Influence of parental anxiety on children's behaviour during dental treatment in relation to the caries experience among 3-5-years-olds in three public dental clinics in Nairobi
Background: Dental anxiety is a fear traditionally defined as an irrational and exaggerated fear of dentists and dental procedures. It is a worldwide phenomenon with a prevalence ranging from 3-43%. Females have been known to have higher anxiety than males and the younger age groups also have higher anxiety than the older age groups. Anxious parents might incorporate this anxiety onto their children and this can manifest as poor behaviour of the child during dental treatment. Also, anxious parents might present their children late to the clinic as a result of their own fear and this can predispose the children to a high caries experience. Objective: To determine the influence of parental anxiety on child behaviour during treatment in relation to the child caries experience among the 3-5-yearolds. Study Design: This was a descriptive cross-sectional study. Study Area: Using purposive sampling, three public dental clinics in Nairobi were selected, namely, Kenyatta National Hospital, the University of Nairobi, School of Dental Sciences, and the Lady Northey City Council Clinic. Methods and Materials: All patients who met the inclusion criteria during the duration of the study were included, and this involved a total of 330 children aged between 3-5-years of age and their accompanying parents/guardians. A semistructured questionnaire was used to obtain information on the parent/guardian on previous clinical experiences for themselves and the children. The Modified Dental Anxiety Scale was used to determine' parental anxiety and child behaviour was measured using the Frankl Scale and recorded in a clinical examination form. Children were examined for dental caries experience using the WHO Criteria 1997 (dmft) and the caries experience recorded in a clinical examination form. Data analysis and presentation: The data collected was coded, and analyzed using the statistical package for social sciences [SPSS] 12.0[SPSS Inc, Chicago, lIIinois,USA.] Results were presented using charts, graphs and tables. Chisquare (X2) test was used to determine the relationship between variables for the categorical data. Mann Whitney U Rank test was used to determine relationship between non-categorical variables. A P-value of less than 0.05 was considered significant. Descriptive analysis was done using frequencies for various variables. Results: Overall prevalence of high anxiety was 3.9%. Among those with high anxiety 12 (92.3%) were mothers, 1 (7.7%) were fathers and none of the guardians had any high anxiety. There was no relationship between parental anxiety and previous clinical experience (p=0.40). Similarly, there was no relationship between parental/guardian anxiety and history of previously visiting a dentist or not was obtained (p=0.09). Parents/guardians were accurately able to rate their own anxiety correctly (p=O.OO). 'Definitely negative' behaviour was observed among 33 (10%) of the children, while 94 (28.5%) had 'negative' behaviour, 108 (32.7%) had 'positive' behaviour and 95 (28.8%) had 'definitely positive' behaviour. There was no relationship between child behaviour and previous clinical experience of the parent/guardian (p=0.21). The older children were significantly better behaved than the younger children (p=0.04). There was a significant relationship between child behaviour xv exhibited and previous clinical experience of the child (p=O.004). However, there was no relationship between behaviour exhibited by the children and previous history of visiting a dentist (p=O.21). Parents/guardians were accurately able to predict the behaviour of their children in the clinic (p=O.OO). Prevalence of dental caries was 93.6% and a mean dmft of 8.14. There was a high proportion of unmet treatment needs with a mean decayed component of 7.27, mean missing component of 0.80 and a mean filed component of 0.06. There was a significant increase in caries experience with increase in age (p=0.01). There was no association between parental/guardian anxiety and child behaviour (p=O.08). Similarly there was no association between parental anxiety and caries experience of the child (p=0.42). Also, there was no association between child behaviour and child dental caries experience (p=0.21). CONCLUSIONS: The overall prevalence of high dental anxiety was low but parents/guardians were accurately able to predict their own anxiety. Majority of the children had positive behaviour and their behaviour was significantly related to the age. Parents are able to accurately predict the behaviour of their children, and the same behaviour was also significantly related to previous clinical experience of the child. There was a high dmft score for the children of 8.14 with a high unmet treatment with the decay (d) component contributing the biggest portion with a very low filled component of 0.06. There was no association between parental/guardian anxiety and child behaviour or dental caries experience of the child.