EPP435
Understanding and Managing Dental Fear and Anxiety in Children: An Evidence-Based Clinical Pathway Across Paediatric Dentistry and Child Psychiatry
S. G. Abbas 1,*, M. Rashid 2, H. Tahseen 3
1Sixth Form, The Grange School, Northwich, 2Dentistry, The Woodlands Dental Practice, Middlewich, 3Psychiatry, Somerset NHS Trust, Taunton, United Kingdom
Introduction: Child dental fear is a common, modifiable barrier to care that predicts avoidance, emergency-driven attendance and poorer oral/psychosocial outcomes in later life. Fear arises through learned and neurobiological (amygdala–HPA) pathways. producing heightened autonomic arousal in the dental setting. Embedding early identification and brief interventions in routine dentistry could change trajectories.
Objectives: (1) Synthesize evidence on the development and maintenance of dental fear in children;
(2) appraise subjective (psychometric/observational) vs objective (physiological) assessment for clinical usability;
(3) evaluate behavioural/psychological interventions with real-world feasibility;
(4) propose a pragmatic, stepped-care pathway linking paediatric dentistry with child mental health.
Methods: Critical narrative review across paediatric dentistry, clinical psychology and neurobiology. Inclusion prioritised child-focused studies, validated measures (CFSS-DS, DFSS-SF, DAS, Venham), and interventions (Tell-Show-Do, graded exposure, distraction/VR, CBT-informed approaches; pharmacological adjuncts for severe cases). Each source was logged for credibility, strengths/limits, applicability and convergence/divergence; findings were thematically synthesised (aetiology, measurement, management).
Results: Aetiology: Fear typically begins in childhood via conditioning, modelling (parental anxiety) and information pathways; neurobiology (amygdala/HPA) explains autonomic hyperarousal and avoidance.
Measurement: Subjective tools (CFSS-DS/DFSS-SF) are reliable and chairside-feasible; DAS is less age-specific; observation (Venham) supports non-verbal cases. Objective indices (HR, skin conductance, salivary cortisol) track arousal but are resource-heavy—best for research/specialist clinics. Combining brief subjective screening with selective physiological monitoring optimises validity and practicality.
Interventions: Behavioural methods (Tell-Show-Do, graded exposure, distraction/modelling) consistently reduce fear; dentist-communication micro-skills (predictability, choice, control) are key “active ingredients.” CBT-informed packages and VR are promising; pharmacological support is reserved for severe treatment-blocking anxiety.
Pathway: (i) Screen (DFSS-SF/CFSS-DS); (ii) Match to stepped care (universal communication+behavioural strategies → CBT-informed/VR → specialist/adjunctive pharmacology); (iii) Review to prevent avoidance cycles.
Conclusions: Child dental fear is identifiable and treatable. Embedding screening and stepped behavioural care in routine dentistry, with clear escalation routes, provides a practical bridge to child mental health. Next steps: implement in primary care, test cost-effectiveness of CBT-informed/VR options, and develop low-cost biosensors. This model can reduce avoidance and improve long-term oral-health trajectories.
Disclosure of Interest: None Declared