Maaike Ten Berge

Aim of this study was to investigate behavioural and emotional problems in preschool children in relation with behaviour problems during a highly stress provoking dental treatment. Eighty one healthy children between 2 and 4 years referred to the clinic of Special Dental Care (SBT) in Amsterdam were selected, based on dental need (extraction of one or more primary incisors). Each child was sedated with oral midazolam. Their behaviour was rated by registering the degree of acceptance during four consecutive time periods of the dental treatment. Prior to the treatment parents were asked to fill in a questionnaire. No significant correlations between temperament and behaviour were found with the total CBCL profile or its subscales. This confirms the results of earlier studies that the relationship of temperament, dental anxiety and behaviour problems is a complex matter and not yet fully understood. It is also indicated that within the entire treatment a child's behaviour is closely related to its behaviour in the preceded treatment step.

The aim of this study was to assess the relation between parental self-reported child-rearing attitudes and dental fear in children. The parents of 51 children with high dental fear and of 56 children with low dental fear, of different age groups, completed the Amsterdam version of the Parental Attitude Research Instrument. In addition, parents were asked to rate their own dental fear. Multivariate analysis of variance (child fear x parental fear x child age) showed a significant main effect only of child dental fear on parental self-complaints ( p = .03). For parental dental fear, main effects were found on overprotection and on promotion of autonomy ( p ≤ .01). No age effects were found. Also, no relation between children's dental fear and parental dental fear was found. Based on the present findings, it was concluded that parents may play a more secondary, mediating role in the etiological process of dental fear in children.

The aim of the present study was to assess the structure of childhood dental fear, using the Dutch parent's version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) and to report on its validity. Factor analysis (principal components, varimax rotation) was performed using the scores of a group of high fearful children (n=322). Results were compared with those from a previous study among low fearful children, also using the parent's version of the CFSS-DS. In addition, mean item scores between the samples were compared to examine specific differences. Factor analysis resulted in a stronger factor pattern than that found in previous research. Four factors accounting for 60% of the variance were found: 1) fear of general, less invasive aspects of dental treatment; 2) fear of medical aspects; 3) fear of drilling; 4) fear of strangers. It was concluded that with increasing fear levels, underlying factors of dental fear can be distinguished more clearly. The CFSS-DS was indicated to be a reliable and valid measure of dental fear.

Objective: This study aimed to present normative data on dental fear for the Dutch child population, by identifying not only highly fearful children but also children at risk for developing this high dental fear. Methods: Fear distribution of samples of high and low fearful children was studied, using the Dutch parent's version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS‐DS). Total fear scores were calculated for both samples, for different age levels and for boys and girls separately. To establish cut‐off scores, mean CFSS‐DS scores were associated with dentists' clinical fear ratings and, in addition, were transformed into stanines. Results: Scores between 32 and 38 were found to represent a borderline area for dental fear, and scores of 39 and higher to represent high dental fear. Conclusion: The results have shown 6% of the Dutch child population to be highly fearful, while another 8% may be at risk to develop high dental fear. By providing extra attention for these children, the development of high dental fear or phobia may be prevented.

This study aimed to examine the relative importance of invasive treatment experiences in the acquisition of dental fear in children. For this purpose, the complete dental history of 401 children (5-10 years) from 2 dental practices was studied. The level of dental fear in these children was assessed using the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Differences in treatment variables between high fearful and low fearful children were analysed, and regression analysis was performed to determine significant predictors of dental fear. A significant though weak relation of dental fear with the number of experienced extractions was found, while no relation with the number of experienced fillings was found. The results indicate that within the (direct) conditioning pathway, objective dental procedures seem to play a minor role in children's fear acquisition. Clinical support for the 'latent inhibition' theory was provided: a history of neutral or positive dental visits seems to serve as a defence against the development of dental fear in children.

The aim of this study was to assess parental beliefs on the causes and prevention of child dental fear in the Netherlands. The parents of 123 children (67 high fearful and 56 low fearful children) were interviewed about the causes of their children's dental fears, and about factors contributing to the prevention of this fear. Parents attributed their child's dental fear to the following factors: invasive dental experiences (37 percent), medical problems (19 percent), child's temperament (16 percent), negative dentist behavior (13 percent) and social influences (5 percent). In the prevention of child dental fear, an empathetic dentist (34 percent) and parental guidance (30 percent) were mentioned most frequently. In conclusion, conditioning factors were reported to be highly important in the development of child dental fear. Some of the parents, however, indicated temperamental factors to have played a role, suggesting that subgroups of dentally fearful children exist. These temperamental or psychological factors seem also to contribute substantially to the development of dental fear. Possible differences in parental attributional style are discussed.

Dental fear is a multifactorial problem frequently encountered during dental treatment of children. Studies have indicated that, among others, the behavior of the dentist may play a part in the development of this dental fear. The present study was undertaken to examine the behavioral aspects of the dentist-patient relationship, and specific dentists' behavior that can reduce dental fear. The behavior of forty children referred to a center for special dental care and of two dentists was assessed during treatment. T-test results showed that the children's level of fear decreased after treatment (mean 3.2 vs. 2.1, t = -5.6, p = .000). In addition, it was found that the dentists behaved more directly and authoritatively during the treatment of highly fearful children than during the treatment of relatively less fearful children (p < or = .034). It seems that this direct approach had a positive, long-term effect on these children's fearful behavior during treatment.

Abstract– This study was conducted among 203 children (103 boys) referred to a centre for special dental care because of a high level of dental fear. It was under‐taken to explore to what extent behavioural and emotional problems co‐exist in these children compared with children of a Dutch norm group. The children's parents filled out the parental version of the Child Behaviour Checklist (CBCL), before their first appointment at the centre. The behavioural and emotional problems of the children were assessed by this CBCL, and the mean scores of the children in the study were compared with the mean scores of the norm group. The mean scores on all scales, except on the subscale ‘sex problems’, of the children with a high level of dental fear proved to be significantly higher than the mean scores of the norm group (P≦0.001). The results indicated that children referred to a special dental care centre not only suffer from high dental fear but also have problems in several other behavioural and emotional areas. These problems appear to be heterogeneous; they were found in several specic problem areas, both external and internal.