Measure Of Dental Fear Research Articles

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

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

Is there a relationship of negative oral health beliefs with dental fear and anxiety regarding diverse dental patient groups? A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to critically appraise the evidence on the relationship of oral health beliefs with dental fear and anxiety in distinct patient groups. Observational studies were retrieved by Cochrane, Embase Search, Portal BVS, Clinical Trials, Ovid, Open Gray, PubMed, Scopus, and Web of Science, and they were manually checked for the inclusion of additional articles of interest. The assessment of quality of studies was performed by the application of three different versions of the Newcastle-Ottawa Scale, for cohort, case-control, and cross-sectional studies. Only studies with low or unclear/moderate risk of bias contributed to meta-analyses, regarding the analysis of random effects of mean differences of dental beliefs scores between dental fear/anxiety and control groups, and the correlation of dental beliefs with dental fear and anxiety measures. Of 276 articles initially retrieved, 10 were included in the systematic review, while only 6 studies with unclear/moderate risk of bias were considered in meta-analyses. The mean difference of dental beliefs effects was higher in patients with dental fear and anxiety compared to controls (1.20; 95% CI 0.27-2.14; P = 0.01). Additionally, a moderate positive correlation was observed between dental beliefs and dental fear measures (r = 0.54, 95% CI 0.47-0.60;P< 0.001). Based on these results, the presence of negative health beliefs is directly related to the increase of dental fear and anxiety; however, these findings are supported in studies with unclear/moderate risk of bias. Dental fear and anxiety is an important obstacle for the access of dental treatment and patient-dentist relationship, leading to inadequate oral health levels.

Pressure pain sensitivity is associated with dental fear in adults in middle age: Findings from the Northern Finland 1966 birth cohort study.

Dental fear is a prevalent problem leading to severe deterioration of oral health and health-related quality of life. Despite the knowledge that dental fear is closely linked to painful experience, the association between pain sensitivity and dental fear remains unclear. This study was designed to evaluate this association with validated measures of dental fear and pressure pain sensitivity in a cohort population. The study population consisted of a subpopulation of the Northern Finland Birth Cohort 1966. At the age of 46years, 1736 participants completed the valid and reliable Modified Dental Anxiety Scale (MDAS) and participated in a clinical examination, where their nonorofacial pressure pain sensitivity was evaluated by validated pressure pain threshold (PPT) and tolerance (PPTo) measurements. Gender-specific Tobit regressions were performed to analyse this association adjusted for smoking and depressive and anxiety symptoms. Women with moderate dental fear had 5% (31.3 kPa; P<0.05), and women with high dental fear had 7% (42.9 kPa; n.s.) lower pressure pain threshold than women with low dental fear. Women with moderate dental fear had 4% (35.4kPa; P<0.05) and women with high dental fear had 9% (82.7 kPa; P<0.01) lower pressure pain tolerance than women with low dental fear. Men with moderate and high dental fear had 3% lower pressure pain tolerance (35.4kPa; P<0.05 and 29.6kPa; n.s., respectively) than men with low dental fear, whereas the associations with pain threshold were not statistically significant. Among women, both anticipatory and treatment-related dental fears were associated with pain threshold and pain tolerance. Among men, pain threshold was associated with treatment-related dental fear only and the associations with pain tolerance were not statistically significant. Nonorofacial pressure pain threshold and tolerance appeared to be lower in participants with dental fear, which emphasizes the role of pain sensitivity in dental fear.

Reliability and validity of the Italian versions of the Children's Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale.

Children's dental fear and anxiety (DFA) causes significant problems in clinical practice. The 15-item Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the 8-item Modified Child Dental Anxiety Scale (MCDAS) are the most widely used measures of dental fear in children. The aim of this study is to examine the reliability and validity of the Italian versions of the CFSS-DS and MCDAS, also in comparison with a simple visual analogue scale (VAS). The CFSS-DS and MCDAS were translated into Italian by a consensus panel of experts and administered to 210 dental patients aged 4-11 years from three Italian Institutions. Internal reliability was assessed using the Cronbach's alpha correlation. A sub-sample of 60 children was selected for test-retest analysis. CFSS-DS and MCDAS, plus a VAS scale, rated both by children and parents, were validated using as gold standard the 4-item Frankl scale for behaviours assessed by dentists. Mean CFSS-DS score was 30.8 (SD: 11.1) and mean MCDAS score was 17.9 (SD: 7.2), significantly higher among children aged 4-7 years and among children at their first dental visit. The alpha value for internal reliability was 0.90 (95%, CI= 0.88-0.92) for CFSS-DS and 0.87 (95% CI=0.85-0.90) for MCDAS. Both CFSS-DS and MCDAS showed good test-retest reliability (rsp= 0.80; p<0.001 for both scales). CFSS-DS and MCDAS predicted a Frankl score &#8804;2 (i.e., indicating children with an uncooperative behaviour) with a fair accuracy (AUC=0.69 and AUC=0.68, respectively). The VAS scale was more effective in predicting a negative behaviour (AUC=0.78). The scales self-reported by children were only slightly more accurate than those reported by parents. The Italian versions of the CFSS-DS and MCDAS are valid and reliable tools for the assessment of dental fear in Italian children aged 4-11 years. A simple, one-item VAS, and dental fear and anxiety evaluation by parents may be valid and quick alternatives to multi-item indices to predict an uncooperative children behaviour.

The role of cognitions in short-term temporal changes in dental fear among Australian adults.

To determine if temporal changes in dental fear over a 4-month period are predicted by changed cognitive vulnerability-related perceptions of going to the dentist. Australian adults (n = 484) completed mailed questionnaires at baseline and follow-up, containing measures of dental fear, cognitive vulnerability-related perceptions, dental services received, and possible aversive experiences during the study period. Change in dental fear was the main outcome measure, categorized as decreased (Fear- ), unchanged (Fear0 ), and increased (Fear+ ). Across the study period, 15.5 percent of people had Fear- , 73.4 percent had Fear0 , and 11.1 percent had Fear+ . In a multinomial logistic regression, after controlling for participant gender, income, time since last dental visit at baseline, dental fear at baseline and experiencing an aversive event, increased vulnerability-related perceptions were significantly associated with Fear+ (OR = 2.83, P < 0.001) while decreased vulnerability-related perceptions were associated with Fear- (OR = 0.17, P < 0.001). This study found, across a relatively short 4-month period, that increased vulnerability-related perceptions of visiting the dentist predicted increased dental fear while decreased vulnerability-related perceptions predicted decreased dental fear. More appropriate study designs, such as longitudinal designs, and longer follow-up periods are needed to determine the possible causal nature of these associations.

Performance of the Index of Dental Anxiety and Fear in a population-based sample of adults.

The Index of Dental Anxiety and Fear (IDAF-4C) was introduced to overcome the theoretical and practical shortcomings of previously developed dental fear measures. This new scale has not been tested on population samples other than in its country of origin, Australia. The aim of this study was to validate the IDAF-4C in a different cultural setting and to determine the prevalence and sociodemographic associations of dental anxiety. A cross sectional study of a representative New Zealand adult population sample was undertaken. The questionnaire was mailed to 523 randomly-selected participants. Data were collected on sociodemographic characteristics, oral and general health care, and dental anxiety using both the IDAF-4C and the Dental Anxiety Scale (DAS). The response rate was 51.8%. The factor structure of the IDAF-4C was confirmed. The prevalence estimates for high dental anxiety and fear were 18.6% using the DAS and 13.0% using the IDAF-4C. Mean scores for the IDAF-4C and DAS were higher among episodic dental visitors and those without a recent dental visit. The performance of the IDAF-4C in this New Zealand community sample supports its use for dental anxiety measurement.

Toward a genetic understanding of dental fear: evidence of heritability.

Dental fear is a prevalent problem that impacts dental treatment-seeking behavior and thus oral, systemic, and psychological health. Among other important predictors, fear of pain has been shown to be a critical component of dental fear. While learning history (id est, past experience) is known to shape development and maintenance of dental fear and fear of pain, minimal work has addressed genetic etiological variables for these healthcare-related anxieties. With the aim of coming to a more complete conceptualization of dental fear, this study assessed the heritability of dental fear and fear of pain and elucidated the role of genetics in the relation between the constructs. Participants (n = 1370; 827 female), aged 11-74 years (M = 29.2, SD = 12.2), in a family-based cohort study completed measures of dental fear and fear of pain. Heritability and genetic correlation were estimated using likelihood-based methods under the variance components framework. Dental fear was 30% heritable (P < 0.001) and fear of pain was 34% heritable (P < 0.001). Notably, there was substantial genetic correlation between dental fear and fear of pain, ρG = 0.67, suggesting they are genetically related, but likely are distinct phenotypes. It is clear that, in addition to environmental factors, genetic influences are important in the etiology of dental fear and anxiety and should be considered in future studies of fear and anxiety associated with dental treatment and, potentially, interventions aimed at reducing distress that is a barrier to dental treatment utilization.

The role of negative and positive memories in fear of dental treatment.

Most young adults transition from childhood dental care to adult dental care without problems. However, a substantial minority leaves childhood dental care with considerable fear of dental treatment. In the present study, we hypothesized that fear of dental treatment in the young adult is influenced by memories of positive and negative childhood experiences with dental care. More specifically, we predicted that the emotional impact, sense of reliving, rehearsal, and belief in the accuracy of a negative treatment memory would be associated with increased dental fear, while positive treatment memories would show the opposite relation. One hundred thirty-six young adults leaving childhood dental care responded to a online measures of dental fear, the most negative and most positive memory of dental treatment, and symptoms of posttraumatic stress disorder. Negative memories of events that involved pain and dentist behaviors such as impatience or scolding were frequently described and significantly associated with dental fear and symptoms of posttraumatic stress. Positive memories were more frequent, but did not show a consistent relationship with dental fear. The importance of negative memories suggests an avenue for intervention against dental fear that focuses on restructuring those memories to emphasize positive aspects.

Reliability and validity of the Children's Fear Survey Schedule-Dental Subscale for Arabic-speaking children: a cross-sectional study.

BackgroundEarly recognition of dental fear is essential for the effective delivery of dental care. This study aimed to test the reliability and validity of the Arabic version of the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS).MethodsA school-based sample of 1546 children was randomly recruited. The Arabic version of the CFSS-DS was completed by children during class time. The scale was tested for internal consistency and test-retest reliability. To test criterion validity, children’s behavior was assessed using the Frankl scale during dental examination, and results were compared with children’s CFSS-DS scores. To test the scale’s construct validity, scores on “fear of going to the dentist soon” were correlated with CFSS-DS scores. Factor analysis was also used.ResultsThe Arabic version of the CFSS-DS showed high reliability regarding both test-retest reliability (intraclass correlation = 0.83, p < 0.001) and internal consistency (Cronbach’s α = 0.88). It showed good criterion validity: children with negative behavior had significantly higher fear scores (t = 13.67, p < 0.001). It also showed moderate construct validity (Spearman’s rho correlation, r = 0.53, p < 0.001). Factor analysis identified the following factors: “fear of invasive dental procedures,” “fear of less invasive dental procedures” and “fear of strangers.”ConclusionThe Arabic version of the CFSS-DS is a reliable and valid measure of dental fear in Arabic-speaking children. Pediatric dentists and researchers may use this validated version of the CFSS-DS to measure dental fear in Arabic-speaking children.

Reliability and validity of the Korean version of the Dental Fear Survey.

BackgroundMany people experience varying levels of discomfort when confronted with the prospect of dental treatment. Dental treatment can be a traumatic experience, especially for children and adolescents with dental anxiety. In this age group, dental fear causes a significant problem in dental management and has been related to severe dental caries and dental pain. The Dental Fear Survey ( DFS ) is the most widely used measure of dental fear. This study was undertaken to develop the Korean version of the DFS ( K-DFS ) and test its reliability and validity.MethodsThe K-DFS, which uses projective techniques to measure children's and adolescents' dental fear, was developed. The DFS was translated into Korean and participants were selected via convenience sampling. Reliability and validity were tested using data from a sample of 813 middle school students in Gyeonggi Province, selected from the Self questionnaire survey. The K-DFS was administered twice to 102 adolescents aged 12-15 years.ResultsThe K-DFS had high internal consistency reliability (99.1%) but low test-retest reliability.ConclusionsThe results indicate that the Korean versions of the DFS have good internal consistency reliabilities and test-retest validities. However, we need to further examine the test-retest reliability of the K-DFS and replicate the current study in different samples covering various age groups.

Applying the Cognitive Vulnerability Model to the analysis of cognitive and family influences on children's dental fear

Negative experiences, cognitions, and family variables are involved in the etiology of child dental fear, but previous research has frequently considered them separately. This study uses the Cognitive Vulnerability Model to explore the influence of negative dental experiences and family members on children's dental anxiety. The participants were 185 children who completed a questionnaire comprising measures of dental fear and cognitive vulnerability-related perceptions. Measures were obtained for 88 of the participants' fathers and for 97 of the participants' mothers. Cognitive vulnerability perceptions had the strongest association with children's dental fear (β = 0.40), explaining 14-21% of the variance in dental fear scores beyond that explained by other variables. Furthermore, vulnerability perceptions mediated the relationship between negative dental experiences and dental fear. Children's dental fear and cognitive vulnerability perceptions were significantly associated with those of their fathers (r = 0.23 and r = 0.40, respectively) and mothers (r = 0.28 and r = 0.35, respectively). Moreover, fathers' (β = 0.24) and mothers' (β = 0.31) levels of cognitive vulnerability significantly predicted the children's levels of dental fear. The Cognitive Vulnerability Model offers a framework to understand child dental fear. Furthermore, this cognitive approach may help explain why some children develop dental fear problems after suffering a negative dental experience and how dental anxiety is passed on from parents to children.

Adaptation and psychometric properties of the Spanish version of the Index of Dental Anxiety and Fear (IDAF-4C+).

The Index of Dental Anxiety and Fear (IDAF-4C+) constitutes a theory-grounded, reliable and valid instrument, which, due to its modular structure, allows different uses such as assessing dental anxiety levels, establishing preliminary dental phobia diagnoses and identifying feared stimuli. This study aimed to develop a Spanish version of the original IDAF-4C+ and evaluate its psychometric properties. A sample of 231 Spanish undergraduate students (70.6% female; mean age 21.4 years) completed a questionnaire comprising the Spanish version of the IDAF-4C+ and other measures related to dental anxiety. The structure, reliability and validity of the adapted IDAF-4C+ were analysed. The adapted IDAF-4C fear module yielded a single-factor structure and demonstrated good internal consistency (Cronbach's alpha) and test-retest reliability. It shared a greater amount of variance with phobia diagnoses than the Modified Dental Anxiety Scale (MDAS) and a single-item measure of dental fear (SIDF). Moreover, the IDAF-4C was moderately to highly correlated with the MDAS and the SIDF measure, as well as with variables connected with dental anxiety such as negative dental thoughts, having had a negative dental experience and negative affect. The frequency of dental visits was also linked to IDAF-4C scores, and IDAF-stimulus items involving cognitive vulnerability, interpersonal and cost concerns were associated with dental attendance. The Spanish version of IDAF-4C+ presents similar psychometric properties to the original version which, considering the advantages of this instrument, qualifies the adapted one for its use in different research and applied contexts.

The extent and nature of dental fear and phobia in Australia

For the general dental practitioner, fearful patients are harder and more stressful to treat and are most likely to attend irregularly. This study presents updated and refined dental fear and phobia prevalence estimates in Australia as well as information on the nature of dental fear and phobia. A total of 1084 Australian adults (response rate = 71.7%) completed a mailed questionnaire. The survey contained four measures of dental fear and phobia, as well as questions regarding potentially anxiety-eliciting dental stimuli and past aversive dental experiences. The prevalence of high dental fear ranged from 7.8% to 18.8%, and more incapacitating dental phobia from 0.9% to 5.4%, depending upon the scale, cut-point and specific criteria used. Dental phobia was significantly associated with blood-injection-injury (BII) concerns. The cost of dental treatment was endorsed as the most anxiety-eliciting dental situation (64.5%), followed by fear of needles/injections (46.0%) and painful or uncomfortable procedures (42.9%). Anxiety-eliciting stimuli and the type of aversive dental experiences varied significantly by gender, age, income, education, language spoken at home and dental visiting frequency. High dental fear and dental phobia are common in Australia although prevalence estimates are highly dependent on both the scale and cut-points used.

Towards a better understanding of dental anxiety and fear: cognitions vs. experiences

Traumatic dental experiences are associated with dental anxiety and fear. However, many people with no dental fear have had negative dental experiences, and some people with considerable fear fail to recall any traumatic incidents. This study aimed to determine whether dental fear was better explained by experiences or by cognitive perceptions of going to the dentist as being uncontrollable, unpredictable, dangerous, and disgusting. A random sample of 1,084 Australian adults (response rate = 71.7%) completed a mailed questionnaire with measures of dental fear, perceptions of going to the dentist, and dental experiences. Perceptions of uncontrollability, unpredictability, dangerousness, and disgustingness had strong bivariate associations with scores on the Index of Dental Anxiety and Fear (IDAF-4C). Vulnerability-related perceptions accounted for 46.3% of the variance in IDAF-4C scores beyond that accounted for by demographic variables and five possible dental experiences comprising intense pain, considerable discomfort, gagging, fainting, and having a personal problem with the dentist. In contrast, dental experiences accounted for < 1% of the variance in IDAF-4C scores beyond that accounted for by the four cognitive perceptions. Perceptions of uncontrollability, unpredictability, dangerousness, and disgustingness were superior predictors of dental fear compared with negative dental experiences.

Development and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4C+).

The measurement of dental fear is important due to its high prevalence and appreciable individual, clinical, and public health consequences. However, existing measures of dental anxiety and fear (DAF) have theoretical or practical limitations. This study describes the development and subsequent assessment of the reliability and validity of test scores of a new DAF scale for adults. The Index of Dental Anxiety and Fear (IDAF-4C+) contains 3 modules that measure DAF, dental phobia, and feared dental stimuli. The final 8-item DAF module (IDAF-4C) assesses emotional, behavioral, physiological, and cognitive components of the anxiety and fear response. The proposed scale dimensionality received support from exploratory factor analysis. IDAF-4C items showed good internal consistency (Cronbach's alpha = .94) and test-retest reliability at 4 months (r = .82), and the scale was strongly associated with other dental fear scales as well as with dental visiting patterns, avoidance of the dentist, and dental phobia diagnosis. The convergent and predictive validity of the IDAF-4C compared positively to Corah's (1969; Corah, Gale, & Illig, 1978) Dental Anxiety Scale and a single-item measure of dental fear, and the scale predicted future dental visiting and visit perceptions. Both phobia and stimulus modules showed strong and statistically significant associations with DAF ratings. In all, sufficient evidence is provided to demonstrate that the new scale would be a useful tool to assess DAF in an adult population. The IDAF-4C+ is based on strong theoretical underpinnings, yet the scale is practical enough for application across a variety of potential uses.

Dental Fear And Anxiety In Different Gender Of Chennai Population

Gender differences in dental fear have been of increasing interest among clinicians and researchers and dental fear is a common obstacle to obtain dental care. People with high dental fear have poorer oral health and often suffer significant social and psychological impacts associated with their oral state. People with dental phobia may also suffer from a variety of anxiety disorder, mood disorder, personality and behavioral disorder s as well as from multiple other specific fears. One measure of dental fear captures the aspect of state anxiety more while another measure emphasizes the aspect of trait anxiety. This study examines the gender differences of dental fear among the Chennai population across a broad range of relevant factors, including biological influences, temperamental factors, stress and trauma, cognitive factors, and environmental factors. Gender differences are observed with increasing consistency as the scope of analysis broadens to molar levels of functioning. Socialization processes cultivate and promote processes related to anxiety, and moderate gender differences across levels of analysis.

Psychometric properties of Spanish-language adult dental fear measures

BackgroundIt would be useful to have psychometrically-sound measures of dental fear for Hispanics, who comprise the largest ethnic minority in the United States. We report on the psychometric properties of Spanish-language versions of two common adult measures of dental fear (Modified Dental Anxiety Scale, MDAS; Dental Fear Survey, DFS), as well as a measure of fear of dental injections (Needle Survey, NS).MethodsSpanish versions of the measures were administered to 213 adults attending Hispanic cultural festivals, 31 students (who took the questionnaire twice, for test-retest reliability), and 100 patients at a dental clinic. We also administered the questionnaire to 136 English-speaking adults at the Hispanic festivals and 58 English-speaking students at the same college where we recruited the Spanish-speaking students, to compare the performance of the English and Spanish measures in the same populations.ResultsThe internal reliabilities of the Spanish MDAS ranged from 0.80 to 0.85. Values for the DFS ranged from 0.92 to 0.96, and values for the NS ranged from 0.92 to 0.94. The test-retest reliabilities (intra-class correlations) for the three measures were 0.69, 0.86, and 0.94 for the MDAS, DFS, and NS, respectively. The three measures showed moderate correlations with one another in all three samples, providing evidence for construct validity. Patients with higher scores on the measures were rated as being more anxious during dental procedures. Similar internal reliabilities and correlations were found in the English-version analyses. The test-retest values were also similar in the English students for the DFS and NS; however, the English test-retest value for the MDAS was better than that found in the Spanish students.ConclusionWe found evidence for the internal reliability, construct validity, and criterion validity for the Spanish versions of the three measures, and evidence for the test-retest reliability of the Spanish versions of the DFS and NS.

The relationship between temperament and fearfulness in adult dental phobic patients

Temperament has been associated with dental fear (DF) and dental behavioural management problems (DBMP) in children, but little is known about what role temperament plays in the aetiology of DF. Thus, measures of temperament suitable for use among children, adolescents, and adults would be of value for longitudinal and family studies of DF, where relations between children's and parent's ratings are investigated. Our aim was to explore the adapted EASI (emotionality, activity, sociability, and impulsivity) in adult patients, and to evaluate the instrument in comparison with established measures of DF and general emotional reactions in adults. The subjects were 230 adult patients applying for treatment for DF and 41 nonfearful patients (reference group). Questionnaires investigated temperament (general and DF) and general anxiety and depression. The previously described factor structure of the EASI among children was confirmed and the adapted EASI had acceptable psychometric qualities. Emotionality correlated with DF and with measures of general psychological distress. No differences were found in mean scores of EASI dimensions between DF group and the reference group, which was in contrast with studies in children. The adapted EASI seem promising for use in future longitudinal and familial studies of development of DF and DBMP.

Development and validation of the Spanish Interval Scale of Anxiety Response (ISAR).

As increasing attention is paid to disparities in oral health care, cross-cultural means for assessing dental fear, a significant barrier to dental care, are in high demand. There is, however, a surprising shortage of Spanish-language dental fear measures in the literature, despite evidence of dental fear and avoidance in Spanish-speaking populations. The goals of the current series of studies were to develop and validate a Spanish-language version of the Interval Scale of Anxiety Response (ISAR). Magnitude estimation, a technique in which participants are asked to assign a number to indicate the perceived intensity of a stimulus or phrase, was used to compare the Spanish ISAR to the original English ISAR during the development studies. As a result of the 4 initial development studies, modifications were made to both the Spanish and English scales. Once 2 seemingly equivalent scales were established, validation studies were completed with native Spanish- and English-speaking dental patients. The results suggest that both the Spanish and modified English ISAR scales are valid measures of state anxiety associated with dental treatment. Additionally, the results of these studies highlight the importance of thoroughly testing translated measures to ensure they are accurately assessing that which they purport to measure.

Common use of a Fear Survey Schedule for assessment of dental fear among children and adults

Little is known about children with dental fear (DF) in a long-term perspective. Measures of DF suitable for use among children, adolescents, and adults would be of value for longitudinal and family studies. Our aim was to explore the DF subscale of the Children's Fear Survey Schedule (CFSS-DS) in highly fearful adult dental patients. The subjects were 230 adult patients applying for treatment for severe DF at a specialized DF clinic. Questionnaires investigated background data, general fear and DF, and general anxiety and depression. Reference data were obtained from 36 nonfearful patients on a subset of questionnaires. The fearful group reported high levels of DF on all measures and at a level similar to children with severe DF. The DF measures clearly differed between the fearful and reference groups. A factor analysis revealed a three-factor structure (fear of dental treatment, medical treatment, and of strangers and choking), which explained 68% of the variance. The CFSS-DS appears suitable for use in studies of adult populations. The results indicated that some areas of DF (physiology, avoidant behaviour, anticipatory anxiety), areas of importance among adult patients, are not assessed by the CFSS-DS. Studies of adults should therefore also include established adult measures of DF.