Medo e ansiedade odontológicos: concordância entre diferentes instrumentos de mensuração e associação com fatores individuais da criança e da família

Abstract

Dental fear and anxiety are highly prevalent in dental practice, particularly among children, and are defined as strongly negative feelings associated with dental treatment and its context. There is a gap in literature, as studies with representative samples using children’s self-reports outside the clinical environment are scarce. Therefore, the objectives of this study were to assess the prevalence of self-reported dental fear and anxiety in children and to investigate the agreement between different measurement instruments, as well as the association of children’s dental fear and anxiety with that of their primary caregivers, socioeconomic factors, and oral health conditions. A population-based, cross-sectional study was conducted with children aged 4 to 6 years and their caregivers, in the city of Carmópolis de Minas, Minas Gerais, from March to September 2023. Children’s dental fear and anxiety were measured using caregiver proxy reports with the Dental Anxiety Question (DAQ) and children’s self-reports with the Children Fear Survey Scale - Dental Subscale (CFSS-DS). Caregivers completed the Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS) regarding their own feelings of dental fear and anxiety. They also answered a socioeconomic questionnaire and provided information about the child’s history of toothache and dental visits. Dental caries was assessed by two calibrated examiners according to the World Health Organization decayed, missing, and filled teeth index (dmft). The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (CAAE No. 31334720.1.0000.5149). Data were subjected to descriptive analysis, Intraclass Correlation Coefficient (ICC), Bland-Altman analysis, and Structural Equation Modeling (SEM). The final sample consisted of 272 children, with a prevalence of self-reported dental fear and anxiety (CFSS-DS) of 58.1%. No correlation was found between children’s self-reports and caregivers’ proxy reports of children’s dental fear and anxiety (ICC = 0.037; 95%CI = -0.231–0.247; p = 0.381). However, a moderate correlation was found between caregivers’ self-reports using DFS and DAS (ICC = 0.43; 95%CI = 0.27–0.56; p < 0.001). Bland-Altman analysis demonstrated a lack of agreement between CFSS-DS and DAQ, as well as between DFS and DAS. SEM showed that children with dental caries experience (β = 0.145; p = 0.036) and those who had a dental visit within the last six months (β = -0.158; p = 0.037) presented higher levels of dental fear and anxiety. Caregivers’ dental fear and anxiety were not associated with children’s dental fear and anxiety, nor were other caregiver-related factors. This study concludes that caregivers’ reports of children’s dental fear and anxiety do not agree with children’s self-reports. It is suggested that DFS and DAS should not be used interchangeably. Furthermore, individual factors in children, such as dental caries and toothache, were associated with dental fear and anxiety, whereas caregiver-related factors were not.