Does Sedation Method and Parental Experience Affect Dental Fear in Children?

Recent research shows that the type of sedation used during pediatric dental treatment as well as past parental experience impacts a child's dental fear level.

By Dr. Mehmood Asghar (B.D.S, M. Phil., P.hD.,)

As dental professionals, one of our most challenging responsibilities is treating fearful, apprehensive patients. Unfortunately, the high prevalence of dental fear among pediatric patients causes many to avoid treatment or see the dentist only when the pain becomes unbearable. According to a systematic review by Grisolia et al. (2021), the global incidence of dental anxiety among schoolchildren is 25.8%.

Thankfully, general anesthesia (GA) and nitrous oxide inhaled sedation (IS) can calm uncooperative and treat physically or mentally challenged individuals. In addition, both options effectively decrease fear in dental patients. For example, a study by Collado et al. (2006) found that dental anxiety in children was reduced from 22.3% to 8.5% after the third session under IS. Besides, GA is known to be a safe option for children who need urgent treatment or those who need to undergo lengthy procedures in a single sitting.

Can General Anesthesia and Inhalation Sedation Help Reduce Dental Fear in Children?

The prevalence of dental fear among pediatric patients is influenced by multiple factors. For example, Luoto et al. (2017) found a positive correlation between parents' self-reported dental anxiety and their children. More importantly, another factor that could influence dental fear in children is their oral health status. Currently, no studies have evaluated the effect of oral hygiene and dental fear prevalence.

By understanding the various factors influencing dental fear and anxiety in children, we, as dental professionals, can improve the quality of pediatric dental services and help them overcome their fears. An interesting study was published in the International Journal of Pediatric Dentistry by a multi-specialty team of researchers from the University of Chicago, the Center for Child Health, Behavior, and Development (Seattle).

This study aimed to examine the factors associated with dental fear among 4-12-year-old children (mean age = 5.8 ± 1.8 years) after restorative treatments at different time points – pre-treatment (T1 = 4 weeks), post-treatment (T2 = 16 weeks), and follow-up (T3 = 29 weeks), using GA or IS.

Among the 82 children who participated, 69% had only one treatment visit. Among these, 56 (65.9%) received treatment under GA, while the remaining 29 (31.4%) were treated under IS. Therefore, only 82 children participated in the follow-up survey at T3. Children's Fear Survey Schedule, Dental Subscale (CFSS-DS), was used as the measurement of fear in the patients.

Dental Fear and Sedation Procedures – the Results

Here is the interesting part, children treated under GA had higher CFSS-DS (32.7 ± 14.6) than those who received IS treatment (27.0 ± 10.0) at T1. At T2, GA-treated children a non-significant increase in CFSS-DS (p > 0.05), which, however, increased at T3 (T3 – T1 = 2.36 ((95% CI = -3.43, 8.15)). As expected, children treated under IS had a statistically significant increase in CFSS-DS from T1 to T3 (T3 – T1 = 3.73 (CI = 0.38, 7.09)). It may be due to the lesser need for complex treatment for IS-treated patients than GA. Interestingly, the author's initial hypothesis that the greater the number of treatment procedures required, the higher the likelihood of dental fear in the children was not supported by the available data.

What's more intriguing was that children who experienced an increase in CFSS-DS had parents who had reported a "poor" experience of dental treatment. So, we can see that dental treatment experience can directly influence the level of dental fear in children.

The Take-home Message

This study by Heaton et al.(2023) clarifies that the prevalence and the level of dental fear in children are not influenced solely by the type of sedation used. Instead, other factors, such as previous dental treatment experiences of children, are also crucial. So, children whose parents have had good dental treatment throughout life are less likely to have dental fear than those whose parents report a "poor" treatment experience.

However, the results of this study should be interpreted with caution. Firstly, due to the small sample size, the results were collected from a single clinic lacking diversity. More importantly, children were not randomly assigned to groups. Furthermore, GA-treated patients usually need to undergo more complex and time-taking treatment than those treated under IS. Therefore, this factor could also influence the results.

Nevertheless, the study paves a way forward for future research. As dental professionals, our focus should be on improving our patients' treatment experience so that – as per the findings of this study – their children don't suffer from dental anxiety or phobia in the future. Besides, further research should be performed to identify other factors that could influence dental fear in pediatric patients.

Author: Dr. Mehmood Asghar is a dentist and Assistant Professor of Dental Biomaterials at the National University of Medical Sciences, Pakistan. Dr. Asghar received his undergraduate and postgraduate dental qualifications from the National University of Science and Technology (NUST). He obtained a Ph.D. in Restorative Dentistry from Universiti Malaya, Malaysia. Besides his hectic clinical and research activities, Dr. Asghar likes to write evidence-based, informative articles for dental professionals and patients. Dr. Asghar has published several articles in international, peer-reviewed journals.

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  1. Collado, V., Hennequin, M., Faulks, D., Mazille, M.-N., Nicolas, E., Koscielny, S., & Onody, P. (2006). Modifying behavior with 50% nitrous oxide/oxygen conscious sedation over repeated visits for dental treatment a 3-year prospective study. Journal of clinical psychopharmacology, 26(5), 474-481.
  2. Grisolia, B. M., Dos Santos, A. P. P., Dhyppolito, I. M., Buchanan, H., Hill, K., & Oliveira, B. H. (2021). Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta‐analyses. International Journal of Paediatric Dentistry, 31(2), 168-183.
  3. Heaton, L. J., Wallace, E., Randall, C. L., Christiansen, M., Seminario, A. L., Kim, A., & McKinney, C. M. (2023). Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and dental health. International Journal of Paediatric Dentistry, n/a(n/a).
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