Psychometric Properties of the Faces Version of the MCDAS

Objectives: To evaluate the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDAS_f) in 5-6 and 9-11 year-old Malaysian children. Method: Three studies were conducted. In the Study 1, to determine test-retest reliability of MCDAS_f scale, 166 preschool children aged 5-6 years were asked to rank orders five cartoons faces depicting emotions from ‘very happy’ to ‘very sad’ faces on two separate occasions 3 weeks apart. A total of 87 other 5-6 year-old children completed the MCDAS_f  on two separate occasions 3 weeks apart to determine test-retest reliability for Study 2. In study 3, 239 schoolchildren aged 9-11 years completed the  MCDAS_f and the Dental Subscale of the Children Fear Survey Schedule (CFSS-DS) at the same sitting to determine the criterion validity. Results: In study 1, Kendall W test showed a high degree of concordance in ranking the cartoon faces picture cards on each of the 2 occasions (time 1, W=0.955 and time 2, W=0.954). In study 2, ‘dental general analgesia’ and ‘relative analgesia’ items were omitted. The MCDAS_f demonstrated moderate test-retest reliability (Pearson correlation coefficient, r = 0.462, p < 0.001) and acceptable internal consistency (Cronbach’s alpha, α1= 0.77, α2= 0.65). The highest MCDAS_f scores were observed for the items ‘injection’ and ‘tooth taken out’. The MCDAS_f significantly correlated with the CFSS-DS (r=0.65, p<0.001). Conclusions: These psychometric findings support for the inclusion of a cartoon faces rating scale to assess child dental anxiety and the MCDAS_f is a reliable and valid measure of dental anxiety in Malaysian children.