Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses.

BACKGROUND: Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time. AIM: To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence. DESIGN: Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879). RESULTS: Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents. CONCLUSION: DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

Validade da Escala de Imagens Faciais (FIS) para uso com crianças brasileiras na clínica odontopediátrica / Validity of the Facial Image Scale (FIS) for use with Brazilian children in the pediatric dental clinic

O objetivo deste estudo foi avaliar a validade da Escala de Imagens Faciais (Facial Image Scale; FIS) em pacientes odontopediátricos do Rio de Janeiro, Brasil, por meio da: 1) validade de critério concorrente, medida através do Venham Picture Test ­ versão brasileira; 2) validade de construto, medida através da correlação da FIS com as variáveis idade, sexo, ansiedade percebida pelos pais/cuidadores, classificação socioeconômica (renda), primeira visita ao dentista, tipo de tratamento realizado, uso de anestesia local, experiência prévia e atual de dor de dente, índice de cárie dentária e comportamento durante a consulta odontológica; 3) avaliação qualitativa com 30 crianças de forma a conhecer se o instrumento estava capturando o sentimento da criança em relação à ATO. A forma de aplicação da FIS foi adaptada para o contexto brasileiro por um grupo de quatro odontopediatras brasileiras e uma psicóloga britânica (autora da FIS). O trabalho foi aprovado pelo comitê de ética em pesquisa do Hospital Universitário Pedro Ernesto - HUPE/UERJ. Foram incluídas crianças de três a 12 anos de idade e seus responsáveis, que compareceram ao tratamento odontológico em clínicas de odontopediatria da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro, do serviço de Odontologia da Policlínica Piquet Carneiro e do Ambulatório Naval da Penha da Marinha do Brasil. Foram excluídas crianças com deficiências e que não quiseram participar do estudo. Foi realizado um estudo piloto com objetivo de avaliar a compreensão da FIS e testar os procedimentos que seriam empregados no estudo principal, em uma amostra não probabilística de 15 crianças/responsáveis. Os resultados sugeriram que a idade poderia influenciar na mensuração da validade da escala e foi decidido realizar um processo de amostragem por cotas, adaptações das instruções de aplicação da FIS e VPT para uma linguagem mais acessível e decisão de realizar o estudo qualitativo. A amostra selecionada por cotas do estudo de validação compreendeu 150 crianças, divididas em grupos de 31 crianças nas faixas etárias 3-4 anos, 5-6 anos, 7-8 anos, 9-10 anos e 26 crianças na faixa etária de 11-12 anos; 65 (43%) eram do sexo feminino; 20 (13,3%) estavam indo ao dentista pela primeira vez; 47 procedimentos invasivos foram realizados no dia da entrevista (tratamento restaurador, procedimentos sob isolamento absoluto, exodontia e/ou tratamento endodôntico); 55 (36,7%) não tiveram experiência de cárie na dentição decídua (ceod=0) e 111 (74%) na dentição permanente (CPOD=0). O coeficiente de correlação de Spearman (rs) com a Venham Picture Test foi moderado (rs= 0,50; p<0,01) e foram encontradas associações estatisticamente significativas (p <0,05) com sexo feminino, ansiedade percebida pelos cuidadores, uso de isolamento absoluto, dor de dente atual e experiência de cárie. O estudo qualitativo encontrou discrepâncias entre a escolha da FIS e o sentimento da criança em relação à ATO em todas as faixas etárias. Os resultados sugerem que a FIS não parece ser capaz de medir de forma válida a ATO em crianças brasileiras

This study aimed to evaluate the validity of the Facial Image Scale (FIS) in pediatric dental patients in Rio de Janeiro, Brazil, based on: 1) the criterion validity, which was measured with the Venham Picture Test - Brazilian version; 2) the construct validity, using the correlation of FIS with the following variables: age, sex, DA perceived by parents/caregivers, socioeconomic classification (income), first visit the dentist, type of treatment performed, use of local anesthesia, previous and current experience of toothache, dental caries index and behavior during the dental appointment; and 3) a qualitative assessment with 30 children to evaluate if the instrument was capturing the child's feeling regarding DA. The form of application of the FIS was adapted to the Brazilian context by a group of four Brazilian pediatric dentists and a British psychologist (author of the FIS). The work was approved by the research ethics committee of the Pedro Ernesto University Hospital ­ HUPE/UERJ. Children aged 3 to 12 years old and their guardians who attended a dental appointment in the pediatric dentistry clinics of the Faculty of Dentistry of the Rio de Janeiro State University, the dental service of the Policlínica Piquet Carneiro Polyclinic and Penha's Naval Ambulatory of the Brazilian Navy were included. Children with special needs and who did not want to participate in the study were excluded. A pilot study was carried out to assess the understanding of FIS and test the procedures that would be used in the main study, in a non-probabilistic sample of 15 children/guardians. The results suggested that age could influence the measurement of FIS validity and it was decided to carry out a sampling process by quotas, adaptations of the FIS and VPT application instructions for a more accessible language and decision to carry out the qualitative study. The sample selected by quotas of the validation study comprised 150 children, divided into groups of 31 children aged 3-4 years, 5-6 years, 7-8 years, 9-10 years, and 26 children aged 11-12 years; 65 (43%) were female; 20 (13.3%) had their first dental appointment; 47 invasive procedures were performed on the day of the interview (restorative treatment, procedures under rubber dam, extraction and/or endodontic treatment); 55 (36.7%) had no experience of caries in the primary dentition (dmft=0) and 111 (74%) in the permanent dentition (DMFT=0). Spearman's correlation coefficient (rs) with the Venham Picture Test was moderate (rs=0.50; p<0.01); statistically significant associations (p<0.05) was found with female gender, anxiety perceived by caregivers, use of rubber dam, current toothache, and caries experience. The qualitative study found discrepancies between the choice of FIS and the child's feelings towards DA in all age groups. The results suggest that FIS does not seem to be able to measure DA in Brazilian children.

Prevalência de ansiedade ao tratamento odontológico em crianças e adolescentes: uma revisão sistemática / Prevalence of dental anxiety in children and adolescents: a systematic review

O objetivo deste estudo foi estimar a prevalência de ansiedade ao tratamento odontológico (ATO) em crianças e adolescentes de 1985 a 2015, avaliando a influência de fatores como sexo, idade, presença de cárie dentária, experiência prévia com tratamento odontológico, prevalência de ATO dos responsáveis nas criança e adolescentes e associados a metodologia do estudo. Foi realizada busca eletrônica nas bases de dados MEDLINE via PubMed, EMBASE, WEB OF SCIENCE, CINAHL, SCOPUS, PsycINFO, LILACS e uma busca manual no Banco de Teses e dissertações da CAPES e em seis periódicos especializados. Critérios de inclusão: estudos seccionais e ensaios clínicos aninhados em estudos de coorte ou realizados após um estudo transversal de 1985 a 2015, com crianças e adolescentes entre três e 18 anos de idade e desfecho a prevalência de quaisquer tipos de medos e fobia odontológicos, estimada a partir de uma escala validada para a população-alvo do estudo. Os registros foram importados para o software EndNote Web e exportados para uma planilha Microsoft Excel®. Duas pesquisadoras realizaram a extração de dados de forma independente. O risco de viés dos estudos incluídos foi avaliado com uma adaptação da ferramenta "The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data". As análises estatísticas foram realizadas com o programa STATA 14®. Após a remoção das duplicatas, restaram 926 registros; 170 artigos para leitura na íntegra. Ao final, 37 estudos foram incluídos, nenhum com baixo risco de viés. Cinco instrumentos diferentes foram usados nos estudos incluídos para a mensuração da ATO: CFSS-DS, DAQ, DFS, MCDASf e VPT. A prevalência global combinada de ATO foi 0,22 (IC 95% 0,19 a 0,25 e por faixa etária: 0,33 (IC 95% 0,22 a 0,43) em pré-escolares, 0,20 (IC 95% 0,15 a 0,26) em escolares e 0,14 (IC 95% 0,10 a 0,18) em adolescentes, com diferenças significantes entre pré-escolares e adolescentes. Nove estudos foram incluídos na meta-análise por sexo; as prevalências foram 17% (IC95% 10%; 23%) e 18% (IC95% 11%; 25%) em meninos e meninas respectivamente, sem diferença significativa. Na análise de sensibilidade observouse influência do tipo de respondente sobre a prevalência de ATO segundo a faixa etária. A ATO é um problema frequente em crianças e adolescentes e estudos de base populacional bem desenhados são necessários para se aprimorar o nosso conhecimento a respeito da prevalência desta condição na população mundial.

The aims of the study were estimate the prevalence of dental anxiety (DANX) in children and adolescents from 1985 to 2015 and evaluate the influence of the following variables: sex, age, dental caries, previous dental treatment, parents DANX on childrens anxiety and variables related to the study design. Electronic searches were performed in the following databases: MEDLINE via PubMed, EMBASE, WEB OF SCIENCE, CINAHL, SCOPUS, PsycINFO, LILACS; handsearching was performed in Banco de Teses e Dissertações da CAPES and six specialized journals. Inclusion criteria were: observational studies (cross-sectional and longitudinal), clinical trials nested in cohort studies or clinical trials initiated after a cross-sectional study between 1985 to 2015, with children and adolescents between three and 18 years of age and having as outcome measure the prevalence of any dental fear or phobia as measured by questionnaires validated for their target population. Records imported into EndNote Web software and organized in a Microsoft Excel® spreadsheet. Two investigators independently performed data extraction. Risk of bias was assessed using an adapted format of "The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data" tool. Statistical analysis was performed using STATA 14®. After exclusion of duplicates, 926 records remained and 170 were selected for full-text reading. Thirtyseven studies were included and no study had low risk of bias. Five different dental anxiety scales were used in the included studies: CFSS-DS, DAQ, DFS, MCDASf e VPT. Pooled overall global dental anxiety prevalence was 0.22 (95% CI 0.19 to 0.25). The prevalence of dental anxiety by age group was: 0.33 (95% CI 0.22 to 0.43) in preschoolers; 0.20 (95% CI 0.15 to 026) in schoolchildren and 0.14 (95% CI 0.10 to 0.18) in adolescents, with significant differences between preschoolers and adolescents. Nine studies were included on sex variable meta-analysis and prevalecence was 17% (IC95% 10%; 23%) e 18% (IC95% 11%; 25%) in boys and girls respectively, no significant diference. Influence of type of respondent on preschoolers wa observed on sensitive analysis. Dental anxiety is a frequent problem in children and adolescents and population-based well-designed studies are needed in order to improve our knowledge regarding the prevalence this condition in the world population

Children's Toothbrushing Practices Recommended on the Internet by Pediatric Dentistry Associations.

PURPOSE: The purpose of this study was to describe online recommendations by North and South American National Associations of Pediatric Dentistry (NAPD), intended for laypersons, concerning children's toothbrushing practices. METHODS: In February 2015, the International Association of Pediatric Dentistry (IAPD) website and the Latin American Association of Pediatric Dentistry (ALOP) Facebook webpage were searched to identify which countries had NAPD. Attempts were made to obtain the electronic addresses of ALOP national member societies, and Google and Facebook were used to identify NAPD not found using the previous strategies. RESULTS: Of the 35 countries in North and South America, 19 had NAPD that were shown on the Internet, and 11 of them provided data for the study. All NAPD gave advice on fluoride concentrations in toothpaste and when to start toothbrushing; most made recommendations on the amount of toothpaste, toothbrushing frequency, and when to brush, and a few gave advice on toothbrushing supervision and rinsing after toothbrushing. There was no consensus on most of the recommendations that were evaluated. CONCLUSIONS: Only a few National Associations of Pediatric Dentistry from the Americas provide online information for parents and laypersons concerning children's toothbrushing practices. Of the information provided, some are either controversial, outdated or lack scientific evidence.