Dentophobia, Exploring Parental Factors - A Cross-sectional Survey

Introduction

A common emotional response to one or more specific threatening stimuli in a dental situation is dental fear (DF). Dental anxiety (DA) is a state of fear that something terrible will happen during dental treatment.¹

The terms dental fear and anxiety (DFA) were used in this study to refer to strong negative feelings connected to dentistry because the concepts of dental fear and dental anxiety are frequently used interchangeably in the dental literature.

There is a consensus that adverse dental treatment experiences may cause DFA in children, and that a high level of DFA has been linked to poor dental health.²

Additionally, parental DFA has been linked to a rise in childhood caries incidence^3,4 and a strong association between parental and child DFA has been demonstrated.⁵

The primary objective of the present study was to determine the percentage of kids afraid of dentist and the relationship between parenting style and kid's fear of dentist, to contrast parental dental anxiety with that of children, and to ascertain the child's level of fear.

Materials and Methods

A cross-sectional study was designed with a sample size of 101 children. All the children who were physically and mentally healthy in the age group of 6-13 years, who visited the Department of Pedodontics and Preventive Dentistry at Krishnadevaraya College of Dental Sciences along with their parents for their dental treatment needs were included in the study.

Sample size for continuous outcome– (Fisher’s Formula)

Inclusion criteria

1. Systemically and mentally healthy 6 -13-year-old children and their parents. 
2. Kannada and English-speaking children and parents.

Exclusion criteria

1. Patients having acute pain with systemic or mental illness or who were extremely uncooperative.
2. Children with special health care needs.
3. Children visiting with their bystanders who aren’t with their parents.
4. Parents who don’t know either Kannada or English.

Two google forms were formulated; one for the parents to fill out and the other form for the children.

Form 1 had the following four sections (to be filled by the parent):

1. Socio-demographic details

2. Dental anxiety scale (CORAH’S revised DAS-R)

3. Parenting style and dimension questions (PSDQ)

4. Children’s fear survey schedule (CFSS-DS)

Form 2 included three sections (to be filled by the child):

1. Dental anxiety scale (CORAH’S revised DAS-R)

2. Oral health behavior perception scale

3. Children’s fear survey schedule (CFSS-DS)

Electronic method of communication through google forms was used in our study. Statistical analysis was done using SPSS version 26.0

Results

Descriptive Statistics – Child

Association Matrix

1. Dental anxiety of kids and dental anxiety of parents were significantly associated.
2. Dental anxiety of kids and the oral health behaviour of parents were significantly associated.
3. Dental anxiety of kids and fear in parents were significantly associated.
4. Oral health behavior perception of kids was significantly associated with dental anxiety of parents.
5. Oral health behavior perception of kids was significantly associated with the oral health behavior perception of parents.
6. Oral health behavior perception of kids was significantly associated with fear in parents.
7. Fear in kids was significantly associated with dental anxiety in parents.
8. Fear in kids was significantly associated with oral health behavior perception of parents.
9. Fear in kids was significantly associated with fear in parents.

Dental anxiety, perception and fear

1. Kid’s dental anxiety was not significantly associated with family type.
2. Kid’s oral health behavior perception was not significantly associated with family type. 
3. Kid’s fear was significantly associated with family type.
4. Kid’s dental anxiety was significantly associated with the education of head of the family. 
5. Kid’s oral health behavior perception was significantly associated with education of head of the family.
6. Kid’s fear was significantly associated with the education of head of the family.
7. Kid’s dental anxiety was not significantly associated with the monthly income of family.
8. Kid’s oral health behavior perception was not significantly associated with the monthly income of family.
9. Kid’s fear was not significantly associated with the monthly income of the family.

Discussion

Association of oral hygiene behavior of kid

This study demonstrated significant association of oral health behaviour of the child with oral health behavior of parents and education of the head of the family. A child usually develops habits by observing parents at home. Children are usually surrounded by grown-ups and are included in the family until they are in the adult age group, particularly in countries like India. Thus, there is a high parental influence on children.

Our results (Tables 1-7) showed that maximum parent and child pairs had the same perception regarding their oral health status. However, certain children did not match their parents. Societal appeal prejudices could be the reason for difference in perceptions.

The attitude towards oral health of parents who are the primary role models for developing children’s oral health behavior depends on their education.⁶ Therefore, parents’ education levels should be considered a powerful social force to ensure oral well-being of children. This is in accord to the previous study conducted in rural India by Naveen Kumar et al. ⁷ It is also similar to the results of a study conducted in Istanbul which reported significant similarities between children and their parents in terms of frequency of dentist visits, the therapy they underwent in their last dentist visit, the cause of caries, the frequency of tooth brushing, the material used for oral hygiene, the duration of tooth brushing, method of tooth brushing, and tooth sites most brushed (p <0.01).⁸

Families with higher levels of education are more knowledgeable about the significance of oral hygiene. Therefore, for parents to successfully fulfill their responsibility of setting a good example for their children in terms of oral and dental health, accurate information should first be provided to them.

Table 8 shows a significant correlation between child's oral hygiene practices and the parent's dental anxiety. Three to forty-three percent of children worldwide, according to statistical analysis, experience dental anxiety.⁹ The Corah Dental Anxiety Scale was employed in this study to gauge the levels of dental anxiety among parents.

While "dental fear" is a typical emotional response to one or more specific threatening stimuli in a dental situation, some authors define "dental anxiety" as a feeling of dread about dental treatment that is not necessarily related to a specific stimulus.¹⁰ Tickle et al. ¹¹ found that children with anxious parents are more likely to experience anxiety themselves. Additionally, they are less likely to visit the dentist because of their anxiety, which has an impact on their oral hygiene.²

Association of fear and anxiety in kids

This study showed that education of head of the family significantly affects the dental fear and anxiety of children. Table 8 shows that child's dental anxiety and dental fear were significant.

Dental fear and anxiety (DFA) is a major issue affecting children’s oral health and clinical management. This study investigated the association between children’s DFA and family related factors, including parents’ DFA, education of head of the family and oral health behaviour of the parents.

Children who experience dental anxiety and fear frequently delay or postpone receiving dental care, which worsens their oral health. Children who overhear their parents' frequent discussions about their anxieties and dental visits may start to feel anxious themselves.

The two main causes of dental anxiety were frequently listed as dental pain and invasive procedures.¹² In a similar vein, 37% of the parents in this study admitted that a dental appointment scheduled the following day makes them feel anxious. In 64% of cases, parents were worried about injections. Kids reported being scared to receive an injection in 47% of cases.

Children with anxious parents are more likely to report anxiety, as reported by Tickle et al.¹¹ It appears that family members have similar health behaviours and habits. Young adults' dental anxiety is correlated with bad toothbrushing habits and children seem to mimic their parents' behavioural and dental hygiene habits.¹³ Parents who are anxious and afraid exhibit the same attitude which shapes the child.

Drilling by dentists and "noise of drill" also came up as a top fear for the respondents. According to a study, mothers' favourable attitude towards dental care in children aged 5 to 6 years was linked to lower rates of caries, better oral hygiene, and more frequent trips to the dentist.¹⁴ Kids dental fear was observed to be associated with oral health behavior of parents (p <0.01).

Parents with poor oral health are more likely to have frequent dental visits. Their neglect and negative attitude significantly impacts children.

Most psychologists concur that fears can be learned. Fear is a learned emotion, but it can also be unlearned. People can gain knowledge by watching the actions of others and the results of those actions.^15.16

It was proposed that parents act as role models for DFA development. Parental attitudes towards children's oral health may be viewed as a modelling process in which kids copy what adults do.¹⁷

A family may have a particular cognitive style for dealing with pain, which is related to a child's reaction to pain experiences, according to a study by Suzyen Kraljevic et al.

Conclusion

In this study, 63.3% children reported feeling anxious and tense before a dental examination. It was found that parental dental anxiety was significantly correlated with children's fear; so parents should be made more aware of dental therapy (not just kids). In order to lessen the transmission of fear from parent to child, parenting practices also need to be modified.

Source of fund

Self-funded by the principal author

Conflict of Interest

Nil