European Archives of Paediatric Dentistry

, Volume 17, Issue 3, pp 157–163 | Cite as

Predicting children’s behaviour during dental treatment under oral sedation

  • L. Lourenço-MatharuEmail author
  • A. Papineni McIntosh
  • J. W. Lo
Original Scientific Article



The primary aim of this study was to assess whether parents’ own anxiety and their perception of their child’s dental fear and child’s general fear can predict preoperatively their child’s behaviour during dental treatment under oral sedation. The secondary aim was to assess whether the child’s age, gender and ASA classification grade are associated with a child’s behaviour under oral sedation.

Study design

Cross-sectional prospective study.


The Corah’s Dental Anxiety Scale (DAS), Children’s Fear Survey Schedule Dental-Subscale (CFSS-DS) and Children’s Fear Survey Schedule Short-Form (CFSS-SF) questionnaires were completed by parents of children undergoing dental treatment with oral midazolam. Behaviour was rated by a single clinician using the overall behaviour section of the Houpt-Scale and scores dichotomised into acceptable or unacceptable behaviour. Data were analysed using χ 2, t test and logistic regression analysis.


In total 404 children (215 girls, 53 %) were included, with the mean age of 4.57 years, SD = 1.9. Behaviour was scored as acceptable in 336 (83 %) and unacceptable in 68 (17 %) children.


The level of a child’s dental fear, as perceived by their parent, was significantly associated with the behaviour outcome (p = 0.001). Logistic regression analysis revealed that if the parentally perceived child’s dental fear (CFSS-DS) rating was high, the odds of the child exhibiting unacceptable behaviour under oral sedation was two times greater than if their parents scored them a low dental fear rating (OR 2.27, 95 % CI 1.33–3.88, p = 0.003).


CFSS-DS may be used preoperatively to help predict behaviour outcome when children are treated under oral sedation and facilitate treatment planning.


Children Oral sedation Parental anxiety Child dental and general fears 


  1. Aartman IHA, van Edinger T, Hoogstraten J, et al. Self report measurements of dental anxiety and fear in children: a critical assessment. ASDC J Dent Child. 1998;65:252–8.PubMedGoogle Scholar
  2. Al-Zahrani AM, Wyne AH, Sheta SA. Comparison of oral midazolam with a combination of oral midazolam and nitrous oxide-oxygen inhalation in the effectiveness of dental sedation for young children. J Indian Soc Pedod Prev Dent. 2009;27:9–16.CrossRefPubMedGoogle Scholar
  3. Armfield JM, Spencer AJ, Stewart JF. Dental fear in Australia: who’s afraid of the dentist? Aust Dent J. 2006;51:78–85.CrossRefPubMedGoogle Scholar
  4. Arnrup K, Broberg AG, Berggren U, et al. Lack of cooperation in pediatric dentistry–the role of child personality characteristics. Pediatr Dent. 2002;24:119–28.PubMedGoogle Scholar
  5. Chadwick B. Non-pharmalogical behaviour management. In: Clinical guideline. Royal College of Surgeons England. 2002. Accessed 12 April 2015.
  6. Corah NL. Development of a dental anxiety scale. J Dent Res. 1969;48:596.CrossRefPubMedGoogle Scholar
  7. Corah NL, Gale E, Illig S. Assessment of a dental anxiety scale. J Am Dent Assoc. 1978;97:816–9.CrossRefPubMedGoogle Scholar
  8. Cuthbert MI, Melamed BG. A screening device: children at risk for dental fears and management problems. ASDC J Dent Child. 1982;49(6):432–6.PubMedGoogle Scholar
  9. Dripps RD. New classification of physical status. Anaesthesiology. 1963;24:111.Google Scholar
  10. 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. 2004a;14(4):241–5.CrossRefPubMedGoogle Scholar
  11. Folayan MO, Idehen EE, Ojo OO. Dental anxiety in a subpopulation of African children: parents ability to predict and its relation to general anxiety and behaviour in the dental chair. Eur J Paediatr Dent. 2004b;5(1):19–23.PubMedGoogle Scholar
  12. Folayan MO, Fatusi A. Effect of psychological management techniques on specific item score change during the management of dental fear in children. J Clin Pediatr Dent. 2005;29:335–40.CrossRefPubMedGoogle Scholar
  13. Gustafsson A, Arnrup K, Broberg AG, et al. Child dental fear as measured with the Dental Subscale of the Children’s Fear Survey Schedule: the impact of referral status and type of informant (child versus parent). Community Dent Oral Epidemiol. 2010;38:256–66.CrossRefPubMedGoogle Scholar
  14. Hallonsten AL, Jensen B, Raadal M, et al. EAPD guidelines on sedation in paediatric dentistry. 2003. Accessed 12 April 2015.
  15. Hosey MT. Managing anxious children: the use of conscious sedation in paediatric dentistry. In: Clinical guideline. Royal College of Surgeons England. 2002. Accessed 12 April 2015.
  16. Houpt MI, Koenigsberg SR, Weiss NJ, et al. Comparison of chloral hydrate with and without promethazine in the sedation of young children. Pediatr Dent. 1985;7:41–6.PubMedGoogle Scholar
  17. Houpt MI, Kupietzky A, Tofsky N, et al. Effects of nitrous oxide on diazepam sedation of young children. Pediatr Dent. 1996;18:236–41.PubMedGoogle Scholar
  18. Klingberg G, Löfqvist LV, Bjarnason S, et al. Dental behavior management problems in Swedish children. Community Dent Oral Epidemiol. 1994;22(3):201–5.CrossRefPubMedGoogle Scholar
  19. 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;52:255–6.CrossRefPubMedGoogle Scholar
  20. Klingberg G, Berggren U, Carlsson SG, et al. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci. 1995;103:405–12.CrossRefPubMedGoogle Scholar
  21. Klingberg G, Broberg AG. Temperament and child dental fear. Pediatr Dent. 1998;20(4):237–43.PubMedGoogle Scholar
  22. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent. 2007;17:391–406.CrossRefPubMedGoogle Scholar
  23. Krikken JB, Wijk AJ, Cate JB, et al. Measuring dental fear using the CFSS-DS. Do children and parents agree? Int J Paediatr Dent. 2013;23(2):94–100.CrossRefPubMedGoogle Scholar
  24. Lochary ME, Wilson S, Griffen AL, et al. Temperament as a predictor of behavior for conscious sedation in dentistry. Pediatr Dent. 1993;15(5):348–52.PubMedGoogle Scholar
  25. Lourenço-Matharu L, Ashley PF, Furness S. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2012;. doi: 10.1002/14651858.CD003877.pub4 (Art. No.: CD003877).PubMedGoogle Scholar
  26. Milgrom P, Mancl L, King B, et al. Origins of childhood dental fear. Behav Res Ther. 1995;33:313–9.CrossRefPubMedGoogle Scholar
  27. Miller CS, Dembo JB, Falace DA, et al. Salivary cortisol response to dental treatment of varying stress. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(4):436–41.CrossRefPubMedGoogle Scholar
  28. Milsom KM, Tickle M, Humphris GM, et al. The relationship between anxiety and dental treatment experience in 5-year-old children. Br Dent J. 2003;194(9):503–6.CrossRefPubMedGoogle Scholar
  29. Newton TJ, Buck DJ. Anxiety and pain measures in dentistry: α guide to their quality and application. J Am Dent Assoc. 2000;131:1449–75.CrossRefPubMedGoogle Scholar
  30. Nuttall NM, Gilbert A, Morris J. Children’s dental anxiety in the United Kingdom in 2003. J Dent. 2008;36:857–60.CrossRefPubMedGoogle Scholar
  31. Rantavuori K, Zerman N, Ferro R, et al. Relationship between children’s first dental visit and their dental anxiety in the Veneto Region of Italy. Acta Odontol Scand. 2002;60(5):297–300.CrossRefPubMedGoogle Scholar
  32. Ten Berge M, Veerkamp JSJ, Hoogstraten J, et al. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol. 2002a;30:101–7.CrossRefPubMedGoogle Scholar
  33. Ten Berge M, Veerkamp JSJ, Hoogstraten J, et al. The Dental Subscale of the Children’s Fear Survey Schedule: predictive value and clinical usefulness. J Psychopathol Behav Assess. 2002b;24:115–8.CrossRefGoogle Scholar
  34. Wogelius P, Poulsen S, Sørensen T. Prevalence of dental anxiety and behaviour management problems among six to eight years old Danish children. Acta Odontol Scand. 2003;61:178–83.CrossRefPubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2015

Authors and Affiliations

  • L. Lourenço-Matharu
    • 1
    Email author
  • A. Papineni McIntosh
    • 2
  • J. W. Lo
    • 3
    • 4
  1. 1.Unit of Paediatric DentistryDental InstituteLondonUK
  2. 2.Oral and Maxillofacial Surgery DepartmentQueen Mary’s Hospital, King’s College Hospitals NHS Foundation TrustSidcupUK
  3. 3.Division of Health and Social Care ResearchKing’s College LondonLondonUK
  4. 4.NIHR Biomedical Research Centre at Guy’s and St. Thomas’ National Health Service Foundation Trust and King’s College LondonLondonUK

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