• Gulrez Hanif Raja Institute of Tropical Medicine and International Health, Charité University Berlin
  • Faisal Shafiq Malik Department of Community Dentistry, Islamic International Dental College and Hospital, Islamabad
  • Ulfat Bashir Department of Orthodontics, Islamic International Dental College and Hospital, Islamabad
  • Atta ullah Department of Community Dentistry, Islamic International Dental College and Hospital, Islamabad


Background: The assessment of dental anxiety among children will aid in dealing with management issues related to dental treatment. There is no study available from Pakistan on dental anxiety in children. The aim of this study was to assess the prevalence of dental anxiety in children attending a teaching dental hospital in Islamabad, Pakistan. Methods: A cross-sectional study was conducted on 252 children aged between 5–10 years attending a dental clinic in a dental hospital in Islamabad, Pakistan. Dental anxiety was assessed by using the Faces Version of the Modified Child Dental Anxiety Scale. This scale uses faces as pictograms to indicate the levels of dental anxiety making it easier for children to answer the questionnaire. Results: A total of 252 children were observed for assessment of dental anxiety having mean age of 7.88±1.55 years with 123 (48.8%) males and 129 (51.2%) females. Out of these children 150 (59.5%) had previously visited a dentist and 102 (40.5%) had no experience with a dentist before; 38% (95/252) of children had moderate and severe dental anxiety. Dental anxiety decreased significantly with age (p=0.0003). The difference in anxiety levels was not statistically significant between males and females and in different socio-economic status. Conclusion: This study has highlighted dental anxiety as a potential public health concern regarding children in Pakistan. Assessment of dental anxiety is a useful way to identify anxious dental patients. 


Taani DQ, El-Qaderi SS, Abu Alhaija ES. Dental anxiety in children and its relationship to dental caries and gingival condition. Int J Dent Hyg 2005;3(2):83–7.

Armfield JM, Spencer AJ, Stewart JF. Dental fear in Australia: who's afraid of the dentist? Aust Dent J 2006;51(1):78–85.

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(6):391–406.

Eli I. Dental anxiety: a cause for possible misdiagnosis of tooth vitality. Int Endod J 1993;26(4):251–3.

Cohen SM, Fiske J, Newton JT. The impact of dental anxiety on daily living. Br Dent J 2000;189(7):385–90.

Logan HL, Baron RS, Keeley K, Law A, Stein S. Desired control and felt control as mediators of stress in a dental setting. Health psychol 1991;10(5):352–9.

Oliveira MM, Colares V. The relationship between dental anxiety and dental pain in children aged 18 to 59 months: a study in Recife, Pernambuco State, Brazil. Cad Saude Publica 2009;25(4):743–50.

Ost LG. Age of onset in different phobias. J Abnorm Psychol 1987;96(3):223–9.

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(4):289–94.

Liddell A, Locker D. Dental anxiety in the elderly. Psychol Health 1993;8:175–83.

Chapman HR, Kirby-Turner NC. Dental fear in children--a proposed model. Br Dent J 1999;187(8):408–12.

Kumar S, Bhargav P, Patel A, Bhati M, Balasubramanyam G, Duraiswamy P, et al. Does dental anxiety influence oral health-related quality of life? Observations from a cross-sectional study among adults in Udaipur district, India. J Oral Sci 2009;51(2):245–54. Epub 2009/06/25.

Shaikh MA, Kamal A. Over dental anxiety problems among university students: perspective from Pakistan. J Coll Physicians Surg Pak 2011;21(4):237–8.

Wong HM, Humphris GM, Lee GT. Preliminary validation and reliability of the Modified Child Dental Anxiety Scale. Psychol Rep 1998;83(3 Pt 2):1179–86.

Howard KE, Freeman R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paediatric Dent 2007;17(4):281–8.

Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc. 1978;97(5):816–9.

Berggren U, Meynert G. Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc 1984;109(2):247–51.

Hakeberg M, Berggren U, Grondahl HG. A radiographic study of dental health in adult patients with dental anxiety. Community Dent Oral Epidemiol 1993;21(1):27–30.

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(3):83–9.

Salem K, Kousha M, Anissian A, Shahabi A. Dental Fear and Concomitant Factors in 3-6 Year-old Children. J Dent Res Dent Clin Dent Prospects 2012;6(2):70–4.

Lee CY, Chang YY, Huang ST. Prevalence of Dental Anxiety among 5- to 8-Year-Old Taiwanese Children. J Public Health Dent 2007;67(1):36–41.

Wogelius P, Poulsen S, Sørensen HT. Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children. Acta Odontol Scand 2003;61(3):178–83.

Klingberg G. Dental fear and behavior management problems in children. A study of measurement, prevalence, concomitant factors, and clinical effects. Swedish dental journal Supplement. 1995;103:1–78.

Ten Berge M, Veerkamp JS, Hoogstraten J, Prins PJ. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol 2002;30(2):101–7.

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;194(9):503–6.

Akbay Oba A, Dülgergil ÇT, Sönmez IS. Prevalence of Dental Anxiety in 7- to 11-Year-Old Children and Its Relationship to Dental Caries. Med Princ Pract 2009;18(6):453–7.

Nicolas E, Bessadet M, Collado V, Carrasco P, Rogerleroi V, Hennequin M. Factors affecting dental fear in French children aged 5–12 years. Int J Paediatr Dent 2010;20(5):366–73.

Folayan MO, Idehen EE, Ufomata D. The effect of sociodemographic factors on dental anxiety in children seen in a suburban Nigerian hospital. Int J Paediatr Dent 2003;13(1):20–6.

Toledano M, Osorio R, Aguilera FS, Pegalajar J. Children's dental anxiety: influence of personality and intelligence factors. Int J Paediatr Dent 1995;5(1):23–8.