COSMIN database

Evidence-based dentistry: analysis of dental anxiety scales for children

Al-Namankany, A., de Souza, M., and Ashley, P.
OBJECTIVES: To review paediatric dental anxiety measures (DAMs) and assess the statistical methods used for validation and their clinical implications.

METHOD: A search of four computerised databases between 1960 and January 2011 associated with DAMs, using pre-specified search terms, to assess the method of validation including the reliability as intra-observer agreement 'repeatability or stability' and inter-observer agreement 'reproducibility' and all types of validity.

RESULTS: Fourteen paediatric DAMs were predominantly validated in schools and not in the clinical setting while five of the DAMs were not validated at all. The DAMs that were validated were done so against other paediatric DAMs which may not have been validated previously. Reliability was not assessed in four of the DAMs. However, all of the validated studies assessed reliability which was usually 'good' or 'acceptable'. None of the current DAMs used a formal sample size technique. Diversity was seen between the studies ranging from a few simple pictograms to lists of questions reported by either the individual or an observer.

CONCLUSION: To date there is no scale that can be considered as a gold standard, and there is a need to further develop an anxiety scale with a cognitive component for children and adolescents.
Br Dent J
1476-5373 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Children (0-18)
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
6 - Clinical rating scales
7 - Observations
BPRS - Behaviour Profile Rating Scale
CDFP - Child Dental Fear Picture
CFSS-DS - Childrens Fear Survey Schedule Dental Subscale
DA5 - Dental Anxiety Scale for 5-year-old children
FCRS - Frankl Category Rating Scale
FIS - Facial Image Scale
GRS - Global Rating Scale
HCRS - Houpt Categorical Rating Scale
MCDASf - Modified Child Dental Anxiety Scale with Faces
MCDAS - Modified Child Dental Anxiety Scale
VABRS - Venham Anxiety and Behaviour Rating Scales
VAS - Visual Analogue Scale   [see: ZUYD (NL)]
VPT - Venham Picture Test