Dental fear and anxiety of preschool children in school-based dental service

Abstract

Much of dental care in children involves prevention, early detection and reversal of caries. A literature review on caries management through the medical model was conducted. The medical model contrasts with the traditional surgical way of dental disease management, which is often associated with the ironically destructive ‘restorative cycle’. Instead of treating cavities, which are signs of a disease, the dental practitioner should focus on managing the disease itself by elimination of the aetiology and risk factors. Through understanding caries as a bacterial disease associated with risk factors such as sugary diet and inadequate oral hygiene, the medical model emphasises bacterial control by both mechanical and reduction of such risk factors to prevent the occurrence of caries. Furthermore, remineralisation by the use of remineralising agents such as calcium- and/or fluoride-containing substances combined with scheduling regular long term reviews are considered essential strategies to tackle early and reversible caries. The provision of dental services should embrace the paradigm shift from a surgical to a medical model with the goal of maintaining caries free status for everyone starting from a young age. In children, prevention of dental diseases such as caries is paramount to a good start in oral health. Dental professionals usually deliver comprehensive dental care in clinical settings. However, one of the major challenges to receiving or providing paediatric dental care is dental fear and anxiety. This is associated with dental avoidance or uncooperative behaviour in children which often makes dental treatment difficult or impossible, and deters the individual from future dental visits. The prevalence of children’s dental fear and anxiety worldwide ranges widely around 10% and up to 20% depending on the method of assessment. Conducting a valid assessment of dental fear and anxiety in children is important in understanding and planning how to overcome their fear in various scenarios and patient groups. A review has been performed on assessment methods of children’s dental fear and anxiety and an analysis of existing assessment tools has been carried out. Studies have revealed multiple existing tools for identifying and measuring the severity of dental fear and anxiety in children, including through self-report, parental proxy, behaviour observation and physiological assessment. Each of these strategies have their merits and limitations. In Hong Kong, little is known about the level of dental fear and anxiety in children of preschool level in the context of dental outreach. A cross-sectional study was carried out in 2019-2020 to study the dental fear and anxiety of preschool children in school-based outreach settings by means of behavioural assessment. High levels of positive and cooperative behaviour and low levels of fear was found in this population. Conducting regular outreach dental services to kindergartens by providing oral examination and topical silver diammine fluoride therapy could be a promising strategy to control childhood caries, manage and reduce dental fear that encourages long term dental attendance in line with the medical model.