Evaluation of dental anxiety among children visiting Paediatric Dental Department at Children Hospital.

OBJECTIVE: To determine efficacy of the Urdu version of Dental Subscale of Children's Fear Survey Schedule on children for identifying children with dental anxiety. METHODS: This cross-sectional study was conducted at the Children's Hospital, Lahore, Pakistan, in November 2015, and comprised child patients who were selected using convenient sampling. Dental Subscale of Children's Fear Survey Schedule was translated into Urdu using forward-backward translation method and administered to subjects aged 4-14 years to evaluate its psychometric properties and set a cut-off score for identifying fearful children. Factor analysis technique evaluated the translated items and analysis of variance explored age-anxiety linkage. RESULTS: Of the 204 participants, 89(43.6%) were girls and 115(56.4%) were boys. The survey yielded a normal distribution on anxiety scale, with a mean score of 32.13±12.06 and high reliability (a=0.934). Factor analysis indicated 3 factor pattern similar to Western findings. Items about ' choking, drilling sound and open-your-mouth' were mostly feared. Anxiety score declined with age. Setting cut-off score at 70th percentile patients having anxiety score of > 43 were labelled as fearful, and those below as not fearful. CONCLUSIONS: The scale was deemed valid and reliable tool.

The factor structure of dental fear.

There is limited empirical information as to whether or how stimuli associated with dental fear can be classified into distinct subtypes. The purpose of the current study was to develop a descriptive framework for the classification of dental fear. Data were collected using a survey among Dutch twin families (n = 11,771). The sample was randomly divided into two subsamples of, respectively, 5,920 and 5,851 individuals. An exploratory factor analysis (EFA) was performed on the first subsample to delineate the multidimensional structure of a set of 28 dental-fear-provoking objects and situations. The second sample was used to confirm the newly derived model using confirmatory factor analysis (CFA). The EFA yielded a three-factor solution with 70.7% explained variance pertaining to: (i) invasive treatment or pain; (ii) losing control; and (iii) physical sensations. The CFA showed an acceptable fit to the data, thereby confirming the stability of the three-factor structure. There are at least three different subtypes of dental fear. As these subtypes require a different treatment approach in clinical practice, it could be important to assess the severity of patients' fear response along these three dimensions.

Reliability and validity of the Italian versions of the Children's Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale.

AIM: Children's dental fear and anxiety (DFA) causes significant problems in clinical practice. The 15-item Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the 8-item Modified Child Dental Anxiety Scale (MCDAS) are the most widely used measures of dental fear in children. The aim of this study is to examine the reliability and validity of the Italian versions of the CFSS-DS and MCDAS, also in comparison with a simple visual analogue scale (VAS). MATERIALS AND METHODS: The CFSS-DS and MCDAS were translated into Italian by a consensus panel of experts and administered to 210 dental patients aged 4-11 years from three Italian Institutions. Internal reliability was assessed using the Cronbach's alpha correlation. A sub-sample of 60 children was selected for test-retest analysis. CFSS-DS and MCDAS, plus a VAS scale, rated both by children and parents, were validated using as gold standard the 4-item Frankl scale for behaviours assessed by dentists. RESULTS: Mean CFSS-DS score was 30.8 (SD: 11.1) and mean MCDAS score was 17.9 (SD: 7.2), significantly higher among children aged 4-7 years and among children at their first dental visit. The alpha value for internal reliability was 0.90 (95%, CI= 0.88-0.92) for CFSS-DS and 0.87 (95% CI=0.85-0.90) for MCDAS. Both CFSS-DS and MCDAS showed good test-retest reliability (rsp= 0.80; p<0.001 for both scales). CFSS-DS and MCDAS predicted a Frankl score ≤2 (i.e., indicating children with an uncooperative behaviour) with a fair accuracy (AUC=0.69 and AUC=0.68, respectively). The VAS scale was more effective in predicting a negative behaviour (AUC=0.78). The scales self-reported by children were only slightly more accurate than those reported by parents. CONCLUSION: The Italian versions of the CFSS-DS and MCDAS are valid and reliable tools for the assessment of dental fear in Italian children aged 4-11 years. A simple, one-item VAS, and dental fear and anxiety evaluation by parents may be valid and quick alternatives to multi-item indices to predict an uncooperative children behaviour.

An experimental elective report examining and comparing current levels of dental anxiety and disease in child populations in Peru and the UK.

INTRODUCTION: Dental anxiety is an important factor in influencing patients' decisions to access treatment. It is crucial dental care professionals understand its causative factors in order to prevent and manage it, particularly as dentally anxious patients often have poor oral health. This report is of an elective study that tried to ascertain whether children with signs of dental neglect suffered greater dental anxiety, as existing research suggests that anxiety can stem from previous experiences. METHOD: 100 children in both the United Kingdom and Peru were examined for signs of dental neglect using the PUFA (Pulpal exposures, Ulcers, Fistulas & Abscesses) system, and their anxiety levels surveyed with the Modified Child Dental Anxiety Scale. A Spearman's rank analysis was performed. RESULTS: Both groups showed similar disease levels, but Peruvian children were significantly less anxious. The r values (United Kingdom r=-0.020 Peru r=-0.0099) were less than rc=0.165 at a significance level of P=0.05, showing that increased dental neglect does not make children more anxious. DISCUSSION: It appears that having a neglected dentition as a child does not make you more anxious, but the resultant invasive treatment procedures likely to have been experienced as a child may have a role. Ultimately, cultural background and attitude to dental care are suggested as being more important in determining the dental anxiety levels of children.

Validation of the Malay version of the Modified Dental Anxiety Scale and the prevalence of dental anxiety in a Malaysian population.

AIM: The aims of the present study were to evaluate the reliability and validity of the Malay version of the Modified Dental Anxiety Scale (MDAS), and to determine the prevalence of dental anxiety and associated factors in a Malaysian population. METHODS: A Malay-language questionnaire with questions to elicit demographic and dental care-related information, and the Malay version of the MDAS, were administered to 455 patients at the dental outpatient clinics of the Hospital Universiti Sains Malaysia. Factor analysis and internal consistency statistics were generated. A test-retest of the questionnaire was performed with 30 participants. RESULTS: Cronbach's alpha was 0.854, indicating good internal consistency. Factor analysis yielded results showing good validity. Approximately 3.5% of the participants expressed the highest levels of anxiety. Dental anxiety was significantly higher among females than males. Age correlated inversely with dental anxiety. Individuals seeking dental care only if a problem appeared had significantly more anxiety than regular attendees. Patients who postponed treatment because of fear had significantly higher anxiety levels than those who delayed treatment for other reasons. Past adverse dental experience exacerbated dental anxiety. CONCLUSION: The Malay version of the MDAS had good reliability and validity. Anxiety levels found in the Malaysians studied were comparable to participants from other countries.

Video modelling for reducing anxiety related to the use of nasal masks place it for inhalation sedation: a randomised clinical trial.

AIM: A randomised controlled trial to investigate if video modelling can reduce the level of dental anxiety and increase the patient's acceptance of the nasal mask usage for children receiving dental treatment using inhalation sedation (IS). METHODS: A sample of 80 (8-16 years) children due to have dental treatments under IS were randomly allocated to either the modelling video or the control video (oral hygiene instruction). The level of anxiety was recorded before and after watching the video on the Abeer Children Dental Anxiety Scale and each child's ability to cope with the subsequent procedure was assessed on the visual analogue scale. A two-group Chi-square test was used as the basis for the sample size calculation; a significance level of 0.025 was chosen rather than the conventional 0.05 to avoid spurious results arising from multiple testing. RESULTS: Children in the test group had significantly less anxiety after watching the video than those in the control group throughout the subsequent dental procedure; particullary, at the time of the nasal mask administration (P<0.001). CONCLUSIONS: Video modelling appeared to be effective at reducing dental anxiety and has a significant impact on the acceptance of the nasal mask administration for Inhalation Sedation in children.

Effect of audiovisual distraction on children's behaviour, anxiety and pain in the dental setting.

AIM: To evaluate whether the parental perception of the patient's anxiety, children's anxiety, pain, behaviour and heart rate of paediatric patients improves when an audiovisual technique is used as a distraction method during dental treatment. MATERIALS AND METHODS: This non-randomised crossover trial was performed with 34 patients aged 6-8 years, who required a minimum of two treatment visits for restorative therapy. During the last visit, the patient was shown a cartoon film. RESULTS: There was a significant improvement in the global behaviour when children were shown a cartoon film (P < 0.001). A significant increase in heart rate was recorded in both visits (P = 0.0001) when the anaesthetic was injected. A 97% of the sample would like to continue seeing their chosen film during subsequent visits. No statistically significant differences were found (P > 0.05) between the visits in terms of parental perception of the patient's anxiety, or the patient's self-reported anxiety, pain and heart rate. CONCLUSIONS: The use of the audiovisual material used as a method of distraction produces a global improvement in patient behaviour, but not in parental perception of the patient's anxiety, self-reported anxiety, pain or heart rate according to the measurement scales used. This material is also highly accepted by paediatric patients.

Dexmedetomidine sedation with and without midazolam for third molar surgery.

Twenty-four patients were randomly divided into 2 groups. Intraoperatively, one group received a continuous intravenous infusion of dexmedetomidine alone, whereas the other received a continuous dexmedetomidine infusion plus a small dose of midazolam. Early measurements of patient anxiety and psychomotor performance were lower in patients who had received midazolam. This difference was not seen later in the appointment. An amnesic effect was observed in those patients who received midazolam. This effect, however, did not translate into increased patient satisfaction in the group receiving midazolam. Our findings suggest a prolonged discharge time for patients who had been given midazolam that may be clinically significant. Overall, dexmedetomidine showed an unpredictable sedative response and may be less practical than more common alternatives for oral surgery procedures.

Assessment of anxiety related to dental treatments among patients attending dental clinics and hospitals in Ranga Reddy District, Andhra Pradesh, India.

PURPOSE: To assess the levels of dental anxiety among patients anticipating dental treatments in dental clinics/hospitals of Ranga Reddy district. MATERIALS AND METHODS: A cross-sectional study was conducted among a representative sample of 1200 subjects (at least 18 years old) in dental clinics/hospitals which were selected from a list obtained through systematic random sampling. The data were collected using a pre-tested and calibrated questionnaire consisting of the Modified Corah Dental Anxiety Scale (MDAS) to assess anxiety levels. RESULTS: The majority (52.4%) of subjects showed a low level of anxiety. Females (11.44 ± 4.41) were found to have higher mean MDAS scores than males, and the highest mean MDAS scores were found among 18- to 34-year-olds (11.28 ± 4.67) (P < 0.05). Significant differences were found among subjects anticipating different treatments, with higher MDAS scores for extraction (11.25 ± 5.4), followed by examination, root canal treatment, gum surgery, scaling, restoration and others, e.g. orthodontic treatment, restoration with crowns, bridges and dentures (7.79 ± 3.80). The highest mean MDAS scores were found among subjects who were apprehensive due to 'past difficult experience in dental treatments', followed by 'drill' and 'injection', with the lowest scores among subjects indicating 'other reasons' (7.82 ± 3.84). CONCLUSION: The present data show that anxiety levels are higher in patients who have to undergo extractions than those who must be fitted with dentures. Thus, dental health care providers should pay more attention to patients' anxiety levels associated with different types of treatment.

Factores de riesgo asociados con el estado de ansiedad en niños de cuatro a seis años de edad que acuden por primera vez con el odontopediatra / Risk factors for anxiety in children aged four to six, attending a pediatric dental appointment for the first time

Determinar los principales factores de riesgo asociados con el estado de ansiedad en los niños de cuatro a seis años de edad que asisten a la Clínica Reforma (FES Zaragoza, UNAM) para su primera consulta con el odontopediatra. Diseño del estudio: Se realizó un estudio a 100 niños de cuatro a seis años de edad. Se aplicó un cuestionario a sus padres con el fin de determinar los principales factores de riesgo asociados con el estado de ansiedad que pudieran presentar los pacientes. Para evaluar el grado de ansiedad en los niños antes de la consulta se utilizó una escala visual análoga de rostros. El análisis de datos se realizó mediante el paquete estadístico SPSS versión 17.0. Resultados: El 44 por ciento de los pacientes evaluados presentó ansiedad. En la distribución por sexo, el 50 por ciento de los sujetos de sexo femenino mostró ansiedad, a diferencia de los de sexo masculino, donde sólo el 38.5 por ciento la manifestó. El 87.5 por cientode los hijos de aquellos padres que sintieron confianza al dejarlos pasar solos con el odontopediatra no presentó ansiedad (p < 0.001). Por otro lado, la escolaridad fue determinante, ya que el 86.4 por ciento de los niños de nivel preescolar presentó ansiedad (p < 0.0001). Asimismo, el 72.7 por ciento de los menores que no entendieron las explicaciones de sus padres de por qué asistían a la consulta también mostró ansiedad (p = 0.032), así como los que reaccionaron negativamente al separarse de sus padres (70.5 por ciento con [p < 0.0001] p = 0.0001). Finalmente, 70.5 por ciento de los menores que reportaron temor a las inyecciones presentaron ansiedad (p < 0.0001). Conclusiones: La prevalencia de ansiedad en la población de estudio fue de un 44 por ciento; los factores de riesgo asociados fueron: padres ansiosos, grado escolar del paciente, reacción negativa al separarse de los padres; temor hacia el personal de salud, a las inyecciones, al llegar a su cita y al reconocer la clínica

To determine the main risk factors associated with a state of anxiety before their first contact with pediatric dentistry in children between four and six years of age attending the Reforma Multidisci-plinary Clinic (FES Zaragoza, UNAM).study design: A study of 100 children aged between four and six years old was carried out. The parents of the children were given a questionnaire aimed at identify-ing the main risk factors associated with the state of anxiety that the patient might display. A visual analog scale of faces was used to assess the degree of anxiety in the children before their appointment. Data analysis was performed using SPSS version 17.0. results: 44% of the patients assessed displayed anxiety. In terms of differences between the sexes, 50% of females presented anxiety, whilst 38.5% of the males did. Where parents felt confident enough to leave their children alone with the pediatric dentist, 87.5% of the patients showed no anxiety (p < 0.001). Furthermore, the child’s academic level played a major role, with 86.4% of preschool children feeling anxiety (p < 0.0001). Similarly, 72.7% of children who did not understand their parents’ explanations of why they were visiting the dentist also showed anxiety (p = 0.032), as did a significant proportion of those who reacted nega-tively to being separated from their parents (70.5%, with p < 0.0001). Finally, 70.5% of children who reported a fear of injections showed anxiety (p < 0.0001).conclusions: The prevalence of anxiety in the study population was 44%, and the risk factors were: anxious parents, the school grade of the patient, a negative reaction to being separated from their parents, a fear of health personnel, injections, fear when arriving at the appointment and recognizing the clinic.

Dental anxiety and fear: relationship with oral health behavior in a Turkish population.

The aim of this study was to assess fear and anxiety in dental patients. Five hundred patients were evaluated using the Modified Dental Anxiety Scale and the Dental Fear Scale, along with a questionnaire. Oral health status was assessed using the Decayed, Missing, and Filled Teeth (DMFT)/Decayed, Missing, and Filled Surfaces (DMFS) index. Statistic al analysis was performed (P < .05). Sex significantly affected dental anxiety (P < .05), and sex, marital status, having children, and time elapsed since last visit to clinician affected dental fear (P < .05). DMFT/DMFS scores were not related to dental anxiety or fear (P > .05). Female sex alone was a significant predictor of dental anxiety; female sex, adulthood, marriage, having children, and time passed since last visit to a clinician are significant predictors of fear.

Validating a measure of the prevalence of dental anxiety as applied to Kuwaiti adolescents.

OBJECTIVES: To assess self-reported dental anxiety (DA) among Kuwaiti adolescents and to test whether different dental anxiety scales are valid for measuring DA in Kuwait. BASIC RESEARCH DESIGN: Cross-sectional, structured, anonymous questionnaire survey in Arabic completed at government schools. PARTICIPANTS: 757 pupils aged 13-15 years from three schools filled the questionnaire. Useable response rate was 93.0%. MAIN MEASURES: DA was assessed by: 1, a single-item dental fear question (DF); 2, the Modified Dental Anxiety Scale (MDAS); and 3, the Modified Child Dental Anxiety Scale: faces (MCDAS(f)). RESULTS: A third of the girls and 6% of boys reported being very much afraid of visiting a dentist. Use of the drill and injection in the gum were the most anxiety arousing MDAS items; tooth extraction and injection of the MCDAS(f) items. Total mean for MDAS was 11.4 (sd 4.6) and for MCDAS(f) 16.6 (sd 6.5). A tenth of the children were highly dentally anxious when measured by MDAS (score ≥ 19). Girls reported statistically significantly higher DA scores with all the measures. There was a high correlation between the total score of the MDAS and the total score of the MCDAS(f) (p = 0.855). Statistically significant relationship (p < 0.001) was found between the single-item DF and the total score of the MDAS and a single item and the total score of the MCDAS(f). CONCLUSIONs: A tenth of children were highly dentally anxious; girls reporting higher scores. A single-item dental fear question, MDAS and MCDAS(f) were valid tools for measuring DA among Kuwaiti adolescents.

The indicator of sedation need (IOSN).

UNLABELLED: Conscious sedation in dentistry is usually indicated because a patient's anxiety can prohibit the necessary dental treatment being undertaken. It may also be indicated because of unpleasant or lengthy treatment or to prevent exacerbation of a patient's medical or behavioural condition by anxiety. The indicator of sedation need (IOSN) tool has been developed to help support dentists in their clinical decision-making and uses information about a patient's anxiety, medical and behavioural status and treatment complexity. The IOSN has been used to measure sedation need and has shown that 5.1% of patients attending general dental practices have a high need of conscious sedation. IOSN has also been used to investigate the need for conscious sedation in the general population among dental practice attenders and those who don't attend. The proportion was found to be 6.7%. CLINICAL RELEVANCE: Some patients require conscious sedation in order to access dental care. The indicator of sedation need (IOSN) tool helps in the decision-making process.

The role of dental therapists in pharmacological and non-pharmacological treatment of anxious and phobic patients.

Dental Therapists are in a prime position to be involved with the management of anxious and phobic patients. They earn less than dentists and are therefore a more cost-effective way of providing specialised care for anxious patients. Dental Therapists can spend more time educating and acclimatising these patients, do most if not all of the patient's treatment, only referring back to the dentist for RCT, crown/bridgework/dentures and permanent extractions. Ultimately this means that the patient receives high quality continuity of care. Treating anxious and phobic patients is time-consuming but ultimately very rewarding. If handled correctly and sensitively the anxious and phobic patient will not always be anxious or phobic, in the same way that children won't always be children. Dental Therapists can now extend their duties to include Relative Analgesia. This should enhance their employability and role within the dental team especially in the management of anxious and phobic patients. Employing a therapist with a toolbox of techniques at their disposal can be seen as part of a long-term practice plan to ensure that anxious and phobic patients become rehabilitated, happy, compliant and loyal to the practice! In fact .... the sort of patients every dentist really wants to see.

Effect of text message follow-up on patient's self-reported level of pain and anxiety.

OBJECTIVES: To determine whether a text message reduces the severity of patient self-reported levels of pain and anxiety following initial placement of orthodontic appliances. MATERIALS AND METHODS: Thirty-nine orthodontic patients were randomly assigned to one of two groups and matched for age, gender, and bracket type (self-ligating vs conventional). The subjects completed baseline questionnaires to ascertain their levels of pain and anxiety before initiating orthodontic treatment. Following the initial appointment, subjects completed the pain questionnaire and anxiety inventory at the same time daily for 1 week. One group received a structured text message showing concern and reassurance, while the second group served as a control and received no postprocedural communication. RESULTS: There was a statistically significant difference in pain in relation to time between the text message group and the control group as it was demonstrated that demonstrated that compared with the text message group, mean pain intensity increased and selfreported discomfort was longer in the control group. Anxiety was determined to be at its peak the day following initial orthodontic appliance placement and gradually tapered off from that time point. No intergroup difference was noted when analyzing anxiety. CONCLUSIONS: This study demonstrated that a text message sent from an orthodontic office following initial appliance placement resulted in a lower level of patient's self-reported pain. Additionally, patient anxiety is at its peak the day following the initial appointment and decreases from that point forward.

Anxiety in children during occlusal ART restorations in primary molars placed in school environment and hospital dental setup.

OBJECTIVE: To evaluate the anxiety in children during occlusal atraumatic restorative treatment (ART) in the primary molars of children; and compare the anxiety for ART procedure performed in school environment and in hospital dental setup. STUDY DESIGN: A randomized controlled trial where one dentist placed 120 ART restorations in 60 five- to seven year-olds who had bilateral matched pairs of occlusal carious primary molars. A split-mouth design was used to place restorations in school and in hospital dental setup, which were assigned randomly to contralateral sides. Anxiety was evaluated by Modified Venhem score and the heart rate of the children at five fixed moments during dental treatment. RESULTS: At the entrance of the children into the treatment room, statistically significant difference between treatment in school environment and treatment in hospital dental setup for venham score and heart rate could be found (P = 0.023 and P = 0.037 respectively). At the start of the treatment procedure higher venham score and heart rate was observed in children treated in hospital dental setup in comparison with the children treated in school environment, finding was statistically significant (P = 0.011 and P = 0.029 respectively). During all other three points of treatment, the Venham scores of the children treated in school were lower than those of the children treated in hospital dental setup but statistically not significant (P > 0.05). Positive co-relation between Venham scores and Heart rate was established. No statistically significant relation could be established between boys and girls. CONCLUSIONS: Overall anxiety in children for ART treatment was found to be less and the procedure was well accepted irrespective of environment where treatment was performed Hospital dental setup by itself made children anxious during entrance and starting of the treatment when compared to children treated in school environment.

Effect of a combination of oral midazolam and low-dose ketamine on anxiety, pain, swelling, and comfort during and after surgical extractions of mandibular third molars.

PURPOSE: To assess the clinical efficacy of a combination of oral midazolam plus low-dose ketamine for reducing anxiety during surgery and in preventing postoperative pain and swelling after the surgical extraction of third molars. MATERIALS AND METHODS: Thirty patients requiring bilateral surgical extraction of mandibular third molars were included in this study. Prior to extraction of the tooth on the right side, a combination of oral midazolam and low-dose ketamine was given to the patient, while this protocol was not followed for extraction of the tooth on the left side. Anxiety levels were checked before surgery. The postoperative pain and swelling and patient's comfort with and without the premedication were compared. RESULTS: Facial swelling on the postoperative days was lower on the right side than on the left. Pain scores at 30 minutes and 24 hours after surgery were significantly higher on the left side. Also, anxiety during the surgery was less and comfort levels were higher postoperatively when the combination of oral midazolam plus low-dose ketamine was used. CONCLUSIONS: Premedication with midazolam plus low-dose ketamine prior to surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less pain.

Effect of nitrous oxide on the efficacy of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis.

INTRODUCTION: The inferior alveolar nerve (IAN) block does not always result in successful pulpal anesthesia. Anesthetic success rates might be affected by increased anxiety. Nitrous oxide has been shown to have both anxiolytic and analgesic properties. Therefore, the purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of nitrous oxide on the anesthetic success of the IAN block in patients experiencing symptomatic irreversible pulpitis. METHODS: One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth were enrolled in this study. Each patient was randomly assigned to receive an inhalation regimen of nitrous oxide/oxygen mix or room air/oxygen mix (placebo) 5 minutes before the administration of the IAN block. Endodontic access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on access or instrumentation. RESULTS: The success rate for the IAN block was 50% for the nitrous oxide group and 28% for the placebo group. There was a statistically significant difference between the 2 groups (P = .024). CONCLUSIONS: For mandibular teeth diagnosed with symptomatic irreversible pulpitis, administration of 30%-50% nitrous oxide resulted in a statistically significant increase in the success of the IAN block compared with room air/oxygen.

Evidence-based dentistry: analysis of dental anxiety scales for children.

OBJECTIVES: To review paediatric dental anxiety measures (DAMs) and assess the statistical methods used for validation and their clinical implications. METHOD: A search of four computerised databases between 1960 and January 2011 associated with DAMs, using pre-specified search terms, to assess the method of validation including the reliability as intra-observer agreement 'repeatability or stability' and inter-observer agreement 'reproducibility' and all types of validity. RESULTS: Fourteen paediatric DAMs were predominantly validated in schools and not in the clinical setting while five of the DAMs were not validated at all. The DAMs that were validated were done so against other paediatric DAMs which may not have been validated previously. Reliability was not assessed in four of the DAMs. However, all of the validated studies assessed reliability which was usually 'good' or 'acceptable'. None of the current DAMs used a formal sample size technique. Diversity was seen between the studies ranging from a few simple pictograms to lists of questions reported by either the individual or an observer. CONCLUSION: To date there is no scale that can be considered as a gold standard, and there is a need to further develop an anxiety scale with a cognitive component for children and adolescents.

Comparison of clonidine and midazolam as anxiolytic premedication before wisdom tooth surgery: a randomized, double-blind, crossover pilot study.

PURPOSE: Anxiolytic and possible side effects of clonidine 150 µg compared to midazolam 7.5 mg for premedication in surgical wisdom tooth extraction were evaluated. METHODS: In a prospective, randomized, double-blind crossover trial, ten patients undergoing bilateral wisdom tooth surgery received clonidine or midazolam orally 1 h before the treatment. Patients receiving midazolam for the first surgery received clonidine at the second surgery and vice versa. The anxiolytic efficacy was evaluated with a visual analogue scale (VAS) upon admission and 30, 50 and 60 min after administration of the medication. Patient satisfaction was recorded on a VAS after surgery and 7 days postoperatively. RESULTS: As soon as 30 min after administration of midazolam (p < 0.03) and clonidine (p < 0.02), an anxiolytic effect was recorded. Both medications did not differ in patient satisfaction. CONCLUSION: Oral administration of clonidine 150 µg and midazolam 7.5 mg were rated as medications with equal anxiolytic effects before wisdom tooth surgery under local anesthesia.