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 Table of Contents  
Year : 2019  |  Volume : 11  |  Issue : 6  |  Page : 321-324  

Prevalence of dental anxiety level in 6- to 12-year-old South Indian children

1 Department of Pedodontics and Preventive Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
2 Department of Oral and Maxillofacial Pathology and Microbiology, Faculty of Dentistry, MAHSA University, Kuala Lumpur, Malaysia
3 Faculty of Dentistry, AIMST University, Kedah, Malaysia
4 Department of Oral Pathology and Microbiology, MNR Dental College and Hospital, Sangareddy, Telangana, India

Date of Web Publication28-May-2019

Correspondence Address:
Dr. Vinod Kumar
Department of Pedodontics and Preventive Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka 584102
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JPBS.JPBS_22_19

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Background: Dental anxiety is one of the prime reasons for discouraging children to receive dental treatment. Measurement of the dental anxiety is very useful to know the prevalence level among 6- to 12-year-old children. Thus, the aim of the study was to determine the dental anxiety among 6- to 12-year-old children using Modified Dental Anxiety Scale (MDAS) score. Materials and Methods: A total of 400 south Indian children in the age group of 6-12 years who had visited Dental College and Hospital were recruited in the study. Dental anxiety was measured before dental treatment using MDAS. Statistical analysis was performed using Wilcoxon signed rank test. Results: Of the 400 children, 240 (61.5%) had severe dental anxiety, 92 (23%) had mild anxiety, and 78 (17%) had no anxiety. Females had higher anxiety level compared to males. Many study subjects answered that local anesthesia (LA) injection was considered most fearful. Dental anxiety was highest in smaller age groups. Conclusion: In our research, high percentage of children had dental anxiety, so counseling before dental visits is very important to reduce the dental anxiety among these 6- to 12-year-old children.

Keywords: Blind children, dental anxiety, visual impairment

How to cite this article:
Kumar V, Goud E V, Turagam N, Mudrakola DP, Ealla KK, Bhoopathi PH. Prevalence of dental anxiety level in 6- to 12-year-old South Indian children. J Pharm Bioall Sci 2019;11, Suppl S2:321-4

How to cite this URL:
Kumar V, Goud E V, Turagam N, Mudrakola DP, Ealla KK, Bhoopathi PH. Prevalence of dental anxiety level in 6- to 12-year-old South Indian children. J Pharm Bioall Sci [serial online] 2019 [cited 2020 Nov 26];11, Suppl S2:321-4. Available from:

   Introduction Top

The oral health causes a significant impact on quality of life of a person. Various people from all ages and all social classes are affected by dental anxiety, which is a serious concern for the dentist to deliver efficient routine dental care.[1] The important barriers for availing dental services are fear and anxiety.[2] Many scales have been in use to detect dental anxiety, but many researchers have proved that Modified Dental Anxiety Scale (MDAS) is most valid scale to determine dental anxiety.[3],[4],[5] Many patients are reluctant to receive dental treatment because of preoccupied dental anxiety.[6] Dental anxiety and fear create a problem in the management of children in dental clinic.[7]

There is lack of published data about the prevalence of dental anxiety in 6 to 12 years’ age group in South India. Hence, this investigation has been conducted to determine level of dental anxiety in 6- to 12-year-old South Indian children.

   Materials and Methods Top

South Indian children in the age group of 6-12 years who had visited the Dental College and Hospital, as out patients were included in the study. Dental anxiety was measured before dental treatment. Before commencement of the study, ethical approval was taken from the institutional ethical committee. Informed consent was taken from the parents of the children after explaining the procedure and about related questions of MDAS. The study participation was voluntary and confidentiality was maintained about the replies given by study subjects. Anxiety levels were assessed using MDAS. Questionnaires printed on paper were offered to study subjects and parents and the filled questionnaires were collected. The MDAS contains five questionnaires (five items), which are presented in [Table 1].[4],[5] Each question has five answers with corresponding scores for each answer ranging from 1 (not anxious) to 5 (extremely anxious). The scores for each of the five questions were added to calculate a total dental anxiety score value. The score of 19 or above has been considered to be dentally anxious, the score of 12–19 was considered mild dental anxious, and the score of 5–11 was considered not anxious. The statistical analysis of the obtained data was conducted using Wilcoxon signed rank test.
Table 1: Modified Dental Anxiety Scale score

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   Results Top

Total 400 children participated and all questionnaires were filled by all study subjects, so the response rate was 100% [Table 2]. In our investigation, there were 166 males and 234 females [Table 2]. Mean MDAS score of total sample was 18.06 [Table 3]. Mean MDAS score in total male samples was 16.16, whereas that in total female sample was 18.32 [Table 4].
Table 2: Total study population and response rate to questions

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Table 3: Mean Modified Dental Anxiety Scale (MDAS) score, SD, and P-value of total sample size

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Table 4: Mean Modified Dental Anxiety Scale (MDAS) score values in both genders

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Mean MDAS score from 6- to 13- year age group is presented in [Table 5]. Mean MDAS score in 6-year age group was 19.12, in 7-year age group was 18.64, in 8-year age group was 18.10, in 9-year age group was 17.28, in 10-year age group was 16.66, in 11-year age group was 16.12, in 12-year age group was 15.38, and in 13-year age group was 14.46 [Table 5].
Table 5: Mean Modified Dental Anxiety Scale (MDAS) score values in all age groups

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A total of 240 (61.5%) study subjects exhibited severe dental anxiety, 92 (23%) had mild anxiety, and 78 (17%) displayed no anxiety. Among males, 92 (55.42%) study subjects had severe anxiety, 50 (30.12%) had mild anxiety, and 24 (14.45%) had no anxiety. In females, 148 (63.24%) respondents had severe anxiety, 42 (17.94%) showed mild anxiety, and 44 (18.8%) had no anxiety [Table 6].
Table 6: Level of dental anxiety in both genders

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Question 5 was most fearful; it had aggregate score of 3.48 and 3.54 in males and in females, respectively [Table 7].
Table 7: Responses to five questions of Modified Dental Anxiety Scale (MDAS) by both sexes

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   Discussion Top

The prevalence of dental anxiety has posed a challenge for the delivery of dental services to the children. There are various scales available to measure dental anxiety. Tunc et al.[3] and Ilgüy et al.[6] have proved that MDAS is most reliable and most acceptable scale. Determination of the dental anxiety among children will be helpful to plan treatment and also to equip with preventive measures to decrease dental anxiety.

In our observation of 400 study subjects, the prevalence of severe anxiety was 61.5% and 23% had mild anxiety, so total dental anxiety in our study sample was 84.5%. Our study showed increase in anxiety levels just before the dental visit in 6- to 12-year- old children, which is an indication that they have fear of unknown about the dental treatment. Our findings are in accordance with the following studies. de Menezes Abreau et al.[8] investigated 302 children in the age group of 6–7 years and concluded that dental anxiety reduced after dental visit. Reduction in anxiety after visiting dental clinic is an indication that use of appropriate behavior management has helped in reducing dental anxiety in children.

In our observation, females exhibited high aggregate MDAS score (18.32) compare to males (16.16). This finding is supported by the studies of Fayad et al.,[9] Taani,[10] and Weinstein et al.[11] In our study, females exhibited higher anxiety compare to males. The previous studies have supported that females have higher levels of neuroticism, so that could be the reason for high anxiety in females.[12] Dental anxiety can occur due to fear of bleeding, gagging, criticism, or needle; noise created by dental instrument; and previous unpleasant dental visits.[13],[14]

In our study among 6- to 12- year-old South Indian children, the prevalence of dental anxiety was high (84.4%) contrary to the study by Chhabra et al.,[7] who proved that prevalence of dental anxiety was 6.3% in North Indian children of 5–10 years.

   Conclusion Top

Our investigation suggests that prevalence of anxiety in 6-12 years old children was high, which indicates they have been preoccupied with fear of unknown. Better exposure and educative programs will reduce the anxiety level in children. So there is necessity of preventive dental health education to reduce fear and anxiety in 6- to 12-year-old children.

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   References Top

Appukuttan D, Subramanian S, Tadepalli A, Damodaran LK. Dental anxiety among adults: An epidemiological study in South India. N Am J Med Sci 2015;7:13-8.  Back to cited text no. 1
Gordon SM, Dionne RA, Snyder J. Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs. Spec Care Dentist 1998;18:88-92.  Back to cited text no. 2
Tunc EP, Firat D, Onur OD, Sar V. Reliability and validity of the modified dental anxiety scale (MDAS) in a Turkish population. Community Dent Oral Epidemiol 2005;33:357-62.  Back to cited text no. 3
Humphris GM, Morrison T, Lindsay SJ. The modified dental anxiety scale: Validation and United Kingdom norms. Community Dent Health 1995;12:143-50.  Back to cited text no. 4
Humphris GM, Freeman R, Campbell J, Tuutti H, D’Souza V. Further evidence for the reliability and validity of the modified dental anxiety scale. Int Dent J 2000;50:367-70.  Back to cited text no. 5
Ilgüy D, Ilgüy M, Dinçer S, Bayirli G. Reliability and validity of the modified dental anxiety scale in Turkish patients. J Int Med Res 2005;33:252-9.  Back to cited text no. 6
Chhabra N, Chhabra A, Walia G. Prevalence of dental anxiety and fear among five to ten year old children: A behaviour based cross sectional study. Minerva Stomatol 2012; 61:83-9.  Back to cited text no. 7
de Menezes Abreau DM, Leal SC, Mulder J, Frencken JE. Patterns of dental anxiety in children after sequential dental visits. Eur Arch Paediatr Dent 2011;12:298-302.  Back to cited text no. 8
Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of dental anxiety among dental patients in Saudi Arabia. J Int Soc Prev Community Dent 2017;7:100-4.  Back to cited text no. 9
Taani DQ. Dental attendance and anxiety among public and private school children in Jordan. Int Dent J 2002;52:25-9.  Back to cited text no. 10
Weinstein P, Smith TA, Bartlett RC. A study of the dental student-patient relationship. J Dent Res 1973;52:1287-92.  Back to cited text no. 11
Stecker T. Wellbeing in an academic environment. Med Educ 2004;38:465-78  Back to cited text no. 12
Ranchman S. The conditioning theory of fear acquisition: A critical examination. Behave Res Ther 1977;15:375-387.  Back to cited text no. 13
Goldberg LR. An alternative “description of personality”: The big-five factor structure. J Pers Soc Psychol 1990;59:1216-29.  Back to cited text no. 14


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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