How Well Do We Assess Dental Anxiety in Children?

Accurate categorisation of dental fear in children is the precursor to developing appropriate psychological treatments. Objectives: The aim of this study is to see if identifying anxious thoughts of children adds to the information obtained using standard measures. Methods: All participants were children referred to the Dental Anxiety Clinic at Dundee Dental Hospital. The sample N=50 was composed of 29 females and 21 males. Mean age 12.2 years(SD=1.7) range 10 to 16 years. All participants completed a set of standard measures: Modified Child Dental Anxiety Scale(MCDAS), Child Fear Survey Scedule-Dental Subscale (CFSS-DS) and Fear Hierarchy. Twenty-five participants completed a semi-structured interview to elicit anxious cognitions. The fear hierarchy and cognitions were categorised based on the literature. This fear categorisation system is abbreviated C.H.U.M.P.S. It categorises anxious thoughts as: catastrophe, hostility, fear of the unknown, mistrust, pain and specific stimuli. Results: The cognitions interview and fear hierarchy reveal similar but additional information to that provided by the MCDAS and CFSS-DS. Results of the Fear Hierarchy and semi-structured interview revealed higher anxiety was associated with more frequent reporting of fear of the unknown, catastrophe, pain and mistrust. Results of the semi-structured interview revealed the mean number of thoughts reported per participant was 4.4 (SD=3.5). The categorisation of thoughts using the C.H.U.M.P.S. system revealed thoughts distributed actoss all categories. Thirty-one of the 111 thoughts (33%) were associated with pain. Pain, catastrophe, hostility and fear of the unknown are not represented in the MCDAS or CFSS-DS. Conclusions: We conclude that the assessment of children with dental anxiety using the MCDAS or CFSS-DS only, may be incomplete. A more thorough assessment of child dental anxiety is provided by eliciting cognitions. Development of a child dental cognitions questionnaire would provide a more accurate and expedient assessment of dental anxiety.