Evaluation of dental anxiety in school going children using modified dental anxiety scale and facial image scale


Dental fear anxiety
Facial image scale
Modified dental anxiety scale

How to Cite

Khanal, S., Shah, P. ., & Khapung, A. . (2023). Evaluation of dental anxiety in school going children using modified dental anxiety scale and facial image scale. Journal of Kathmandu Medical College, 12(1), 17–24. Retrieved from https://jkmc.com.np/ojs3/index.php/journal/article/view/1230


Background: Dental anxiety refers to patient’s response toward stresses associated with dental procedures. It can present problem for both dentist and patient, particularly in paediatric dentistry. Hence, it is important to identify anxious patients for improved patient management and development of better treatment strategies.

Objectives: To evaluate the prevalence of dental anxiety in schoolchildren using Modified Dental Anxiety Nepali version (MDAS-N) and Facial Image Scale (FIS).

Methods: An analytical cross-sectional study was carried out in 401 schoolchildren (11.34 ± 1.85 years) using convenience sampling method from 2022 June to 2022 August after ethical approval was obtained from Nepal Medical College. The dental anxiety was assessed by questionnaire provided in MDAS-N and FIS. Independent t-test was done in SPSS v.20.0 to analyse the data.

Results: The data have shown that 375 (93.52%) had dental anxiety (mean MDAS-N = 11.83 ± 3.59) with low and moderate anxiety in 153 (38.15%) and 140 (34.92%) respectively. Seventy (36.08%) females presented with moderate anxiety and 92 (44.44%) males had low anxiety. The mean score difference was statistically significant (p-value <0.001) between the genders. Statistically significant difference (p-value = 0.023) was found between FIS mean score of primary and middle school level students. Injection and drilling the tooth were the procedures with high anxiety score in both scales. There was a moderate positive correlation between MDAS-N and FIS (r = 0.574).

Conclusion: Assessing dental anxiety and factors provoking fear and anxiety in dental clinic is useful, as behaviour management can be applied accordingly for child patients.



Shim YS, Kim AH, Jeon EY, An SY. Dental fear and anxiety and dental pain in children and adolescents: a systemic review. J Dent Anaesth Pain Med. 2015;15:53-61. [PubMed | Full Text | DOI]

Sadana G, Grover R, Mehra M, Gupta S, Kaur J, Sadana S. A novel chotta bheem–chutki scale for dental anxiety determination in children. J Int Soc Prevent Commun Dent. 2016;6:200-5. [PubMed | Full Text | DOI]

Alhareky M, Nazir MA, AlGhamdi L, Alkadi M, AlBeajan N, AlHossan M, et al. Relationship between maternal dental anxiety and children’s dental caries in the eastern province of saudi arabia. Clin Cosmet Investig Dent. 2021;13:187-94. [PubMed | Full Text | DOI]

Sarapultseva M, Yarushina M, Kritsky I, Ibragimov R, Sarapultsev A. Prevalence of dental fear and anxiety among russian children of different ages: The cross-sectional study. Eur J Dent. 2020 Oct;14(04):621-5. [Full Text]

Enright A, Enright S. Dental anxiety and phobia – Causes, impacts, and treatment. Dent Oral Maxillofac Res. 2021;7:1-6. [Full Text]

Shindova MP, Belcheva AB. Dental fear and anxiety in children: A review of the environmental factors. Folia Medica. 2021;63(2):177-82. [Full Text]

Rath S, Das D, Sahoo SK, Raj A, Guddala NR, Rathee G. Childhood dental fear in children aged 7-11 years old by using the Children’s Fear Survey Schedule-Dental Subscale. Journal of Medicine and Life. 2021 Jan;14(1):45-9. [Full Text]

Dikshit P, Limbu S, Bhattarai K. Evaluation of dental anxiety in parents accompanying their children for dental treatment. Orthod J Nepal. 2013;6:47-52. [Full Text]

Oliveira LB, Massignan C, De Carvalho RM, Savi MG, Bolan M, Porporatti AL, Canto GD. Children’s perceptions of dentist’s attire and environment: A systematic review and meta-analysis. Int J Clin Paediatr Dent. 2020;13:700-11. [PubMed | Full Text]

Buchanan H, Niven N. Validation of a Facial Image Scale to assess child dental anxiety. Int J Paediatr Dent . 2002;12:47-52. [Full Text]

Panda S, Quadri MF, Hadi IH, Jably RM, Hamzi AM, Jafer MA. Does dental fear in children predict untreated dental caries? An analytical cross-sectional study. Children. 2021;8:382-92. [Full Text]

Kilini G, Akay A, Eden E, Sevin?n N, Ellidokuz H. Evaluation of children’s dental anxiety levels at a kindergarten and at a dental clinic. Braz Oral Research. 2016 Aug;30:1-8. [Full Text]

Porritt J, Buchanan H, Hall M, Gilchrist F, Marshman Z. Assessing children's dental anxiety: A systematic review of current measures. Community Dent Oral Epidemiol. 2013 Apr;41(2):130-42. [Full Text]

Setty JV, Srinivasan I, Radhakrishna S, Melwani AM, DR MK. Use of an animated emoji scale as a novel tool for anxiety assessment in children. Journal of Dental Anaesthesia and Pain Medicine. 2019 Aug;19(4):227-33. [Full Text]

Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of dental anxiety among dental patients in saudi arabia. J Int Soc Prevent Commun Dent. 2017 Mar;7:100-4. [PubMed | Full Text]

Giri J, Pokharel PR, Gyawali R, Bhattarai B. Translation and validation of modified dental anxiety scale: The Nepali version. International scholarly research notices. 2017;1-6. [Full Text]

Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health.2009 Dec;9(1):1-8. [Full Text]

Kakkar M, Wahi A, Thakkar R, Vohra I, Shukla AK. Prevalence of dental anxiety in 10-14 years old children and its implications. J Dent Anaesth Pain Med. 2016;16:199-202. [Full Text]

Shindova MP, Belcheva AB. Dental fear and anxiety in children: A review of the environmental factors. Folia Medica. 2021;63(2):177-82. [Full Text]

Rãducanu AM, Feraru V, Herteliu C, Anghelescu R. Assessment of the prevalence of dental fear and its causes among children and adolescents attending a department of paediatric dentistry in Bucharest. Medicine Psychology. 2009 Mar;8(1):42-9. [Full Text]

Fathima F, Jeevanandan G. Validation of a facial image scale to assess child dental anxiety. Drug Invent Today. 2018 Sep;10:2825-8. [Full Text]

Niharika P, Reddy NV, Srujana P, Srikanth K, Daneswari V, Geetha KS. Effects of distraction using virtual reality technology on pain perception and anxiety levels in children during pulp therapy of primary molars. J Ind Soc Paed Prev Dent. 2018 Oct 1;36(4):364. [Full Text]

Yon MJ, Chen KJ, Gao SS, Duangthip D, Lo EC, Chu CH. An introduction to assessing dental fear and anxiety in children. Healthcare 2020 Apr ;4:8(2) 86-94. [Full Text]

Wu L, Gao X. Children’s dental fear and anxiety: exploring family related factors. BMC Oral Health. 2018 Dec;18:1-10. [Full Text]

Alaki S, Alotaibi A, Almabadi E, Alanquri E. Dental anxiety in middle school children and their caregivers: Prevalence and severity. J Dent Oral Hyg. 2012 Jan;4(1):6-11. [Full Text]

Zanetti P, Flores MR, Rigo L. Evaluation of anxiety to dental treatment in students: Cross-section study. Ann Paediatr Child Health. 2019;7:1164-70. [Full Text]

Khanduri N, Singhal N, Mitra M. The prevalence of dental anxiety and fear among 4–13-year-old Nepali children. J Ind Soc Paed Prev Dent. 2019;37(4):345. [Full Text]

Ogawa M, Sago T, Furukawa H. The reliability and validity of the japanese version of the modified dental anxiety scale among dental outpatients. The Scientific World Journal. 2020 May 1;1-6. [Full Text]

Ghimire N, Kayastha B, Nepal P. The first dental visit. Journal of Chitwan Medical College. 2013;3(4):30-3. [Full Text]

De Hersa SCRA, Herdiyati Y, Tjahajawati S. Relation of anxiety and pulse rate before tooth extraction of 6-9 years old children. Padjadjaran Journal of Dentistry. 2012 Jul;24 (2):148-52. [Full Text]