Academic Edi o : Takeyasu Maeda
Recei ed: 5 Feb ua y 2025
Re ised: 22 Feb ua y 2025
Accep ed: 7 Ma ch 2025
Published: 10 Ma ch 2025
Ci a ion: Bayón, G.; S ie nhu ud, F.;
Ribas-Pé ez, D.; Biedma Pe ea, M.;
Mendoza Mendoza, A. Pa en al
Anxie y Diso de s and Thei Impac
on Den al T ea men in Child en Aged
4 o 13 Yea s: A C oss-Sec ional
Obse a ional S udy. J. Clin. Med.
2025,14, 1869. h ps://doi.o g/
10.3390/jcm14061869
Copy igh : © 2025 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license
(h ps://c ea i ecommons.o g/
licenses/by/4.0/).
A icle
Pa en al Anxie y Diso de s and Thei Impac on Den al
T ea men in Child en Aged 4 o 13 Yea s: A C oss-Sec ional
Obse a ional S udy
Glo ia Bayón, Fabiola S ie nhu ud, Da id Ribas-Pé ez * , Ma ía Biedma Pe ea and Asunción Mendoza Mendoza
Depa men o S oma ology, Facul y o Den is y, Uni e si y o Se ille, A icena S ee s/n, 41009 Se ille, Spain;
[email p o ec ed] (M.B.P.); [email p o ec ed] (A.M.M.)
*Co espondence: [email p o ec ed]
Abs ac : In oduc ion: Child en wi h den al ea and/o anxie y will use all a ailable
means o a oid o delay den al ea men , which can cause a de e io a ion in hei o al
heal h. A close ela ionship has been demons a ed be ween pa en s’ ea and/o anxie y
abou he den is and he de elopmen o den al anxie y in child en. Objec i e: Ou aim is
o e alua e he anxie y o child en’s pa en s and he ac o s ha in luence he p edic ion o
anxie y and child en’s beha io , as well as i s impac on he isk o ca ies. Me hod: This is a
desc ip i e c oss-sec ional s udy. Fo da a collec ion, scien i ically alida ed ques ionnai es
we e used o pa en s (n= 101) and child en (n= 101). S a is ical analysis was pe o med
using he Chi2 es , he independen sample es , and he Mann–Whi ney es . Resul s: A
di ec ela ionship (p= 0.095) was ound be ween he Co ah es and he Venham es , as
well as s a is ical signi icance (p= 0.035) be ween he STAI-T ai and he Venham es . The
ype o ea men he child is going o unde go is a de e mining ac o in pa en al anxie y. A
o al o 85% o he pa ien s exhibi ed posi i e beha io ega dless o he deg ee o pa en al
anxie y. Conclusions: The ela ionship be ween he anxie y o he pa en and he child was
e y limi ed and es ic ed o speci ic cases; di ec associa ions we e ound be ween he
o al s a e o he child and he anxie y o he pa en s.
Keywo ds: den al anxie y; den al ea ; ca ies index; den al ea men
1. In oduc ion
Fea and anxie y a e co ela ed emo ional s a es. Fea is he eac ion gene a ed by
a eal o imminen dange and is linked o he s imulus ha p oduces i ; he e o e, i
is an objec i e eac ion. On he o he hand, anxie y is he an icipa o y s a e o a u u e
dange ha has no ye occu ed and ha we do no know will occu ; i is conside ed a
“subjec i e ea ”, as he e is no appa en cause ha gene a es i [
1
,
2
]. These emo ional
p ocesses a e, o a ce ain ex en , essen ial o he human a ec i e epe oi e because hey
enhance pe o mance in mo o , physiological, and cogni i e asks. In his con ex , hey will
be conside ed adap i e phenomena. Howe e , when hese emo ions exceed le els ha a e
conside ed “no mal” and comp omise an indi idual’s pe o mance o daily ac i i ies, hey
will be conside ed pa hologies [3].
Den al anxie y is de ined as a eeling o app ehension abou den al ea men [
4
].
I is an excessi e, nega i e, and un easonable emo ional s a e expe ienced by pa ien s
be o e, du ing, o a e den al ea men [
5
]. In con as , den al ea e e s o an unpleasan
emo ional eac ion o speci ic h ea ening s imuli ha occu in si ua ions associa ed wi h
den al ea men [5].
J. Clin. Med. 2025,14, 1869 h ps://doi.o g/10.3390/jcm14061869
J. Clin. Med. 2025,14, 1869 2 o 14
Childhood beha io associa ed wi h den al anxie y and ea has been one o he g ea
challenges in pedia ic den is y. The emo ional s a e o he child du ing den al ea men
can c ea e di icul ies in e ms o i s e alua ion due o, among o he hings, he child’s
imma u i y in communica ing his eelings [6].
Cu en ly, he e is a high pe cen age o gene alized den al anxie y in he popula ion.
I is es ima ed ha 264 million people su e om anxie y, a p e alence ha has inc eased
by up o 15% om 2005 o 2015 as a esul o popula ion g ow h and an inc ease in
li e expec ancy [
7
]; i is ecognized by he Wo ld Heal h O ganiza ion (WHO) as a ue
pa hology [
8
–
10
]. In Spain, acco ding o he la es epo (Decembe 2020) om he p ima y
ca e clinical da abase (BDCAP) [
11
], anxie y is he mos equen men al heal h p oblem
in he Spanish popula ion, a ec ing 88.4% o women and 45.2% o men aged be ween 35
and 84 yea s.
The e a e mul iple ac o s ha cause o igge den al anxie y, namely, he age and sex
o he pa ien [
5
,
12
,
13
], he den al ea men o which he o she will be subjec ed [
14
], he
eaching s yle and amily s uc u e [
15
], he numbe o siblings and hei bi h o de [
16
],
and he anxie y o he pa en s o p ogeni o s. The e o e, i is impo an o in o m and guide
pa en s abou he o al heal h o hei child en and he in luence o hei eelings on hose o
he child. Less anxious child en end o accep mo e easily he p ocedu es o which hey
will be subjec ed, which allows o he success o he den al ea men [17].
I has been shown ha by ca ying ou es s on den al anxie y p io o ea men , i
is possible o iden i y pa ien s who su e om his diso de , he eby allowing o g ea e
coope a ion and a educ ion in he anxie y le els o hese pa ien s. Howe e , e y ew
p o essionals ca y ou his ype o es ing be o e den al ea men , since mos ely on hei
expe ience and in ui ion o assess a pa ien ’s den al anxie y le el. In con as , pedia ic
den is s ha e been shown o be mo e success ul in iden i ying anxious and non-anxious
pedia ic pa ien s, leading o be e ou comes when pe o ming hese ypes o ea men s
on child en [18–20].
In he cu en li e a u e, he e a e di e en scales o assess he anxie y o gua dians
o pa en s, namely, he Co ah Den al Anxie y Scale [
21
,
22
] and i s a ian , he Modi ied
Co ah Den al Anxie y Scale (MDAS) [
23
], he Ea ly Childhood O al Heal h Impac Scale
(ECOHIS) [24], and/o he Den al Anxie y In en o y (IDATE) [25].
On he o he hand, den al anxie y in child en can be assessed using he Child en’s
Fea Su ey Schedule (CFSS) [
26
], designed by Sche e and Nakamu a o s udy he dis-
ibu ion and e iology o den al ea in child en, and/o he Venham Clinical Anxie y
Ra ing
Scale [27,28]
, which consis s o a se ies o ca oon igu es ep esen ing a ious emo-
ional s a es. This app oach allows he child o iden i y wi h each o he si ua ions shown,
esul ing in a simple ye alid and eliable scale o he child’s esponse o si ua ional s ess.
The aim o he p esen s udy is o es ablish he possibili y o a ela ionship be ween
he emo ional s a e o he pa en s and he child’s beha io du ing den al p ac ice, as well
as he isk o ca ies ha he child p esen s.
2. Ma e ials and Me hods
2.1. Design and Sample o This S udy
A desc ip i e c oss-sec ional s udy was ca ied ou wi h 202 pa ien s, including
101 gua dians o pa en s and 101 child en aged be ween 4 and 13 yea s, who a ended he
pedia ic den is y se ices o a p i a e clinic loca ed in he sou h o Badajoz (Spain). This
age ange is jus i ied since a minimum le el o knowledge is necessa y on he pa o he
child o be able o answe he ques ions in he ques ionnai e.
J. Clin. Med. 2025,14, 1869 3 o 14
In he s a is ical analysis, he p oposed sample will be adjus ed, and a 95% con idence
in e al will be p oposed wi h a 5% ma gin o e o ; he da a may be modi ied acco ding o
he ci cums ances o a be e adap a ion o he wo k.
2.2. Da a Collec ion
Following app o al by he e hics commi ee o he Andalusian Go e nmen , inclusion
and exclusion c i e ia will be es ablished, and da a collec ion will be ou ; ques ionnai es and
anxie y scales ha ha e al eady been scien i ically esea ched and p e iously ansla ed in o
Spanish, wi h high eliabili y, easy applica ion, and low cos will be used. Da a collec ion
will be ca ied ou h ough in e iews wi h pa en s o gua dians, as well as in e iews and
clinical– adiog aphic examina ions o child en. These will be pa o he den al p ocedu e
ha he pa ien will unde go and will also se e o de e mine he ca ies index (d /DMFT,
as equi ed) o each pa ien , hus helping us unde s and i s in luence on he le el o anxie y.
Reading he in o ma ion shee and signing he in o med consen by pa en s o legal
gua dians was essen ial o pa icipa ion in his esea ch s udy.
2.3. Den al Anxie y in Child en
The scales used o e i y den al anxie y in child en a e as ollows:
➢
Venham Clinical Anxie y Ra ing Scale [
27
,
28
]: Pe o med on child en be ween he
ages o 4 and 8 yea s, inclusi e. F om each illus a ion, he pa ien mus choose one o
he igu es, which will de e mine hei emo ional s a e.
➢
Child and Adolescen Fea Scale (CFSS) [
26
]: Designed by Sche e and Nakamu a
o s udy he dis ibu ion and e iology o den al ea in child en. This es will be
pe o med on pa ien s o e 8 yea s o age.
➢
F ankl Beha io Scale [
29
]: In 1962, F ankl de ised a beha io scale o s udy chil-
d en’s eac ions o being sepa a ed om hei pa en s in he den al o ice. Fo his
eason, F ankl analyzed child en’s beha io in each o he ci cums ances in ol ed
in a i s isi (clinical examina ion, X- ay, p ophylaxis, e c.) and a ea men isi
(anes hesia injec ion, ca i y p epa a ion, illing, e c.), classi ying he pa ien s acco d-
ing o hei beha io as de ini ely posi i e, sligh ly posi i e, sligh ly nega i e, o
de ini ely nega i e.
➢
Collec ion o i al signs: The pulse will be eco ded, wi h he help o a Homiee Pulse
Oxime e
®
, and, using he No h Ca olina Beha io Scale [
30
], pa ame e s will be
analyzed, including he mo emen s o he legs and a ms, he p esence o c ying, and
any o al and/o physical esis ance om he child.
2.4. Den al Anxie y in Gua dians o Pa en s
The scales used o e i y den al anxie y in gua dians o pa en s a e as ollows:
➢
Modi ied Co ah Den al Anxie y Scale (MDAS) [
23
]: The e a e se e al me hods o
measu ing den al anxie y, one o hem being he Modi ied Co ah Den al Anxie y
Scale [
23
], which was la e expanded and modi ied. Each ques ion p esen s i e
al e na i e esponses e alua ed on a scale om 1 o 5, indica ing he absence o
anxie y and he highes le el o anxie y, espec i ely. The sco e anges om 5 (no
anxie y) o 25 (high anxie y).
➢
The Ea ly Childhood O al Heal h Impac Scale (ECOHIS) [
24
]: In o de o e i y
he mo he ’s pe cep ion in ela ion o he child en, we used he ECOHIS, o he
Ea ly Childhood O al Heal h Impac Scale [
24
]. Acco ding o he WHO, his scale
includes a sec ion on child impac (domains o symp oms, unc ion, psychology, and
sel -image/social in e ac ion) and a sec ion on amily impac (domains o dis ess and
amily unc ion). The ques ionnai e con ains 13 ques ions, whose answe s include
J. Clin. Med. 2025,14, 1869 4 o 14
(a) ne e , (b) almos ne e , (c) occasionally, (d) o en, (e) e y o en, and ( ) I do no
know. In addi ion, 2 ex a ques ions we e added o he ques ionnai e so ha pa en s
could a e hei child en’s gene al and o al heal h.
➢
In en o y o Anxie y (IDATE) [
25
]: I consis s o wo scales ob ained om a ques ion-
nai e designed o measu e wo di e en anxie y concep s: s a e anxie y (s a e A) and
ai anxie y ( ai A). The ai anxie y scale consis s o 20 s a emen s ha equi e
subjec s o desc ibe how hey eel in gene al. The s a e anxie y scale also consis s o
20 s a emen s om indi iduals o indica e how hey eel a a speci ic ime. Fo each
s a emen , he subjec mus selec one o he ou al e na i es o indica e how he o
she eels: no a all; a li le; enough; and a lo (on he s a e A scale); o almos ne e ;
some imes; equen ly; and almos always (on he ai A scale). These ques ionnai es
we e e-adap ed by he examine , elimina ing ques ions ha we e no conside ed
app op ia e o his s udy and limi ing he ques ionnai e o 10 gene al s a emen s
(s a e A) and 10 speci ic ones ( ai A), while also adding se e al ques ions du ing he
ea men isi s.
MDAS [
23
] and he IDATE [
25
] will be illed ou on 3 occasions by he pa en s ( i s
isi and i s and las day o ea men ), while he ECOHIS ques ionnai e [
24
] and he ea
es [
26
], gi en o child en o e 8 yea s old, will only be illed ou du ing he i s isi , as
hey consis o mo e gene alized ques ions.
The le el o anxie y o he pa en s o gua dians in ela ion o he ype o ea men ha
he child will unde go will also be analyzed in o de o assess whe he he pa en s’ anxie y
a ies depending on he ype o ea men o be ca ied ou .
2.5. Ca ies Analysis
The ca ies examina ion was ca ied ou by a single calib a ed ope a o h ough isual
and adiog aphic examina ion, which was subsequen ly eco ded in an odon og am. The
calib a ion was ca ied ou acco ding o he guidelines desc ibed by he WHO [
31
], whe e
he indices used o analyze den al ca ies conside he oo h as a uni . Thus, pa ien s who
ha e only empo a y den i ion will be assigned he cod index, while hose who ha e
pe manen den i ion will be assigned he DMFT index. The e o e, hose who ha e mixed
den i ion will be assigned he cod and DMFT indices independen ly, depending on he
pieces p esen .
The isk o ca ies will be de e mined acco ding o he able o ca ies se e i y indica o s
p o ided by he WHO [32].
3. Resul s
The sample consis ed o 101 adul s (pa en s o gua dians) and 101 child en be ween
4 and 13 yea s o age who we e eligible o den al ea men ; he mean age o he s udy
popula ion was 6.4 yea s. O he o al sample, 46.5% we e boys and 53.5% we e gi ls, wi h
he ollowing age dis ibu ion (Figu e 1):
J. Clin. Med. 2025,14, 1869 5 o 14
J. Clin. Med. 2025, 14, x FOR PEER REVIEW 5 o 14
Figu e 1. Age dis ibu ion o he sample
Acco ding o hei age, mos o he pa ien s had p ima y den i ion (DT) (45.5%) o
mixed den i ion (DM) (53.5%), and only one had pe manen den i ion (DP). Fo he 100
child en wi h DT o DM, whe e he e alua ion o he cod index was possible, a mean o
6.7 ± 2.7 was ob ained. Fo he 55 child en wi h DM o DP, he mean DMFT was 0.4 ± 0.9,
as shown in Table 1.
Table 1. Ca ies isk dis ibu ion acco ding o he ype o den i ion.
DENTITION
Ca ego y To al N To al % Tempo al N Tempo al % Mixed N Mixed % Pe manen N Pe manen %
To al 101 100.0% 46 100.0% 54 100.0% 1 100.0%
Low 1 1.0% 1 2.2% 0 0.0% 0 0.0%
Mode a e 10 9.9% 10 21.7% 0 0.0% 0 0.0%
High 17 16.8% 16 34.8% 0 0.0% 1 100.0%
Ve y high 19 18.8% 19 41.3% 0 0.0% 0 0.0%
Low/Ve y low 3 3.0% 0 0.0% 3 5.6% 0 0.0%
Mod./Ve y low 8 7.9% 0 0.0% 8 14.8% 0 0.0%
Al o/Ve y low 10 9.9% 0 0.0% 10 18.5% 0 0.0%
Ve y high/Ve y low 30 29.7% 0 0.0% 30 55.6% 0 0.0%
Ve y high/Low 3 3.0% 0 0.0% 3 5.6% 0 0.0%
The isk o ca ies in child en wi h DT is e y high in 76.1% o cases.
In he analysis o pa en al anxie y, 67.3% o pa en s a e classi ied as ha ing “low”
anxie y, and 31.7% a e classi ied as ha ing “mode a e” anxie y. Only one pa en p esen s
“high” anxie y, acco ding o he ECOHIS. As in he Co ah and IDATE es s, nei he pa en
exhibi s a pa hological s a e o anxie y.
In he analysis o anxie y and beha io in child en, he ea es (CFSS > 8 yea s) e-
eals ha 30.8% o pa ien s a e classi ied as ha ing “no ea ” and 69.2% as ha ing “li le
ea ”. Simila ly, in he Venham es (<8 yea s), 96.6% a e classi ied as “non-anxious” chil-
d en.
Rega ding child en’s beha io , acco ding o he F ankl scale, mos o he child en
exhibi ed e y posi i e beha io du ing he in e en ions ( i s isi o he den is , T1; i s
ea men isi , T2; and second ea men isi , T3) (Table 2).
12.9
16.8
31.7
15.8
9.9 7.9
212
0
10
20
30
40
%
Age
4 5 6 7 8 9 10 12 13
Figu e 1. Age dis ibu ion o he sample.
Acco ding o hei age, mos o he pa ien s had p ima y den i ion (DT) (45.5%)
o mixed den i ion (DM) (53.5%), and only one had pe manen den i ion (DP). Fo he
100 child en wi h DT o DM, whe e he e alua ion o he cod index was possible, a mean o
6.7
±
2.7 was ob ained. Fo he 55 child en wi h DM o DP, he mean DMFT was 0.4
±
0.9,
as shown in Table 1.
Table 1. Ca ies isk dis ibu ion acco ding o he ype o den i ion.
DENTITION
Ca ego y To al N To al % Tempo al N Tempo al % Mixed N
Mixed %
Pe manen N Pe manen %
To al 101 100.0% 46 100.0% 54 100.0% 1 100.0%
Low 1 1.0% 1 2.2% 0 0.0% 0 0.0%
Mode a e 10 9.9% 10 21.7% 0 0.0% 0 0.0%
High 17 16.8% 16 34.8% 0 0.0% 1 100.0%
Ve y high 19 18.8% 19 41.3% 0 0.0% 0 0.0%
Low/Ve y low 3 3.0% 0 0.0% 3 5.6% 0 0.0%
Mod./Ve y low 8 7.9% 0 0.0% 8 14.8% 0 0.0%
Al o/Ve y low 10 9.9% 0 0.0% 10 18.5% 0 0.0%
Ve y high/Ve y low 30 29.7% 0 0.0% 30 55.6% 0 0.0%
Ve y high/Low 3 3.0% 0 0.0% 3 5.6% 0 0.0%
The isk o ca ies in child en wi h DT is e y high in 76.1% o cases.
In he analysis o pa en al anxie y, 67.3% o pa en s a e classi ied as ha ing “low”
anxie y, and 31.7% a e classi ied as ha ing “mode a e” anxie y. Only one pa en p esen s
“high” anxie y, acco ding o he ECOHIS. As in he Co ah and IDATE es s, nei he pa en
exhibi s a pa hological s a e o anxie y.
In he analysis o anxie y and beha io in child en, he ea es (CFSS > 8 yea s) e eals
ha 30.8% o pa ien s a e classi ied as ha ing “no ea ” and 69.2% as ha ing “li le ea ”.
Simila ly, in he Venham es (<8 yea s), 96.6% a e classi ied as “non-anxious” child en.
Rega ding child en’s beha io , acco ding o he F ankl scale, mos o he child en
exhibi ed e y posi i e beha io du ing he in e en ions ( i s isi o he den is , T1; i s
ea men isi , T2; and second ea men isi , T3) (Table 2).
J. Clin. Med. 2025,14, 1869 6 o 14
Table 2. Child beha io acco ding o he F ankl scale.
FRANKL SCALE
Ca ego y N %
FRANKL T1
To al 101 100.0%
De . posi i e 85 84.2%
Lig. posi i e 14 13.9%
Lig. nega i e 2 2.0%
FRANKL T2
To al 101 100.0%
De . posi i e 91 90.1%
Lig. posi i e 10 9.9%
FRANKL T3
To al 101 100.0%
De . posi i e 85 84.2%
Lig. posi i e 15 14.9%
Lig. nega i e 1 1.0%
As o c ying and limb mo emen , an inc ease was ound as he ea men
p og essed (Table 3).
Table 3. Rela ionship be ween VENHAM in child en and pulse/mani es a ions: esul s o Pea son
co ela ion coe icien ( ), Chi2 es , and Fishe ’s exac es . * p alue < 0.05.
; p-Value Chi2/Fishe ; p-Value
PULSE T1 = 0.06; p= 0.575 p= 0.801
T2 = −0.01; p= 0.919 p= 0.838
T3 = −0.09; p= 0.411 p= 0.819
CRYING T1 p= 0.193
T2 p= 1.000
T3 p= 0.003 *
ARM MOV. T1 p= 0.385
T2 p= 0.501
T3 p= 0.105
LEG MOV. T1 p= 0.279
T2 p= 1.000
T3 p= 0.084
ORAL RESIST. T1 p= 1.000
T2 p= 1.000
T3 p= 1.000
PHYSICAL RESIST. T1 p= 1.000
T2 p= 1.000
T3 p= 1.000
When ela ing he di e en es s ca ied ou on he gua dians o he es s and da a
collec ed om he child en, only a weak co ela ion ( = 0.18; p= 0.0095) was de ec ed
be ween he anxie y o he gua dians (Co ah) and ha o he child en (Venham < 8 yea s)
a he i s isi (Figu e 2).
As wi h he co ela ion be ween Venham and STAI-T ai a he hi d isi , whe e
s a is ical signi icance is eached (p= 0.035), i can only be assessed as “weak” ( = 0.22).
The highe he pa en s’ ai anxie y sco e, he highe he child en’s Venham sco e a he
las ea men isi (Figu e 3).
J. Clin. Med. 2025,14, 1869 7 o 14
J. Clin. Med. 2025,14, x FOR PEER REVIEW 7o 14
Figu e 2. Rela ionship be ween pa en al Co ah es and child en Venham es a he i s isi .
As wi h he co ela ion be ween Venham and STAI-T ai a he hi d isi , whe e s a-
is ical signi icance is eached (p = 0.035), i can only be assessed as ”weak” ( = 0.22). The
highe he pa en s’ ai anxie y sco e, he highe he child en’s Venham sco e a he las
ea men isi (Figu e 3).
Figu e 3.Rela ionship be ween pa en al STAI- ai es es and child en Venham es a he hi d
isi .
The ype o ea men is signi ican ly associa ed wi h a highe le el o anxie y among
he pa en s, as shown in he ollowing able (Table 4):
Figu e 2. Rela ionship be ween pa en al Co ah es and child en Venham es a he i s isi .
J. Clin. Med. 2025,14, x FOR PEER REVIEW 7o 14
Figu e 2. Rela ionship be ween pa en al Co ah es and child en Venham es a he i s isi .
As wi h he co ela ion be ween Venham and STAI-T ai a he hi d isi , whe e s a-
is ical signi icance is eached (p = 0.035), i can only be assessed as ”weak” ( = 0.22). The
highe he pa en s’ ai anxie y sco e, he highe he child en’s Venham sco e a he las
ea men isi (Figu e 3).
Figu e 3.Rela ionship be ween pa en al STAI- ai es es and child en Venham es a he hi d
isi .
The ype o ea men is signi ican ly associa ed wi h a highe le el o anxie y among
he pa en s, as shown in he ollowing able (Table 4):
Figu e 3. Rela ionship be ween pa en al STAI- ai es es and child en Venham es a he
hi d isi .
The ype o ea men is signi ican ly associa ed wi h a highe le el o anxie y among
he pa en s, as shown in he ollowing able (Table 4):
J. Clin. Med. 2025,14, 1869 8 o 14
Table 4. Rela ionship be ween ECOHIS o pa en s and ea men s: esul s o independen samples
es and Mann–Whi ney es . * p alue < 0.05.
; p-Value MW; p-Value
OBTURATION T2 p= 0.207 p= 0.189
T3 p= 0.049 * p= 0.189
PULPOTOMY T2 p= 0.803 p= 0.834
T3 p= 0.181 p= 0.625
PULPECTOMY T2 p= 0.327 p= 0.573
T3 p= 0.050 p= 0.040 *
EXODONTIA T2 p< 0.001 * p= 0.008 *
T3 p= 0.038 * p= 0.024 *
Acco ding o ECOHIS, 83.3% o pa en s epo ed “mode a e-high anxie y” i a oo h
ex ac ion was pe o med, compa ed o only 29.5% o he wise. Pulpec omy also inc eased
he a e o anxie y in h ee o he pa en s in e iewed (Table 5).
Table 5. Rela ionship be ween CORAH o pa en s and ea men s: esul s o independen samples
es and Mann–Whi ney es . * p alue < 0.05.
; p-Value MW; p-Value
OBTURATION T2 p= 0.324 p= 0.527
T3 p= 0.536 p= 0.471
PULPOTOMY T2 p= 0.553 p= 0.328
T3 p= 0.222 p= 0.046 *
PULPECTOMY T2 p= 0.147 p= 0.097
T3 p= 0.509 p= 0.449
EXODONTIA T2 p= 0.583 p= 0.665
T3 p= 0.856 p= 0.785
Acco ding o Co ah, 90% o pa en s expe ienced “mode a e o g ea e anxie y” when
he ea men o be pe o med was a pulpo omy. In ano he case, only 50.6% expe ienced
his le el o anxie y. Rega ding he STAI-S a e/STAI-T ai , signi ican ela ionships we e
ound a he second ea men isi , when he ea men o be pe o med was a illing o a
pulpec omy, as shown in he ollowing able (Table 6):
Table 6. Rela ionship be ween STAI-Pa en ai s and ea men s: esul s o independen samples
es and Mann–Whi ney es . * p alue < 0.05.
; p-Value MW; p-Value
OBTURATION T2 p= 0.010 * p= 0.365
T3 p= 0.513 p= 0.634
PULPOTOMY T2 p= 0.985 p= 0.728
T3 p= 0.763 p= 0.455
PULPECTOMY T2 p= 0.042 * p= 0.506
T3 p= 0.416 p= 0.132
EXODONTIA T2 p= 0.588 p= 0.813
T3 p= 0.596 p= 0.875
Rega ding he isk o ca ies, al hough s a is ical signi icance is no eached, a weak
co ela ion is sugges ed be ween he cod index and he ECOHIS sco e; in a di ec sense, he
highe he ECOHIS, he highe he ca ies a e (Table 7).
Table 7. Rela ionship be ween cod, DMFT, isk o ca ies in empo a y den i ion, TD, and mixed DM
o child en and ECOHIS o pa en s: esul s o Pea son co ela ion coe icien ( ) and Spea man ( S).
; p-Value S; p-Value
d = 0.19; p= 0.056 --
DMFT = 0.12; p= 0.395 --
DT isk -- S = 0.02; p= 0.888
DM isk -- S = 0.13; p= 0.365
The isk o ca ies in DT (cod), is signi ican ly co ela ed wi h he Co ah sco e o he
pa en , as shown in he ollowing igu e (Figu e 4):
J. Clin. Med. 2025,14, 1869 9 o 14
J. Clin. Med. 2025, 14, x FOR PEER REVIEW 9 o 14
Table 7. Rela ionship be ween cod, DMFT, isk o ca ies in empo a y den i ion, TD, and mixed DM
o child en and ECOHIS o pa en s: esul s o Pea son co ela ion coe icien ( ) and Spea man ( S).
; p-Value
S; p-Value
d
= 0.19; p = 0.056
--
DMFT
= 0.12; p = 0.395
--
DT isk
--
S = 0.02; p = 0.888
DM isk
--
S = 0.13; p = 0.365
The isk o ca ies in DT (cod), is signi ican ly co ela ed wi h he Co ah sco e o he
pa en , as shown in he ollowing igu e (Figu e 4):
Figu e 4. Ca ies isk in DT acco ding o CORAH Pa en s Anxie y Scale.
Rega ding he isk o ca ies s. STAI-S a e, no ele an co ela ion was ound. How-
e e , ega ding he STAI-T ai , a highe isk o ca ies was ound in DM i he pa en s
sco ed highe on he STAI-T ai (Table 8).
Table 8. Rela ionship be ween d , DMFT, isk o ca ies in empo a y den i ion, TD, and mixed DM
o child en and STAI-T ai o pa en s: esul s o Pea son co ela ion coe icien ( ) and Spea man
( S). * p alue < 0.05.
; p-Value
S; p-Value
d
= 0.07; p = 0.483
--
DMFT
= 0.10; p = 0.462
--
DT isk
--
S = −0.03; p = 0.865
DM isk
--
S = 0.28; p = 0.040 *
4. Discussion
In ou s udy, we ha e shown ha gua dians o pa en s wi h ea o anxie y abou he
den is can ansmi hese uncons uc i e emo ions o hei child en. This can a ec he
child’s beha io du ing isi s o he den is (especially du ing he i s isi ), bu no he
child’s de elopmen o anxie y o ea symp oms; a weak ela ionship was obse ed be-
ween he child’s anxie y and ha o he pa en s when we compa ed he di e en es s
5.6
22.2 27.3
50
27.3
16.7
22.2
45.5
83.3
0
25
50
75
100
%
Muy al o
Al o
Mode ado
Bajo
Sligh /Null Mode a e High/Se e e
Ve y high
High
Mode a e
Sligh
Figu e 4. Ca ies isk in DT acco ding o CORAH Pa en s Anxie y Scale.
Rega ding he isk o ca ies s. STAI-S a e, no ele an co ela ion was ound. How-
e e , ega ding he STAI-T ai , a highe isk o ca ies was ound in DM i he pa en s sco ed
highe on he STAI-T ai (Table 8).
Table 8. Rela ionship be ween d , DMFT, isk o ca ies in empo a y den i ion, TD, and mixed DM
o child en and STAI-T ai o pa en s: esul s o Pea son co ela ion coe icien ( ) and Spea man ( S).
*p alue < 0.05.
; p-Value S; p-Value
d = 0.07; p= 0.483 --
DMFT = 0.10; p= 0.462 --
DT isk -- S = −0.03; p= 0.865
DM isk -- S = 0.28; p= 0.040 *
4. Discussion
In ou s udy, we ha e shown ha gua dians o pa en s wi h ea o anxie y abou
he den is can ansmi hese uncons uc i e emo ions o hei child en. This can a ec
he child’s beha io du ing isi s o he den is (especially du ing he i s isi ), bu no
he child’s de elopmen o anxie y o ea symp oms; a weak ela ionship was obse ed
be ween he child’s anxie y and ha o he pa en s when we compa ed he di e en es s
conduc ed du ing each isi o he den is . Howe e , gi en he small sample size, we
canno ejec he null hypo hesis.
Pe ó ic e al. (2024) [
33
] also show, in hei s udy, ha he emo ional s a e o he
pa en s will in luence he child’s beha io , ei he posi i ely o nega i ely; howe e , his
will no esul in less o g ea e anxie y o he den is , a leas no in all cases. On he
con a y, he s udies by Rames e al. (2024) [
34
] and Besi oglu e al. (2024) [
35
] show ha
child en’s ne ousness du ing den al ea men is mainly caused by he mo he ’s anxie y.
G ea e ea and anxie y a e ound in young child en han in adolescen s, despi e he ac
ha he la e may ha e been exposed o mo e auma ic den al episodes p e iously [
17
,
36
].
These esul s also coincide wi h ou s udy, in which he majo i y o pa ien s who
unde wen he CFSS we e no a aid o he den is . In con as , despi e he da a ob ained
om his es , he ques ion ha gene a ed he g ea es ea in pa ien s (>8 yea s old) was he
one ela ed o “needles and injec ions”. This coincides wi h he Co ah scale adminis e ed o
