Fear Survey Schedule-Dental Subscale Research Articles

Prevalence of dental fear and its relationship with primary dental caries in 7-year-old-children

BackgroundChild's dental fear has been reported as one of the reasons that increase, aggravate dental diseases and facilitate other oral diseases. This study is aimed to describe the type and prevalence of dental fear and to assess the relationship between cavities of primary teeth and dental fear in 7-year-old children at Phulam Primary School, Hanoi. MethodsThe sample comprised of 132 children aged 7 years. The questionnaire examined the profile of participants and assessed their dental fear using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Children have “dental fear” when the total CFSS-DS score is greater than or equal to 38. By contrast, those without dental fear gain the total point which is less than 38. After completing the questionnaire, a dental examination was undertaken according to the International Caries Detection and Assessment System (ICDAS). ResultsThe prevalence of dental fear was 34.85%. Fear scores were highest for “Dentist drilling” (2.92 ± 1.47) and “Injections” (2.87 ± 1.53). In the univariate analysis, the odds of girls having dental fear were approximately equal to boys (OR = 0.98, 95% CI = −0.75-0.70). The odds of only children having dental fear were 1.6 times higher than others, but there were not significant. Dental fear was found to be no associated to sex, birth order and primary dental caries (p > 0.05). ConclusionOur findings demonstrated the status of 7-year-old children's dental fear at Phulam primary school, and found that primary dental caries had no correlation with child dental fear score.

The psychometric properties of the CFSS-DS for schoolchildren in Saudi Arabia: A confirmatory factor analytic approach.

To test the psychometric properties of an Arabic version of the Child Fear Survey Schedule-Dental Subscale (CFSS-DS) a using confirmatory factor analysis. Two convenience samples were obtained: Sample [1]: 600 boys (33%) and girls attending 4 public schools in Onizah and Sample [2] 800 girls attending 8 public schools in Buridah. The questionnaire asked the participant's age, gender, and completion of the CFSS-DS. The data were subjected to exploratory factor analysis (EFA), parallel factor analysis, Cronbach's alpha, confirmatory factor analysis (CFA), and goodness of fit statistics. A total of 513 children in Sample [1] and 503 children in Sample [2] participated giving a valid response rate of 86% and 67%, respectively. From the EFA, 3 factors were identified and confirmed statistically using parallel factor analysis. The internal consistency of the 3 factors, Dental Fear Subscale (0.86), Hospital Fear Subscale (0.77), and Stranger Fear Subscale (0.71), was good. The CFA showed that the current EFA model was an equivalent fit to the El Housseiny etal (BMC Oral Health 2016;16:49). model; however, the solution using El Housseiny etal's structure was distorted. A 3-factor structure with acceptable reliability exists for this Arabic version of the CFSS-DS, confirmed by a CFA using an additional data set.

The prevalence of dental anxiety and fear among 4-13-year-old Nepalese children.

The aim of the study was to assess the prevalence of dental fear and anxiety among children aged 4-13 years using three fear scales, i.e., facial image scale (FIS), Nepalese version of Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and Modified Child Dental Anxiety Scale (MCDAS). The study was conducted on 300 children (4-13 years) who visited the Department of Pedodontics and Preventive Dentistry. The fear and anxiety levels were measured using three fear measurement scales, i.e., FIS, Nepalese version of CFSS-DS, and MCDAS. The dental behavior observed was rated according to the Frankl's Behavior Rating Scale (FBRS). The prevalence of dental fear according to FIS was 11.9% as evident from children having FIS 4 and 5 scores. Dental fear with CFSS-DS ≥38 was identified in 49 children (21 [12.5%] male and 28 [21.21%] female). In assessment of the behavior of children in the clinics through FBRS, it was observed that the maximum number of respondents (70.6%) showed Frankl's rating 3, i.e., positive. The Nepalese versions of the CFSS-DS and the MCDAS are both reliable and valid scales for evaluating dental anxiety and fear in young children. Assessing dental anxiety and fear is useful, as behavior management can be designed accordingly for child patients.

Effects of Familial Characteristics on Dental Fear: A Cross-sectional Study

Dental fear (DF) in children is a multifactorial problem that may affect the child's dental treatment and behavior at the dental office. This study aimed to evaluate the familial characteristics affecting DF among Arabic-speaking 12- to 15-year-old children in Jeddah, Saudi Arabia. A cross-sectional study assessing 16 middle schools in Jeddah, Saudi Arabia, was performed through multistage stratified random sampling. DF among children was measured using the children fear survey schedule-dental subscale (CFSS-DS) questionnaire. A parental questionnaire was used to collect information regarding familial socioeconomic status, parental DF, and DF among siblings and friends. The data were analyzed using the t test, one-way analysis of variance (ANOVA), and multiple linear regression analysis. A total of 1,522 children were included. Socioeconomic variables were not associated with DF among children. Parental DF, parental dental experiences, siblings' DF, and friends' DF were significantly associated with DF in children. In the regression analysis, mothers' anxiety at the last dental visit, siblings' DF, and friends' DF were significant predictors of DF among children. DF in children is associated with mothers' anxiety during their last dental visit and DF in siblings or friends. Obtaining comprehensive dental, family, and social history from patients is as essential as asking about medical history for pediatric dentists to plan the most appropriate and effective behavioral management techniques for their pediatric patients. Understanding the etiology of DF assists clinicians to provide better oral health services for their fearful patients.

Dental fear and its determinants in 7-11-year-old children in Tehran, Iran.

To assess dental fear and its determinants in 7-11-year-old children. In this cross-sectional (descriptive-analytical) study, the standard Persian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire was completed by 240 parent-child (children aged 7-11years) pairs referred to dental clinics in Tehran city, Iran. Background characteristics were also inquired. An equal number of boys and girls participated in the study. The mean score of fear among the children was 21.66 ± 8.33. The causes of fear among the children were, first, injection, and then, seeing the dentist's drill, choking feeling, and finally, filling the tooth. There was a significant correlation between the scores of children's dental fear and their experience of meeting with the dentist (p = 0.001). The result of the regression test showed that the age of the children (p = 0.022) and high levels of dental fear among their fathers (p < 0.001) was related to high levels of dental fear among the children. The present children revealed a moderate level of dental fear. Taking children's age into account in behavioural management and challenging father's fear seemed to play a key role to reduce the child's fear and prevent its long-term consequences.

The long-term effect of previous dental treatment under general anaesthesia on children's dental fear and anxiety.

Dental treatment under general anaesthesia (DGA) is deemed to contribute to children's dental fear and anxiety (DFA), both in the short term and long term. To compare DFA between children who had previous DGA and those who did not. A cross-sectional survey included 5- to 12-year-old children who had undergone DGA (n=43) and a control group who had not (n=55). Questionnaires were completed by parents regarding sociodemographic and dental profiles. Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale (faces) (MCDASf) were completed by children. The mean age of the control group and the DGA group was 9.5±1.7 and 8.8±1.5years old, respectively (P>0.05). The time passed since DGA was experienced ranged between 1.2 and 6.9years ago (mean: 4.2±1.1years). The mean CFSS-DS and MCDASf scores for the DGA group (34.3 and 20.4, respectively) were significantly greater when compared to the control group (23.6 and 12.7, respectively) (P<0.001). Children who experienced DGA are a high-risk group for DFA several years after the procedure. The DGA status could be used for identifying anxious children to promote better behaviour management.

Hubungan kecemasan dental anak umur 7-11 tahun dengan indeks karies di SD Negeri 27 Pemecutan Denpasar Barat

Background: Early routine check up to dentist was one of the caries preventive measures, however there are still many people ignore about dental health and mouth because they feel anxious or fear of it. Method: This research is an analytic research by doing cross sectional approach. The respondent in this research are 95 children among 7-11 years at SD Negeri 27 Pemecutan in West Denpasar in 2016/2017 period. The samples was taken by using the stratified random sampling technique with the questioner entitled Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) as the measuring instrument which were already translated into Bahasa Indonesia and caries index to count the number of caries. Results: The result of this research shows that the respondent who had anxiety has DMF-T index with the higher median which is 2 with the interquartile range at 3 than other respondent who had no anxiety which is 0 with the interquartile range at 3 and that means statistically (p= 0.022). The respondent who had anxiety has def-t index with the higher median which is 5 with the interquartile range at 5 than the respondent who had no anxiety which the median is 2 with the interquartile range at 5 and that means statistically (p=0.001). Conclusion: Based on the result of this research, the writer can conclude that there is a relation which is significant with the children dental anxiety among 7-11 years with the caries index at SD Negeri 27 Pemecutan in West Denpasar.

Gagging prevalence and its association with dental fear in 4-12-year-old children in a dental setting.

The aims were to determine the prevalence of gagging in children in the dental setting, detect any association between gagging and dental fear in that setting, and determine if the association varied by type of setting. A total of 734 children (4-12years old), seeking dental care either at a University paediatric dental clinic (UC) or at a private paediatric practice (PP), filled out the Greek version of the Gagging Assessment Scale (GAS, subjective assessment) and the Greek version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The shorter form of the Gagging Problem Assessment-dentist part for children (GPA-de-c/SF, dentist's objective measurement) was used to assess their gag reflex. A total of 209 children (28.47%) gagged according to the GPA-de-c/SF. There was no significant difference in gagging between UC and PP children. Children rated as gaggers on the GPA-de-c/SF reported significantly higher GAS and CFSS-DS scores (U=33629.000; P<0.001, U=31955.500, P<0.001, respectively). Also, there was a significant association between GAS and CFSS-DS (rho=0.307, P<0.001). In the dental setting, there were significant relationships between dental fear, the dentist's objective measurement of gagging severity, and the child's subjective gagging assessment.

Is Dental Fear related to Clinical Consequences of Untreated Dental Caries in Children?

Purpose: To explore correlation between dental fear and consequences of untreated dental caries in children. Methods: Assessments of dental fear using Children’s Fear Survey Schedule-Dental Sub-scale, dental caries using decayed, missed and filled teeth index and consequences of untreated dental caries using pufa/PUFA index. Children (n= 250) were selected from clinics of Pediatric Dentistry and Dental Public Health Department, Cairo University. Results: Prevalence of pufa/PUFA>0 was 84.8% and 11.2% respectively. Mean score of pufa/PUFA was 3.83 and 0.20 respectively. Positive significant correlation between fear and dmft (primary dentition) was noted (P=0.003). Whereas, a negative significant correlation between fear (CSFSS-DS) and PUFA (permanent dentition) was revealed (P=0.021). On the other hand, no significant correlations between fear and pufa (primary dentition) (P=0.073) as well as DMFT (permanent dentition) were found (P=0.919). No significant association was noted between fear scores, gender and age. Conclusion: fear may have an impact on scores of caries and its consequences.

The Reliability and Validity of the Three Modified Versions of the Children's Fear Survey Schedule-Dental Subscale of 9-12 Year Old Children in a Clinical Setting in Bosnia and Herzegovina.

This study sought to obtain a comprehensive, reliable and valid instrument for evaluation of the presence of dental fear and anxiety (DFA) in children, through evaluation of the reliability and validity of three modified versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The study sample comprised children aged 9, 10, 11 and 12 years. The first sample group (200 patients) filled in a modified version of the CFSSDS scale, the second sample group (100 patients) filled in a short form of the Dental Fear Survey Schedule, and the third sample group (100 patients) filled in a short version of the CFSS-DS scale, prior to dental treatment, respectively. In order to determine test-retest reliability, the 184 patients from the first sample group filled in the modified version of the CFSS-DS scale again, prior to their next scheduled dental appointment. The modified version of the CFSS-DS scale had the best internal consistency reliability (α=0.907), as well as validity results, compared to the other two instruments used. Test-retest reliability was moderate (Intraclass correlation coefficient: 0.58). Of the three psychometric instruments used for evaluation of DFA presence in children, the modified version of the CFSS-DS scale showed the most clinically adequate reliability and validity values. This study thus provides a new psychometric instrument that should be considered for clinical use in evaluation of DFA presence in 9-12 year-olds, in a clinical setting sample type of children.

Children\u2019s dental fear and anxiety: exploring family related factors

BackgroundDental fear and anxiety (DFA) is a major issue affecting children’s oral health and clinical management. This study investigates the association between children’s DFA and family related factors, including parents’ DFA, parenting styles, family structure (nuclear or single-parent family), and presence of siblings.MethodsA total of 405 children (9–13 years old) and their parents were recruited from 3 elementary schools in Hong Kong. Child’s demographic and family-related information was collected through a questionnaire. Parents’ and child’s DFA were measured by using the Corah Dental Anxiety Scale (CDAS) and Children Fear Survey Schedule-Dental Subscale (CFSS–DS), respectively. Parenting styles were gauged by using the Parent Authority Questionnaire (PAQ).ResultsDFA was reported by 33.1% of children. The mean (SD) CFSS-DS score was 29.1 (11.0). Children with siblings tended to report DFA (37.0% vs. 24.1%; p = 0.034) and had a higher CFSS-DS score (29.9 vs. 27.4; p = 0.025) as compared with their counterpart. Children from single-parent families had lower CFSS-DS score as compared with children from nuclear families (β = − 9.177; p = 0.029). Subgroup analysis showed a higher CFSS-DS score among boys with siblings (β = 7.130; p = 0.010) as compared with their counterpart; girls’ from single-parent families had a lower CFSS-DS score (β = − 13.933; p = 0.015) as compared with girls from nuclear families. Children’s DFA was not associated with parents’ DFA or parenting styles (p > 0.05).ConclusionsFamily structure (nuclear or single-parent family) and presence of siblings are significant determinants for children’s DFA. Parental DFA and parenting style do not affect children’s DFA significantly.

Development of the Turkish version of the Index of Dental Anxiety and Fear (IDAF-4C+): Dental anxiety and concomitant factors in pediatric dental patients.

The aim of this study was to develop the Turkish version of the Index of Dental Anxiety and Fear (IDAF-4C+) and also to explore factors associated with dental anxiety in clinical pediatric dental patients (PDPs). The study sample consisted of 421 PDPs aged 12-14, 104 of whom were selected for test-retest analysis. The psychometric evaluation included linguistic validity, exploratory factor analysis, reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intra-class correlation coefficient, ICC). Construct validity was tested by comparing a commonly used instrument, the Children's Fear Survey Schedule Dental Subscale (CFSS-DS). Associations between parental dental anxiety, frequency of dental visits, dental caries, dental visit behaviour and children's dental anxiety were also examined. The Turkish version of the IDAF-4C demonstrated good internal consistency (Cronbach's alpha α=.96) and test-retest reliability (ICC=.87). Factor analysis showed a fit IDAF-4C model with a single factor, 8 items. Dental anxiety scores were significantly correlated with all measured variables (p<0.001). Girls showed significantly higher dental anxiety scores than boys (p<0.05). This study suggests that the Turkish version of the IDAF-4C+ is a valid and reliable instrument for assessing dental anxiety and fear in Turkish children.

Effect of Dentists' Appearance Related with Dental Fear and Caries aStatus in 6–12 Years Old Children

The aims of this study were to determine the prevalence of dental fear, the relationship between dental fear and dental caries and the dentist appearance most likely to reduce anxiety among children. In this way, dental treatment could be made more effective by changing the dentist's appearance. The "Children's Fear Survey Schedule-Dental Subscale" and a questionnaire 'designed to examine the children's preferences for their dentist's appearance', were administered to 810 patients between 6-12 years of age. Patients were examined after completing the questionnaires, and their DMFT/dmft indexes were determined. Patients were divided into three subgroups according to their CFSS-DS scores. Among patients, anxiety scores differed significantly by age and gender (p=0.046, p=0.001). Specifically, higher anxiety scores were identified among 6- to 8-year-olds and in female patients relative to their respective counterparts. A statistically significant association between anxiety and dental caries was detected. (DMFT p=0.030/dmft p=0.015), and DMFT/dmft scores were found to be higher among patients with high levels of dental anxiety than among patients with low levels of dental anxiety. Additionally, children were highly perceptive of and exhibited strong preferences for the appearance of their dentist. Anxiety and dental caries were associated; small alterations in a dentist's appearance may reduce dental anxiety among children.

A Comparative Study to evaluate Parent's Ability to assess Dental Fear in their 6- to 10-year-old Children using Children's Fear Survey Schedule-Dental Subscale.

AimParental presence often provides unique challenge in dental operatory and is directly related to the quality dental treatment. The present study was done to investigate parent’s ability to assess dental anxiety of their 6- to 10-year-old child and to determine how parent’s and children’s fear assessments correlate with each other.Materials and methodsPrior to dental treatment, 94 child-parent combinations were included to complete Children’s Fear Survey Schedule—Dental Subscale (CFSS-DS) questionnaire, and Frankl score was assigned to children during treatment by operator.ResultsMean dental anxiety score reported by the children was 27.74, whereas by their parents was 39.64. There was a poor consistency of parents to predict their child dental fear (p < 0.05). Parents reported higher dental fear for their children.ConclusionParents assessment of their child’s fear may vary in accordance to factors, including their own dental fear. Such input may prevent dentists from establishing an accurate association with the child’s patient.How to cite this article: Malhotra R, Gandhi K, Kumar D, Ahuja S, Kapoor R, Sahni A. A Comparative Study to evaluate Parent’s Ability to assess Dental Fear in their 6- to 10-year-old Children using Children’s Fear Survey Schedule—Dental Subscale. Int J Clin Pediatr Dent 2018;11(3):205-209.

Reliability and Validity of the Modified Version of Children's Fear Survey Schedule-dental Subscale in 9-12 Years Old Schoolchildren in Bosnia and Herzegovina.

Background:Dental fear and anxiety (DFA) are present worldwide globally, as well as in children. These psychological clinical entities in its progressive phase lead to avoiding of dentists and dental appointments, and consequtive impairments of oral health. If we ignore these facts, we would have the strenghtening of this relationship in a way of further oral health impairments and lost of dental hard and soft tissues, as well as appearance of dental phobia as the most negative form of psychological reaction to dental stimuli. Original CFSS-DS scale and its modifications, as the most used instruments for evaluation of DFA presence so far, showed various disadvantages. These were the reasons why we wanted to design new psychometric instrument for better evaluation of DFA presence in children compared to evaluation which the existed scales could offer nowadays, in a form of the Modified Version of CFSS-DS scale (CFSS-DS-mod scale).Materials and methods:There were 809 schoolchildren from 8 cities of Bosnia and Herzegovina aged 9-12 years that participated in the study. There was one school per city where the schoolchildren answered to the questions from the CFSS-DS-mod scale.Results:636 schoolchildren correctly answered to the scale questions. The CFSS-DS-mod scale showed excellent internal consistency reliability values (with Cronbach α>0.9), and also validity results (mostly over 60% of explained variance of obtained results) with two-dimensional concept of DFA presence.Conclusion:The CFSS-DS-mod scale represents good psychometric instrument for evaluation of the DFA presence in 9-12 year old schoolchildren in Bosnia and Herzegovina. Some of normative values of this psychometric instrument should be determined, in order to expand its usage in children.

Dental fear in primary school children and its relation to dental caries.

Successful management of dental fear in children prevents its progression into adulthood. This study aimed to assess the level of dental fear among school children and to determine its relationship with dental caries. The study design was a cross-sectional analytical study. A sample of 1,546 primary school children were randomly selected. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was completed in class to assess child dental fear. Caries experience was measured as decayed, missed, and filled permanent and primary teeth (DMFT/dmft) according to the World Health Organization (WHO) criteria. Approximately 24% of the participated children had high dental fear, and 12.50% of them had severe dental fear. Girls had higher rate of severe dental fear than boys (20% vs. 5%). The severity of caries was significantly increased in children who had higher fear scores (P = 0.035). About one quarter of 6- to 12-year-old children had dental fear; about half of them had severe dental fear. Dental fear has a direct relationship with decayed permanent teeth and an inverse relationship with restored permanent teeth.

Dental anxiety and oral health-related quality of life in children following dental rehabilitation under general anesthesia or intravenous sedation: A prospective cross-sectional study.

The study aimed to investigate dental anxiety and oral health-related quality of life among children undergoing dental rehabilitation under general anesthesia (GA) and intravenous sedation (IVS). Participants were 99 healthy children aged 3-5 or 6-12 years operated under GA or IVS. Dental anxiety before treatment and 1 month postoperatively were measured using the Frankl behavior scale (FBS), the venham picture test (VPT), the early childhood oral health impact scale (ECOHIS), and the children's fear survey schedule-dental subscale (CFSS-DS). Data were analyzed using Student's t-test and Mann-Whitney U-test. ECOHIS scores decreased in all groups. VPT scores increased in the 3-5-year-olds treated under GA (P = 0.003). Postoperative CFSS-DS anxiety scores were lower in IVS groups. FBS scores were significantly higher for both age groups (P < 0.001). There was no effect of numbers of extracted or treated teeth. Dental rehabilitation under GA and IVS improved the quality of life and dental behavior. In the 6-12-year-olds, there was no statistically significant difference between children undergoing dental operations under GA and those undergoing dental operations under IVS. Dental anxiety decreased in 3-5-year-olds after treatment under GA but not after IVS.

Prevalence of Dental Anxiety and Associated Factors among Indian Children

Objective: To determine the prevalence of dental anxiety and associated factors among 5 to10 years old Indian children. Material and Methods: In this cross-sectional study, the sample was composed by 462 children (240 male and 222 female). Questionnaires consisting of dental anxiety scales were distributed to mother-child pair participants. Children fear survey schedule-dental subscale was used to assess child dental anxiety and Corah’s dental anxiety scale was used to measure maternal dental anxiety. Age, gender, religion were also recorded to check the correlation of these factors with the child dental anxiety. Data was analyzed using SPSS software. Fisher’s exact test and Pearson correlation tests were applied. The level of significance was set at 5%. Results: The cut-off score for CFSS-DS was 36. The prevalence of dental anxiety was 24.5% among 5 to 10 year old children. Although a statistically significant association was found between maternal and child dental anxiety (p=0.000), no significant association existed between age, gender, culture (religion) and child dental anxiety (p>0.05). Conclusion: Prevalence of dental anxiety was high in the Indian child population. Maternal dental anxiety was found to significantly influence the child dental anxiety, as compared to age, gender or the religion.

Application of a projective method for the assessment of children’s dental fear

The aims of this study were to assess children's dental fear by using a projective technique CDFP (Children’s dental fear picture test). 40 patients from a pediatric dental clinic, between 5-9 years old, took part in this study. At first, the CDFP was applied to the children. This method has three subtests and its overall assessment classifies children as "fearful, non fearful and uncertain". The children answered the CFSS-DS (Children Fear Survey Schedule–Dental Subscale). The results showed that CDFP has inter-examiner reliability and a significant correlation with the CFSS-DS was observed.

Treatment of intra-oral injection phobia: a randomized delayed intervention controlled trial among Norwegian 10- to 16-year-olds

Objective: To evaluate the effect of five sessions of cognitive behavioural therapy (CBT) for 10- to 16-year-olds with intra-oral injection phobia.Material and methods: This was a randomized delayed intervention controlled trial in 67 patients, fulfilling the DSM-5 criteria for specific phobia. All patients received the same CBT performed by dentists specially trained in CBT. The patients were randomly assigned to either an immediate treatment group (ITG) (34 patients) or a waitlist-control group (WCG) (33 patients). The WCG was put on a waitlist for 5 weeks. After treatment, all patients were combined for post-treatment analyses. Assessments including the psychometric self-report scales Intra-oral injection fear scale (IOIF-s), Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), Injection Phobia Scale for children (IS-c) and Mutilation Questionnaire for children (MQ-c) and a behavioural avoidance test (BAT) followed by a questionnaire on cognitions during the BAT, occurred pre-, post-treatment/waitlist and at a 1-year follow-up.Results: CBT had a significant effect compared to no treatment (WCG). After treatment, the scores on the psychometric self-report scales were significantly reduced and higher levels in the BAT were achieved. The results were maintained at 1-year follow-up. Of the 67 patients, 70.1% received intra-oral injections during CBT treatment, whereas 69.4% of those completing the CBT, in need for further dental treatment, managed to receive the necessary intra-oral injections at their regular dentist.Conclusions: The 10- to 16-year-olds diagnosed with intra-oral injection phobia benefitted positively on CBT performed by specially trained dentists.