Validation of a Facial Image Scale to assess child dental anxiety.

TLDR: The findings suggest that the FIS is a valid means of assessing child dental anxiety status in a clinical context.

Abstract: Summary. Objective. To examine the validity of a scale that uses faces as an indicatorof children’s dental anxiety. Setting. Department of Child Dental Health waiting room, Newcastle Dental Hospital. Subjects and methods. 100 children (aged 3–18 years) completed the Facial ImageScale (FIS) and the Venham Picture Test (VPT) in the dental hospital waiting room. Results. A strong correlation (0·7) was found between the two scales, indicating goodvalidity for the FIS. Findings also showed that a small, but significant, number of childrenare anxious in the dental context.Conclusion. The findings suggest that the FIS is a valid means of assessing child dentalanxiety status in a clinical context. Introduction Dental anxiety in children has been recognized asa problem in patient management for many years.Furthermore, the effects of this anxiety have beenshown to persist into adulthood, which can oftenlead to dental avoidance [1] and the subsequentdeterioration of oral health [2]. It is important thatdentists are able to assess dental anxiety in childpatients as early as possible so that they may identifypatients who are in special need with regards to theirfear. For this purpose, formal assessment measuresare essential. Upon reviewing the literature, it isclear that there are many different assessmentmethods available for this purpose (see Aartman andcolleagues [3,4] for comprehensive reviews). Whenconsidering the usefulness of an assessment measure,however, there are essentially three important factorsto take into account: 1 The validity of the instrument used must be con-sidered. This can be problematic, especially whenthe measure is indirect. For example, the use ofphysiological methods has been criticised on thegrounds that anxiety may be evoked due to the natureof the equipment used, and not because the child isdentally anxious [5]. In addition, projective techniquessuffer from questionable reliability and validity dueto difficulties in the interpretation of stories and thestandardization of scoring; 2 The assessment measure must be appropriate foruse with children. Indirect measures overcome thisto a certain degree as they mostly rely on observationsand reactions of the child by others. Techniques thatrely on some form of verbal-cognitive self-report(e.g. questionnaires) can be problematic, however.Questioning children directly about their dental anxietyis reasonably straightforward, but verbal methodsemployed with young children can have limitationsdue to comprehension and intellectual ability [4]; 3 It is important to consider whether an assessmentmeasure is of practical use to the dental practitioner,an issue that is rarely addressed in the literature.Techniques such as projective tests and behaviouralobservation are not designed for everyday use by theclinician. Projective techniques, such as the Children’sDental Fear Picture Test [6], require expertise in carry-ing out interviews and administering (and scoring)tests. Similarly, physiological methods often require