Natavan Yagubova ¹, Hulya Cerci Akcay ²

¹ Kocaeli Health and Technology University Faculty of Dentistry, Kocaeli, Turkey

² Department of Pedodontics, Kocaeli Health and Technology University Faculty of Dentistry, Kocaeli, Turkey


Received: 14 June 2024

Revised: 24 June 2024

Accepted: 24 June 2024

Published: 24 June 2024

Corresponding author:

Hulya Cerci Akcay.

Department of Pedodontics,

Kocaeli Health and Technology University

Faculty of Dentistry, Kocaeli, Turkey.

hulya.akcay@kocaelisaglik.edu.tr

Cite as:

Yagubova N, Cerci Akcay H. Dental Anxiety in Pediatric Dentistry. Acta Med Eur. 2024;6(3):92-94. doi: 10.5281/zenodo.12515881

doi: 10.5281/zenodo.12515881

ABSTRACT

Children’s fear and anxiety towards dental procedures is a prevelant factor within the field of dental healthcare. This could lead to avoidance of treatment, consequently progressing the worsening of the oral condition which could impact tooth development. In this conspectus, a brief outline of the root causes of dental anxiety will be described, supported by a summary of other research. As well as innovative ways to combat these irrational reactions to dental procedures, that is tailored to each fear. The aim of this article is to help dental professionals differenciate and improve their understanding of these conditions, in addition to providing certain tools.

Keywords:

Dental anxiety, pediatric dentistry, scales.

INTRODUCTION

Definition and Etiology

Dental fear and anxiety are often used interchangeably, but they differ in terms of the extent of progression regarding the same psychological state. Dental fear is an expected negative emotional attitude toward threatening stimuli in a dental environment, such as needles. In contrast, dental anxiety is an exaggerated, persistent, and irrational negative emotional reaction that a patient can experience with reference to basic dental procedures (1). A comparative study (2) concluded that at least 1 out of 10 children had such a high level of dental fear and anxiety (DFA) that it impaired their capability to withstand the duration of dental treatment, confirming the prevalence of higher levels of anxiety in young children. Table 1 highlights the strengths and weaknesses of various diagnostic methods for assessing dental anxiety in children. Each method offers unique insights but also comes with specific limitations, emphasizing the need for a comprehensive approach to accurately measure dental anxiety.

Table 1. Advantages and disadvantages of different diagnostic markers of dental anxiety in children.

Types (Examples)	Advantages	Limitations
Self-report assessment	Measures cognitive element component of DF directly from child’s perspective	Developmental maturity may affect the ability for self-reporting and reliability in reporting. – Adequate level of comprehension and intellectual ability required – Interpretation of children’s drawings may require professional training.
Parental proxy-based assessment	Presents adult’s perspective of child’s DFA	May form bias through their own DFA and dental experiences
Observation-based assessment	Measures behavioral component of fear – Presents adult’s perspective of child’s DFA	Describes only observable signs of DFA – Training or calibration, especially when multiple observers are involved, to minimize observer effect or bias
Physiological assessment	Measures physiological component of DFA – Most objective measure of DA	Requires specialized equipment – Must be performed during the dental visit (instead of in non-clinical settings) – Observer effect due to invasive and fear- provoking measuring procedures

DF: Dental fear, DFA: Dental fear and anxiety, DA: Dental anxiety.

The etiology of anxiety is hard to pinpoint, as there are multiple possible theories. One theory states that anxiety can be divided into two subcategories: exogenous or endogenous. In the exogenous category, anxiety arises from either a scary personal experience or an observed terrifying experience of others. In contrast, a person in the endogenous category has an internal, predisposed inclination to restlessness. Another theory (3) states that dental anxiety is multidimensional, a combination of personality, fear of inflicted pain, previous personal or vicariously observed worrisome experiences, and most commonly, fear of blood. Freud’s initial theory posited that anxiety was caused by excitation of internal organs driven by the autonomic nervous system, dividing such responses by the body into three categories: Reality, Neurotic, and Model. Reality anxiety is due to existing sources, such as sharp objects or fear of pain, rooted in the notion of a threat. Neurotic anxiety results in physical manifestations after uncontrollable fear. Model Anxiety stems from feelings of guilt or shame, where the person is scared of being punished for their shortcomings and contradicting the ego’s ideal.

Management of Dental Anxiety

Reducing dental anxiety in children is paramount for cultivating a positive attitude towards oral health care. A multifactorial approach involving numerous strategies can effectively address this concern. Behavioral management techniques (4), such as the Tell-Show-Do method, involve explaining procedures in a way that is pleasing to the child’s mental development age, then demonstrating them either on a model or using a polishing brush while rotating on a low setting on their finger and then performing them gradually in their mouth alongside explaining. Positive reinforcement, such as using praise and rewards for cooperation, further reinforces good behavior during dental visits. Distraction techniques, including providing electronics such as phones or iPads or interactive toys, can divert the child’s attention from dental procedures, diminishing anxiety (5). Moreover, creating a relaxing and playful environment with colorful decorations, friendly staff, and child-friendly utilities such as playpens or dental educational toys can significantly reduce stress and fear associated with dental appointments. By combining these methods, dental professionals can nurture a positive dental experience for children, laying the foundation for a lifetime of optimal oral health habits.

Addressing such issues in recent years has led to some interesting, tailored approaches to each patient’s wishes. Beyond conventional methods described above, some dental clinics incorporate innovative strategies such as virtual reality (VR) experiences, where patients can immerse themselves in calming environments during procedures (6). Moreover, the integration of aromatherapy, utilizing soothing scents like lavender or chamomile, has shown promise in reducing anxiety levels due to the chemicals that excite the olfactory nerves, impacting the amygdala, which is responsible for emotional perception. Additionally, the implementation of pet therapy, with trained therapy animals providing comfort and distraction, has gained traction in dental practices aiming to create a relaxing atmosphere (7). These unique approaches, coupled with effective communication and personalized care, redefine

the dental experience, fostering a sense of tranquility and well- being for apprehensive patients.

DISCUSSION

In pediatric dental settings, the main stress-inducing factor is often the appearance of dental equipment, such as needles, and the child’s curiosity regarding the details of the procedure, where they may catch a glimpse of blood, leading to a negative reaction. To mitigate this scenario, virtual reality audiovisual systems are used as a distraction. A study (8) assessed the effectiveness of virtual reality eyeglasses in reducing anxiety during dental procedures in 6-10-year-olds. and concluded that this distraction technique was effective in reducing physiological reactions but not self-reported anxiety.

Another factor that can increase anxiety in certain patients is the chemical smell in dental clinics. This can be mitigated by introducing other smells to mask this odor. Aromatherapy, which uses certain oils to calm and relax patients, can improve their psychological well-being. A study investigated (9) the effects of aromatherapy with lavender or sweet orange oil scents, administered through a nebulizer or inhaled, on 150 children aged 8-12 years old. The findings of their research determined that aromatherapy decreased dental anxiety within the patients. Moreover, they established that sweet orange could pacify pain, as self-reported by the children.

In recent years, addressing dental anxiety has led to innovative, patient-tailored approaches. Some dental clinics incorporate strategies such as virtual reality experiences, aromatherapy, and pet therapy to create a relaxing atmosphere for patients (10). These unique approaches, coupled with effective communication and personalized care, redefine the dental experience, fostering a sense of tranquility and well-being for apprehensive patients.

In conclusion, dental fear and anxiety are common among children and can have a significant impact on their oral health care (11,12). It is essential for dental professionals to be aware of these issues and employ effective strategies to reduce anxiety and create a positive dental experience. By implementing behavioral management techniques, positive reinforcement, distraction techniques, and creating a child-friendly environment, dental professionals can help children develop a positive attitude towards oral health care, laying the foundation for a lifetime of optimal oral health habits.

CONCLUSION

Dental anxiety is particularly important in pediatric patients due to its potential long-term effects on oral health and future dental visits. Utilizing methods such as virtual reality and aromatherapy can significantly alleviate anxiety in children, leading to better overall dental experiences and improved oral health outcomes.

CC BY License

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

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