Dental Fear in Children: Association with Dental Caries and Molar Incisor Hypomineralization.

Isla Camilla Carvalho Laureano,Liege Helena Freitas Fernandes,Catarina Ribeiro Barros De Alencar,Alessandro Leite Cavalcanti,Franklin Delano Soares Forte,Daniela Rios Honório,Lunna Farias

doi:10.1590/0103-6440202003880

Abstract

The aim of this study was to investigate the prevalence of dental fear and to evaluate its association with dental caries and molar incisor hypomineralization (MIH) in schoolchildren aged 8-10 years from a municipality in Northeastern Brazil. Data from 466 students enrolled in urban public schools in a cross-sectional study were collected. Parents/guardians answered a questionnaire addressing sociodemographic characteristics, dental fear was measured by means of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and clinical examinations were performed by three calibrated examiners for diagnosis of dental caries, using the International Caries Detection & Assessment System - ICDAS II and a previously validated index for MIH. Descriptive data analysis was performed, and associations between dental fear, dental caries and MIH were analyzed using robust Poisson regression for complex samples (p<0,05). The prevalence of dental fear was 21.6%, and the mean total CFSS-DS score was 29.97 (CI 95%=29.05-30.89). In the multivariate adjusted model, the prevalence of dental fear was associated to family income (PR=1.78; CI 95%=1.02-3.08; p= 0.041). Monthly family income was associated with dental fear in children, whereas dental caries and MIH were not associated with dental fear.

Highlights

Dental fear is an amplified physiological, behavioral and emotional reaction to one or more threatening stimuli in dental practice (1)
There is a wide variation in the prevalence of dental fear worldwide identified with rates ranging from 2.4% in study conducted in the Netherlands (2), to 66.0% in São Paulo, Brazil (3), and the use of different methodologies for measuring fear, application in different age groups, and different cultural parameters may be responsible for these variations (4)
In children with molar incisor hypomineralization (MIH), the risk of developing fear, anxiety and behavioral problems may be increased (9,10), because MIH is associated with many dental problems such as dentin hypersensitivity, rapid development of carious lesions and need for recurrent dental treatment (9,10), as well as dental pain (10,11) and difficulties in obtaining adequate anesthesia (9)

Summary

Introduction

Dental fear is an amplified physiological, behavioral and emotional reaction to one or more threatening stimuli in dental practice (1). In children with molar incisor hypomineralization (MIH), the risk of developing fear, anxiety and behavioral problems may be increased (9,10), because MIH is associated with many dental problems such as dentin hypersensitivity, rapid development of carious lesions and need for recurrent dental treatment (9,10), as well as dental pain (10,11) and difficulties in obtaining adequate anesthesia (9). These findings led to the idea of a vicious cycle of fear, in which individuals highly affected by dental fear delay treatment, which leads to the development of more complex diseases, which possibly require more invasive and potentially painful treatments, reinforcing or increasing the level of fear (12). Identification of dental fear in children is essential so that it can be controlled or reduced, and dental treatment can be effective (13)

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