Children's Fear Survey Schedule Research Articles

Concordance of Fathers and Mothers in the Assessment of Their 5-Year-Old Child's Dental Fear.

The aim of this study was to evaluate the concordance of parents' assessments of their child's dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children's Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother-father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen's Kappa coefficients were used in the analyses. The concordance of parents' assessments was poor (Kappa range 0.072-0.258). The majority of parents replied "No Experience" to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child's fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent's assessment, and whether or not the child has experience with the question asked should also be considered.

Change in oral health-related behaviours of children before and after dental treatments under general anaesthesia.

This study evaluated the behavioural changes pertaining to children's oral health before and after the dental general anaesthesia (DGA), with particular focus on the factors associated with these changes. The records were collected for the children who received DGA from July 2015 to November 2016, and relevant questionnaires were obtained from their parents/guardians for the information prior to and after the DGA. The questionnaire included Early Childhood Oral Health Impact Scale (ECOHIS) and Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) to investigate the changes in Oral Health-related Quality of Life (OHRQoL) and dental fear. The DGA impact on children's oral hygiene habits and oral health-related behaviours was assessed by analysing the data. The chi-square test and Mann-Whitney test were employed to evaluate the differences. Total of 141 patients (89 before DGA and 77 after DGA, 25 being common) participated in this study. There were 60 children below 5 years and 29 over 5 years before DGA, while 41 children below 5 years and 36 over 5 years after DGA. Most parents/guardians were educated above undergraduate level (59.6% before DGA, 55.8% after DGA). More children lived with grandparents (61.8% before DGA, 54.5% after DGA) than only with parents (20.2% before DGA, 26.0% after DGA). In total, 73.0% (65/89) children before DGA brushed teeth more than twice a day. This proportion increased to 90.9% after DGA (70/77, p = 0.03). The eating difficulty decreased after DGA according to ECOHIS (p = 0.01). CFSS-DS score also decreased after DGA (p < 0.05). After DGA, children's oral hygiene habits and oral health-related quality of life (OHRQoL) improved, children fear for dental treatment decreased, and parents became more attentive towards children oral health.

Assessment of Dental Fear and Anxiety in Children Undergoing Nitrous Oxide-Oxygen Inhalation Sedation visiting BPKIHS

Introduction: Dental treatment of children is the most needed service that remains neglected because of a lack of skill to manage dental fear and anxiety (DFA). Both the non-pharmacological and pharmacological behavior management continuum should be followed to treat children. Objective: To assess and compare DFA levels in children before and after dental treatment using nitrous oxide-oxygen inhalation sedation (NOIS), to assess and compare the change in behavior in children undergoing NOIS, and to compare the level of DFA in children undergoing invasive and non-invasive dental treatment. Methods: DFA was measured using the Children's Fear Survey Schedule Dental Subscale (CFSS-DS), Modified Child Dental Anxiety Scale (MCDAS), and Facial Image Scale (FIS) before and after the dental treatment under NOIS. The change in children’s behavior during invasive and noninvasive treatment under NOIS was assessed by Frankl Behavior Rating Scale (FBRS). Results: A significant reduction in DFA was seen within each cohort as measured by 3 scales: CFSS-DS, MCDAS, and FIS (P≤0.001). There was also a positive change in behavior of children during the time of dental treatment under NOIS as measured by FBRS. However, there was no significant difference between invasive and non-invasive treatment groups with regard to DFA. Conclusions: Minimal sedation provided by NOIS significantly reduced DFA in children, and there was a positive change in their behavior during the time of treatment. NOIS was effective in decreasing DFA in both invasive and non-invasive dental treatment.

The impact of fear and psychopathological symptoms on neural responses to naturalistic stimuli in adolescents

The presentation of real-world images can swiftly engage processing mechanisms within specific brain regions and neural pathways. In this study, we explore the effects of fear and psychopathological symptoms on neural processing of realistic stimuli during a free viewing naturalistic task in a sample of adolescents (11–16y). Thirty-one participants performed an experimental task consisting of the visualization of animal pictures according to three conditions - Snakes, Spiders, and Dogs - during EEG recordings. Dimensions of fear and psychopathological symptoms were previously assessed through The Fear Survey Schedule for Children- Revised and the Brief Symptom Inventory. Earlier and later visual processing was analyzed through ERP components’ peak amplitudes. The results show a robust effect of psychopathology-related dimensions in the visual processing of naturalistic images, suggesting an increase of neural activity at later stages of visual processing (at the N200 time window) in symptomatic adolescents, corroborating the role of psychopathological symptoms in modulating neural responses to naturalistic images, and also guiding clinicians by providing additional data on how symptomatic adolescents perceive and process reality.

An Interactive Augmented and Virtual Reality System for Managing Dental Anxiety among Young Patients: A Pilot Study

Dental anxiety is a common health problem among children. It creates major issues for patients, parents, and dental professionals. Children who cancel or otherwise miss their dental appointments generally do so due to fear of the unknown and lack of understanding of what they can expect from the environment and treatment when they arrive there. Some distraction interventions are already used by dental professionals, such as using clown doctors, watching cartoons, and utilizing the tell–show–do (TSD) technique. Still, the problem is common, and the fail to attend (FTA) rates at clinics are high. Familiarizing children with the dental setting and procedures in advance may help to manage their anxiety. This paper aims to help in managing children’s dental anxiety in a simple, attractive, and age-appropriate way through the use of augmented reality (AR) and virtual reality (VR) technologies. The developed system is named “Dr. Barea”. It targets Arabic-speaking children aged from 7 to 10 years old. It uses model–view–control (MVC) as its architectural design pattern. The proposed solution consists of three main sections: a 360° VR video that simulates a dental clinic environment, an educational description on dental tools using AR technology, and interactive educational stories that educate children about dental hygiene. The system performance was evaluated using unit, integration, performance, and user acceptance testing. The results demonstrate that the proposed solution, which performed reasonably, achieved the usability requirements and was engaging for learning information about dental hygiene. A feasibility study with 16 children was conducted to evaluate the effectiveness of the proposed system. The Child Fear Survey Schedule—Dental Subscale (CFSS-DS) was used to measure children’s dental anxiety level. The T test was used to evaluate the differences between groups, and Fisher’s exact test was used to compare the distributions of gender and age between the groups. The CFSS-DS index in the VR group decreased after dental consultation (35.04 ± 9.14 before consultation and 32.32 ± 8.32 after consultation, p = 0.041). The implications of this study shall be beneficial to patients, parents, and dental professionals.

The prevalence and influencing factors of gag reflex in children aged 7-14 years in the dental setting.

Gag reflex may occur in patients of all ages and often considered having a multifactorial aetiology. The aim of the study was to evaluate the prevalence and influencing factors of gag reflex in Turkish children aged 7-14 years in the dental setting. This cross-sectional study was carried out among 320 children aged between 7 and 14 years. First, an anamnesis form which include sosyodemographic status, monthly level of income, children past medical and dental experiences was filled by mothers. Children's fear levels were evaluated using the Dental Subscale of Children's Fear Survey Schedule(CFSS-DS) while mother's anxiety levels using the Modified Dental Anxiety Scale(MDAS). The revised dentist section of gagging problem assessment questionnaire (GPA-R-de) was used for both children and mothers. Statistical analysis was done with SPSS program. The prevalence of gag reflex among children was 34.1%, among mothers was 20.3%. The association between child and mother gagging was found statistically significant (χ2 =53.121, p < 0.001). When the mother of the child gagged, the risk of child gagging increases 6.83 times (p < 0.001). Higher CFSS-DS scores of children increase risk of gagging (OR=1.052, p=0.023). Children who were previously treated mostly in public hospitals significantly more likely to gag compared with private dental clinics (OR=10.990, p < 0.001). It was concluded that negative past dental experiences, previous dental treatments with local anaesthesia, history of hospital admission, number and place of previous dental visits, dental fear level of children, and low education level and gagging of mother have an influence on the gagging of children.

Gender differences in children’s fears: A meta-analysis study

ABSTRACT Children’s fears have received scholarly attention for well over 50 years. A considerable amount of literature has focused on such fear variables as fear intensity and fear prevalence scores and age and gender differences. We used meta-analysis to systematically review the findings related to gender differences in children’s fear intensity scores and fear prevalence scores and to examine the moderator effect of sample, year of study, and type of instrument on gender differences. Research studies that used the Fear Survey Schedule for Children (FSSC) or an updated version of the FSSC, were included in this meta-analysis. The findings from 58 intensity and 17 prevalence studies suggest that females have 11.4% higher total fear scores than males and females have 7.2% more fears than males. Results of sub-group analyses indicate that moderator variables of sample, year of publication, and type/version of FSSC cause significant variability in gender differences.

Reliability and Validity of the Dental Anxiety Question Used With Children.

Dental fear screening is an important part of providing a positive pediatric dental experience. To improve efficiency, the development of a single-item dental fear assessment tool for children has been desired. In this psychometric analysis, the reliability and validity of the Dental Anxiety Question (DAQ) is studied when used in children aged 7 to 18 years. Participants completed the DAQ (pre-tx-DAQ), the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and a demographic information questionnaire before treatment. Participants repeated the DAQ after treatment (post-tx-DAQ) and once more at least 2 weeks later (follow-up-DAQ). Stability reliability within the DAQ scores and criterion validity with the CFSS-DS were evaluated. Stability reliability analyses between pre-tx-DAQ/post-tx-DAQ and post-tx-DAQ/follow-up-DAQ demonstrated significant positive correlations: Spearman rank correlation coefficient (rs) = 0.420, rs2 = 0.18, P &lt; .001, and rs = 0.563, rs2 = 0.32, P &lt; .001, respectively. Criterion validity analysis between the pre-tx-DAQ and CFSS-DS also demonstrated a significant correlation: Pearson correlation coefficient (r) = 0.584, r2 = 0.34, P &lt; .001. The stability reliability and criterion validity of the DAQ was proved among children.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient.

Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients. Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety. Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

Dental fear and its related factors among patients managed in a paediatric dental clinic of a university hospital in Tanzania

Objective: This study aimed to determine the prevalence of dental fear and its related factors among patients managed in a pediatric dental clinic of a university hospital in Tanzania.&#x0D; Material and Methods: This was a cross-sectional study carried out at the paediatric dental clinic of the Muhimbili University of Health and Allied Sciences(MUHAS) between November 2018 and April 2019. It included all paediatric dental patients aged between 6 and 12 years. A questionnaire used in this study captured information regarding patient's socio-demographic characteristics and the number of previous visits to the dental clinic. A fifteen-item Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) was used to assess the dental fear status in these pediatric patients.&#x0D; Results: A total of 223 paediatric dental patients aged between 6 years and 12 years were included in the study. The mean age of participants was 9.52 ± 1.74 years with a male to female ratio ofl: 1.04. The means CFSS-DS score was 31.1 ± 8.57. Fear scores were high for Injections (3.37 ± 1.13), a stranger's touch (2.81 ± 1.08) and choking (2.69 ± 0.99). The presence of dental fear was found to be significantly associated with the parents' education level (p=0.001) and previous dental visits (p &lt; 0.001 ).&#x0D; Conclusion: The results of this study suggest that the prevalence of paediatric dental fear was low among the participants of this study. The education level of parents and previous dental visits were determinants of dental fear in children. Injections, being touched by strangers, and choking were the common fear-provoking factors.

A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth extraction: A randomized clinical trial.

IntroductionBehavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety.MethodsThe aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS‐DS), Wong‐Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness.ResultsCFSS‐DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p = .02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p = .015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p = .35, p = .305).ConclusionThe use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness.

&lt;strong&gt;The relationship of the formation of dental fear between mothers and their 7 to 9 year-old children&lt;/strong&gt;

Introduction: Dental fear is a common occurrence that responds to the stress induced by various dental procedures. Its intensity varies from nervousness and anxiety to dental phobia, and it is considered the main barrier to successful completion of treatment. This research aims to analyse the relationship of the formation of dental fear between mother and their 7 to 9-year-old children. Methods: The research design was analytical studies with a cross-sectional survey technique, with samples chosen by the simple random sampling method. Thirty-five mothers and children aged 7-9 years who attended Neglasari 2 and Neglasari 5 Public Elementary School, Sadang Serang, Bandung, were the respondents. This study used a questionnaire called the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS), tested and proven to be a reliable and valid psychometric instrument for dental fear evaluation in children in Bahasa Indonesia. This study was analysed using Spearman's rank correlation coefficient. Results: The mean score of the mothers was 24.314, and the mean score of the children was 23.571. The correlation value was 0.765. The figure scales in the 'strong' criteria. Conclusion: There is a strong relationship between the formation of dental fear in mothers and their 7-9 years-old children.

Children’s Behavior toward Tooth Extraction: Comparison of Age, Chief Complaint, Method of Anesthesia, Dental Fear and Dental Anxiety with Level of Cooperation

Aim: To compare children’s behavior toward tooth extraction taking into account their gender, age, chief complaint, method of anesthesia, presence of dental fear and dental anxiety. Methodology: This cross sectional descriptive study was conducted at the Department of Maxillofacial Surgery, Nishtar Institute of Dentistry, Multan, Pakistan, from June 2021 to November 2021. The Wright’s Clinical Classification and Children's Fear Survey Schedule Dental Subscale (CFSS-DS) were used respectively to assess the degree of cooperation and presence of dental fear anxiety (DFA) toward tooth extraction. Data was analyzed using SPSS 22. Results: Female children 167 (65%), age group of 7-8 years 83(98%), children presented with loose tooth 120 (66%), children received Inj. lignocaine 2%, 152 (70%) and children diagnosed with dental fear and anxiety 406(82%) showed uncooperative behavior toward tooth extraction. Chi squared test showed that gender (p=.01), age (p=.01), chief complaint (p=.04), method of anesthesia (p=.01), dental fear and anxiety (p=.01) were significantly associated with children’s level of cooperation toward tooth extraction procedure. Conclusion: Invasive procedure like tooth extraction brought out negative behavior hampering level of cooperation in pediatric dental treatments.

The effect of socioeconomic aspects and dental history on pediatric patients' dental anxiety.

This study aimed to characterize the profile of dental anxiety in pediatric patients, identifying the effect exerted by socioeconomic factors using dental data. A cross-sectional study design with a sample of 120 children aged 7-12 years old was used. Data relating to anxiety levels prior to dental care, socioeconomic aspects (family income, education level, child's school type), and child's dental history (previous dental appointments, previous treatment, caries experience) were collected. Additionally, participants completed the Brazilian version of the Children's Fear Survey Schedule- Dental Subscale (B-CFSS-DS) to assess dental anxiety. Descriptive analyses, chi-squared (X 2 ) tests, and Mann-Whitney U tests were performed, with a significance level of 5%. A total of 51 boys (42.5%) and 69 girls (57.5%) were included. There was no significant difference in dental anxiety between them. However, younger children had higher mean B-CFSS-DS scores (p = 0.036, Mann-Whitney). A higher prevalence of dental anxiety was found in participants from low-income families (p = 0.012, X 2 ) and in patients who did not receive endodontic treatment (p=0.034, X 2 ). Higher mean B-CFSS-DS scores were also observed in participants who did not receive endodontic treatment (p=0.001, Mann-Whitney) compared with those that did receive endodontic treatment. No relationship was found between education level, patient school type, first dental appointment, caries experience, and dental anxiety data. Younger children presented a profile of greater dental anxiety. Socioeconomic factors and dental data exerted some effect on dental anxiety, where children from low-income families and those not subjected to endodontic treatment displayed higher rates of dental anxiety.

Evaluation of the mother's anxiety and child's fear in two different age groups in the child's first and second dental visit.

The study aimed at evaluating the mother's anxiety and a child's fear of first and second dental visits in two different age groups. The cross-sectional study design consisted of a total of 100 mother-child pairs attending Pediatric Dental clinics was included in the study. Group I consisted of 50 mother-child pairs of 6-8 years of age. Group II consisted of another 50 mother-child pairs between 12-15 years of age. Short Form of the Dental Subscale of the Children's Fear Survey Schedule (DFSS-SF) was administered to the child. Corah's Dental anxiety scale was administered to the mother. The Tell-Show-Do (TSD) technique was used in all children before the treatment. SPSS software 21 was used for descriptive and inferential statistics. Pearson's correlation coefficient was used for bivariate correlation between variables in the study. The anxiety level of mothers on both appointment days in both age groups was found to be highly significant. The correlation of maternal anxiety to the gender of the child in both groups was found to be highly significant. The fear of dental treatment was commonly found in children irrespective of gender in both age groups. The TSD technique was found to reduce fear in the subsequent appointment.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE.

There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

The relationship between dental fear and cooperation of children during dental treatments with their parents’ general health

Objective: Dental fear is a common phenomenon in children and parents can have a key role in the development of child's dental anxiety. There is moderate evidence to support the relationship between the parental general health and children’s dental fear. The aim of this study was to investigate the relationship between dental fear and cooperation of children during dental treatment with the general health of parents.Methods: This cross-sectional descriptive study was done on 130 children aged 6 to 12 at the Department of Pediatric Dentistry, Guilan University of Medical Sciences from May to September 2020.The personality traits and general health of parents were assessed by using the General Health Questionnaire (GHQ-28). The Frankl's behavior rating scale and Children's Fear Survey Schedule Dental Subscale (CFSS-DS) were used to respectively assess the degree of cooperation during dental practices and children’s dental fear. Statistical approaches included T-test, Chi-square and Pearson Linear correlation. A significant level of differences was taken as P&lt;0.05.Results: 69.3 % of children behaved positively and definitely positively during dental treatment. 56 boys and 74 girls with mean age of 9.13 ±2.02 years participated in this study. There was a significant correlation between the children's age with dental fear and cooperation level (P&lt;0.001). There was no significant difference in dental fear score (P=0.63) and cooperation level (P=0.99) between boys and girls. There was not statistically significant relationship between the general health of the parents and the level of children's cooperation and dental fear during dental treatment (P&gt;0.001).Conclusion: There was not relationship between parent's general health with children's dental fear and cooperation.

Evaluation of efficacy of computer-controlled local anaesthetic delivery system vs traditional injection system for minor pediatric surgical procedures in children

BackgroundOne of the biggest barriers to successful delivery of quality dental care to paediatric patients is fear related to injection of local anaesthetic. This study aimed to evaluate the efficacy of a computer-controlled local anaesthetic delivery (CCLAD) system when compared with a traditional anaesthetic injection. The two systems were compared with respect to reducing pain-related fear and anxiety. MethodsEighty children in the age group between 6 and 13 yrs requiring minor paediatric dental procedures on both sides of the dental arch were administered local anaesthesia using a CCLAD system and traditional injection system in two consecutive treatment sessions. The anxiety and fear related to the injection before and after the procedure was evaluated using Children's Fear Survey Schedule - Dental Subscale (CFSS-DS). The pain perception was evaluated using Wong-Bakers pain scale. ResultsThe percentage wise distribution of pain rating as filled out by the subjects after being administered the local anaesthesia using CCLAD system, and the conventional injection system showed that pain levels experienced by the subjects was lower with the CCLAD injection system than with the conventional injection system. The comparison of CCLAD and conventional groups pretest and post-test CFSS-DS scores showed significantly lower values for CCLAD group indicating lower anxiety levels. ConclusionThis study showed that the CCLAD system could be an useful alternative in administration of local anaesthesia. However, its effectiveness could be tested when used in highly anxious children. The disadvantages of CCLAD systems is that it requires a longer time during administration and cost.

A Novel Mobile App Intervention to Reduce Dental Anxiety in Infant Patients.

Introduction: Anxiety and fear are feelings routinely associated with the dental experience, especially in childhood and adolescence. These have been prominent in the world for many years and are currently considered a public health issue. Since the young population is an assiduous user of virtual inputs, it was sought to develop a mobile application (app) with the function of reducing the levels of dental anxiety in children before dental treatment and evaluate its effectiveness. Materials and Methods: An app, entitled "Hello, Dentist!", containing dental anticipation videos, was developed by a multidisciplinary team and evaluated. This app was tested in two children groups (dental and school settings), aged 6-10 years. Children and caregivers answered sociodemographic questions. In addition, to measure children's dental anxiety, they completed the Children's Fear Survey Schedule before and after app utilization. Control groups were utilized. A total of 100 children were included in this study. Results: Anxiety levels were statistically lower in the groups using the app when compared with their control groups (p < 0.05). The effectiveness in reducing anxiety was greater when the initial anxiety values were higher, as seen in the dental environment group (p = 0.029). Dental procedures previously experienced, as well as the environment (dental or school) in which children were inserted, were factors that influenced their initial anxiety levels. Conclusions: The creation and utilization of an app to reduce dental anxiety are feasible and effective. The app developed decreased children's anxiety, especially in the dental setting, by anticipating dental situation.

Reliability and validity in Mexico of the Spanish version of the Children's Fear Survey Schedule - Dental Subsca.

Low attendance and abandonment of dental treatment caused by dental fear varies from 6% to 20%. Various specific scales have been used to evaluate and measure dental fear, like Children´s Fear Survey Schedule - Dental Subscale, which is considered the "gold standard", due to its efficacy and validity. However, not all the studies that have been conducted have performed the Exploratory Factorial and Confirmation Analysis to infer the validity of the scale's content, which is why this study has as its main objective to analyse the confidentiality and validation of this scale. In a sample of 163 school age children, from 6 to 12 years old, of both genders, from a public school, a Children's Fear Survey Schedule - Dental Subscale was applied to measure dental fear. The internal consistency of the scale was estimated with the Cronbach's alpha, we also performed the Exploratory Factorial Analysis with the method of the main component with Varimax rotation and the Confirmatory Factorial Analysis to confirm the structure of the factors. The Cronbach's alpha was obtained with a .837 (p?.05). The adequate coefficients were determined with the Kaiser-Meyer-Olkin (KMO = .843) and the Bartlett's test of specificity (?2 = 565,325, p= .000), in which there was a good adequate data, expressing an appropriate and intercorrelation between items or strongly related. The factorial structure showed four factors extracted, 4 factors explain the 53.57% of the accumulated variation; 14 items were above the .40. The statistics of the second and third model obtained adequate values in the statistics of goodness of fit index. The Mexican version of the CFSS-DS in the present study gives us data about the adaptation and validation of the dental fear scale of CFSSS-DS by the Exploratory Factorial Analysis through a model of structural equations. This means that this instrument is a trusting and valid tool to measure dental fear in the children's population of Mexico.