, J. Koneru, N. Myla, C. Thatimatla, Dental patient anxiety: possible deal with Lavender fragrance, J. Res. Pharm. Pract.2014;3 100–103.
• 75. Peden CJ, Cook SC. Sedation for dental and other procedures. Anaesthesia & Intensive Care Medicine 2014;15:362-5.
• 76. American Society of Anesthesiologists (ASA). Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.
• 77. Patricia J Flynn, Leo Strunin. General anaesthesia for dentistry. Anesthesia & Intensive Care Medicine. 2005;8:263-265.
• 78. Lee HH, Milgrom P, Starks H, Burke W. Trends in death associated with pediatric dental sedation and general anesthesia. Paediatr Anaesth 2013;23:741-6.
• 79. Delfiner A, Myers A, Lumsden C, Chussid S, Yoon R. Characteristics and Associated Comorbidities of Pediatric Dental Patients Treated under General Anesthesia. J Clin Pediatr Dent 2017;41:482-5.
• 80. Baygın Ö, Işık B. Çocuk Diş Hekimliğinde Nitröz Oksit/Oksijen Sedasyonu. Hacettepe Diş Hekimliği Fakültesi Dergisi 2010;34:53-61.
• 81. Cravero JP, Blike GT. Review of pediatric sedaton. Anesth Analg 2004;99:1355-64.
• 82. Padfield A. Just a little whiff of gas. A partial history of UK dental chair anaesthesia. Anaesthesia News. 2007;243:27– 28.
• 83. American Dental Assosication. Guidelines for the Use of Sedation and General Anesthesia by Dentists.
• 84. Savanheimo N, Sundberg SA, Virtanen JI, Vehkalahti MM. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service. BMC Oral Health 2012;12(1):45
• 85. Stratmann G: Review article: Neurotoxicity of anesthetic drugs in the developing brain. Anesth Analg 2011;113:1170–1179.
• 86. Sun L. Early childhood general anaesthesia exposure and neurocognitive development. Br J Anaesth. 2010;105:(1):i61-68.
• 87. Ganzberg S. The FDA Warning on Anesthesia Drugs. Anesth Prog. 2017;64:57-58
• 88. Chen XX, Jiang X, Zhong J, Zhang HM, Huang Q, Xia B. [Postoperative complications following dental rehabilitation under general anesthesia in children]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2017;52(11):661-666.
• 89. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. , 2021, American Academy of Pediatric Dentistry. : Chicago. p. 306-24
• 90. Liu Y, Gu Z, Wang Y. Effect of audiovisual distraction on the management of dental anxiety in children: a systematic review. Int J Paediatr Dent 2019; 29: 14‐21
• 91. Eitner S, Schultze-Mosgau S, Heckmann J, Wichmann M, Holst S. (2006) Changes in neurophysiologic parameters in a patient with dental anxiety by hypnosis during surgical treatment. J Oral Rehabil. 33(7): 496-500. doi: 10.1111/j.1365-2842.2005.01578.x
• 92. Attar RH, Baghdadi ZD. Comparative efficacy of active and passive distraction during restorative treatment in children using an iPad versus audiovisual eyeglasses: a randomised controlled trial. Eur Arch Paediatr Dent 2015;16:1-8. 9.
• 93. Sullivan C, Schneider PE, Musselman RJ, Dummett CJ, Gardiner D. The effect of virtual reality during dental treatment on child anxiety and behavior. ASDC J Dent Child 2000;67:193-6