Prevalence of Dental Anxiety Level in 6- to 12-Year- Old South Indian Children.

BACKGROUND: Dental anxiety is one of the prime reasons for discouraging children to receive dental treatment. Measurement of the dental anxiety is very useful to know the prevalence level among 6- to 12-year-old children. Thus, the aim of the study was to determine the dental anxiety among 6- to 12-year-old children using Modified Dental Anxiety Scale (MDAS) score.
MATERIALS AND METHODS: A total of 400 south Indian children in the age group of 6-12 years who had visited Dental College and Hospital were recruited in the study. Dental anxiety was measured before dental treatment using MDAS. Statistical analysis was performed using Wilcoxon signed rank test.
RESULTS: Of the 400 children, 240 (61.5%) had severe dental anxiety, 92 (23%) had mild anxiety, and 78 (17%) had no anxiety. Females had higher anxiety level compared to males. Many study subjects answered that local anesthesia (LA) injection was considered most fearful. Dental anxiety was highest in smaller age groups.
CONCLUSION: In our research, high percentage of children had dental anxiety, so counseling before dental visits is very important to reduce the dental anxiety among these 6- to 12-year-old children.

INTRODUCTION

The oral health causes a significant impact on quality of life of a person. Various people from all ages and all social classes are affected by dental anxiety, which is a serious concern for the dentist to deliver efficient routine dental care.[1] The important barriers for availing dental services are fear and anxiety.[2] Many scales have been in use to detect dental anxiety, but many researchers have proved that Modified Dental Anxiety Scale (MDAS) is most valid scale to determine dental anxiety.[345] Many patients are reluctant to receive dental treatment because of preoccupied dental anxiety.[6] Dental anxiety and fear create a problem in the management of children in dental clinic.[7]

There is lack of published data about the prevalence of dental anxiety in 6 to 12 years’ age group in South India. Hence, this investigation has been conducted to determine level of dental anxiety in 6- to 12-year-old South Indian children.

MATERIALS AND METHODS

South Indian children in the age group of 6-12 years who had visited the Dental College and Hospital, as out patients were included in the study. Dental anxiety was measured before dental treatment. Before commencement of the study, ethical approval was taken from the institutional ethical committee. Informed consent was taken from the parents of the children after explaining the procedure and about related questions of MDAS. The study participation was voluntary and confidentiality was maintained about the replies given by study subjects. Anxiety levels were assessed using MDAS. Questionnaires printed on paper were offered to study subjects and parents and the filled questionnaires were collected. The MDAS contains five questionnaires (five items), which are presented in Table 1.[45] Each question has five answers with corresponding scores for each answer ranging from 1 (not anxious) to 5 (extremely anxious). The scores for each of the five questions were added to calculate a total dental anxiety score value. The score of 19 or above has been considered to be dentally anxious, the score of 12–19 was considered mild dental anxious, and the score of 5–11 was considered not anxious. The statistical analysis of the obtained data was conducted using Wilcoxon signed rank test.

Table 1

Modified Dental Anxiety Scale score

Questions	Score
(1) If you had to go the dentist tomorrow for a checkup, how would you feel about it?
(a) I would look forward to it as reasonably enjoyable experience	1
(b) I wouldn’t care one way or other	2
(c) I would be a little uneasy about it	3
(d) I would be afraid that it would be unpleasant and painful	4
(e) I would be very frightened of what the dentist do	5
(2) When you are waiting in the dentist office for your turn in the chair, how do you feel?
(a) Relaxed	1
(b) A little uneasy	2
(c) Tense	3
(d) Anxious	4
(e) So anxious that I sometimes break out in a sweat or almost feel physically sick	5
(3) When you are in the dentist’s chair waiting while the dentist gets the drill ready to begin working on your teeth, how do you feel?
(a) Relaxed	1
(b) A little uneasy	2
(c) Tense	3
(d) Anxious	4
(e) So anxious that I sometimes break out in a sweat or almost feel physically sick	5
(4) Imagine you are in the dentist’s chair to have your teeth cleaned. While you are waiting and the dentist or hygienist is getting out the instruments which will be used to scrape your teeth around the gums, how do you feel?
(a) Relaxed	1
(b) A little uneasy	2
(c) Tense	3
(d) Anxious	4
(e) So anxious that I sometimes break out in a sweat or almost feel physically sick	5
(5) If you were about to have local anesthetic injection in your gum, how would you feel?
(a) Relaxed	1
(b) A little uneasy	2
(c) Tense	3
(d) Anxious	4
(e) So anxious that I sometimes break out in a sweat or almost feel physically sick	5

RESULTS

Total 400 children participated and all questionnaires were filled by all study subjects, so the response rate was 100% [Table 2]. In our investigation, there were 166 males and 234 females [Table 2]. Mean MDAS score of total sample was 18.06 [Table 3]. Mean MDAS score in total male samples was 16.16, whereas that in total female sample was 18.32 [Table 4].

Table 2

Total study population and response rate to questions

Gender	Total participants	Response to all questions	Response rate (%)
Male	166	166	100
Female	234	234	100
	400	400	100

Table 3

Mean Modified Dental Anxiety Scale (MDAS) score, SD, and P-value of total sample size

Overall	Mean	SD	P-value
400	18.06	3.6	<0.0001

Table 4

Mean Modified Dental Anxiety Scale (MDAS) score values in both genders

Gender	MDAS score	P-value
Male	16.16 ± 4.3	<0.0001
Female	18.32 ± 3.2	<0.0001

Mean MDAS score from 6- to 13- year age group is presented in Table 5. Mean MDAS score in 6-year age group was 19.12, in 7-year age group was 18.64, in 8-year age group was 18.10, in 9-year age group was 17.28, in 10-year age group was 16.66, in 11-year age group was 16.12, in 12-year age group was 15.38, and in 13-year age group was 14.46 [Table 5].

Table 5

Mean Modified Dental Anxiety Scale (MDAS) score values in all age groups

Age (years)	Mean MDAS score	P-value
6	19.12 ± 7.16	0.04
7	18.64 ± 0.66	0.02
8	18.10 ± 2.81	0.06
9	17.28 ± 3.29	0.007
10	16.66 ± 4.2	0.05
11	16.12 ± 1.34	0.001
12	15.38 ± 1.58	0.051
13	14.46 ± 4.2	0.01

A total of 240 (61.5%) study subjects exhibited severe dental anxiety, 92 (23%) had mild anxiety, and 78 (17%) displayed no anxiety. Among males, 92 (55.42%) study subjects had severe anxiety, 50 (30.12%) had mild anxiety, and 24 (14.45%) had no anxiety. In females, 148 (63.24%) respondents had severe anxiety, 42 (17.94%) showed mild anxiety, and 44 (18.8%) had no anxiety [Table 6].

Table 6

Level of dental anxiety in both genders

Gender	Anxiety levels			Total
	No anxiety (MDAS score 5–11)	Mild anxiety (MDAS score 12–18)	Severe anxiety (MDAS score above 19)
Female	44 (18.8%)	42 (17.94%)	148 (63.24%)	234
Male	24 (14.45%)	50 (30.12%)	92 (55.42%)	166
Total	78 (17%)	92 (23%)	240 (61.5%)	400

MDAS = Modified Dental Anxiety Scale

Question 5 was most fearful; it had aggregate score of 3.48 and 3.54 in males and in females, respectively [Table 7].

Table 7

Responses to five questions of Modified Dental Anxiety Scale (MDAS) by both sexes

Questions	Male	Female
Q1	1.46(±0.021)	1.74(±0.036)
Q2	1.97(±0.029)	2.39(±0.033)
Q3	3.06(±0.043)	3.10(±0.035)
Q4	2.59(±0.042)	2.86(±0.040)
Q5	3.48(±0.054)	3.54(±0.063)

DISCUSSION

The prevalence of dental anxiety has posed a challenge for the delivery of dental services to the children. There are various scales available to measure dental anxiety. Tunc et al.[3] and Ilgüy et al.[6] have proved that MDAS is most reliable and most acceptable scale. Determination of the dental anxiety among children will be helpful to plan treatment and also to equip with preventive measures to decrease dental anxiety.

In our observation of 400 study subjects, the prevalence of severe anxiety was 61.5% and 23% had mild anxiety, so total dental anxiety in our study sample was 84.5%. Our study showed increase in anxiety levels just before the dental visit in 6- to 12-year- old children, which is an indication that they have fear of unknown about the dental treatment. Our findings are in accordance with the following studies. de Menezes Abreau et al.[8] investigated 302 children in the age group of 6–7 years and concluded that dental anxiety reduced after dental visit. Reduction in anxiety after visiting dental clinic is an indication that use of appropriate behavior management has helped in reducing dental anxiety in children.

In our observation, females exhibited high aggregate MDAS score (18.32) compare to males (16.16). This finding is supported by the studies of Fayad et al.,[9] Taani,[10] and Weinstein et al.[11] In our study, females exhibited higher anxiety compare to males. The previous studies have supported that females have higher levels of neuroticism, so that could be the reason for high anxiety in females.[12] Dental anxiety can occur due to fear of bleeding, gagging, criticism, or needle; noise created by dental instrument; and previous unpleasant dental visits.[1314]

In our study among 6- to 12- year-old South Indian children, the prevalence of dental anxiety was high (84.4%) contrary to the study by Chhabra et al.,[7] who proved that prevalence of dental anxiety was 6.3% in North Indian children of 5–10 years.

CONCLUSION

Our investigation suggests that prevalence of anxiety in 6-12 years old children was high, which indicates they have been preoccupied with fear of unknown. Better exposure and educative programs will reduce the anxiety level in children. So there is necessity of preventive dental health education to reduce fear and anxiety in 6- to 12-year-old children.

Financial support and sponsorship

Nil.

Conflict of interest

None.