Dental anxiety and psychological functioning in children: its relationship with behaviour during treatment

  • J. VerslootEmail author
  • J. S. J. Veerkamp
  • J. Hoogstraten


Aim: In this study the relationship between the levels of dental anxiety, psychological functioning and earlier experience with dental injections are examined and the possible influence of these factors on children’s behaviour before and during a local anaesthesia injection. Methods: A total of 128 children (4–11 years) were included. The level of dental anxiety and the psychological functioning were measured using the ‘Children’s Fear Survey Schedule’ (CFSS-DS) and the ‘Strengths and Difficulties Questionnaire’ (SDQ). Based on video recordings the anxiety behaviour was scored on the Venham-scale. Results: There was a positive correlation between levels of dental anxiety, psychological functioning and anxiety behaviour before and during the dental injection. In particular children with emotional problems or peer problems tended to show more anxiety behaviour before the injection and children with emotional or hyperactivity problems tend to show more anxiety behaviour during the injection. Furthermore, the younger children (below 6 years of age), with previous dental experience in the past 6 months, tended to display more anxiety behaviour both before and during the injection than children without or with experience from longer ago. Conclusion: The level of dental anxiety and psychological functioning and recent previous dental experience are important factors in determining which child is likely to display more anxiety and uncooperative behaviour during treatment and therefore potentially need more attention to be able to cope well with dental treatment.

Key words

children distress temperament behaviour, anxiety 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Arnrup, K, Broberg, AG, Berggren, U, Bodin, L. Temperamental reactivity and negative emotionality in uncooperative children referred to specialized paediatric dentistry compared to children in ordinary dental care. Int J Pediat Dent 2007;17(6):419–429.CrossRefGoogle Scholar
  2. Bergdahl, M, Bergdahl, J. Temperament and character personality dimensions in patients with dental anxiety. Eur J Oral Sci 2003;111:93–98.PubMedCrossRefGoogle Scholar
  3. Chen, E, Zeltzer, LK, Craske, MG, Katz, ER. Children’s memories for painful cancer treatment procedures: implications for distress. Child Development 2000;71:933–947.PubMedCrossRefGoogle Scholar
  4. Eli, I, Uziel, N, Blumensohn, R, Baht, R. Modulation of dental anxiety-the role of past experiences, psychopathologic traits and individual attachment patterns. Brit Dent J 2004;194:689–694.CrossRefGoogle Scholar
  5. Goedhart, AW, Treffers, PD, Widenfelt, BM van. Vragen naar psychische problemen bij kinderen en adolescenten. Strength and Difficulties Questionnaire (SDQ). Maandblad Geestelijke volksgezondheid 2003;58:1018–1035.Google Scholar
  6. Goodman, R. The strength and difficulties questionnaire: a research note. J Am Acad Child Adolesc Psychiatry 1997;38:581–586.CrossRefGoogle Scholar
  7. Hägglin, C, Hakeberg, M, Hällstöm, T, et al. Dental anxiety in relation to mental health and personality factors. A longitudinal study of middle-aged and elderly women. Eur J Oral Sci 2001;109:27–33.PubMedCrossRefGoogle Scholar
  8. Locker, D, Liddell, A, Dempster, L, Shapiro, D. Age of onset of dental anxiety. J Dent Res 1999;78;790–796.PubMedCrossRefGoogle Scholar
  9. Locker, D, Poulton, R, Thomson, WM. Psychological disorders and dental anxiety in a young adult population. Community Dent Oral Epidemiol 2001a; 29: 456–63.PubMedCrossRefGoogle Scholar
  10. Locker, D, Thomson, WM, Poulton, R. Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood. J Dent Res 2001b;80:1588–1592.PubMedCrossRefGoogle Scholar
  11. Muris, P, Meesters, C, Berg van de, F. The strength and difficulties questionnaire (SDQ). Further evidence for its reliability and validity in a community sample of Dutch children and adolescents. Eur Child Adolesc Psychiatry 2003;12:1–8.Google Scholar
  12. Rachman, S. The conditioning of fear-acquisition: a critical examination. Behav Res Ther 1977;15:375–387.PubMedCrossRefGoogle Scholar
  13. ten Berge, M, Veerkamp, JS, Hoogstraten, J, Prins, PJ. Behavioural and emotional problems in children referred to a centre for special dental care. Community Dent Oral Epidemiol 1999:27:181–186.PubMedCrossRefGoogle Scholar
  14. ten Berge, M, Veerkamp, JS, Hoogstraten, J. The etiology of childhood dental fear: the role of dental and conditioning experiences. J Anxiety Disord 2002a;16:321–329.PubMedCrossRefGoogle Scholar
  15. ten Berge, M, Veerkamp, JS, Hoogstraten, J, Prins, PJ. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol 2002b;30:101–107.PubMedCrossRefGoogle Scholar
  16. Thomson, WM, Locker, D, Poulton, R. Incidence of dental anxiety in young adults in relation to dental treatment experience. Community Dent Oral Epidemiol 2000;28:289–294.PubMedCrossRefGoogle Scholar
  17. Treffers, PDA, Widenfelt, BM. Dutch translation of the Strengths and Difficulties Questionnaire (SDQ). Oegstgeest: Curium, 2000.Google Scholar
  18. Venham, LL, Gaulin-Kremer, E, Munster, E, Bengston-Audia, D, Cohan, J. Interval rating scales for children’s dental anxiety and uncooperative behavior. Pediatr Dent 1980;2:195–202.PubMedGoogle Scholar
  19. Woerner, W, Becker, A, Rothenberger, A. Normative data and scale properties of the German parent SDQ. Eur Child and Adolesc Psychiatry 2004;13 (subl 2):3–10.Google Scholar

Copyright information

© Adis Internationals 2008

Authors and Affiliations

  • J. Versloot
    • 1
    Email author
  • J. S. J. Veerkamp
    • 1
  • J. Hoogstraten
    • 1
  1. 1.Department of Cariology, Endodontlogy and Pedodontology, Academic Centre for Dentistry AmsterdamACTAAmsterdamthe Netherlands

Personalised recommendations