Understanding The Prevalence of Childhood Dental Fear and Anxiety

A recently published systematic review and meta-analysis highlights over one-third of children suffer from dental fear and anxiety.

By Mehmood Asghar, Ph.D.

Dental fear and anxiety (DFA) are commonly observed in dental settings and are described by intense negative emotions associated with dental treatment. The high global prevalence of DFA among children is alarming as it could seriously affect their oral health and physical well-being as these children tend to postpone or avoid dental treatment.

Available scientific evidence suggests a considerable variation between the calculated prevalence of DFA among children, ranging between 4% and 98%. This significant variation in the pooled prevalence of DFA could be due to various factors, such as the type of tools used for assessment, cultural influences, hereditary factors, individual experiences of the child, and family-related factors.

Global Incidence of DFA During Early Childhood

Systematic reviews provide robust scientific information regarding the incidence of a particular disease or problem. Interestingly, previously published systematic reviews have evaluated both children and adults. However, except for a systematic review published by Grisolia et al. (2021) – which reported a pooled prevalence of DFA of 37% among preschool children – no systematically reviewed publication has focused on the incidence of DFA during early childhood.

The Need for Precise Estimation of Global Pediatric DFA

Understanding the precise prevalence of DFA among children could help develop targeted interventions and policies to improve global pediatric oral health and overcome the fear of dental treatment. Hence, dental professionals from China and the USA joined hands and performed a systematic review and meta-analysis (SRMA) to calculate the global prevalence of DFA among children. Furthermore, studies included in this SRMA analyzed various factors associated with DFA among children aged 2 – 6.

The study acquired data from three English language databases (PubMed, EMBASE, and Web of Science). A total of 2,895 studies that evaluated DFA among young children, published between 2000 and 2023, were considered, and only 25 were included in the review that met the inclusion criteria. The following factors associated with DFA among children were studied:

  1. Type of assessment tool used
  2. Location of the study
  3. Dental experiences of the respondents/reporter (parents or dentist) and children

Findings of the SRMA

The findings of this SRMA were published in the Journal of Dentistry in February 2024 (Sun et al., 2024), and very interesting results were observed. The overall pooled prevalence of DFA among 2- to 6- year-old children was found to be 30% (05% CI = 25, 36). Another interesting finding was that children who did not visit their dentist (OR=1.37, 95 % CI=1.18, 1.59) or those who had dental caries (OR=1.18, 95 % CI=1.09, 1.27) had higher odds of experiencing DFA than those who visited their dentist and didn’t have tooth decay.

Summary of the Extracted Information

Among the different types of assessment tools used, the most commonly used were the Frankl Behaviour Rating Scale (32%), the Children's Fear Survey Schedule-Dental Subscale (20%) the Dental Anxiety Question tools (20%). It was shown that the prevalence of DFA was higher in dental settings than in a non-dental environment.

Over 92% of the included studies were cross-sectional, and 64% employed the convenience sampling technique. Similarly, 16 out of 25 studies used dental settings to collect data. The majority of the respondents were dentists (12), followed by parents (8) and children (5).

Interestingly, this SRMA did not find any statistically significant difference between DFA prevalence among boys and girls. The authors attribute this to the young age of the children evaluated. Gender-specific differences in DFA prevalence can be expected in later ages due to the impact of social, environmental, and cultural factors. However, research states that the prevalence of DFA is higher among adolescent girls compared to boys (Grisolia et al., 2021).

The heterogeneity of the respondents could have influenced the findings. The authors propose that further research should be performed to ascertain the most suitable respondent for DFA incidence evaluation among children.

The Research Gap

It is interesting to note that the included studies were primarily from Europe, Asia, and South America, and no studies were from continents of North America, Africa, and Australia. This implies a research gap that needs to be filled to improve the precision of the global incidence of pediatric DFA.

The Take-Home Message

This study highlights that nearly one-third of children in the early childhood bracket experience DFA globally. While the choice of the assessment tool did not significantly affect the prevalence, children without a previous dental visit and caries experience were more likely to experience DFA than those who visited the dentist and were caries-free.

The overall global incidence of DFA in children is very high. Policy-level interventions are needed to overcome this issue and improve dental treatment and oral healthcare acceptance among children worldwide.

After all, good dental hygiene habits learned during childhood tend to go a long way in keeping one healthy and smiling.


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, 168-183.

Sun, I. G., Chu, C. H., Lo, E. C. M. & Duangthip, D. 2024. Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis. Journal of Dentistry, 142, 104841.


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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 is also currently pursuing a Ph.D. in Restorative Dentistry from 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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