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Table of Contents   
ORIGINAL RESEARCH  
Year : 2022  |  Volume : 33  |  Issue : 2  |  Page : 126-129
Evaluation of the mother's anxiety and child's fear in two different age groups in the child's first and second dental visit


1 Department of Pedodontics & Preventive Dentistry, Chettinad Dental College & Research Institute, Kancheepuram District, Tamil Nadu, India
2 Department of Pedodontics, SRM Dental College, Chennai, Tamil Nadu, India
3 Department of Oral & Maxillofacial Surgery, Chettinad Dental College & Research Institute, Kancheepuram Dist, Tamil Nadu, India
4 Department of Pedodontics & Preventive Dentistry, Sri Venkateshwara Dental College, Karur District, Tamil Nadu, India

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Date of Submission20-Mar-2020
Date of Decision19-May-2022
Date of Acceptance13-Jul-2022
Date of Web Publication13-Oct-2022
 

   Abstract 


The anxiety of the mother influences the child's behaviour in a dental setting. Objectives: The study aimed at evaluating the mother's anxiety and a child's fear of first and second dental visits in two different age groups. Study Design: The cross-sectional study design consisted of a total of 100 mother-child pairs attending Pediatric Dental clinics was included in the study. Group I consisted of 50 mother-child pairs of 6-8 years of age. Group II consisted of another 50 mother-child pairs between 12-15 years of age. Short Form of the Dental Subscale of the Children's Fear Survey Schedule (DFSS-SF) was administered to the child. Corah's Dental anxiety scale was administered to the mother. The Tell-Show-Do (TSD) technique was used in all children before the treatment. Statistical Analysis Used: SPSS software 21 was used for descriptive and inferential statistics. Pearson's correlation coefficient was used for bivariate correlation between variables in the study. Results: The anxiety level of mothers on both appointment days in both age groups was found to be highly significant. The correlation of maternal anxiety to the gender of the child in both groups was found to be highly significant. Conclusion: The fear of dental treatment was commonly found in children irrespective of gender in both age groups. The TSD technique was found to reduce fear in the subsequent appointment.

Keywords: Corah, fear survey schedule, fear, maternal anxiety, TSD

How to cite this article:
Srinivasan D, Senthil D, Senthil Eagappan A R, Rajesh P, Prakash KS, Shanmugavadivel G. Evaluation of the mother's anxiety and child's fear in two different age groups in the child's first and second dental visit. Indian J Dent Res 2022;33:126-9

How to cite this URL:
Srinivasan D, Senthil D, Senthil Eagappan A R, Rajesh P, Prakash KS, Shanmugavadivel G. Evaluation of the mother's anxiety and child's fear in two different age groups in the child's first and second dental visit. Indian J Dent Res [serial online] 2022 [cited 2022 Nov 30];33:126-9. Available from: https://www.ijdr.in/text.asp?2022/33/2/126/358445



   Introduction Top


The attitude of the mother towards dental treatment influences the behaviour of the child in accepting or rejecting the treatment.[1] Anxiety is an unconscious response occurring to an unknown danger. Anxiety is a learned process in one's environment. The Association of neutral stimuli with a negative experience causes anxiety. This is based on the classical conditioning theory by Ivan Pavlov. Fear of the unknown provokes anxiety. Yet one's response to an anxiety-provoking condition depends upon the individual's psychological trait, biological difference, and the environment. Albert Bandura in his Social Learning theory through the classic Bobo doll experiment clearly stated the influence of peers, and family in influencing the behaviour of a person. Fear occurs consciously and reduces one's coping mechanism and reduces the threshold of pain which produces Fight-or-Flight response. The characteristic of the mother governs the personality, behaviour, attitude, and perception of the child. Generally, the interactions between the parent and the child could be labelled under any of the two heads: autonomy vs control or hostility vs love. Mothers who exhibit autonomy have children that are friendly and cooperative. The hostile nature of the mother produces negative behaviour in a child. Shy, submissive, or anxious children have generally been subjected to overprotective or dominant parenting.[2] The hostile nature of the mother could make the child shy or aggressive, making him uncooperative with dental treatment.

Aim and objectives

To evaluate the mother's anxiety level and the child's fear response during the child's first, and second dental visit. To find a correlation between mothers' anxiety and fear responses exhibited by the children on a dental visit. To compare the level of a child's fear response between the two appointments, before and after behaviour modification techniques have been implemented.


   Materials and Methods Top


The cross-sectional study design consisting of a total of 100 mother-child pairs attending the pediatric dental clinic was taken into the study [Table 1]. Group I consisted of 50 mother-child pairs with children aged 6-8 years. Group II consisted of another 50 mother-child pairs with children aged 12-15 years. If the mother had visited the hospital with more than one child for dental treatment only the elder child was taken into the study. Inclusion criteria included children on the first dental visit who were accompanied by their mother and who required a minimum of two dental visits for treatment. Exclusion criteria included children with mental retardation, physical disabilities, systemic illnesses, intraoral or any extraoral swellings or sinus openings, children with acute dental symptoms, children not accompanied by their mothers, or children unable to understand or comprehend the questionnaire.
Table 1: Distribution of sample across two groups

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A structured questionnaire was administered to both mother and child. Short Form of the Dental Subscale of the Children's Fear Survey Schedule (DFSS-SF) consists of 8 questions with 5 options[3] [Table 2]. The responses of children ranged from 8 to 40. A child's fear was rated as low fear: 8-16, moderate fear: 17-24, high fear: 25-32, and severe fear: 33-40 based on their scores. To the mother, Corah's Dental anxiety scale [Table 3] was administered.[4] It consists of 4 questions with 5 options each. Option ratings were a = 1, b = 2, c = 3, d = 4, e = 5. Values ranged from a minimum of 4 to a maximum of 20. Based on anxiety scores, mothers were classified as having low anxiety <9, moderate anxiety: 9-12, high anxiety: 13-14, and severe anxiety/phobia: 15-20 scores. A vernacular (Tamil) version of the questionnaire was given to both the mother and the child. The study was approved by the Institutional Ethical Committee (IHEC/032015) and written informed consent was taken from the mother accompanying the child.
Table 2: Questionnaire to the child: Modified simplified children's Fear Survey Schedule

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Table 3: Questionnaire to mother: Corah's Dental anxiety scale

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The dental personnel, dental instruments, and the dental procedure to be done were explained to the children in a language understandable to the child. The Tell-Show-Do (TSD) technique was used for all the children before the treatment. The first-day treatment consisted of oral prophylaxis or restoration of decayed teeth. Positive reinforcement was used after completion of the treatment. The next appointment was scheduled within a week. Both the questionnaires were again repeated to both mother and child at the next dental appointment. The TSD technique was again used in the second appointment.

Statistical analysis

Descriptive and Inferential statistics were done using IBM SPSS Version 20.0 (IBM Corp, Released 2011, IBM SPSS Statistics for Windows, Version 20, Armonk, NY, IBM Corp). Mean and Standard deviation was used to summarize quantitative data. Frequency and percentage were used to analyse qualitative data. Pearson's correlation coefficient was used for bivariate correlation between variables in the study. Throughout the study, a P value of <0.05 was considered a statistically significant difference.


   Results Top


The average maternal anxiety level in Group I was 11.02 (moderate anxiety) and 7.6 (low anxiety) in the first and second appointments respectively [Table 4]. The average maternal anxiety in Group II was 9.3 (moderate) and 8.94 (low) in the first and second appointments respectively. The average fear in Group I children was 21.46 and 17.7 in the first and second appointments respectively (both moderate). The average fear in Group II children was 18.82 (moderate) and 16 (low) in the first and second appointments respectively [Table 4]. The correlation between the anxiety level of the mother on both appointment days was found to be highly significant. Comparing the fear level of the child in both the appointments was found insignificant. The correlation between maternal anxiety to gender was found to be highly significant. The correlation between dental fear and gender was found to be insignificant [Table 5].
Table 4: Average maternal anxiety and fear of the child in both the groups

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Table 5: Correlation of findings in both age groups

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   Discussion Top


Parents teach children in expressing and modulating their emotions. The reference frame provided by the parent helps children to observe and imitate the behaviour. Factors like the family type (joint or nuclear family), the influence of the father and/or mother, number of siblings, sibling interaction, and peers also influence the behaviour of the child.[5] A child's fear should be addressed as soon as possible. Anxiety has been defined as a “state of unpleasantness with associated fear of danger from within or a learned process of one's environment.”[6] A mother with a high level of dental anxiety exerts a negative influence on the child.[7] Anxiety and fear reduce the normal physiological response of a person. It even prevents the person from seeking dental treatment. Emotional responses of the patient, such as anxiety, fear, crying, phobia, and anger, impede the dentist's ability to provide effective treatment. Fear can be learned through direct conditioning (classical conditioning theory), reinforced conditioning (negatively reinforced-operant conditioning theory), or observation of a model exhibiting fearful behaviour (social learning theory). Children's fear survey schedule (CFSS), developed by Scherer and Nakamura consists of 80 items on a 5-point Likert scale.[8] Cuthbert and Melamed modified CFSS and developed it as a Dental Subscale of Children's Fear Survey Schedule (CFSS-DS). It consists of 15 items, with each item having five options ranging from “not afraid at all (1)” to “very much afraid (5)”.[9] The present study used the Short Form of the Dental Subscale of the Children's Fear Survey Schedule (DFSS-SF) developed by Carson and Freeman. It consists of eight items with 5 options. The total score ranges from 8 to 40.[3],[10] The scale is highly reliable and found to have a positive correlation with Frankl's behavioural scale.[10] The mothers were administered the Corah Dental scale to assess their anxiety.[11] Assessment of the anxiety of the patient is very essential before the treatment is initiated.[12] The scale differentiates between low anxiety to severe anxiety and even phobias. There has been a strong correlation found between parental anxiety and the child's fear.[13] A higher score of modified CFSS-DS could lead to interference in treatment by the patient. Modifying the behaviour-guidance technique could probably reduce the fear of the child. Repeated exposure to the dental environment could desensitize the patient and reduce the fear. TSD was used with age-appropriate language in all children for easy comprehension. It is the most widely used behaviour management technique.[14] A painful first dental visit is more likely to result in more anxiety in the subsequent appointments.[15] Thus, on the first dental visit, non-invasive procedures were carried out. Invasive procedures if required were carried out in subsequent appointments. In the present study, dental fear is reduced in older age groups similar to other studies.[16] This could be related to a child's better cognitive ability in coping with a stressful situation. The behaviour rating of children during the treatment was not recorded in the present study. Past medical experience can influence fear but, may not influence the behaviour of the child. A child may not be fearful but can have behavioural issues that can affect the treatment process.

In the present study, the anxiety level of mothers in both age groups decreased in the second appointment but did not significantly alter, whereas the fear level of the children has been found to decrease in both the age group in the second appointment. The reason could be that behaviour modification techniques were introduced only to the child and not to the mother. This could have helped to decrease the fear and respond positively to dental treatment. The relationship between the mother's anxiety and the gender of the child was found to be highly significant in both age groups. A mother's anxiety is related to the severity of a child's dental disease.[17],[18],[19] Children who miss dental appointments are seen with very anxious parents.[20] This could be related to the socio-cultural background of the children being raised. The type of society that the parents raise their children in could have a strong bearing on the anxiety of the mother concerning gender. The society in which the present study was carried out could be labelled as a conservative male-dominated one which would probably increase the mother's apprehension towards the female child. The fear of dental treatment was commonly found in children irrespective of gender in both age groups. Fear of the unknown was probably related to the first dental visit, and negative conditioning by their parents, peers, and friends. Thus behaviour modification approach is very much needed, as seen in the present study. The TSD technique has been able to reduce fear in the subsequent appointment. Dental educational initiatives regarding various treatments could probably modify the negative conditioning of the patient which would increase the awareness of various dental procedures. This could reduce the preconceived bias towards dental treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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2.
Maccoby EE. The role of parents in the socialization of children: An historical overview. In: Parke RD, Ornstein PA, Rieser JJ, Zahn-Waxler C, editors. A Century of Developmental Psychology. Washington, DC: American Psychological Association.1992. p. 589-615.  Back to cited text no. 2
    
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Ripa LW. Maternal influence on children's behavior in the dental situation. In: Ripa LW, Barnie JT, editors. Management of Dental Behavior in Children. Littleton, MA: PSG Publishing; 1979.p. 15-76.  Back to cited text no. 7
    
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Cuthbert MI, Melamed BG. A screening device: Children at risk for dental fear and management problems. J Dent Child 1982;49:432-6.  Back to cited text no. 8
    
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Scherer MW, Nakamura CY. A fear survey schedule for children (FSS-FC): A factor analytic Comparison with manifest anxiety (CMAS). Behav Res Ther 1968;6:173-82.  Back to cited text no. 9
    
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Assuncão CM, Losso EM, Andreatini R, de Menezes JV. The relationship between dental anxiety in children, adolescents and their parents at dental environment. J Indian Soc Pedod Prev Dent 2013;31:175-9.  Back to cited text no. 12
    
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Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V. Evaluation of dental fear in children during dental visit using children's fear survey schedule-dental subscale. Int J Clin Pediatr Dent 2013;6:12.  Back to cited text no. 16
    
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Pramila M, Murthy AK. Dental fear in children and its relation to dental caries and gingival condition-a cross sectional study in Bangalore City, India. International Journal of Clinical Dental Science 2010;1(1).  Back to cited text no. 17
    
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Alhareky M, Nazir MA, AlGhamdi L, Alkadi M, AlBeajan N, AlHossan M, et al. Relationship between maternal dental anxiety and children's dental caries in the Eastern Province of Saudi Arabia. Clin CosmetInvestig Dent2021;13:187-94.  Back to cited text no. 19
    
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Correspondence Address:
Dr. Daya Srinivasan
32 Rajalakshmi Nagar, 3rd Main Road, Velachery, Chennai - 600 042, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_256_20

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