Identified factors in child-dentist relationship important for the management of dental anxiety in Nigerian children.

AIM: To investigate the effects and interrelationship between dental anxiety and dentist's experience, dentist's behaviour, type of treatment received and the behaviour of Nigerian children during treatment. METHODS: Pre- and post-dental treatment anxiety levels of 69 child patients, who were attending the dental clinic to receive dental treatment for the first time, were assessed using the DFSS-SF. The dentist's and child's behaviour during treatment procedures were unobtrusively observed and recorded. The pre- treatment anxiety levels were classified as high (HAC) and low (LAC), while those of the dentists who managed the children were categorized as experience or inexperienced. The interrelationship between a child's dental anxiety level, dentist's behaviour during child management, dentist's experience and the type of treatment the child received were analysed. RESULTS: The anxiety level of the children decreased significantly post-treatment when experienced dentists managed the child in comparison to inexperienced dentists (Z=3.22, p<0.02). The dentist's behaviour did not significantly affect the anxiety level of the child. However, physical contact was used more frequently with HAC than LAC (z=2.27;p<0.023). There was no association between a child's behaviour in the dental chair and their anxiety level (chi(2)=0.08, p<0.93). Also, the more invasive the procedure, the less the tendency for a noted decrease in anxiety level of a child post-treatment, though this was statistically insignificant (z=1.34; p<0.44). CONCLUSION: The dentist's behaviour played no role in changing the anxiety level of a child nor did it have any influence on anxiety-related behaviour of a child. However, the experience of the dentist was a very significant factor for effecting a decrease in the dental anxiety level change for children.

Effect of information on dental anxiety and behaviour ratings in children.

AIM: To establish the effect of information received about dental care on the anxiety level of the child prior to receiving any form of dental treatment and on their behaviour during dental treatment. METHODS: Eighty-four healthy child patients at their first dental visit, between the ages of 8 and 13 years attending a paediatric dental clinic in Nigeria participated in the study. Information on their dental anxiety level was collected using the Dental Subscale of the Child Fear Survey Schedule. The children were asked to identify their source and type of dental information received. The information given was later categorised into positive or negative for analysis purposes. The children's behaviour during dental treatment was assessed using Venham's clinical ratings of anxiety and cooperative behaviour. The mean dental anxiety scores, as well as the mean Venham behavioural ratings, of those that had received information on dental treatment were compared with those that had never received any information. RESULTS: Previously received information did not appear to have any significant impact on the measures of the dental anxiety level of these children neither was there a statistically significant association between information received and behaviour of the child in the dental chair. CONCLUSION: Past information may play only a minor role in affecting dental anxiety levels and behaviour of the child during dental treatment.

The modulating effect of culture on the expression of dental anxiety in children: a literature review.

The experience of anxiety is a universal human phenomenon. Studies have shown a world-wide variation in the prevalence of dental anxiety with estimates ranging between 3% and 43%. The aetiology of dental anxiety is multifactorial, with factors acting in synergy to affect its expression. For children, age and gender play fundamental roles in its expression. However, these two factors are modulated by other variables such as culture which may influence the context in which anxiety is experienced, the interpretation of its meaning and responses to it. The modulating effect of culture in synergy with other variables may be one of the reasons why reports on dental anxiety have varied from region to region. This paper attempts to identify the interrelating roles of culture, age and gender, and how these relationships may affect variability in the expression and measurement of dental anxiety in children.

Dental anxiety in a subpopulation of African children: parents ability to predict and its relation to general anxiety and behaviour in the dental chair.

AIM: This was to investigate the ability of Nigerian parents to predict their child's dental anxiety level and the relationship between the child's dental anxiety, general anxiety and behaviour in the dental chair. METHODS: A group of 53 mothers and 35 fathers and their respective children completed schedules that measured general and dental anxiety. The child's behaviour on the dental chair was also assessed. The child's self report of dental anxiety and general anxiety was compared with that of the parents. Dental anxiety ratings by the children and parents were correlated with the behaviour assessment of the dentist. Statistical significance was determined at <0.05. RESULTS: There was no statistically significant difference between the parent's assessment of their child's dental anxiety level and the child's self report (t=0.389; p=0.689). However, the mothers were able to rate their child's dental anxiety level better than the fathers (r=0.497 and p<0.001 for mothers, r=-0.049 and p=0.789 for fathers). Also there was a moderate correlation between the child's self reported dental anxiety and general anxiety levels (r=0.58, p<0.05) and a low correlation between the clinical behaviour ratings and the child's self reported dental anxiety level (r=0.10, p>0.05). CONCLUSION: The Nigerian mothers could be relied upon to make objective assessment of their child's dental anxiety. General anxiety appears to play a significant role in dental anxiety development in Nigerian children who appear to behave well in the dental chair despite their reported dental anxiety levels.

Factors influencing the use of behavioral management techniques during child management by dentists.

Dental anxiety develops from a vicious cycle of bodily arousal from dental stimuli, cognitive interpretation and ineffective coping all working in a runaway feedback loop. Behavioral management strategies (BMT) aim at cognitive reorientation, which results in better compliance with instruction. This paper therefore tried to find out possible factors that influence the effective use of BMT during child dental management during treatment by dental operators in Nigeria. The levels of anxiety pre and post treatment were assessed using the short form of the dental version of the Child Fear Survey Schedule. Also, the type of treatment given to the child, the types and number of behavioral strategies employed during dental management as well as the gender and age of the child were noted. The professional status of the attending dental operator was also noted. Prior to the commencement of the study, the five students in the final year, who were to attend to the children in this study received one week training on the psychological management of dental anxiety in children. Results obtained from the dental operators were compared. The type of treatment received by the child did not significantly affect the dental anxiety score. The number of techniques combined by house officers and senior registrars were significantly higher than would be expected by chance (chi2=16.030, P=0.0001 and chi2=9.000, P=0.0001 respectively). Combination of techniques was also more frequent during invasive procedures and when dental anxiety levels were high. Combining techniques also tended to decrease dental anxiety more significantly than otherwise. Training has a role to play in the basic and efficient use in the management of the child dental patient. The training of dentists should thus entail the full spectrum (content and instructional effectiveness) of all psychological techniques.

The effect of psychological management on dental anxiety in children.

The aim of this study was to determine the effect of using of psychological management techniques on the level of anxiety in Nigerian children during dental management. The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending a suburban dental clinic for the first time. This schedule was re-administered again two weeks later when they came for a follow up visit. The age of the patients was recorded. The types as well as number of psychological techniques employed during treatment were also noted. The overall mean dental anxiety level of the children decrease from an average of 15.23 +/- 5.03 before treatment to 13.40 + 4.13 after treatment (p < 0.001). However, the mean dental anxiety score in children in whom no psychological technique was employed during treatment increased after treatment. On the other hand, there was also a statistically significant decrease in the mean dental anxiety level of children treated using either a single psychological technique or combined psychological techniques after treatment. Better results were obtained when combined psychological techniques where used than when only a single technique was used. It was concluded that psychological techniques used in the management of dental anxiety in children are highly effective in decreasing dental anxiety levels. Better results are obtained when a number of techniques are combined effectively.

The effect of sociodemographic factors on dental anxiety in children seen in a suburban Nigerian hospital.

OBJECTIVE: This paper attempts to determine the sociodemographic factors that relate to dental anxiety in suburban African children. METHODS: A short form of the Dental subscale of the Child Fear Survey schedule (DFSS_SF) was administered to 81 patients (first time attendees at the clinic) between the ages of eight and 13 years. The psychometric scale was used after determining its reliability and validity to ensure that it was culturally appropriate. Age, gender, sociodemographic status were also recorded. The dental anxiety score distribution, its threshold level as well as the relationship between the sociodemographic variables and patients' anxiety were determined. RESULTS: There was no statistically significant association between age (P = 0.856), gender (P = 0.124), socio-economic status of the children (P= 0.12) and level of dental anxiety. However, a statistically significant relationship did exist between the type of school the child attended and the anxiety level (P = 0.009). Also, 18 (14.8%) of the children were found to have high anxiety levels. CONCLUSIONS: Further studies involving larger non-clinic samples are needed to examine the issues raised by the findings of this study.

Aetiology of dental anxiety in children: a review of the literature.

Dental anxiety has long been identified as a factor that affects the effective provision and acceptance of dental treatments by patients. For children, this becomes a handicap especially when they have not developed an ability to cope with the problem. This paper reviews factors that have been identified as aetiological factors for dental anxiety in children. Also a note has been made on a possible concomitant factor to other identified aetiological factors in Nigerian children though there is the need for more studies in the country on this subject. An understanding of the various aetiological factors in dental anxiety would help in the child-patient management with there being the possibility of a multidisciplinary approach to this multidimensional problem.