Systematic Review of Dental Anxiety Scales used in Pediatric Dentistry

BACKGROUND: Dental Anxiety is usually assessed by self-report and specific scales. In Pediatric Dentistry, this is a challenge, since children rarely have the cognitive ability to demonstrate anxiety in words, and this could reflect sometimes in uncooperative behavior during dental treatment. OBJECTIVE: To assess the use of dental anxiety scales in Pediatric Dentistry. METHODS: PubMed Database was searched for articles. The limits chosen were: studies with children and adolescents (0 -18 years-old) and published after the year 2000. The key words used were ‘child' and ‘dental anxiety'. RESULTS: The literature search identified 363 articles. All these abstracts were screened, and 183 were identified and selected as containing information on dental anxiety investigations. The inclusion criteria were studies that aimed to measure dental anxiety of children and adolescents through scales. A total of fifty different scales were described. The most used scale was the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) - 31,7%, followed by the Venham's clinic anxiety rating scale (27,9%) and Frankl Behavior Scale (10,4%). Anxiety was measured by Corah Dental Anxiety Scale (DAS) in 8,7%, by a Visual Analog Scale (VAS) in 6,5% and by Spielberger State-Trait Anxiety Scale for Children (STAI) in 4,4% of the articles rated. CONCLUSION: Although the studies selected had the objective to analyze the anxiety of children and adolescents, the most used scale, CFSS-DS, was usually completed by their parents. DAS and VAS, scales that could be completed by a literate child, were used only by 15,2% of the studies. The fact that 50 different scales were found indicated that there is still no agreement on the best method for assessing childhood anxiety, which could discourage dentists to make this evaluation.