Development of the Children’s Index of Dental Anxiety and Fear

Objectives: The Children’s Index of Dental Anxiety and Fear (CIDAF-4C⁺) is designed to address the theoretical shortcomings of existing children’s dental fear scales by measuring the emotional, behavioural, physiological and cognitive components of dental anxiety. The CIDAF-4C⁺ comprises a modular design with three sections assessing the four components of dental anxiety and fear (CIDAF-4C), dental phobia and anxiety-invoking stimuli. This study aimed to develop and assess reliability and validity information on the CIDAF-4C⁺ in a sample of Australian children and compare the CIDAF-4C with the Smiley Faces Paper Scale (SFPS).
Methods: 83 parents and children from Western Australia completed a questionnaire distributed through public school dental service clincis. Item selection for the final scale was determined by examination of item response distributions, intercorrelations, and test-retest correlations, as well as exploratory factor analysis (EFA).
Results: An 8-item scale was created from a pool of 16 positively and negatively worded items. The scale assesses positive and negative valence (4 items each) related to dental visiting. The CIDAF-4C showed good internal consistency (α=0.90; single measures intraclass correlation=0.52) and acceptable test-retest reliability at 2 weeks (r=0.72). The IDAF-4C was significantly correlated with the SFPS (r=0.73). In comparison to the SFPS, the CIDAF-4C better predicted the child having had a previous unpleasant experience at the dentist and the parent’s belief that their child actively avoids going to the dentist or else endures with intense fear and anxiety.
Conclusions: The CIDAF-4C⁺ is a both a theoretically derived and useful measure of dental anxiety and fear, but requires further validity and reliability evidence.