|Year : 2015 | Volume
| Issue : 4 | Page : 172-174
An assessment of dental anxiety in nonclinical setting among Saudi Arabian children using Abeer Children Dental Anxiety Scale
Shabina Shafi1, Abdulrhman Alasmri2, Abdulaziz Mustafa2, Amal S Shiban AlShahrani2, Hassan Alasmri2, Mohammed Nadeem Ahmed Bijle1
1 Department of Pediatric Dentistry and Orthodontic Sciences, Division of Pedodontics, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
2 College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
|Date of Web Publication||17-Feb-2016|
Department of Pediatric Dentistry and Orthodontic Sciences, Division of Pedodontics, College of Dentistry, King Khalid University, Abha
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Introduction: Dental anxiety is an abnormal fear or dread of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures. It is a common problem that affects people of all ages and appears to develop mostly in childhood and adolescence. The present study assesses dental anxiety among children in a nonclinical setting among Saudi Arabian children who underwent preventive treatment procedure using Abeer Children Dental Anxiety Scale (ACDAS). Materials and Methods: The children attending an oral health program were screened for oral health problems and preventive treatment such as topical fluoride applications. The dental anxiety among children was assessed using ACDAS. Results: A total of 51 children participated in the research. The results showed that maximum children were not scared of dentist in nonclinical setting and had low dental anxiety levels. Overall, 74% of the child subjects had ACDAS scores below 26. Conclusions: Knowing the degree of anxiety of dental children is important to guide them through their dental experience and carry on the preventive dental treatments at an early age in nonclinical setting. Their level of cooperation will improve, and anxiety will be reduced as well. Further research is required to compare dental anxiety levels in children between clinical and nonclinical setting.
Keywords: Anxiety, children, cognitive, dentistry
|How to cite this article:|
Shafi S, Alasmri A, Mustafa A, Shiban AlShahrani AS, Alasmri H, Bijle MA. An assessment of dental anxiety in nonclinical setting among Saudi Arabian children using Abeer Children Dental Anxiety Scale. J Dent Res Rev 2015;2:172-4
|How to cite this URL:|
Shafi S, Alasmri A, Mustafa A, Shiban AlShahrani AS, Alasmri H, Bijle MA. An assessment of dental anxiety in nonclinical setting among Saudi Arabian children using Abeer Children Dental Anxiety Scale. J Dent Res Rev [serial online] 2015 [cited 2022 Nov 27];2:172-4. Available from: https://www.jdrr.org/text.asp?2015/2/4/172/176682
| Introduction|| |
The term anxiety entered the field of psychology as a translation of the German word "Angst," which was used by Freud in 1936. Currently, anxiety is defined as a nonspecific feeling of apprehension toward a concrete situation that does not necessarily require previous experience and is not proportional to the response that is triggered in the individual.  Dental anxiety can prevent patients from cooperating fully during dental treatment, which can result in lost time for the practitioner and unnecessary difficulties when carrying out the treatment, and most importantly, can limit the effectiveness of the dental treatment and prevent the early detection of pathological processes. , It was specifically established that children with higher levels of dental anxiety have a greater number of untreated caries. Dental anxiety is a unique problem that affects people of all ages, but mostly seen in childhood and adolescence. Childhood dental anxiety is not only torment for the child and their family, but also related with poor oral health outcomes and increased dental services. 
A dentist who does not pay attention to the psychological needs of a child will soon be faced with an uncooperative patient.  As pointed out by Pinkham (1990), for clinical success in pediatric dentistry, behavior management is as fundamental as dexterity and knowledge of the material to be used.  Dentist needs to know how to identify behavior that indicates anxiety so that a relationship of trust may be established with the patient for the implementation of strategies aimed at minimizing the anxiety caused by the dental treatment.  There are various questionnaires and scales that assess dental anxiety.  The prevalence of dental anxiety among children varies according to the methodology employed and the age of the subjects. Fourteen different self-reported scales have been developed for children since the 1960s, but none of them could be considered ideal.  It is crucial to understand the importance of measuring children's dental anxiety and its association with the child's cognitive status. Abeer Children Dental Anxiety Scale (ACDAS)  helps to highlight the unmet needs of many children who do not go to the dentist just because of fear of general anesthesia.
The aim of the present study was to measure dental anxiety among children in nonclinical setting through the application of the ACDAS with the age group of 6-15-year old.
| Materials and Methods|| |
This study was conducted among Saudi children, attending an oral health program during Gulf Oral Health Week organized by the King Khalid University, College of Dentistry. The participating children were screened for oral health problems, and preventive treatments such as topical fluoride applications were done.
Dental anxiety was measured using ACDAS among children aged 6-15 years, willing to participate in the research. The children were given a brief introduction to the questionnaire and informed how to complete it. The questionnaire was used under examinations conditions with children completing it individually.
The questionnaire consists of 13 self-reported questions arranged in logical order that asked about the feeling of the child when facing dental experiences. Each question used three faces. Face 1 represented the feeling of a relaxed, not scared, "happy" person. Face 2 represented a neutral fair feeling of being "OK." Face 3 represented the anxious feeling of being "Scared." The child was asked to check under the face that best represented his or her response to the questions. The dental anxiety scores were calculated for all the child subjects. ACDAS scores of more than 26 are indicative of high dental anxiety. The data were further statistically analyzed for the results.
| Results|| |
A total of 51 children participated in the research. The child responses to the questionnaire are represented in [Table 1]. Most of the responses were toward "happy" with the explained dental situation. About 78.4% children were happy and not scared of dentist wearing mask. About 74.5% were happy and not scared of the dentist checking teeth with mouth mirror. About 66.7% were comfortable with the smell of the dentist, 62.7% were happy not scared of using electric hand piece that sprays water, and 60.8% were happy not scared of having a strange taste in their mouth.
|Table 1: Child subject's response to Abeer Children Dental Anxiety Scale|
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The children had scared response to the question such as tooth having out (43.1%) and feeling of numbness in lip/tongue (31.4%). Overall, 74% of the child subjects had ACDAS scores below 26 [Graph 1].
| Discussion|| |
Dental procedures are often invasive and generate a certain degree of anxiety in children.  Dentist must consider the multifactor etiology of anxiety to gain a better understanding of pediatric patients.  The need to help children face up to their anxiety has been recognized for more than 30 years because on many occasions, anxiety prevents them from receiving the necessary dental treatment that will enable them to maintain proper health.  Given the fact that there are many self-reported measurements available, none of them encompasses the ideal to be regarded as the gold standard and the first cognitive measure for dental anxiety worldwide. Hence, there is a need to develop a new scale to assess dental anxiety with other dental anxiety-contributing factors, such as the cognitive behavioral, psychological, and negative thought features. ,, ACDAS performance was validated using 165 participants from clinical and nonclinical sites, and externally validated on 274 children from two different locations.
The significance of the crucial role of negative cognitive patterns in anxiety evocation that could make the person apprehensive and difficult to treat and not comply with anxiety treatment techniques, indicates the use of ACDAS. 
The ACDAS is unique from previous scales, as it is the first dental anxiety scale for children and adolescence which corresponds dental anxiety with the cognitive state. It can recognize the stimuli for dental anxiety in a logical clinical order by asking about the feeling of the child when facing dental experiences.
Each question used three faces as a response set. Face 1 represented the feeling of a relaxed, not scared, "happy" person. Face 2 represented a neutral fair feeling of being "OK." Face 3 represented the anxious feeling of being "Scared." It also comprises child's feeling of shyness about the dentist and further assessment of the child, as reported by the legal guardian. 
ACDAS was validated using 51 participants from nonclinical setting sites. Most of the clinical scales have been validated in nonclinical settings and this is likely to influence the child's responses. Some key areas where this scale improves on current scales are:
- It uses three faces as a response
- It investigates the main cognitive thoughts in children
- It validates in both clinical and nonclinical situations.
The study results showed that 78.4% children were happy and not scared of dentist wearing a face mask, 74.5% not scared of dentist checking teeth with a mouth mirror, and 66.7% were comfortable with the smell of the dentist. Only 43.1% and 31.4% had scared response to the questions such as tooth having taken out and feeling of numbness in lip/tongue, respectively. Overall, 74% of the child subjects had ACDAS scores below 26. According to ACDAS, a child is being considered anxious if his/her overall score is more than 26.
Even though wide majority of measures are available to assess the level of dental anxiety, ACDAS scale seems to be different as it is the first dental anxiety scale for children that correlates dental anxiety with cognitive status.  The results from this investigation support that children have less dental anxiety in nonclinical setting and thus can be helpful in the preventive strategies. ACDAS highlights the unmet needs of children in clinical or nonclinical set up who do not visit dentist because of fear.
| Conclusions|| |
The dental anxiety levels were lower among the subjects participating in the oral health program in a nonclinical setting. Based on this study's results, the following conclusions can be made that ACDAS is a cognitive scale to measure dental anxiety for children and enclose the required criteria to be a gold standard dental anxiety scale for children and adolescents.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guinot Jimeno F, Yuste Bielsa S, Cuadros Fernández C, Lorente Rodríguez AI, Mercadé Bellido M. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Paediatr Dent 2011;12:239-44.
Assuncão CM, Losso EM, Andreatini R, de Menezes JV. The relationship between dental anxiety in children, adolescents and their parents at dental environment. J Indian Soc Pedod Prev Dent 2013;31:175-9.
Porritt J, Marshman Z, Rodd HD. Understanding children's dental anxiety and psychological approaches to its reduction. Int J Paediatr Dent 2012;22:397-405.
Al-Namankany A, de Souza M, Ashley P. Evidence-based dentistry: Analysis of dental anxiety scales for children. Br Dent J 2012;212:219-22.
Possobon RF, Carrascoza KC, Moraes AB, Costa AL. Dental treatment as anxiety - Inducing. Psicol Study Maringa 2007;12:609-16.
Tambelini MM, Gorayeb R. Dental fear scales to children and adolescents - A review of literature. Paideia 2003;26:157-61.
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:e219-24.
Lindsay S, Jackson C. Fear of routine dental treatment in adults: Its nature and management. Psychol Health 1993;8:135-53.
Locker D, Shapiro D, Liddell A. Who is dentally anxious? Concordance between measures of dental anxiety. Community Dent Oral Epidemiol 1996;24:346-50.
Ayer W. Psychology and Dentistry: Mental Health Aspects of Patient Care. 1 st
ed. UK: Haworth Press Inc.; 2005.
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