The Influence of Caregivers’ Dental Anxiety on Children’s Dental Utilization

Objectives: To investigate the pathway through which caregiver dental anxiety influences oral health care utilization for children.
Methods: The sample consisted of 223 low-income African-American caregivers (mean age: 24.9±4.8) with 36 month old children who were part of a birth cohort study investigating preterm birth and oral health. Caregivers completed a questionnaire which included the Modified Dental Anxiety Scale (MDAS, range 5-25) and oral health behaviors for themselves and for their children. Oral health care utilization was assessed using two questions based on: preventive visit vs. problematic visit and annual visit vs. no annual visit. The multiple imputation of missing data was performed using Bayesian analysis. A path analysis was performed to test a hypothesized causal model with three stages: (1) caregiver dental anxiety level as antecedent, (2) caregiver’s oral health care utilization as mediator, and (3) children’s oral health care utilization as the outcome.
Results: The results of path analysis support the hypothesis that caregivers’ dental anxiety level affects their children’s oral health care utilization, mediated by their own oral health care utilization. A one point increase in MDAS score resulted in a 7% greater odds of a problematic visit for caregivers (OR=0.93, 95%CI: 0.89-0.98). Similarly a one point increase in MDAS score resulted in an 8% less odds of having an annual dental visit for caregivers. (OR=0.92, 95%CI: 0.88-0.97). Furthermore, caregivers, who visited a dentist annually, were approximately twice as likely to take their children for an annual dental visit (OR=1.9, 95%CI: 1.06-3.39). There was no direct influence of caregiver s’ dental anxiety on oral health care utilization for their children.
Conclusions: In low-income African American caregivers, their dental anxiety indirectly influenced the behavior of taking children to the dentist through the mediating influence of the caregivers own oral health care utilization.