Changes in children’s dental fear: a longitudinal study

  • M. A. KlaassenEmail author
  • J. S. J. Veerkamp
  • J. Hoogstraten


Aim: The study aimed to evaluate the development of dental fear in a low fear group and a fearful group of children aged between 8 and 13 years of age and to assess the differences between these groups over time taking into account general variables, such as gender, and treatment variables, such as restorations. Furthermore it was evaluated to what extent general and treatment variables predict the change in dental fear or dental fear at later age. Study design: A three-year longitudinal study. Methods: 401 parents completed the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), 218 of them repeating this after a 3-year interval. Dental records were used to collect the clinical data, starting from the children’s first dental appointment, and the CFSS-DS was used to assess the child’s dental fear. Results/statistics: Analysis of variance for repeated measures showed an interaction effect between fear level and mean total CFSS-DS score. Regression analyses applied to the mean total CFSS-DS score at the second measurement and the change in total CFSS-DS score between both measurement moments revealed that little variance could be explained by the treatment variables over the various periods, such as extractions in the first period. Also that child-characteristic variables could not predict much variance. Independent-samples t-tests showed a significant difference in means for extractions over the whole period between the fearful group (mean=1.73, SD±1.18) and low fear group (mean= 0.68, SD±2.01) (t=−4.05, p<0.001, n=218). Also the frequency of Behavioural Management Problems over the whole period differed between these groups (fearful group: mean=1.40, SD±1.90 and low fear group: mean= 0.40, SD±0.93) (t= −4.58, p<0.001, n=218). Conclusion: The effect of treatment variables and subjective experiences on child dental fear seems to diminish over time. Findings support the theoretical framework of conditioning and gradual exposure in children to prevent dental fear.

Key words

child dental fear dental treatment CFSS-DS longitudinal research 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aartman IHA, van Everdingen T, Hoogstraten J, Schuurs AHB. Self-report measurements of dental anxiety and fear in children: a critical assessment. ASDC J Dent Child 1998; 65:252–258.PubMedGoogle Scholar
  2. Alvesalo I, Murtomaa H, Milgrom P, et al. The Dental Fear Survey Schedule: a study with Finnish children. Int J Paediatr Dent 1993;3:193–198.PubMedCrossRefGoogle Scholar
  3. Baier K, Milgrom P, Russell S, Mancl L, Yoshida T. Children’s fear and behavior in private pediatric dentistry practices. Pediatr Dent 2004;26:316–321.PubMedGoogle Scholar
  4. Branson SM and Craig KD. Children’s spontaneous strategies for coping with pain: a review of the literature. Can J Behav Sci/Rev Can Sci Comp 1988; 20:402–412.CrossRefGoogle Scholar
  5. Corkey B, Freeman R. Predictors of dental anxiety in six-year-old children: findings from a pilot study. ASDC J Dent Child 1994;61:267–271.PubMedGoogle Scholar
  6. Cuthbert MI and Melamed BG. A screening device: children at risk for dental fears and management problems. ASDC J Dent Child. 1982;49:432–436.PubMedGoogle Scholar
  7. Davey GCL. Dental phobias and anxieties: evidence for conditioning processes in the acquisition and modulation of a learned fear. Behav Res Ther 1989;27:51–58.PubMedCrossRefGoogle Scholar
  8. Folayan MO, Idehen EE, Ojo OO. The modulating effect of culture on the expression of dental anxiety in children: a literature review. Int J Paediatr Dent 2004;14:241–258.PubMedCrossRefGoogle Scholar
  9. Holst A, Crossner C-G. Direct ratings of acceptance of dental treatment in Swedish children. Community Dent Oral Epidemiol 1987;15:258–263.PubMedCrossRefGoogle Scholar
  10. Klingberg G. Reliability and validity of the Swedish version of the Dental Subscale of the Children’s Fear Survey Schedule, CFSS-DS. Acta Odontol Scand 1994;52:255–256.PubMedCrossRefGoogle Scholar
  11. Klingberg G, Berggren U, Carlsson SG, Norén JG. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci 1995a;103:405–412.PubMedCrossRefGoogle Scholar
  12. Klingberg G, Vannas Löfqvist I, Hwang CP. Validity of the Children’s Dental Fear Picture test (CDFP). Eur J Oral Sci 1995b;103:55–60.PubMedCrossRefGoogle Scholar
  13. Locker D, Thomson WM, Poulton R. Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood. J Dental Res 2001 Jun;80(6):1588–1592.CrossRefGoogle Scholar
  14. Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999;78:790–796.PubMedCrossRefGoogle Scholar
  15. Lubow RE. Latent inhibition. Psychol Bull 1973;79:398–407.PubMedCrossRefGoogle Scholar
  16. Milgrom P, Jie Z, Yang Z, Tay K-M. Cross-cultural validity of a parent’s version of the Dental Fear Survey Schedule for children in Chinese. Behav Res Ther1994;32:131–135.PubMedCrossRefGoogle Scholar
  17. Milgrom P, Fiset L, Melnick S, Weinstein P. The prevalence and practice management consequences of dental fear in a major US city. J Am Dent Assoc 1988; 116:641–647.PubMedCrossRefGoogle Scholar
  18. Milsom KM, Tickle M, Humphris GM, Blinkhorn AS. The relationship between anxiety and dental treatment experience in 5-year-old children. Br Dent J 2003 10;194:503–506.PubMedCrossRefGoogle Scholar
  19. Murray P, Liddell A, Donohue J. A longitudinal study of the contribution of dental experience to dental anxiety in children between 9 and 12 years of age. J Behav Med 1989;12:309–320.PubMedCrossRefGoogle Scholar
  20. Nakai Y, Hirakawa T, Milgrom P, et al. The Children’s Fear Survey Schedule-Dental Subscale in Japan. Community Dent Oral Epidemiol 2005;33: 196–204.PubMedCrossRefGoogle Scholar
  21. Poulton R, Thomson WM, Davies S, et al. Good teeth, bad teeth and fear of the dentist. Behav Res Ther 1997;35:327–334.PubMedCrossRefGoogle Scholar
  22. Poulton R, Waldie KE, Thomson WM, Locker D. Determinants of early- vs late-onset dental fear in a longitudinal-epidemiological study. Behav Res Ther. 2001; 39:777–785.PubMedCrossRefGoogle Scholar
  23. Rachman S. The conditioning theory of fear acquisition: a critical examination. Behav Res Ther 1977; 5:375–387.CrossRefGoogle Scholar
  24. Ramos-Jorge ML, Marques LS, Pavia SM, et al. Predictive factors for child behavior in the dental environment. Eur Arch Paediatr Dent 2006; 7: 253–257.PubMedCrossRefGoogle Scholar
  25. Scherer MW and Nakamura CY. A fear survey schedule for children (FSS-FC): a factor analytic comparison with manifest anxiety (CMAS). Behav Res Ther 1968;6:173–182.PubMedCrossRefGoogle Scholar
  26. ten Berge M, Veerkamp JSJ, Hoogstraten J. The etiology of childhood dental fear: the role of dental conditioning experiences. J Anxiety Disord 2002a;16:321–329.PubMedCrossRefGoogle Scholar
  27. ten Berge M, Veerkamp JSJ, Hoogstraten J, Prins PJM. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol 2002b;30:101–107.PubMedCrossRefGoogle Scholar
  28. Townend E, Dumigen G, Fung D. A clinical study of child dental anxiety. Behav Res Ther 2000;38:31–46.PubMedCrossRefGoogle Scholar
  29. Versloot J, Veerkamp JSJ, Hoogstraten J, Martens LC. Children’s coping with pain during dental care. Community Dent Oral Epidemiol 2004;32:456–461.PubMedCrossRefGoogle Scholar
  30. Weerheijm K, Veerkamp JSJ, Groen HJ, Zwarts LM. Evaluation of the experiences of fearful children at a Special Dental Care Centre. ASDC J Dent Child 1999;66:253–257.PubMedGoogle Scholar

Copyright information

© Adis Internationals 2008

Authors and Affiliations

  • M. A. Klaassen
    • 1
    • 2
    Email author
  • J. S. J. Veerkamp
    • 1
  • J. Hoogstraten
    • 2
    • 3
  1. 1.Dept Cariology Endodontology Pedodontology (postvak 5, Academic Centre for Dentistry Amsterdam (ACTA))University of Amsterdam and Free UniversityAmsterdamThe Netherlands
  2. 2.Dept Social Dentistry and Behavioural SciencesAcademic Centre for Dentistry Amsterdam (ACTA)Amsterdamthe Netherlands
  3. 3.Dept Psychological MethodsUniversity of AmsterdamAmsterdamthe Netherlands

Personalised recommendations