Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children

  • Kalra, Namita (Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi) ;
  • Sabherwal, Puja (Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi) ;
  • Tyagi, Rishi (Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi) ;
  • Khatri, Amit (Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi) ;
  • Srivastava, Shruti (Department of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital)
  • Received : 2020.12.27
  • Accepted : 2021.03.02
  • Published : 2021.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: This study assessed anticipatory dental anxiety levels among 8- to 12-year-old children based on subjective and physiological measures and their correlation. The variations in anxiety based on sex, age, temperament, and academic performance were evaluated. Methods: An observational study was conducted in 60 children recruited from the waiting room over a 6-month period. The operator recorded subjective anxiety in the children using a novel visual facial anxiety scale. The operator also noted the demographic details and child's temperament using the nine dimensions of the Thomas and Chess criteria, and graded children as "easy," "slow to warm-up," and "difficult." The academic performance of the children was graded (parental ratings) on a five-point Likert scale. Physiological variables (heartrate [HR], oxygen saturation[SpO2], and blood pressure [BP]) were recorded by another evaluator. The correlation between anxiety levels and physiological variables was also assessed. The effects of age, sex, temperament, and academic performance on anxiety were evaluated. Results: The study included 60 children aged 8-12 years, including 36 boys and 24 girls. Seventy percent of children had mild to moderate levels of pre-extraction anxiety, while 30% of children demonstrated high anxiety. A significant positive correlation was noted between anxiety levels and HR (rs = 0.477, P < 0.001⁎) and systolic BP (rs = 0.294, P < 0.05), while a significant but inverse correlation was observed with SpO2 (rs = -0.40, P < 0.05). Anxiety did not influence diastolic BP. Children with difficult temperament and poor academic performance had significantly higher anxiety. Conclusion: A high percentage (70%) of children aged 8-12 years had mild to moderate anxiety prior to the extraction procedure. Increased HR, systolic BP, and reduced SpO2 were significantly associated with high levels of anticipatory dental anxiety. Pre-extraction anxiety was significantly related to the temperament and scholastic performance.

Keywords

References

  1. Carlsson SG, Wide Boman U, Lundgren J, Hakeberg M. Dental anxiety - a joint interest for dentists and psychologists. Eur J Oral Sci 2013; 121: 221-4. https://doi.org/10.1111/eos.12046
  2. Park ES, Yim HW, Lee KS. Progressive muscle relaxation therapy to relieve dental anxiety: a randomized controlled trial. Eur J Oral Sci 2019; 127: 45-51. https://doi.org/10.1111/eos.12585
  3. Thoma MV, Zemp M, Kreienbuhl L, Hofer D, Schmidlin PR, Attin T, et al. Effects of Music Listening on Pre-treatment Anxiety and Stress Levels in a Dental Hygiene Recall Population. Int J Behav Med 2015; 22: 498-505. https://doi.org/10.1007/s12529-014-9439-x
  4. Locker D, Shapiro D, Liddell A. Overlap between dental anxiety and blood-injury fears: psychological characteristics and response to dental treatment. Behav Res Ther 1997; 35: 583-90. https://doi.org/10.1016/S0005-7967(97)00016-8
  5. Seeman K, Molin C. Psychopathology, feelings of confinement and helplessness in the dental chair, and the relationship to the dentist in patients with disproportionate dental anxiety (DDA). Acta Psychiatr Scand 1976; 54: 81-91. https://doi.org/10.1111/j.1600-0447.1976.tb00099.x
  6. Benjamin C, Schuurs AH, Kooreman T, Hoogstraten J. Self-reported and physiologically measured dental anxiety, coping styles and personality traits. Anxiety Stress Coping 1996; 9: 151-62. https://doi.org/10.1080/10615809608249398
  7. Ost LG, Hugdahl K. Acquisition of blood and dental phobia and anxiety response in clinical patients. Behav Res Ther 1985; 23: 27-34. https://doi.org/10.1016/0005-7967(85)90139-1
  8. Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: A review. Aust Dent J 2013; 58: 390-407. https://doi.org/10.1111/adj.12118
  9. Klaassen MA, Veerkamp JS, Hoogstraten J. Changes in children's dental fear: a longitudinal study. Eur Arch Paediatr Dent 2008; 9: 29-35. https://doi.org/10.1007/BF03262653
  10. Corah NL. Development of a dental anxiety scale. J Dent Res 1969; 48: 596. https://doi.org/10.1177/00220345690480041801
  11. Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc 1978; 97: 816-9. https://doi.org/10.14219/jada.archive.1978.0394
  12. Venham LL, Gaulin KE. A self-report measure of situational anxiety for young children. Pediatr Dent 1979; 1: 91-6.
  13. Alwin NP, Murray JJ, Britton PG. An assessment of dental anxiety in children. Br Dent J 1991; 171: 201-7. https://doi.org/10.1038/sj.bdj.4807661
  14. Yumul R, Ahdout J, Goodman A, Elvir Lazo OL, Hernandez-Conte A, Cook-Wiens G, et al. Assessment of preoperative anxiety using visual facial anxiety scale: an alternative to the verbal rating scale? Med Res Arch 2015; 2: 1-12.
  15. Cao X, Yumul R, Elvir Lazo OL, Friedman J, Durra O, Zhang X, et al. A novel visual facial anxiety scale for assessing preoperative anxiety. PLoS One 2017; 12: e0171233. https://doi.org/10.1371/journal.pone.0171233
  16. Myers DR, Kramer WS, Sullivan RE. A study of the heart action of the child dental patient. ASDC J Dent Child 1972; 39: 99-106.
  17. Rosenberg HM, Katcher AH. Heart rate and physical activity of children during dental treatment. J Dent Res 1976; 55: 648-51. https://doi.org/10.1177/00220345760550041801
  18. Guinot Jimeno F, Yuste Bielsa S, Cuadros Fernandez C, Lorente Rodriguez AI, Mercade Bellido M. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Paediatr Dent 2011; 12: 239-44.
  19. Beck FM, Weaver JM 2nd. Blood pressure and heart rate responses to anticipated high stress dental treatment. J Dent Res 1981; 60: 26-9. https://doi.org/10.1177/00220345810600010501
  20. Rayen R, Muthu MS, Chandrasekhar Rao R, Sivakumar N. Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children. Indian J Dent Res 2006; 17: 27-34. https://doi.org/10.4103/0970-9290.29895
  21. Galamb D, Lenkey A, Olah A, Math J, Marton I, Alberth M. Objective and subjective measurements for assessing dental fear in adoloscents: a pilot study. Ital J Dent Med 2017; 2: 3-8.
  22. Soares FC, Lima RA, Santos Cda F, de Barros MV, Colares V. Predictors of dental anxiety in Brazilian 5-7 years old children. Compr Psychiatry 2016; 67: 46-53. https://doi.org/10.1016/j.comppsych.2016.01.006
  23. Goldsmith HH, Buss AH, Plomin R, Rothbart MK, Thomas A, Chess S, et al. Roundtable: what is temperament? Four approaches. Child Dev 1987; 58: 505-29. https://doi.org/10.1111/j.1467-8624.1987.tb01398.x
  24. Strelau J. The concept of temperament in personality research. Eur J Pers 1987; 1: 107-17. https://doi.org/10.1002/per.2410010205
  25. Nigg JT. Temperament and developmental psychopathology. J Child Psychol Psychiatry 2006; 47: 395-422. https://doi.org/10.1111/j.1469-7610.2006.01612.x
  26. Rettew DC, McKee L. Temperament and its role in developmental psychopathology. Harv Rev Psychiatry 2005; 13: 14-27. https://doi.org/10.1080/10673220590923146
  27. Quinonez R, Santos RG, Boyar R, Cross H. Temperament and trait anxiety as predictors of child behaviour prior to general anesthesia for dental surgery. Pediatr Dent 1997; 19: 427-31.
  28. Gustafsson A, Arnrup K, Broberg AG, Bodin L, Berggren U. Psychosocial concomitants to dental fear and behaviour management problems. Int J Paediatr Dent 2007; 17: 449-59. https://doi.org/10.1111/j.1365-263X.2007.00883.x
  29. Jain A, Suprabha BS, Shenoy R, Rao A. Association of temperament with dental anxiety and behaviour of the preschool child during the initial dental visit. Eur J Oral Sci 2019; 127: 147-55.
  30. Alsheneifi T, Hughes CV. Reasons for dental extractions in children. Pediatr Dent 2001; 23: 109-12.
  31. Klaassen MA, Veerkamp JS, Hoogstraten J. Changes in children's dental fear: a longitudinal study. Eur Arch Paediatr Dent 2008; 9 Suppl 1: 29-35. https://doi.org/10.1007/BF03262653
  32. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175-91. https://doi.org/10.3758/BF03193146
  33. Conture EG, Kelly EM, Walden TA. Temperament, speech and language: an overview. J Commun Disord 2013; 46: 125-42. https://doi.org/10.1016/j.jcomdis.2012.11.002
  34. Von-Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbrouke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4: e296. https://doi.org/10.1371/journal.pmed.0040296
  35. Pinkham JR. Dynamic of changes. In: Pediatric Dentistry-Infancy Through Adolescence. 4th ed. Edited by Pinkham JR, Casa Massimo PS. Philadelphia, Elsevier Saunders. 2005, pp 469-71.
  36. Melamed BG, Yurcheson R, Fleece EL, Hutcherson S, Hawes R. Effects of film modeling on the reduction of anxiety-related behaviors in individuals varying in level of previous experience in the stress situation. J Consult Clin Psychol 1978; 46: 1357-67. https://doi.org/10.1037/0022-006X.46.6.1357
  37. Raadal M, Milgrom P, Weinstein P, Mancl L, Cauce AM. The prevalence of dental anxiety in children from low-income families and its relationship to personality traits. J Dent Res 1995; 74: 1439-43. https://doi.org/10.1177/00220345950740080201
  38. Krikken JB, ten Cate JM, Veerkamp JS. Child dental fear and general emotional problems: a pilot study. Eur Arch Paediatr Dent 2010; 11: 283-6. https://doi.org/10.1007/BF03262764
  39. Paryab M, Hosseinbor M. Dental anxiety and behavioral problems: a study of prevalence and related factors among a group of Iranian children aged 6-12. J Indian Soc Pedod Prev Dent 2013; 31: 82-6. https://doi.org/10.4103/0970-4388.115699
  40. Balasubramaniyan N, Rayapati DK, Puttiah RH, Tavane P, Singh ES, Rangan V, et al. Evaluation of anxiety induced cardiovascular response in known hypertensive patients undergoing exodontia - a prospective study. J Clin Diagn Res 2016; 10: ZC123-7.
  41. Fernandez-Aguilar J, Guillen I, Sanz MT, Jovani-Sancho M. Patient's pre-operative dental anxiety is related to diastolic blood pressure and the need for post-surgical analgesia. Sci Rep 2020; 10: 9170. https://doi.org/10.1038/s41598-020-66068-9
  42. Ize-Iyamu IN, Mohammed BI, Ogordi PU. The effect of dental operative procedures on peripheral oxygen saturation and pulse rate in children in Benin-City, Nigeria. Ann Med Health Sci Res 2018; 8: 74-8.
  43. Klingberg G, Broberg AG. Temperament and child dental fear. Pediatr Dent 1998; 20: 237-43.
  44. Owens M, Stevenson J, Hadwin JA, Norgate R. Anxiety and depression in academic performance: an exploration of the mediating factors of worry and working memory. Sch Psychol Int 2012; 33: 433-49. https://doi.org/10.1177/0143034311427433