Fear Survey Schedule-Dental Subscale Research Articles

Haemodynamic response and psychometric test measuring dental anxiety in a spanish population in galicia.

To evaluate haemodynamic changes during dental checkups and preventive treatments and establish the relationship between haemodynamic parameters and psychometric tests. Seventy-one paediatric patients (39 boys and 32 girls ages 6 to 14 years, mean age 8.04) scheduled to receive dental procedures fulfilled the inclusion criteria for this prospective study. Anxiety was measured at three time points by using the following haemodynamic parameters: heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) and oxygen saturation (SaO2). The Children's Fear Survey Schedule Dental Subscale (CFSS-DS) and the Facial Image Scale (FIS) were used as psychometric tests before and after child attendance, respectively. Variations in HR and BP during dental procedures were statistically significant while SaO2 values were not. The highest mean HR, SBP and DBP values were obtained during dental procedures, while the lowest SBP and DBP were recorded at baseline. HR and BP changes (r = 0.32, P < 0.01) were statistically correlated. The most anxious children based on both CFSS-DS and FIS scales also had the highest mean HR. Changes in BP and oxygen saturation parameters were found to have no relationship with anxiety groups in either scale. Dental checkups and preventive treatments cause significant changes in HR and BP. However, the CFSS-DS questionnaire does not adequately predict these changes.

Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment.

ABSTrACTObjective: Objectives of our studies were to predict dental fear in a child patient depending on salivary alpha amylase (sAA) level before and after dental treatment and to evaluate correla­tion of later with behavior of child patient during dental treatment.Materials and methods: Seventy-seven children between age of 5 and 12 years were divided in three groups. Group 1 consisted of 25 school children who did not undergo any dental treatment. Groups 2 and 3 underwent dental treatment without and with local anesthesia respectively. Groups 2 and 3 were administered child fear survey schedule-dental subscale (CFSS-DS) questionnaire before treatment. Salivary samples were collected for sAA estimation in groups 2 and 3 children before and after completion of dental treatment and behavior during treatment was noted using Frankel behavior rating scale. Group 1 acted as control in which salivary sample was collected in absence of dental stress.Results: When groups 2 and 3 were combined, pretreatment sAA level had a statistically significant (p = 0.0094) correlation with CFSS-DS scores.Conclusion: Alpha amylase can be used as a screening tool to predict level of dental fear in a child patient.How to cite this article: Noorani H, Joshi HV, Shivaprakash PK. Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment. Int J Clin Pediatr Dent 2014;7(1):19-23.

Cognitive ability and dental fear and anxiety

Dental fear and anxiety (DFA), as well as dental behavior management problems, are common in children and adolescents. Several psychological factors in the child, and parental DFA, have been studied and found to correlate to the child's DFA. The aim of this study was to investigate the relationship between cognitive ability and DFA in a population-based group of children with identified behavior and learning problems. In conjunction with a dental examination at 11yr of age, 70 children were assessed with regard to DFA using the Children's Fear Survey Schedule Dental Subscale (CFSS-DS), and their cognitive ability was assessed using the Wechsler Intelligence Scale for Children. In addition, parental DFA was measured using the Corah Dental Anxiety Scale. The results revealed that DFA was significantly correlated to verbal intelligence quotient (IQ) but not to any other cognitive index. A significant correlation was found between parental DFA and child DFA. The results indicate that the child's verbal capacity may be one factor of importance in explaining dental fear in children.

Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale.

ABSTRACTFear of dental treatment in children has been recognized as a source of serious health problems and it may persist into adolescence, which may lead to a disruptive behavior, during dental treatment. In order to prevent this psychometric method namely the dental subscale of the children's fear survey schedule (CFSS-DS) is a well-known psychometric scale that was developed by Cuthbert and Melamed in 1982 for assessing dental fear in children. The present study was to evaluate dental fear in children during first dental visit using CFSS-DS between three different age group 4 and 6 years, 7 and 9 years, 10 and 14 years children to select fearful and nonfearful children from a larger reference population and to estimate the dental fear children. Total 600 children show CFSS-DS of 27.17 ± 5.3385, 307 were girls (51.17%) and they showed CFSS-DS of 27.50 ± 5.060 and 293 were boys (48.83%) and they show CFSS-DS 26.84 ± 5.617. This shows that there were no significant difference in fear between boys and girls. In 4 to 6 years show total CFSS-DS 28.78 ± 5.742, 7 to 9 years show that mean and standard deviation of CFSS-DS 27.81 ± 4.783, 10 to 14 years show that mean and standard deviation of CFSS-DS 25.93 ± 5.586. Fear scores were highest for ‘injections', ‘choking', ‘noise of dentist drilling', ‘dentist drilling which was not significant between boy's and girl's but item, ‘having somebody look at you’ showed that significant differences in fear scores between boys and girls in present study. The present study concluded that dental fear decreased as age increased. Total fear scores also exhibited no strong overall sex difference or age by sex interaction. d> Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V. Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 2013;6(1):12-15.

Emotional contagion of dental fear to children: the fathers’ mediating role in parental transfer of fear

Dental fear is considered to be one of the most frequent problems in paediatric dentistry. According to literature, parents' levels of dental fear play a key role in the development of child's dental anxiety. HYPOTHESIS OR AIM: We have tried to identify the presence of emotional transmission of dental fear among family members and to analyse the different roles that mothers and fathers might play concerning the contagion of dental fear to children. We have hypothesized a key role of the father in the transfer of dental fear from mother to child. A questionnaire-based survey (Children's Fear Survey Schedule-Dental Subscale) has been distributed among 183 schoolchildren and their parents in Madrid (Spain). Inferential statistical analyses, i.e. correlation and hierarchical multiple regression, were carried out and possible mediating effects between variables have been tested. Our results support the hypothesis that family members' levels of dental fear are significantly correlated, and they also allow us to affirm that fathers' dental fear is a mediating variable in the relationship between mothers and children's fear scores. Together with the presence of emotional transmission of dental fear among family members, we identified the relevant role that fathers play as regards the transfer of dental fear from parents to children.

Dental Fear in Children with a Cleft Lip and/or Cleft Palate

To assess the level of dental fear in children with a cleft lip and/or palate, to compare this level with that of a normative group testing the hypothesis that children with a cleft lip and/or palate have a higher level of dental anxiety than children from the general population, and to assess the relation between dental fear and coping. Cross-sectional study. VU Medical Centre University Amsterdam. A total of 110 children (4 to 12 years old, 50 girls) with a cleft lip and/or palate. Dental fear in the study group was compared with a normative group of Dutch children. Dental fear was investigated using the parental version of the dental subscale of the Children's Fear Survey Schedule for children aged 4 and 5 years old (n = 36). Also the Inventory of Stressful Situations was completed. Children aged 6 to 12 years old also completed the Dental Cope Questionnaire. Young children with a cleft lip and/or palate experience more dental fear compared with children in a normative control group (Children's Fear Survey Schedule dental subscale scores: 30.3 ± 14.6 compared with 24.6 ± 8.6, p < .01). A weak correlation was found between the child's dental anxiety (Children's Fear Survey Schedule dental subscale) and his or her coping behavior (Dental Coping Questionnaire) (r = .196 p < .05). A clear correlation exists between the total Inventory of Stressful Situations and total Children's Fear Survey Schedule scores of the youngest age group (r = .507 p < .01). Findings support the hypothesis that dental anxiety is related to a higher level of exposure to medical interventions at a young age.

Development of Chinese version of children's fear survey schedule-dental subscale

To establish the Chinese version of the modified children's fear survey schedule-dental subscale (CFSS-DS). The original English version of CFSS-DS with facial image scale (FIS) was translated into Chinese, pre-tested and cross-culturally adapted. Subsequently the Chinese version schedule was randomly investigated among 367 children aged 5 - 12 years and their parents. Reliability and validity of the translated scale was evaluated later. Totally 367 children were investigated and 311 valid questionnaire was received. Cronbach's alpha of the translated scale was 0.85 and test-rest reliability was 0.73. The 15 items were divided into four domains. There was a certain logical relationship between the items among the same domains. There was highly significant association between the self-report of the Modified CFSS-DS and Frankl Behavioral Scale (r(s) = -0.403, P < 0.01). The Chinese version of modified CFSS-DS has been established successfully with good psychometric properties which provide the theoretical evidence for further application in Chinese population.

Child dental fear and behavior: The role of environmental factors in a hospital cohort

Information on the origin of dental fear and uncooperative behavior in a child patient is important for behavior management strategy. The effects of environmental factors have been comparatively less studied, especially in an Indian scenario. To find the association of (1) age, gender, family characteristics, previous medical, and dental experiences with dental fear and behavior (2) dental fear with dental behavior. A cross-sectional questionnaire study involving 125 children aged between 7 and 14 years undergoing dental treatment under local anesthesia. The parent completed a questionnaire on family situation, medical history, and past dental experiences of the child. Child's dental fear was recorded using Children's Fear Survey Schedule-Dental Subscale and behavior was rated using Frankl Behaviour Rating Scale. Data were analyzed using chi square test and binary logistic regression analysis. Unpleasant experience in dental clinic and age of the child significantly influenced dental behavior. Visited pediatrician in the past one year, prior history of hospital admission, previous visit to dentist, experience at the first dental visit, and age of the child were contributing factors for dental fear. There was also significant association between dental fear levels and behavior. In 7 to 14 year olds, dental fear influences dental behavior, but the factors affecting them are not the same. Although dental fear decreases and dental behavior improves with age, experiences at the previous dental visits seem to influence both dental fear and behavior. Past medical experiences are likely to influence dental fear but not dental behavior.

Child dental fear and general emotional problems: a pilot study

This was to investigate the relation between general emotional and behavioural problems of the child and dental anxiety and dental behavioural management problems. Dental treatment involves many potentially unpleasant stimuli, which all may lead to the development of dental anxiety and behavioural management problems (BMP). It is still unclear why some children get anxious in the dental situation while others, with a comparable dental history, do not. Besides the latent inhibition theory it is suggested that this can be explained by differences in child rearing and personality traits. The sample consisted of 50 children (4-12 years old) and their parents participated in this study. Parents filled out the Child Fear Survey Schedule Dental Subscale (CFSS-DS) and the Child Behaviour Checklist (CBCL) on behalf of their child. Child behaviour during consecutive dental treatments was assessed using the Venham scale. There were 39 children subject to analysis (21 boys) with a mean CFSS score of 40.4. Children aged 4 and 5 years who had sleeping problems, attention problems and aggressive behaviour, as scored by parents on the CBCL, displayed more disruptive behaviour during dental treatment. Children with emotionally/ reactive and attention problems were more anxious. In this pilot study a possible relation between general emotional and behavioural problems of young children and dental anxiety was shown. Also a relation between emotional and behavioural problems and dental behavioural management problems was shown. Because of the small number of subjects in our study, further research will be needed to confirm these results.

Reliability and factor analysis of children′s fear survey schedule-dental subscale in Indian subjects

Fear to visit a dentist is a common observation even in adults; however, among children it becomes one of the most important issues for a dentist. Psychographic analysis of the factors that add to fear level of the children can be accessed through Children fear survey schedule-dental subscale (CFSS-DS); however, its varied applicability in different environmental situations has been tested through this paper. The aim of present study is to evaluate the reliability and factor structure of the Indian version of the CFSS-DS. The routine patients attending Outpatient Department of Pedodontics with Preventive Dentistry, Faculty of Dental Sciences, Lucknow, India (n=197, aged 7-12 years old) were evaluated for children's fear survey schedule-dental subscale which was filled by parents on behalf of the child. Reliability analysis (alpha) was performed to assess the internal consistency of the Indian translation of the scale. Factor analysis (principle components, varimax rotation) was employed to assess the factor structure. Children fear survey scale-dental subscale was found to be equally reliable (Cronbach alpha = 0.92) and applicable among Indian subjects. However, factorization revealed emergence of 1) hospital, injections and hospital personnel, 2) drilling and interaction with unknown, 3) dental care personnel and practices. The present study extended the universal applicability of children fear survey schedule -dental subscale, while at the same time it was able to highlight different facets of problem in different environments.

Young children’s Oral Health‐Related Quality of Life and dental fear after treatment under general anaesthesia: a randomized controlled trial

During the past decade the research interest in Oral Health-Related Quality of Life (OHRQoL) has been prospering. This study was performed to test (using a randomized controlled trial design) the hypothesis that young children's OHRQoL improves after oral rehabilitation under general anaesthesia (GA). A further aim of this study was to explore whether dental fear also changes. One-hundred and four children (54 boys; mean age 4.08 yr, standard deviation = 1.09), who had been referred to a specialized clinic in paediatric dentistry, were randomly assigned, based on a Solomon four-group design, to two treatment (GA) and two control conditions. The Early Childhood Oral Health Impact Scale (ECOHIS) and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) were used to assess OHRQoL and dental fear, respectively, before and after the rehabilitation procedures. A 2 x 2 analysis of variance revealed that the total ECOHIS score after GA was more positive in the GA group than in the control group. There was no effect found of the pre-test and there was also no interaction between the pre-test and treatment. In the total CFSS-DS scores no effects were found. The results of this study showed that the child's OHRQoL improved after treatment under GA. Furthermore, children need guidance in reducing dental fear after treatment under GA.

Oral‐health‐related quality of life among children with and without dental fear

This study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured. The participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register (n = 51) and schoolchildren (n = 82). Dental fear was measured with 'Treatment of dental decay' and 'Attending dentist' dimensions of the modified Children's Fear Survey Schedule-Dental Subscale and a single question. ORHQoL was measured with CPQ(11-14). Background variables were gender and the dental care experienced. The response rates were 87% and 51% in the schoolchildren's and CLP groups, respectively. Those who were afraid of 'Treatment of dental decay' had higher mean CPQ(11-14 )total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics. Dental fear may have a negative effect on a child's ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.

The clinically related predictors of dental fear in Taiwanese children

Dental fear has been singled out as one of the most troublesome problems facing paediatric dentistry today. Children with dental fear may avoid visiting dentists; therefore, their oral health protection is often compromised. However, the aetiology of dental fear is still not entirely understood. This study investigated the dental visiting habit, the previous dental experiences, the conditioning pathway, and the clinically related predictors of dental fear in children. The dental history of 247 children (2-10 years old) was obtained when they came to a dental clinic for treatment. The level of dental fear in these children was assessed using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Observers rated the clinically anxious responses and uncooperative behaviour towards dental treatment in these children. Three stepwise regression analyses were performed to determine significant predictors of CFSS-DS score, clinically anxious responses, and uncooperative behaviour of children, respectively. We found that the CFSS-DS score and clinical anxiety have different predictors, but age < or = 3.99 years old and cooperativeness in the first dental visit were important predictors for both the CFSS-DS score and the clinical anxiety. Furthermore, the other predictors of the CFSS-DS score were maternal dental fear, unbearable pain during the first dental visit, and visiting dentists in a regular dental clinic; the other predictors of clinical anxiety were first-born, regular dentist, and CFSS-DS score. Finally, the only significant predictor for uncooperative behaviour was clinical anxiety. Children's dental fear and their anxious response during dental treatment were dynamic processes that consisted of many different factors. The direct conditioning of subjective experience of pain was more important than the objective pathway of child dental fear, and the indirect conditioning does not seem influential in this study sample.

Dental treatment under general anaesthesia: the short-term change in young children’s oral-health-related quality of life

This was to assess the short-term change in children's oral-health-related quality of life (OHRQoL) and family impact after dental treatment under general anaesthesia (GA) in the Netherlands. A pretest-posttest design was used. Children (< 8 years) referred to a clinic for specialized paediatric dentistry and who needed treatment under GA were selected to participate and divided across two groups. Fifty out of 80 parents/children couples participated, one group of parents filled out the questionnaires on behalf of their child before and after treatment (N = 31), and the other group only after treatment (N = 19). The questionnaires used were the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and Parental Perceptions Questionnaire and Family Impact Scale (PPQ and FIS, forming the OHRQoL score). The oral health was assessed using the decayed-missing-filled surfaces or teeth index (dmfs/dmft) for the primary dentition from the status praesens after treatment. There was a significant difference between the pre- and posttest-scores in group A for both the short version and the long version (short: t = 5.088, df = 20, p < 0.001 and long: t = 6.279, df = 20, p < 0.001). There was no statistically significant difference in CFSS-DS scores before and after treatment (group A) (t = 1.815, df = 13, p = 0.093). The children's OHRQoL improved after treatment under GA according to their parents. As expected, dental fear did not change and should be dealt with after treatment to avoid a child's dental fear to persist in the future. A shorter version of the PPQ and FIS seems useful to assess OHRQoL in very young children.

Reliability and validity of the Greek version of the Children's Fear Survey Schedule–Dental Subscale

The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) is a commonly used questionnaire which measures children's dental fear. The aim of this study was to gather data to evaluate the psychometric properties of a Greek version of the CFSS-DS. A sample of 260 children aged 4-12 completed the Greek version of the CFSS-DS while in the waiting room of a paediatric dentist. The dentist, who was unaware of the children's scores, rated the children's behaviour during the dental appointment using the Frankl scale. Children who returned for a second dental appointment during the study period completed the CFSS-DS a second time. The mean CFSS-DS score was 24.80 (standard deviation = 9.17). Age and gender were not related to mean scores. Invasiveness of dental treatment was not related to mean scores. Children who were most uncooperative/fearful on the Frankl had the highest mean scores (Kruskal-Wallis chi2 = 9.48; d.f. = 2; P = 0.009). The internal consistency (Cronbach's alpha) was 0.85, and the test-retest reliability (intraclass correlation) was 0.74. The Greek version of the CFSS-DS appears to be reliable and valid. Further samples should include school samples, to include children who may not go to the dentist.

Changes in children’s dental fear: a longitudinal study

The study aimed to evaluate the development of dental fear in a low fear group and a fearful group of children aged between 8 and 13 years of age and to assess the differences between these groups over time taking into account general variables, such as gender, and treatment variables, such as restorations. Furthermore it was evaluated to what extent general variables and treatment variables predict the change in dental fear or dental fear at later age. A three-year longitudinal study. 401 parents completed the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), 218 of them repeating this after a 3-year interval. Dental records were used to collect the clinical data, starting from the children's first dental appointment and the CFSS-DS was used to assess the child's dental fear. Analysis of variance for repeated measures showed an interaction effect between fear level and mean total CFSS-DS score. Regression analyses applied to the mean total CFSS-DS score at the second measurement moment and the change in total CFSS-DS score between both measurement moments revealed that little variance could be explained by the treatment variables over the various periods, such as extractions in the first period, and that child-characteristic variables could not predict much variance. Independent-samples t-tests showed a significant difference in means for extractions over the whole period between the fearful group (mean=1.73, SD+/-1.18) and low fear group (mean= 0.68, SD+/-2.01) (t=-4.05, p<0.001, n=218). Also the frequency of Behavioural Management Problems (BMP) over the whole period differed between these groups (fearful group: mean=1.40, SD+/-1.90 and low fearful group: mean= 0.40, SD+/-0.93) (t= -4.58, p<0.001, n=218). The effect of treatment variables and subjective experiences on child dental fear seems to diminish over time. Findings support the theoretical framework of conditioning and gradual exposure in children to prevent dental fear.

Is it the injection device or the anxiety experienced that causes pain during dental local anaesthesia?

The aim of this study was to investigate the influence of anxiety and type of dental injection, a plastic syringe or an electronic computerized device, on the pain perceived by children. Two dental injectors, a computerized device (Wand, Milestone Scientific, Livingston, NJ, USA) and a traditional plastic syringe, were compared. Forty-one children, aged 9-13 years, who had registered for treatment in Marmara University, Istanbul, Turkey, were included in the study. Both anxious and non-anxious children were included in the study group. The Children's Fear Survey Schedule-Dental Subscale, Facial Image Scale, Spielberger's State Anxiety Index for Children, and heart rates were used to determine the anxiety levels. Participants were assigned to interventions by using random allocation. The first appointment was designed as an introductive familiarization session and injections were administered in the second and third sessions, with one or the other injector. The visual analogue scale was used for pain measurement after injections. No significant differences in injection pain scores were observed between the Wand and traditional plastic injector. Higher levels of pre-injection anxiety were found to be related to more severe pain reports by the children. Anxiety plays an important role in the pain reaction of children, and was found to be more determinative in pain perception than the injection devices preferred.

Dental fear, communication, and behavioural management problems in children referred for dental problems

Knowledge about the influence of the interaction between child, parent, and dentist and the referral pattern is very limited. This study intended to assess to what extent the pathways of Rachman could clarify why a child is being referred to a specialist in paediatric dentistry and if other aspects in the interaction between child, parent, and dentist play a role in the referral. The referral letters of 500 children referred to a Special Dental Care Centre in Amsterdam were examined. All parents filled out the Children's Fear Survey Schedule-Dental Subscale, on behalf of the child. Information about interaction and the referral was collected from the referral letter and a semistructured interview with the parent and dentist separately. Eighty pairs of parents and dentists of referred children participated in a semistructured interview. Child factors seem to contribute the most to the referral. For the cause of referral the pathways of Rachman and communication were often combined. Apart from fear acquisition, as implied in Rachman's pathways, the interaction between child, dentist, and parent also contributes to the referral of a child to a specialist clinic in paediatric dentistry.

Prevalence of Dental Anxiety among 5- to 8-Year-Old Taiwanese Children

Many people experience discomfort to a greater or lesser degree about the prospect of dental treatment. Dental treatment can be a terrible experience, especially for children with dental anxiety. This study estimated the prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City, Taiwan. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was translated into Chinese, and a receiver operating characteristic (ROC) curve was made based on criteria determined from pretest clinical observations of a sample population to set a cutoff score. Then, the parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5- to 8-year-old children at kindergartens and elementary schools in Kaohsiung City, Taiwan. Participants were selected by stratified random sampling. The stratification was done by geographic district, age group, and sex. A total of 3,597 valid questionnaires were collected. The Chinese version of the CFSS-DS had an optimal cutoff score of 38/39 (sensitivity was 0.857, specificity was 0.882) with an area under the ROC curve of 0.912. The estimated prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City was 20.6 percent. The dental anxiety score was found to decrease as age increased; primary school boys had significantly lower scores. The prevalence of dental anxiety was found to be high for 5- to 8-year-old Taiwanese children. The study's findings point to the urgent need for preventive health education and intervention programs in Taiwan to promote children's oral health and reduce dental anxiety.

The Children's Fear Survey Schedule–Dental Subscale in Japan

The aims of this research are to examine the reliability and validity of the Japanese version of the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS), and to examine the responses of children in the dental setting and in the community. The CFSS-DS was translated into Japanese and administered to three samples. The first sample comprised 134 child patients aged 8-15 years, of whom 100 were assigned for test-retest analysis, and the behavior of the remaining 34 additional children were rated during their dental appointments, and compared with their questionnaire results. A second sample of 532 child patients aged 8-15 years, completed the CFSS-DS and also one additional item measuring fear of returning to the dentist. A third sample of 1250 school children aged 8-15 years was surveyed using the CFSS-DS and the additional item measuring fear of returning to the dentist. The Japanese version of the CFSS-DS showed good internal consistency (alpha=0.91) and test-retest reliability (r=0.90), as well as good criterion validity assessed by the relationship with actual child behavior (r(s)=0.51). It also showed good construct validity assessed by correlation with willingness to return to the dentist. Fear levels were higher in the school sample than in the clinic sample (27.7 versus 24.6). Girls reported more fear than boys (26.2 versus 23.2 in the clinic sample, and 30.7 versus 24.8 in the school sample). Injections, choking, having a stranger touch them, and drilling were the most common fears. Factor analyses demonstrated a factor pattern similar to the results found in other cultures. The results suggest that the CFSS-DS is reliable and valid and operates in Japan as it does in other cultures.