Level Of Dental Fear Research Articles

Uncovering Oral Health Concerns: Exploring dental anxiety within Transgender community- A systematic review

Dental fear and anxiety (DFA) have substantial implications for oral health, often resulting in the avoidance of dental care and negative consequences. Despite facing unique health challenges and discrimination, there is a lack of research on the prevalence of DFA among transgender individuals. This paper seeks to synthesize evidence regarding the prevalence of DFA within this population. We searched multiple databases, including PubMed, Google Scholar, Cochrane Database, Web of Science, and LILACS, for studies published up to May 2024. We included observational studies, cross-sectional studies, surveys, and cohort studies that provided data on DFA prevalence among transgender individuals. Eligible studies were screened, and data extraction was performed according to predefined criteria. The risk of bias was evaluated using the ROBINS-E tool, while the level of evidence and quality were assessed following the Oxford Centre for Evidence-Based Medicine guidelines. Among the 20 studies assessed for eligibility, only 2 met the inclusion criteria and were thus included in the review. These studies reported varying prevalence rates of DFA among transgender individuals, with both exhibiting a moderate risk of bias. However, the quality of evidence was deemed low due to the limited number of studies and their observational nature. The available evidence indicates that transgender individuals experience notable levels of dental fear and anxiety, which contribute to disparities in accessing oral health care and achieving positive outcomes. This review underscores the imperative for further high-quality research to comprehensively understand and address the oral health needs of transgender individuals, ensuring equitable and effective dental care.

Uncovering Oral Health Concerns: Exploring Dental Anxiety within Transgender Community: A Systematic Review

Dental fear and anxiety (DFA) have substantial implications for oral health, often resulting in the avoidance of dental care and negative consequences. Despite facing unique health challenges and discrimination, there is a lack of research on the prevalence of DFA among transgender individuals. This paper seeks to synthesize evidence regarding the prevalence of DFA within this population. We searched multiple databases, including PubMed, Google Scholar, Cochrane Database, Web of Science, and LILACS, for studies published up to May 2024. We included observational studies, cross-sectional studies, surveys, and cohort studies that provided data on DFA prevalence among transgender individuals. Eligible studies were screened, and data extraction was performed according to predefined criteria. The risk of bias was evaluated using the ROBINS-E tool, while the level of evidence and quality were assessed following the Oxford Centre for Evidence-Based Medicine guidelines. Among the 20 studies assessed for eligibility, only 2 met the inclusion criteria and were thus included in the review. These studies reported varying prevalence rates of DFA among transgender individuals, with both exhibiting a moderate risk of bias. However, the quality of evidence was deemed low due to the limited number of studies and their observational nature. The available evidence indicates that transgender individuals experience notable levels of dental fear and anxiety, which contribute to disparities in accessing oral health care and achieving positive outcomes. This review underscores the imperative for further high-quality research to comprehensively understand and address the oral health needs of transgender individuals, ensuring equitable and effective dental care.

Analysis and Consideration of Factors for Predicting Cooperation Levels in Pediatric Dentistry

This study aimed to evaluate various factors related to cooperation levels in pediatric dentistry and determine their correlation with children’s cooperation during dental treatments. This study included one hundred children and their guardians who visited the dental hospital at the Chonnam National University. Children and their guardians completed surveys regarding dental fear, dental caries experience, dental treatment experience, temperament, and guardians’ dental anxiety, as well as the background characteristics of the children. Based on these data, factors associated with children’s cooperation during dental treatment were investigated. Dental fear, caries experience during the primary and mixed dentition stages, and temperament traits such as shyness and negative emotionality significantly impacted children’s cooperation during dental visits, with higher levels of these factors corresponding to lower cooperation. The extent of dental experience also modestly influenced children’ s cooperation, with higher levels of cooperation observed in children with greater dental experience. Additionally, children’s dental fear was strongly correlated with guardians’ dental anxiety, increasing as guardians’ anxiety levels increased. Twelve-year-old children exhibited significantly lower levels of dental fear compared to other age groups, and regardless of cooperation levels, injections (shots) were identified as the primary factor inducing dental fear among the children. To improve children’ s cooperation in pediatric dentistry, strategies should focus on alleviating their fears and adopting an individualized approach that consider their oral health status and temperamental traits.

The effect of dental treatment using conscious sedation therapy on patient satisfaction

Objectives: This study aimed to investigate the effects of conscious sedation on patient satisfaction with dental treatment. Methods: The survey included questions on the patients’ general characteristics, dental treatment fear, anxiety, and satisfaction, and patient evaluation by an observer. Statistical analyses were performed using SPSS 20.0 ver. and data were analyzed using frequency analysis, independent t-test, Pearson’s correlation coefficient, and multilinear regression analysis. Results: Patients who received conscious sedation therapy showed significantly lower levels of dental fear and anxiety, whereas their dental treatment satisfaction was significantly higher than that of patients who received regular dental treatment (p<0.05). Dental treatment fear, anxiety, satisfaction, and conscious sedation depth were significantly correlated in patients who received conscious sedation therapy (p<0.05). Factors influencing dental treatment satisfaction included age, weight, use of medication, smoking habits, use of conscious sedation therapy, dental treatment fear and anxiety, and conscious sedation depth (p<0.05). Conclusions: Conscious sedation therapy can be an effective method to reduce dental treatment fear and anxiety and improve patient satisfaction.

The level of dental fear and anxiety is higher in children with both severe Molar-Incisor Hypomineralisation and active dental caries lesions compared to children without these conditions

PurposeTo assess levels of dental fear and anxiety (DFA) in children with and without Molar-Incisor Hypomineralisation (MIH) and dental caries lesions.MethodsIn this cross-sectional observational study, 159 children between 8 and 12 years of age were included. For the evaluation of DFA, children responded to the validated version of the Children’s Fear Survey Schedule-Dental Subscale. MIH was assessed using the MIH Index. To evaluate the activity of dental caries lesions and dental caries experience, the Nyvad criterion and the dmft/DMFT index were used, respectively. Dental hypersensitivity was evaluated using air stimulation and a Visual Analogue Scale. The association between MIH and dental caries with DFA was assessed using the generalised linear model with Poisson family, identity link function and robust variance estimation. The significance level was set at 5%.ResultsThe mean DFA score was 28.3 (SD = 13.4) with scores ranging from 15 to 64. Amongst children presenting both MIH and dental caries, the perception of DFA was notably higher compared to those with either MIH or dental caries alone. The activity of caries lesion in patients with MIH also influenced DFA levels (diff: 18.6; 95% CI: 12.0–25.2; p < 0.001). Dental caries experience in the primary dentition also demonstrated statistical significance concerning DFA (95% CI: 0.8–13.3; p value = 0.027).ConclusionChildren with MIH exhibit higher levels of DFA than children without MIH. The experience of dental caries and the activity of caries lesions significantly influence the perception of DFA in children with MIH.

Evaluation of The Role of Music and Bach Flower Remedies in The Management of Anxious Pediatric Dental Patients: A Randomised Clinical Trial

Objective: Dental fear and anxiety describe negative feelings towards the dental environment, particularly significant in pediatric dentistry due to their cognitive, behavioral, and physical impacts on children. Managing this anxiety through positive dentist-child relationships and behavioral guidance techniques is crucial. This study aims to evaluate the effectiveness of passive distraction using music and Bach flower remedy in reducing dental fear and anxiety in children aged 6-8 years. Methods: This randomized controlled clinical study included 12 children (n=4 for each group) aged 6-8 years, randomly assigned to Group 1 (control), Group 2 (Bach flower remedy), or Group 3 (passive distraction with music) for treating superficial dentin caries in primary teeth without local anesthesia. Dental fear and anxiety levels were assessed using objective (heart rate, oxygen saturation, systolic and diastolic blood pressure) and subjective (Facial Image Scale and Venham’s Picture Test) measures before and after treatment. Results: The study included 12 children (6 female, 6 male) with a mean age of 7.3±0.8 years. In Group 2, heart rate significantly decreased after treatment (97.8 ± 10.1 to 90.5 ± 8.8, p.05). Conclusion: In this study, although passive distraction with music and Bach flowers did not have a significant effect on physiological and projective measurement tools in children with dental fear and anxiety, a decrease in heart rate was observed in children exposed to Bach flowers.

Dental anxiety and oral health in American Indian and Alaska natives.

American Indian and Alaska native (AI/AN) individuals report distrust of the healthcare system. This study explored associations between having either high levels of dental distrust or high levels of dental care-related fear and anxiety ("dental anxiety") and oral health outcomes in AI/AN adults. The 2022 State of Oral Health Equity in America survey included the Modified Dental Anxiety Scale and asked to what extent respondents agreed with the statement, "At my last oral health visit, I trusted the oral health provider I saw", and asked about self-rated oral health and presence of a dental home. AI/AN individuals (N = 564) who reported low dental trust (n = 110) or with high dental anxiety (MDAS≥19; n = 113) reported significantly worse overall and oral health and were significantly less likely to have a dental home (p < 0.05 used for each analysis). Dental distrust and dental anxiety can significantly impact oral health and dental utilization in AI/AN communities and are important intervention targets to improve AI/AN oral health.

Influence of Education on Dental Anxiety and Fear in Mental Disorders after Viewing a Molar Extraction in Three Types of Mental Disorder Compared to Persons with No Mental Disorder.

Objective: The goal of this study is to validate the psychometric properties of the Modified Dental Anxiety Scale (MDAS) and the Dental Fear Scale (DFS) at three different times: seven days before, immediately after, and seven days after watching a video of surgical extraction of a lower third molar in a sample with four strata: anxiety disorder, adjustment disorder, mixed anxiety-depressive disorder, and no mental disorder ages 18-70 in a psychiatric clinic in Malaga. Methods: The Research Ethics Committee of the Virgen Macarena-Virgen del Rocío Hospitals approved the study. After being interviewed by a psychiatrist and subsequently completing the Hamilton Rating Scales for Anxiety and Depression, the participants were divided into 4 strata (60 persons in each). The influence of education level was then analyzed. Results: The scales demonstrated good psychometric properties, with higher MDAS and DFS scores for lower levels of education and mixed anxiety-depressive disorder. Conclusions: Patients who show higher levels of dental anxiety and dental fear will be those with lower education levels, as well as those who suffer from mixed anxiety-depressive disorder.

Prevalence of Dental Fear and Anxiety among School Children in Zawia City, Libya

Odontophobia, also known as dental fear and anxiety (DFA), is a type of phobia that can negatively affect the dental and oral health of people who experience it. This phobia has psychosocial characteristics that make it complex to address in dental practice. Dealing with dental fear is a challenging issue in dentistry for various reasons. Although this issue has been studied in children for quite some time around the world, no such studies have been conducted in Zawia, Libya. Therefore, this study aimed to determine the prevalence of dental fear and anxiety (DFA) among pupils aged 5 to 12- years in public and private schools in Zawia City. A cross-sectional survey was conducted in Zawia City over three months. In the survey, 205 students were randomly selected from several private and public schools. All participants were given a self-reported questionnaire containing ten closed-ended questions about DFA. After collecting the data, the results were analyzed based on gender and school type and entered into a Microsoft Excel sheet for further analysis. Results of the study showed that 31.71% of all pupils experienced dental fear and anxiety (DFA). Furthermore, the slight variations in fear levels based on school type indicate that the school environment may influence a pupil's perception of dental visits. Most private school students experienced DFA during physical contact with their dentists and upon seeing dental anesthesia injections. Whereas pupils attending government schools experienced DFA when hearing voices during treatment. Across all areas studied, female students reported slightly higher levels of anxiety than male students. Based on the survey results, it is evident that many pupils experience high levels of dental fear and anxiety (DFA). This highlights the need for intervention and attention in such situations, as DFA can significantly affect a pupil's dental experience and oral health outcomes. Therefore, it is essential to address these fears and anxieties to improve the overall dental experience of pupils and promote better oral health

Comparison of Aversion to Visual Dental Stimuli Between Patients and Dentists: A Preliminary Study.

Fearful dental patients often cite various dental instruments or procedures as triggers for their dental fear. Thus, visual dental stimuli provoke anxiety. This preliminary study aimed to assess the level of aversion to visual stimuli in dental patients and compare it with that in dentists. A total of 43 dental patients (25 women, 18 men; average age, 29.9 ± 13.3 years; patient group) and 13 dentists (4 women, 9 men; average age, 28.2 ± 2.0 years; dentist group) were included. All participants had previously undergone dental treatment. The dental fear level was assessed using the self-reported Dental Fear Survey (DFS). Thirty-two images associated with dental treatment were prepared and classified into three categories: dental instruments, dental procedures, and the dental environment. All participants rated their level of disgust toward each image on a visual analog scale with scores ranging from 0 to 100. In the patient group, the disgust ratings for tooth extraction, dental drilling, and local anesthesia were >60, which were significantly different from those in the dentist group (Mann-Whitney U-test, p<0.001, p=0.001, and p=0.001, respectively). The ranking order of the disgust ratings for the 32 images showed significant correlation between the patient and dentist groups (Spearman correlation coefficient, r=0.80, p<0.001). In the patient group, the disgust ratings for dental impressions and the interdental brush, dental light, and dental chair were significantly correlated with DFS scores (r=0.61, p<0.001; r=0.47, p=0.001; r=0.41, p=0.006; and r=0.40, p=0.008, respectively). This study revealed that patients have more negative feelings toward invasive procedures than dentists. However, a significant correlation was identified between the ranking of aversion-provoking dental stimuli by patients and dentists. Furthermore, the level of aversion to several dental-related items that do not cause pain was correlated with the dental fear level.

Cerebral activation caused by dental sounds: a functional magnetic resonance imaging study

Dental drilling sounds can induce anxiety in some patients. This study aimed to use functional magnetic resonance imaging (fMRI) to assess the relationship between dental fear and auditory stimuli. Thirty-four right-handed individuals (21 women and 13 men; average age, 31.2 years) were selected. The level of dental fear was assessed using the dental fear survey (DFS). Based on a threshold DFS score > 52, participants were categorized into two groups: dental fear (DF) group (n = 12) and control group (n = 22). Two types of stimuli were presented in a single session: dental and neutral sounds. Cerebral activation during the presentation of these sounds was evaluated using contrast-enhanced blood oxygenation level-dependent fMRI. In the DF group, dental sounds induced significantly stronger activation in the left inferior frontal gyrus and left caudate nucleus (one-sample t test, P < 0.001). In contrast, in the control group, significantly stronger activation was observed in the bilateral Heschl’s gyri and left middle frontal gyrus (one-sample t test, P < 0.001). Additionally, a two-sample t test revealed that dental sounds induced a significantly stronger activation in the left caudate nucleus in the DF group than in the control group (P < 0.005). These findings suggest that the cerebral activation pattern in individuals with DF differs from that in controls. Increased activation of subcortical regions may be associated with sound memory during dental treatment.

Assessment of the dental fear and anxiety in patients admitted to the Dental Clinic of Hue University of Medicine and Pharmacy Hospital

Background: Fear and anxiety in dentistry are among the factors that hinder access to dental care. This study aimed to assess the level of fear and anxiety regarding dental treatments and related factors. Materials and methods: This cross-sectional descriptive study included 300 patients aged ≥ 18 years who visited the Hue University of Medicine and Pharmacy Hospital for 5 months (12/2022 to 04/2023), The levels of dental fear and anxiety were assessed using DFS and MDAS. The relationship between dental fear and anxiety and the analyzed factors was examined using a multivariate logistic regression model. Results: Of the total sample, 52% had dentophobia, and 51.7% had dental anxiety. The incidence of dental fear and anxiety was higher in females compared to males, in individuals with a history of painful dental treatment than in comfortable ones, and individuals with irregular dental check-ups than in regular ones. Dental fear was also higher among single individuals. Conclusions: Fear and anxiety related to dental treatment were widespread among adult patients. Gender, marital status, treatment history, and frequency of dental visits were associated with dental fear and anxiety. Key words: dental fear, dental anxiety, related factors, multivariate logistic regression model.

OP62 Development Of The Oral Health Risk Adjustment Model To Predict The Outpatient Dental Expenditure In Children With Autism

IntroductionNational health insurance (NHI) Taiwan has provided additional markups on dental service fees for people with specific disabilities, and the expenditure has increased significantly from TWD473 million (USD15 million) in 2016 to TWD722 million (USD24 million) in 2022. The purpose of this study was to determine oral health risk and to develop a risk assessment model for capitation outpatient dental payments in children with Autism.MethodsBased on the literature and expert opinion, we developed a level of oral health risk model from the claim records of 2019. The model uses oral outpatient claim data to analyze: (i) the degree of caries disease; (ii) the level of dental fear or cooperation; and (iii) the level of tooth structure. Each factor was given a score from zero to four and a total score was calculated. Low-, medium-, and high-risk groups were formed based on the total points. The oral health risk capitation models are estimated by ordinary least squares using an individual’s annual outpatient dental expenditure in 2019 as the dependent variable. For subgroups based on age group and level of disability, expenditures predicted by the models are compared with actual outpatient dental expenditures. Predictive R-squared and predictive ratios were used to evaluate the model’s predictability.ResultsThe demographic variables, level of oral health risk, preventive dental care, and the type of dental health care predicted 30 percent of subsequent outpatient dental expenditure in children with autism. For subgroups (age group and disability level) of high-risk patients, the model substantially overpredicted the expenditure, whereas underprediction occurred in the low-risk group.ConclusionsThe risk-adjusted model based on principal oral health was more accurate in predicting an individual’s future expenditure than the relevant study in Taiwan. The finding provides insight into the important risk factor in the outpatient dental expenditure of children with autism and the fund planning of dental services for people with specific disabilities.

Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and dental health.

Dentists often use sedative medications such as nitrous oxide inhaled sedation and general anesthesia (GA) to help decrease patient fear and manage paediatric patients' behavior during treatment. The goal of this study was to examine factors associated with dental fear changes after restorative dental treatment under nitrous oxide or GA in children 4-12 years old. A prospective cohort study of 124 children examined changes in dental fear, number of treatment visits, and parental factors among children receiving restorative dental treatment under nitrous oxide (n = 68) or GA (n = 56) sedation. Data were collected at pretreatment (T1), 16 weeks post-treatment (T2), and at 29-month follow-up (T3). Dental fear increased slightly, but not significantly, under both forms of sedation between T1 and T3. Children's dental fear was associated with parents' poor dental experiences and oral health, but not with number of treatment visits. Progression of children's dental fear seems not dependent solely on the type of sedation used but is likely predicted by factors including pretreatment dental fear and dental needs. Dentists recommending sedation for children's dental care may consider pretreatment dental need, fear levels, and parental factors when determining which type of sedation to use.

Pathways to dental fear from childhood to adolescence: A 10-year cohort study.

Dental fear affects children's oral health; there is, however, no evidence regarding the pathways linking possible predictors for its occurrence. This study aimed at exploring the direct and indirect effects of sociodemographic, clinical, behavioural and psychosocial factors on the development of dental fear in schoolchildren over time. This is a prospective cohort study, with 10 years of follow-up. The first assessment started in 2010 (T1) with a sample of 639 children aged 1-5 years from Southern Brazil. For this study, the follow-up (T2) of these individuals was performed in 2020. Dental fear was assessed at T2 using the Brazilian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Socio-economic, demographic, psychosocial and oral health measures were collected in both assessments. A structural equation model was performed to assess the direct and indirect pathways among variables at T1 and T2 to predict the CFSS-DS scores at T2. Of the 639 children, 429 were re-evaluated at T2. Higher levels of untreated dental caries, younger individuals, dental visits for nonroutine reasons and low sense of coherence at T2 directly impacted dental fear at T2. Considering the indirect effects, the presence of dental caries and low household income at T1 indirectly impacted higher levels of dental fear over 10 years via dental caries at follow-up. Our findings suggest that socio-economic, demographic, clinical, psychosocial and behavioural conditions can influence dental fear from childhood to adolescence.

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.

Comparison of Dental Anxiety Between Aerosol and Non-Aerosol Dental Procedures in Children Aged Between 5-13 Years

Background Fear is an unpleasant emotional state consisting of psychological and physiological changes in response to real external threats or dangers. In contrast anxiety is an emotion similar to fear but arising without any objective source of danger. Dental treatments are well known to trigger anxiety and fear in children as most commonly used instruments such as airotor and suction create a sense of fear and anxiety in them. This impacts not only the quality of outcome of treatment but also the attitude of a child towards dentists and dental care.Objective The aim of the study was to compare the levels of anxiety during various aerosol and non-aerosol dental treatments in children.Method One hundred and twenty children aged 5 to 13 years were evaluated for anxiety levels by undergoing various dental treatments aerosol and non-aerosol techniques. The level of dental fear was measured before during and after the treatment with a pulse oximeter Animated Emoji Scale AES and Face Legs Activity Cry Consolability FLACC scale.Results Subjects belonging to the non-aerosol technique group showed least anxiety levels. Maximum relaxation was seen in children undergoing atraumatic restorative treatment ART followed by the HALL technique group and then the conventional restorative procedures. Least comfort was seen in the conventional stainless steel crown group. Conclusion Non-aerosol techniques generate least anxiety in children and should be considered for treatment procedures involving children with higher anxiety levels.

Periodontal maintenance: individual patient responses and discontinuations

AimThere is a lack of data on long-term impact of different psychological variables on periodontitis. Aim of the current study was to investigate the impact of psychological factors in patients with chronic periodontitis (CP; according to the 1999 Classification of Periodontal Diseases) to explain adherence to or discontinuation of supportive periodontal therapy (SPT) in a university setting.MethodsA sample of n = 119 patients were examined in a questionnaire-based, cross-sectional survey. All patients had received active periodontal treatment (APT) and were reevaluated in a university setting (Kiel) before 2016 [T1: start SPT]. Patients who showed sufficient adherence to SPT of ≥ 2 years (maximum ± 6 months of deviation between SPT intervals, last visit and questionnaire at T2) were assigned to the adherence group (AG: n = 58), or, if they interrupted SPT or stopped treatment altogether, to the non-adherence group (NAG: n = 61). In addition to dental parameters, we assessed socio-demographic, treatment-related (critical attitudes/complaints), dental as well as psychological variables (especially psychological attachment, but also dental fear, patient participation style, personality functioning) and examined between-group differences as well as possible mediating factors of non-adherence to treatment continuation.ResultsFor both groups we found similar average observation time (NAG/AG: 15.9(8.9)/14.9(10.6)years). There were significant differences in age, critical attitudes, dental fear, and patient participation style between the groups. With the help of exploratory sequential mediation models, we found a significant indirect pathway of the impact of attachment anxiety on discontinuation of treatment mediated through dental fear and number of critical attitudes/complaints.ConclusionConsidering the limitations, dentists should be aware of personality-related risk-factors such as attachment anxiety as well as their interplay with levels of dental fear and critical attitudes which may influence adherence to SPT.Trial registration: The clinical trial was retrospectively registered in the DRKS—German Clinical Trials Register (https://www.drks.de) with registration DRKS00030092 (26/08/2022).

Comparison of Fear of Dentistry between Children with Molar-Incisor Hypomineralization and Children with Permanent First Molars without Hypoplasia

Background: Molar incisor hypomineralization (MIH) is a developmental enamel defect of the incisor and molars that can lead to fear of dentistry in children. This study aimed to compare the dental fear of children aged 8 to 12 years with MIH and children with permanent first molars without hypoplasia in 2020 in Isfahan, Iran.Methods: In this descriptive-analytical cross-sectional study, the participants included 200 students aged 8-12 years old in Isfahan, who were randomly selected from the second to sixth- grade students referred to the clinics. The examination was performed by a dentistry intern using a disposable dental mirror and dental probe on the unit. Fifty-two children with MIH and 148 children with permanent first molars without hypoplasia were enrolled. The Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS) questionnaire was used to collect information, which includes two sections: demographic information and 15 questions on different areas of fear of dental treatment in children. Data were analysed through SPSS 20 software and using descriptive-statistical tests (frequency and percentage, mean), t test, chi-square test, and logistic regression test. P < 0.05 was defined as a statistically significant level.Results: The mean score of dental fear was 15 ± 35 (ranged from 15 to 75) which indicated moderate level of dental fear in the participating children. In whole, 62.5% of children were afraid of dentistry. The rate of dental fear in girls was 9 times higher than in boys (P < 0.05). Also, the rate of dental fear in children with MIH was 46 times higher than in children who did not have this disorder (P < 0.05). The frequency of dental fear in children with severe disorders was significantly higher than in children with mild defects (P = 0.000). There was no statistically significant difference in terms of dental fear among different age groups (P = 0.313). Also, with increasing the number of dental visits, dental fear increased by 1.2 times (P < 0.05), which was statistically significant.Conclusion: Fear of dentistry in children with MIH was significantly higher than in children with molar teeth without hypoplasia.

Comparison of two Intranasal Sedatives, Midazolam versus Dexmedetomidine, in Children with High Dental Fear: a Randomized Clinical Trial.

Statement of the Problem: Pharmacologic management of uncooperative behavior is a growing trend in dentistry. Determining the most appropriate drug, route of administration, and proper candidate for sedation have been the goal of several investigations.Purpose: The aim of this study was to compare the sedative effect of intranasal (IN) sedation of midazolam (MDZ) in compare to dexmedetomidine (DEX) while taking into consideration the effect of dental fear, and psychological status on sedation success.Materials and Method: This double-blind randomized clinical trial included 92 uncooperative dental patients aged 4-6. Study participants were randomly assigned to receive either 0.2mg/kg IN MDZ or 1µg/kg DEX. Sedation was evaluated using the Houpt sedation rating scale. Vital signs were recorded before and during sedation. Prior to sedation, the level of dental fear was determined through children's fear survey schedule-dental subscale (CFSS-DS). Psychological characteristics were screened using the strengths and difficulties questionnaire (SDQ). Data were analyzed using T-test, Mann-Whitney, Chi-square, and repeated-measures analysis of variance (ANOVA).Results: Overall ratings of sedation and subscales of sleep, crying, and movement were comparable between groups (p> 0.05); however, more acceptable behavior (overall scores (4+5+6) was observed in MDZ group compared to DEX group (64% vs. 47.7%) (p= 0.007). All participants were found to have abnormal levels of dental fear (CFSS-DS≥38). However, according to SDQ, the study participants have mainly shown normal behavioral status. A significant association was found between dental fear and sedation success (MDZ, p= 0.001, DEX, p= 0.03), while similar findings were not observed for psychological characteristics (MDZ, p= 0.09 and p= 0.41; DEX, p= 0.71 and p= 0.53). Physiological parameters remained within normal limits in both groups.Conclusion: Sedation with IN MDZ resulted in overall behaviors, which were more satisfactory in highly fearful pediatric dental patients. Despite baseline uncooperative behaviors, the psychological status of study participants were close to average and were not associated with sedation failure.