Hand-Holding's Effect on Children's Pain Perception and Anxiety during Dental Anesthetic Injections.

Local anesthetic injections are an essential tool in dentistry, particularly in pediatric dentistry. The needle penetrating the tissue can cause stress, anxiety, and pain. Studies have shown that using touch may alleviate pain and reduce patient anxiety. Yet, this has not been tested in pediatric dental patients. Therefore, this study examined the effect of hand-holding on children undergoing local anesthetic injections. Its effect on children's pain perception was tested, with the hypothesis that pain perception would be lower for children whose hand was held by an assistant. Additionally, the study examined whether hand-holding would affect children's anxiety levels and cooperation. Fifty-five children, who underwent dental treatment within the Department of Pediatric Dentistry at Tel Aviv University, were recruited. The patients were randomly divided into two groups. In the study group, the assistant gently placed her hand on the patient's hand during the anesthetic injection. In the control group, the same treatment was performed without the hand being placed by the assistant. After the anesthetic injection, the child's pain and anxiety levels were assessed using visual analog scales (VAS). The patients' pulse was measured. The level of cooperation was evaluated using the "Frankl" scale. Interestingly, although the trends aligned with this study's hypotheses, no significant effect of hand-holding on pain, anxiety, or cooperation during anesthetic injections was found.

Olfactory and gustatory disorders associated with SARS-CoV-2 infection in children and adults: a topic review.

This paper is aimed at comprehensively reviewing olfactory and gustatory disorders caused by SARS-CoV-2 in children and adults. An electronic and manual search was done on three databases: MEDLINE, Embase, and Web of Science. Inclusion criteria included publications written in English, involving humans in the age range of 0 to 99 years that were captured by a controlled vocabulary of thesaurus terms. Olfactory and gustatory disorders rates in COVID-19 ranged from 22% to 71.9% in adults and 16.6% to 25.8% in children. Olfactory and gustatory disorders might appear as the first symptom, and in adults might even be the only symptom (4.8% to 10%). Anosmia is the most common olfactory disorder and hypogeusia is the most common gustatory disorder. In 33% to 89% of cases, olfactory and gustatory disorders resolve spontaneously within a few weeks, coinciding with the resolution of other COVID-19 symptoms, both in adults and children. However, in some patients, olfactory and gustatory disorders persist beyond the resolution of other symptoms. Notably, children generally experience a swifter and more favorable recovery compared to adults. The precise pathogenesis underlying olfactory and gustatory disorders in the context of COVID-19 remains unclear and is likely multifactorial. Presently, no established treatment protocol exists for olfactory and gustatory disorders and current treatments reviewed lack robust evidence and are not readily available for clinical use. Olfactory training represents the only therapy currently recommended by international authorities. Pediatric practitioners and general dental practitioners should be aware of olfactory and gustatory disorders in both pediatric and adult populations, including their biologic mechanisms, treatment options, and recovery rates.

Dental Loupe's Role in Detection of Caries of Molars in Children by Student and Dentists.

PURPOSE: The objectives of this study were to examine the effectiveness of diagnosing occlusal caries in molar teeth in children under the use of loupes and, secondarily, to examine whether there is a difference in the diagnosis between permanent and primary teeth using dental loupes. In addition, to check whether the student's diagnosis using loupes improves caries diagnosis compared to dentists' diagnosis in both methods. METHODS: The data were collected from 163 patients aged 6-14 who sought treatment in the Pedodontic Department of the Faculty of Dentistry at Tel-Aviv University during 2020-2021. The first and second permanent molars and second primary molars with deep groves were examined. A student and dentists made the diagnosis with and without loupes while using the ICDAS criteria. RESULTS: The student's examinations without the loupes detected no caries in 60% of the cases compared to 76.9% in the examinations with the loupes and found initial caries without cavitation (ICDAS1) in only 17.6% of teeth without loupes examination compared to 33% using loupes. The dentist correctly diagnosed no caries (ICDAS0) in 82.1% of cases without loupes and initial caries without cavitation (ICDAS1) in 62.5% of cases. The dentist correctly diagnosed distinct caries without cavitation (ICDAS2) in 90.8% of cases. No differences were observed in caries diagnosis between primary and permanent teeth when the examiner was a specialist/intern using loupes; however, there was a statistically significant difference (p = 0.047) when the diagnosis was made by a student using loupes. CLINICAL SIGNIFICANCE: The use of dental loupes is an effective method for the correct and early diagnosis of occlusal caries lesions in children's molar teeth by both dentists and students, and this is in accordance with the principle of minimally invasive dentistry. There is a justification for the use of dental loupes for the diagnosis of initial occlusal caries in primary and permanent molars in children in a precise way. Using loupes especially improves the correct diagnosis of initial caries in primary teeth by students.

Exploring a Paradigm Shift in Primary Teeth Root Canal Preparation: An Ex Vivo Micro-CT Study.

Traditional hand instrumentation is a commonly used technique to perform pulpectomy in deciduous teeth by most specialists in pedodontics. Lately, dentists have embraced rotary instrumentation as a safe and effective alternative. This study aimed to compare the efficacy of root canal preparation in extracted primary molars between manual and two rotary file systems using micro-CT. Thirty-six extracted human second primary mandibular molars were divided into three groups according to the instrumentation method: (1) Manually instrumented (MI) group (n = 9) in which the teeth were treated using K-files up to size 30; (2) Kedo-Ssystem (KS) group (n = 9); (3) ProTaper Gold system (PTG) group (n = 10) and control group (n-8). Each tooth was scanned before and after the retrograde root canal preparation. Residual dentin volume was calculated using micro-CT scans to evaluate the technique's efficacy. Additionally, the preparation time and procedural errors were recorded for each tooth preparation. A one-way ANOVA test was carried out to compare the groups' dentin volume and preparation time. The mean preparation time using the manual method (13.14 min) was more than two times longer than that of the rotary techniques (4.62 min and 6.45 min). The manual preparation method using a K-file removed almost half the root canal material when compared with the rotor method (p = 0.025). Conclusion: our results suggest that rotary instrumentation is more efficient for root canal preparation in primary teeth than the traditional manual method. This finding may call for a paradigm shift in current clinical practices, where manual instrumentation is still commonly preferred.

Comparison of Childhood Caries Levels between Children of Pediatric Dentists and Children of General Dentists: A Cross-Sectional Study.

Caries development in children is a prevalent childhood disease. Factors affecting chronic teeth lesions include nutrition, parental involvement, and executing proper dental health attitude. Professional dentists are perceived as role models for the oral health and hygiene of their families. The purposes of the research were 1. To compare caries rates in the children of pediatric dentists and children of general dentists. 2. To compare children's nutrition habits between pediatric dentists and general dentists. 3. To compare children's oral health and hygiene between pediatric dentists and general dentists. 4. To compare children's usage of fluoride-containing products between pediatric dentists and general dentists. A cross-sectional study was conducted by distributing self-reporting questionnaires to pediatric dentists and general dentists via the social media "snowball" platform. The following themes were surveyed: nutrition habits and oral hygiene of the children. The sample consisted of 176 participants. Children of pediatric dentists were found to have fewer cases of caries than children of general dentists (p = 0.018). Nutrition habits did not differ between the two groups. In addition, pediatric dentists reported that their children use more fluoridated toothpaste in comparison with general dentists. Professional training of pediatric dentists contributed to shaping the oral hygiene attitude of their children.

Effect of Different Etching Times on Pit-and-Fissure Sealant Micro-Shear Bond Strength to the Enamel of Primary Teeth.

Successful clinical use of pit-and-fissure sealants relies on the sufficient etching of the enamel, field isolation and sealant retention. The etching time changes the physical and mechanical surface properties of the etched tooth tissues; therefore, it impacts both etching depth and the bond strength of sealants to the enamel. We examined if reducing the recommended 15 s etching time of primary teeth enamel affects the micro-shear bond strength (µSBS) of pit-and-fissure sealants. The cusps of forty non-carious, extracted human primary molars were separately etched for 8, 15 or 30 s. Then, a pit-and-fissure sealant was placed and light-cured. The µSBS values were evaluated and compared among the three groups. The mean µSBS values ± standard deviations were 34.68 ± 16.93, 34.19 ± 17.35 and 36.56 ± 16.57 MPa in the cusps etched for 8, 15 and 30 s, respectively. No statistically significant differences in µSBS were observed among the three test groups. In this study, we showed for the first time that the recommended etching time of primary teeth enamel may be reduced from 15 to 8 s without compromising the µSBS of the sealant. Further evaluations in a clinical setting are warranted.

Knowledge of Breastfeeding Mothers Regarding Caries Prevention in Toddlers.

Mothers' awareness regarding the risk factors for the development of early childhood caries is crucial. The current study aims to examine the knowledge of breastfeeding mothers about their baby's dental health and prevention of ECC while comparing primiparous mothers to multiparous mothers. A total of 165 mothers aged 20-49 y/o participated in the study by completing questionnaires that assessed the knowledge and attitudes of mothers toward their infants' oral health. Results showed that (1) mothers were found to be highly knowledgeable regarding the oral hygiene of their infants and the recommended breastfeeding best practices (71%); (2) mothers with lower education showed poor knowledge regarding the recommended practices of infant oral health; (3) a large proportion of the mothers in the sample (62%) reported that they usually tasted the food before giving it to their baby, in a way they could transmit bacteria to infants; (4) most of the mothers (68%) were not aware that their dental health during pregnancy affects the infants' dental health; and (5) multiparous mothers were more knowledgeable regarding artificial baby milk composition (96%) in comparison with mothers with only a single child (60%). According to the results, there is a need to improve the knowledge of breastfeeding mothers, especially mothers who have one child and mothers with a lower education about their baby's dental health. The results of this study shed light on the knowledge of breastfeeding mothers on this important topic and could serve policymakers to improve practices toward advancing better oral health for infants, without sacrificing the benefits of breastfeeding, which are so crucial for infant health and development.

Knowledge and Decision-Making among Israeli Dentists Treating Young Patients with Type 1 Diabetes Mellitus: A Cross-Sectional Survey.

OBJECTIVE: To assess decision making process and knowledge level of dentists treating children with type 1 diabetes. STUDY DESIGN: Cross-sectional survey among dentistry residents and dental specialists working in clinics that provide dental care to children with type 1 diabetes. RESULTS: A total of 166 respondents were included. 42% of respondents perceived that they have sufficient knowledge to treat children with diabetes, in correlation with an average score of 1.9 out of 4 on knowledge questions. Over 80% of dentists decided to treat patients by consulting with the treating physician or by checking HbA1c and glucose blood levels independently. Greater knowledge was associated with a significantly higher tendency of the dentists to determine if the child's diabetes is controlled, and to refer less often to the hospital. Furthermore, greater knowledge was also associated with dentists' greater perception that they have enough knowledge, skills and confidence to treat children with diabetes. CONCLUSIONS: The study revealed significant gaps in the knowledge on diabetes among dentists who provide dental care to children. Dentists, pediatricians, endocrinologists, and other healthcare professionals who provide care for children should be encouraged to collaborate to create a mutual knowledgeable work environment for delivering best care to their patients.

Characteristics and attitudes of general and pediatric dentists who use loupes.

BACKGROUND: Dental loupes are used by dental professionals to improve visual performance, reduce eye strain and prevent musculoskeletal disorders. Data on their usage in pediatric dentistry are scarce. STUDY DESIGN: We performed a cross-sectional survey to evaluate the approach, knowledge, and frequency of using loupes among 100 general and pediatric dentists. RESULTS: showed that the use of loupes is significantly more prevalent among general dentists (64.3%) compared to pediatric specialists and residents (35.7%). Among dentists who reported that they do not use loupes, 63.6% were pediatric dentists and residents, and 82.5% were dentists working with children. A significantly higher percentage of dentists who self-reported as loupes users perceived that the loupes afford comfortable and stable posture, confidence while working, and contribute to the detection of tooth decay. A significantly higher percentage of dentists who self-reported as non-users of loupes (compared to loupes users), claimed that they weaken the eyes, require long adjustment, and cause discomfort. CONCLUSION: Although the use of loupes in general dentistry is becoming more prevalent, there is still a need to raise awareness for this vision aid among pediatric dentists while promoting its advantages, to reap benefits associated with their usage.

Assessment of the Knowledge and Approach of General Dentists Who Treat Children and Pediatric Dentists Regarding the Proper Use of Antibiotics for Children.

Background: Antibiotics are widely used in dentistry. Dentists often provide antibiotics unnecessarily. Excessive use can induce resistant bacterial strains. There are certain indications for the proper use of antibiotics for pediatric dentistry according to the European and American Pediatric Dentistry (EAPD and AAPD). Very often dentists do not follow these guidelines. Objectives: This study aims to examine the level of knowledge among general dentists (who also treat children) and pediatric dentists on proper use of antibiotics. In addition, we examined whether there is unjustified use of antibiotics, if dentists are aware of the new and conservative approach of administering antibiotics to patients, and whether there is a relationship between years of professional seniority and dentist's knowledge level of proper use of antibiotics. Methods: One hundred general dentists (GD) who treat children in addition to 100 pediatric dentists (PD) completed the study questionnaires which measured knowledge, practice and attitudes regrading using antibiotics during dental treatment among children. Results: The general average of level of knowledge on proper use of antibiotics among general dentists was relatively low for both GD (60.7%) and PDs (65%). PDs demonstrated a relatively greater knowledge of correct use of antibiotics, especially in cases of endodontics and trauma. PDs also showed higher awareness to latest guidelines for the admission of "prophylactic antibiotics" according to the American Association (AAPD) and/or the European Union (EAPD) compared with GDs (86.2% vs. 66.3%). Conclusion: The level of knowledge of both general dentists and pediatric dentists is poor, with a large percentage of dentists from both groups not knowing whether antibiotics are needed in a specific dental case or not. Compliance with the EAPD/AAPD guidelines is also low and inadequate. The method of prescribing antibiotics given by dentists can be improved by increasing awareness, educational initiatives, and postgraduate courses among dentists regarding the recommended indications.

Transfer Deep Learning for Dental and Maxillofacial Imaging Modality Classification: A Preliminary Study.

OBJECTIVE: To apply the technique of transfer deep learning on a small data set for automatic classification of X-ray modalities in dentistry. STUDY DESIGN: For solving the problem of classification, the convolution neural networks based on VGG16, NASNetLarge and Xception architectures were used, which received pre-training on ImageNet subset. In this research, we used an in-house dataset created within the School of Dental Medicine, Tel Aviv University. The training dataset contained anonymized 496 digital Panoramic and Cephalometric X-ray images for orthodontic examinations from CS 8100 Digital Panoramic System (Carestream Dental LLC, Atlanta, USA). The models were trained using NVIDIA GeForce GTX 1080 Ti GPU. The study was approved by the ethical committee of Tel Aviv University. RESULTS: The test dataset contained 124 X-ray images from 2 different devices: CS 8100 Digital Panoramic System and Planmeca ProMax 2D (Planmeca, Helsinki, Finland). X-ray images in the test database were not pre-processed. The accuracy of all neural network architectures was 100%. Following a result of almost absolute accuracy, the other statistical metrics were not relevant. CONCLUSIONS: In this study, good results have been obtained for the automatic classification of different modalities of X-ray images used in dentistry. The most promising direction for the development of this kind of application is the transfer deep learning. Further studies on automatic classification of modalities, as well as sub-modalities, can maximally reduce occasional difficulties arising in this field in the daily practice of the dentist and, eventually, improve the quality of diagnosis and treatment.

Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children.

OBJECTIVES: To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6-14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. STUDY DESIGN: Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. RESULTS: All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). CONCLUSION: Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.

Function of the Family Unit, Oral Hygiene Rules and Attitudes to Dental Health in Children During First-Wave 2020 COVID-19 Lockdown.

OBJECTIVE: To examine whether general and dental health and habits of families were affected by the first-wave lockdown due to COVID-19, and whether these habits were related to family functioning, resilience and stress. STUDY DESIGN: A cross-sectional study using an online survey disseminated among families with kindergarten and primary school-aged children during the lockdown of March and April 2020. RESULTS: A total of 361 respondents completed the survey. Most respondents adapted well to the changes imposed by lockdown and reported that they and their children had low anxiety levels and high mental resilience. Family functioning and behavior were positively correlated with nutrition habits and hygiene. General hygiene was positively correlated with oral hygiene. Respondents who reported requiring dental care had difficulties gaining access to it. Most respondents perceived that it is important to improve patients' digital access to pediatricians and dentists during crises. CONCLUSION: The study showed that better family functioning was associated with better family hygiene and nutrition, parental resilience and lower mental stress among children.

The effect of television distraction versus Tell-Show-Do as behavioral management techniques in children undergoing dental treatments.

OBJECTIVE: Distraction is a highly acceptable technique for diverting a patient's attention from what may be perceived as an unpleasant procedure, reducing anxiety and helping the patient relax. The objective of the present study was to evaluate the effect of watching television during dental treatment on pediatric patients' anxiety and cooperation compared to the commonly used conventional Tell-Show-Do (TSD) behavioral management method. METHOD AND MATERIALS: Sixty-nine children (mean age 6.8 years) scheduled to undergo restorative dental treatment were randomly divided into two intervention groups: a group that was managed by television distraction and a control group that was managed by TSD. During treatment, anxiety was assessed by the Facial Image Scale and cooperative behavior was assessed by the Frankl scale. Pulse rate and oxygen saturation were also measured during the treatment. RESULTS: Compared to TSD, television distraction significantly reduced anxiety by 1.27 (95% confidence interval [CI] 0.798 to 1.744, adjusted P < .001), decreased pulse rate by 6.44 beats per minute (bpm) (95% CI 4.60 to 8.28, adjusted P < .001), and significantly increased cooperation by 1.17 (95% CI -1.318 to -1.020, adjusted P < .001). A greater effect of television distraction on reduced anxiety and increased cooperation was observed during administration of the anesthetic injection. No effect of television distraction on saturation levels was noted. CONCLUSIONS: Television distraction is an effective method for reducing anxiety and improving cooperative behavior in children during dental treatments.

Preemptive Analgesia by Paracetamol, Ibuprofen or Placebo in Pediatric Dental Care: A Randomized Controlled Study.

OBJECTIVE: To compare postoperative pain among children who received an oral dose of paracetamol, ibuprofen or a placebo, prior to tooth extractions. STUDY DESIGN: Thirty minutes prior to dental treatment, children received a liquid dosage, fruit flavored and orange colored, of paracetamol, ibuprofen, or a placebo. Data accessed included children's dental history, their behavior, and their feeling of pain or anxiety according to Wong-Baker FACES: before treatment, following local anesthesia, and following treatment. Parents were interviewed by telephone regarding their children's need for a postoperative analgesia (paracetamol or ibuprofen), and their feeling of pain at four and 24 hours posttreatment. RESULTS: Parents reported administering paracetamol or nurofen following the dental procedure to 9/43 (21%), 2/33 (6%) and 12/29 (41%) of the children in the preemptive paracetamol, ibuprofen, and placebo groups, respectively. For the 3 groups, mean pain assessment were similar: around the middle of the Wong-Baker FACES scale at baseline, slightly higher following local anesthesia, and low (pain-free) at four and 24 hours postoperative. CONCLUSION: Children who received paracetamol or ibuprofen prior to tooth extractions were less likely to need an analgesic following treatment, compared to children who received a placebo.

Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial.

PURPOSE: Sedation is becoming more commonplace for pediatric patients undergoing minor procedures. Fortunately, electronic monitors have contributed to a reduction in the associated respiratory adverse events (RAEs). To test the hypothesis that adding the pretracheal stethoscope (PTS) to standard monitoring methods (SMMs) may improve RAE detection in sedated pediatric dental patients, the frequency of RAEs detected by SMMs (i.e. visual observation, capnography, and pulse oximetry) was compared to that detected by SMMs alongside continuous PTS auscultation. STUDY DESIGN: A prospective, randomised, controlled trial was performed with 100 pediatric patient participants of ASA≤2, who were scheduled to receive dental treatment under 0.75 mg/kg and oxygen. Patients were randomised into Groups A (n=50; SMMs) and B (n=50; SMMs+PTS). Inclusion criteria were behavioral management problems and intolerance to dental treatment despite behavioral management techniques or nitrous oxide administration. Exclusion criteria were high-risk conditions for RAEs, altered mental status, gastrointestinal disorders, parental refusal of conscious sedation and failure of previous conscious sedation. An anesthesist was present throughout the dental treatments. RESULTS: RAEs were detected in 10 (20%) and 22(44%) Group A and B patients respectively (p=0.01). The majority of RAEs within Group B were detected by PTS auscultation (n=19). Capnography produced 13 and 15 false-positive results in Groups A and B respectively, whereas the PTS produced 4(8%) false-positive results in Group B (p=0.009). CONCLUSIONS: PTS was found to be useful for detecting RAEs during pediatric dental sedation with 0.75mg/kg midazolam and oxygen, in the presence of an anesthesist.

Children's Responses to Sensory Stimuli and their Behavior in the Dental Office.

OBJECTIVES: To evaluate children's behavior during dental examinations, their reactions to various selected sensory stimuli and the association between them. STUDY DESIGN: Sixty-three children (28 boys and 35 girls) aged 5-12 years (mean age 7.9 ± 1.6 years) participated in the study. Their parents were asked to complete a questionnaire while in the dentist's waiting room. The dentists evaluated the children's behavior in the dental office using Frankl's behavioral scale and noted the children's reactions to the sensory stimuli of touch, noise, smell and backward tilting of the examination chair. RESULTS: Most of the children cooperated during the dental examination. Lack of cooperation was associated with adverse reactions to all selected sensory stimuli. There was also an association between resistance to brushing teeth and adverse reaction to touch. Children who reacted negatively to sensory stimuli during dental examinations were more likely to have needed advanced management techniques during past dental treatment. CONCLUSIONS: Children's behavior during dental examinations is known to be affected by many factors, including age, previous experiences, anxiety and fear and others. This investigation demonstrates that it is also associated with their reactions to various sensory stimuli.

A comparison of two different dosages of oral midazolam in the same pediatric dental patients.

PURPOSE: The purpose of this paper was to compare the efficacy and safety of two doses of oral midazolam (0.5 mg/kg and 0.75 mg/kg) on the same children when no cooperation could be achieved with the 0.5 mg/kg dose. METHODS: Twenty-three healthy three- to eight-year-olds who were initially unable to tolerate dental treatment using nonpharmacologic behavioral management (sometimes in combination with nitrous oxide) participated in the study. Level of sedation, cooperation, parental satisfaction, parental prediction of child's future anxiety, and outcome of sedation with the two doses were evaluated. All treatments and behavioral evaluations were conducted by the same nonblinded dentist. Parental evaluations were nonblinded as well. RESULTS: No respiratory events or other adverse effects were observed with either regimen. There was no gender difference in any parameter regarding the two doses of midazolam. No treatment was aborted with the 0.75 mg/kg dose. Sedation and cooperation were significantly higher at baseline and after 15, 30, and 45 minutes (P=.001) for the 0.75 mg/kg group. Parental satisfaction with the treatment was significantly greater with the higher dose. CONCLUSION: Midazolam at 0.75 mg/kg with 100 percent oxygen can enhance outcomes for pediatric dental patients who did not cooperate satisfactorily with a dose of 0.5 mg/kg.

Dental anxiety among Israeli children and adolescents in a dental clinic waiting room.

PURPOSE: The purpose of this study was to evaluate dental anxiety among children and adolescents using self-reported questionnaires. METHODS: One hundred thirty 7- to 18-year-old patients (mean age=11.37 ± 2.84) who attended a clinic were asked to complete the Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS) in the waiting room. RESULTS: Females demonstrated higher dental anxiety than males. Higher anxiety was observed among patients who had their last dental visit over a year prior to the current visit and among patients who expected operative procedures. Extraction was the most anxiety-producing item. While in the dental chair, teeth cleaning produced significantly more anxiety than restoration. A significant correlation existed between the DAS and the DFS. CONCLUSIONS: Pediatric dentists can expect high dental anxiety among: females; patients who wait long periods between visits; and patients expecting operative procedures. Teeth cleaning should not be considered an absolutely non-anxiety producing procedure for the patient.