Dental fear and behavior management problems in children. A study of measurement, prevalence, concomitant factors, and clinical effects.

A Swedish parental version of the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) was administered twice to the parents of 52 children aged 4-14 yr, and CFSS-DS was compared with child behavior during treatment. CFSS-DS reached high values for validity and reliability, and scores of 38 or more were found to be related to dental fear. The prevalences, concomitant factors, and clinical effects of dental fear and behavior management problems (BMP) were studied in a representative study population of 4,505 children aged 4-6 and 9-11 yr. Parents of 3,204 of the children (71%) answered a questionnaire containing CFSS-DS, a Short Form of Children's Fear Survey Schedule (CFSS-SF) measuring general emotional status, Corah Dental Anxiety Scale (DAS) to measure maternal and paternal dental fear. The dental records were retrieved from the Public Dental Service, and 4,061 complete dental records provided information regarding behavior management problems, caries, fillings, dental treatments and number of missed appointments. The study population had a mean score of 23.1 on CFSS-DS (sd 8.1; range 15-71). Dental fear (CFSS-DS scores > or = 38) was found in 6.7%, and BMP in 10.5% of the children. Both dental fear and BMP decreased with age. Age, general emotional status, and maternal dental anxiety were identified as concomitant factors in the development of dental fear. Experiences of pain during dental treatment increased the risk of developing dental fear and BMP. Dental fear and BMP were associated with missing of dental appointments and deterioration of dental health. A new method using projective techniques to measure child dental fear, the Children's Dental Fear Picture test (CDFP), was developed. Data regarding reliability and validity of CDFP was established in a group of 146 children selected from the questionnaire survey. The testings with CDFP were performed by two trained dentists. CDFP proved to have high interexaminer reliability (88.9%), and to be a valid test. Sensitivity was calculated to 98.5%.