Validated psychometric scales to measure dental fear/anxiety among children and adolescents in Italy. A systematic review

[su_button url=”” target=”blank” style=”flat” background=”#bd1221″ size=”5″]Download PDF[/su_button]

Stefano Cianetti1, Luigi Paglia2, Roberto Gatto3, A. Montedori4, Michele Nardone7, S. Pagano1, R. Salvato6, Silvano Gallus5, Guido Lombardo1

1 Biomedical Sciences, Unit of Paediatric Dentistry, University of Perugia, Perugia, Italy

Head Department of Pediatric Dentistry, Istituto Stomatologico Italiano, Milan, Italy

Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

Regional Health Authority of Umbria, Health Planning Service of Perugia, Perugia, Italy

Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy

Department of Philosophy, Social and Human Sciences and Education, University of Perugia, Perugia, Italy

Ministry of Health, General secretariat, Rome, Italy



One in seven children or adolescents suffer from a high level of dental fear/anxiety (DFA) hindering or delaying their dental service attendance. To overcome this negative psychological condition an early diagnosis should be performed through validated psychometric scales adequate for children, such as the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale (MCDAS). The aim of this paper is to review the literature in order to verify the existence of validation studies regarding the above mentioned two questionnaires.


A detailed systematic research of studies published at the end of February 2016 into the most relevant electronic data bases (Medline, Embase and Web of Science) with well calibrated Mesh words was performed. Only studies reporting data about the reliability and validity concerning CFSS-DS and/or MCDAS carried out among Italian children and adolescents were selected for data extraction.


The literature review yielded 905 records, for 43 of which the full text was retrieved. In addition, a further 5 full texts were also derived by the searching of available papers. After the examination of all full texts no studies reporting validation procedures carried out among Italian children or adolescents were found.


The absence of validated studies in Italy regarding two of the most relevant psychometric scales (CFSS-DS and MCDAS) raises concerns about the attention shown by Italian dental practitioners to the matter of children’s/adolescents’ dental anxiety. Further methodologically well conduced studies in this field should be performed on Italian population.

Keywords: Children’s Fear Survey Schedule- Dental Subscale (CFSS-DS); Dental Fear/Anxiety (DFA); Italian children and adolescents; Modified Child Dental Anxiety Scale (MCDAS); Validation of psychometric scales.


Dental Fear/Anxiety (DFA) is a condition that affects children and adolescents as well as adult population. Almost one in seven subjects suffer from a high level of DFA enough to prevent an adequate treatment at the dental chair in terms of quality and completeness (1, 2). Moreover, DFA is time consuming and increases costs related to treatment (3) as well as stress for dental practitioners (4).

The DFA represents a relevant barrier causing children’s avoidance or delay in undergoing dental visits, comparable for importance with well known social factors such as low family income, parental education level, geographic location, high costs of dental treatments, lack of perceived need, and weak recommendation by pediatricians (5, 6). An immediate consequence of reduced dental service children’s attendance is the presence of 621 million children with untreated deciduous teeth worldwide (7). An early and regular schedule of dental visits, indeed, constitutes a positive habit for children in prevention as well as in early diagnosis and treatment of caries (8). Advantages are particularly evident when dental visits begin among children younger than 3 years (9).

Among the causes of reduced dental service attendance DFA is the one that most involves the dental practitioners (10). The first visit to a dentist can be a fearful experience, particularly when young patients have to cope with specific fear triggers, such as dental injection (11-17), the sight or noise of a dental drill (11, 12, 15, 18, 19), tooth extraction (19-22), a choking sensation (15), and having a stranger touch them (15, 16, 19).

However the causes of DFA onset can not be all attributed to the dental setting, in fact other personality traits or factors can play a fundamental role in the onset of dental anxiety, such as general anxiety (10, 23, 24), mood (23), temperament (24, 25), emotional status (26), parental dental fear (11, 27-30) and family social status (31, 32).

The DFA such as “trait” of personality expresses the basal children’s propensity to feel fear during dental visit and treatment and it is usually measured through psychometric scales (33). The psychometric scales allow a preliminary assessment of DFA (before treatment) useful to plan specific treatment procedures for children when high level of DFA are diagnosed (34) .

The fearful children undergoing dental visits present a higher probability to show bad reaction/behavior such as to prevent to carry out the treatment correctly. Children’s bad reaction at dental chair causes difficulties for dentist in treating the patient, and this is referred to as behavioral dental management problems (BDMP). Also, BDMP might be assessed and measured by dental operators by means of specific scales (i.e. Frank Scale) (35). There are other methods for DFA measurement, such as “physiological” assessment and “projective tests” (2, 36). The physiological assessment is based on variation of patients’ physiological parameters such as pulse or heart rate as well as salivary cortisol levels. However, doubts about validity of physiological measurements are reported in the literature (37). Moreover, for some types of measurements, such as cortisol tests, further doubts were expressed about costs and difficulties for the application in daily practice (33). The projective tests, based on psychological interpretation of children pictures of the dental setting (i.g. the doctor), are deemed an interesting valid method to assess DFA (38), but there are concerns in terms of reliability (36).

After a review of the scientific literature about DFA among children, the only two psychometric scales we could identify as specifically thought and created for children and adolescents are the “Modified Children’s Dental Anxiety Scale” (MCDAS) and “Children Fear Schedule Survey-Dental Subscale” (CFSS-DS). They both are composed of questions (items) that describe situations that children or adolescents are asked to cope with when sitting on the dental chair (i.g. sight of injection or dental extraction). For each question the child can show his/her fear through a five grade rating scale, ranging from “not afraid at all” (grade 1) to “very afraid” (grade 5), named the Likert Scale. The CFSS-DS is constituted of 15 items with scores varying from 15 to 75 (39), whereas the MCDAS of 8 items with scores ranging from 8 to 40. Translations of these psychometric scales should be validated for their use among the population where they will be used; also a cut off value to indicate high fearful subjects should be tailored on the tested population.

The aim of this study is to review the current scientific literature in order to understand whether there are validated Italian versions of CFSS-DS and MCDAS in order to measure the prevalence and mean score values of DFA among children and adolescents.


Inclusion criteria

Study design: This review includes only cross-sectional and cohort studies that reported data about validity and reliability of Italian versions of CFSS-DS and MCDAS.

Population: Children and adolescents (aged 0-19 years) without diagnosed systemic diseases or psychological disorders.

Setting: private or public dental services (general or pediatric) as well as schools and kindergartens.

Endpoints: Primary data were represented by reliability and validity coefficients of two scales used to measure the trait of DFA among children and adolescents: Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), the Modified Child Dental Anxiety Scale (MCDAS). Secondary outcomes were represented from both mean score and prevalence of DFA recorded in the Italian children and adolescents populations where questionnaires validations were carried out.

Exclusion criteria

Editorials, case reports and retrospective studies were not considered in this review. Studies including fewer than 50 participants, studies reporting validity data alone or reliability data alone were not included. Moreover studies not carried out in Italy as well as studies without clearly expressed correlation indices for CFSS-DS and MCDAS validation procedures were excluded. Lastly, studies that were not written in English or Italian language were also excluded.

Literature search

An adequate search strategy was performed for Medline, but revised appropriately for each database (Medline, Embase, Web Of Science). The entire set of Mesh words as well as their combination in order to perform a detailed literature review about reliability and validity of Italian versions of CFSS-DS and MCDAS are described in Table 1.


Mesh words combination
Dental anxiety/diagnosis* # children
Dental anxiety/diagnosis* # adolescents
Psychometrics #dental anxiety # children
Psychometrics #dental anxiety adolescents
Dental anxiety # validity #children
Dental anxiety # reliability # children
Dental anxiety # validity #adolescents
Dental anxiety # reliability #adolescents
Children Fear Schedule Survey Dental Subscale # dental anxiety
CFSS-DS # dental anxiety
Children’s Fear Schedule Survey Dental Subscale # reliability
Children’s Fear Schedule Survey-Dental Subscale # validity
CFSS-DS # reliability
CFSS-DS # validity
Modified child dental anxiety scale # dental anxiety
MCDAS # dental anxiety
Modified child dental anxiety scale # reliability
Modified child dental anxiety scale # validity
MCDAS # dental anxiety # validity
MCDAS # dental anxiety # reliability
Children Fear Schedule Survey-Dental Subscale # Ital*
CFSS-DS # Ital*
Modified child dental anxiety scale # Ital*
MCDAS # Ital*

Table 1. Search strategy (Medline, Embase, Web Of Science databases)

Search was performed in February 2016.

Selection of studies

All identified records potentially relevant for full text obtained by mean of search conducted over any database were stored into the bibliographic software package EndNote X7 and merged into one core database. Identified duplicate records were eliminated. Records of interest for this review were searched also consulting other sources such as textbooks and reference lists of relevant trials and reviews. A detailed screening of title and abstract of the entire set of retrieved records was performed by two independent reviewers (GL, EL). Then, the full texts of the articles identified as potentially meeting the inclusion criteria were retrieved for data extraction. The search was carried out until the month of March 2016. Disagreements were resolved by discussion or, when resolution was not possible, through assessment by a third review author (RG).

Data extraction and management

Data extraction was performed by two independent reviewers (SC, LP) and disagreements were resolved by discussion or by asking the opinion of a third reviewer (IA). The extracted data were collected in a specific table sheet. Retrieved data described the most relevant features of the studies such as year of publication, country and setting of the study, participants’ characteristics (number, age, gender), type of psychometric scale used, type of correlation coefficient used for the analyses of reliability and validity as well as DFA mean score and prevalence data of Italian children population where CFSS-DS and MCDAS were validated.

Data analysis

For each study that met inclusion criteria, reliability and validity coefficients of the psychometric scales were evaluated in order to verify whether their values were enough to demonstrate that CFSS-DS and MCDAS are reliable and valid DFA measurement tools. For secondary outcomes, crude prevalence estimates (number of cases/sample size), along with standard errors, were extracted. Prevalence rates were transformed to logit estimates using the following formula: lp = ln [p/ (1 − p)], where lp = logit event estimate; ln = natural logarithm; p = study level estimate (40, 41). The DerSimonian and Laird random effects model was used to pool logit event estimates (42). Pooled logit estimates were subsequently transformed to prevalence estimates by the following formula: p = elp/ (elp + 1): where p = prevalence and e = the base of natural logarithm (43). The heterogeneity of the prevalence rates was assessed using the I2 index (44).



 The search in the electronic databases (Medline, Embase, Web Of Science) identified 905 records. From the entire set of selected records, 491 duplicates were removed and 414 records were screened. After detailed evaluation of titles and abstracts, 38 records were assessed as relevant for full text examination. In addition, five full texts were obtained through hand searching procedures from textbooks and reference lists of relevant trials and reviews. Overall, 43 full texts were obtained and assessed for eligibility. The study screening process is described in Figure 1.

Figure 1 Literature search flow chart

All 43 studies were excluded because none of them met the inclusion criteria (Table 2).


Table 2 Studies and reasons for their exclusion.


Dental fear is a worldwide interesting matter described also among the Italian population. Reviewing the literature of the last decade, the most common approach to dental fear was related to adult patients attendance to dental surgical treatment: third molar extraction as well as periodontal or implant surgery. This interest could be due to the fact that surgery is one of the most invasive dental procedures that easily generate anxiety among patients (45-49). In these studies psychometric scales were mostly employed in adult patients, with different characteristics than those considered in this review, such as original or modified versions of Dental Anxiety Scale (DAS or MDAS) as well as Visual Analogue Scale (VAS). Still considering Italian adult population ages, a further study was found dealing with dental fear in relation with bruxism, where psychometric scales useful for adults but not for children were used (48).

Few studies describing the dental fear in children as well as in adults were found concerning the Italian population. Three studies reported dental anxiety prevalence among children in relation with a wide range of variables involving the characteristics and experiences of children as well as their family and social environment (50-52). When also adolescence was considered, only three studies involving Italian teen agers were found. The first study, carried out across several homogeneously distributed European countries, correlated dmft/DMFT caries index with dental fear (53); the second study investigated the causes of adolescents’ dental fear whilst the third study compared the level of dental fear between patients undergoing dental treatment versus untreated subjects.

From the analysis it resulted that there are not any studies describing validation procedures among children and adolescents in Italy.



The absence of validation studies carried out among Italian children and adolescents should stimulate further well conducted research to assess the reliability and validity of the most useful children’s psychometric scales such as both CFSS-DS and MCDAS. The absence in Italy of validated psychometric scales for children generates concerns about the real interest from dentists towards the need to measure dental fear in order to individuate targeted strategies to overcome such specific negative personality trait and then perform an adequate dental treatment.


This study was funded by the National Centre for Disease Prevention and Control – Ministry of Health, (Grant CCM 2015). The study sponsor was not involved in the study design and collection, analysis, and interpretation of data, or the writing of the article or the decision to submit it for publication. The authors were independent from study sponsors.



  1. Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J 2013 Dec;58(4):390-407.
  2. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007 Nov;17(6):391-406.
  3. Rafique S, Banerjee A, Fiske J. Management of the petrified dental patient. Dent Update 2008 Apr;35(3):196-8, 201-2, 204 passim.
  4. Veerkamp JS. The dentist stressful for the child or the child stressful for the dentist? Ned Tijdschr Tandheelkd 2001 Feb;108(2):59-62.
  5. Edelstein BL. Disparities in oral health and access to care: findings of national surveys. Ambul Pediatr 2002 Mar-Apr;2(2 Suppl):141-7.
  6. Lazarus Z, Pirutinsky S, Korbman M, Rosmarin DH. Dental utilization disparities in a Jewish context: reasons and potential solutions. Community Dent Health 2015 Dec;32(4):247-51.
  7. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res 2015 May;94(5):650-8.
  8. Okunseri C, Gonzalez C, Hodgson B. Children’s oral health assessment, prevention, and treatment. Pediatr Clin North Am 2015 Oct;62(5):1215-26.
  9. Bhaskar V, McGraw KA, Divaris K. The importance of preventive dental visits from a young age: systematic review and current perspectives. Clin Cosmet Investig Dent 2014 Mar;20(8):21-7.
  10. Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety. Community Dent Health 1996 Jun;13(2):86-92.
  11. Olak J, Saag M, Honkala S, Nõmmela R, Runnel R, Honkala E, Karjalainen S. Children’s dental fear in relation to dental health and parental dental fear. Stomatologija 2013;15(1):26-31.
  12. Ajayi DM, Arigbede AO. Barriers to oral health care utilization in Ibadan, South West Nigeria. Afr Health Sci 2012 Dec;12(4):507-13.
  13. Alsarheed M. Children’s perception of their dentists. Eur J Dent 2011 Apr;5(2):186-90.
  14. Akbay Oba A, Dülgergil CT, Sönmez IS. Prevalence of dental anxiety in 7- to 11-year-old children and its relationship to dental caries. Med Princ Pract 2009;18(6):453-7.
  15. Nakai Y, Hirakawa T, Milgrom P, Coolidge T, Heima M, Mori Y, Ishihara C, Yakushiji N, Yoshida T, Shimono T. The Children’s Fear Survey Schedule-Dental Subscale in Japan. Community Dent Oral Epidemiol 2005 Jun;33(3):196-204.
  16. Majstorovic M, Veerkamp JS. Relationship between needle phobia and dental anxiety. J Dent Child (Chic) 2004 Sep-Dec;71(3):201-5.
  17. Kuşcu OO, Akyuz S. Children’s preferences concerning the physical appearance of dental injectors. J Dent Child (Chic) 2006 May-Aug;73(2):116-21.
  18. Muppa R, Bhupatiraju P, Duddu M, Penumatsa NV, Dandempally A, Panthula P. Comparison of anxiety levels associated with noise in the dental clinic among children of age group 6-15 years. Noise Health 2013 May-Jun;15(64):190-3.
  19. Chhabra N, Chhabra A, Walia G. Prevalence of dental anxiety and fear among five to ten year old children: a behaviour based cross sectional study. Minerva Stomatol 2012 Mar;61(3):83-9.
  20. Peretz B, Kharouba J. Dental anxiety among Israeli children and adolescents in a dental clinic waiting room. Pediatr Dent 2013 May-Jun;35(3):252-6.
  21. Alsarheed M. Children’s perception of their dentists. Eur J Dent 2011 Apr;5(2):186-90.
  22. Klaassen MA, Veerkamp JS, Hoogstraten J. Changes in children’s dental fear: a longitudinal study. Eur Arch Paediatr Dent 2008 Feb;9 Suppl 1:29-35.
  23. Hakeberg M, Hägglin C, Berggren U, Carlsson SG. Structural relationships of dental anxiety, mood, and general anxiety. Acta Odontol Scand 2001 Apr;59(2):99-103.
  24. Stenebrand A, Wide Boman U, Hakeberg M. Dental anxiety and symptoms of general anxiety and depression in 15-year-olds. Int J Dent Hyg 2013 May;11(2):99-104.
  25. Klingberg G, Broberg AG. Temperament and child dental fear. Pediatr Dent 1998 Jul-Aug;20(4):237-43.
  26. Majstorović M, Skrinjarić T, Szirovicza L, Glavina D, Veerkamp JS. Dental anxiety in relation to emotional and behavioral problems in Croatian adolescents. Coll Antropol 2007 Jun;31(2):573-8.
  27. Assuncão CM, Losso EM, Andreatini R, de Menezes JV. The relationship between dental anxiety in children, adolescents and their parents at dental environment. J Indian Soc Pedod Prev Dent 2013 Jul-Sep;31(3):175-9.
  28. Bezabih S, Fantaye W, Tesfaye M. Dental anxiety: prevalence and associated factors, among children who visited Jimma University Specialized Hospital Dental Clinic. Ethiop Med J 2013 Apr;51(2):115-21.
  29. Jafarzadeh M, Keshani F, Ghazavi Z, Keshani F. Reviewing the parental standpoint about origin of the dental fear in children referred to dentistry centers of Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res 2011 Winter;16(1):133-9.
  30. Bankole OO, Aderinokun GA, Denloye OO, Jeboda SO. Maternal and child’s anxiety-effect on child’s behaviour at dental appointments and treatments. Afr J Med Med Sci 2002 Dec;31(4):349-52.
  31. Dogan MC, Seydaoglu G, Uguz S, Inanc BY. The effect of age, gender and socio-economic factors on perceived dental anxiety determined by a modified scale in children. Oral Health Prev Dent 2006;4(4):235-41.
  32. Bakarcić D, Jokić NI, Majstorović M, Skrinjarić A, Zarevski P. Structural analysis of dental fear in children with and without dental trauma experience. Coll Antropol 2007 Sep;31(3):675-81.
  33. 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.
  34. Abrahamsson KH, Berggren U, Hakeberg M, Carlsson SG. Phobic avoidance and regular dental care in fearful dental patients: a comparative study. Acta Odontol Scand 2001 Oct;59(5):273-9.
  35. Gustafsson A. Dental behaviour management problems among children and adolescents-a matter of understanding? Studies on dental fear, personal characteristics and psychosocial concomitants. Swed Dent J Suppl 2010;(202):2 p preceding 1-46.
  36. Winer GA. A review and analysis of children’s fearful behavior in dental settings. Child Dev 1982 Oct;53(5):1111-33.
  37. Aartman I, Van everdingen T, Hoogstraten J, Shuurs A. Appraisal of behavioral measurement techniques for assessing dental anxiety and fear in children: A review. Int J Paediatr Dent 2010; 20:242-53.
  38. Klingberg G, Löfqvist LV, Hwang CP. Validity of the Children’s Dental Fear Picture test (CDFP). Eur J Oral Sci 1995 Feb;103(1):55-60.
  39. Cuthbert MI, Melamed BG. A screening device: children at risk for dental fears and management problems. ASDC J Dent Child 1982 Nov-Dec;49(6):432-6.
  1. Calvo-Munoz I, Gomez-Conesa A, Sanchez-Meca J. Prevalence of low back pain in children and adolescents: a meta-analysis. BMC Pediatr 2013;13:14.
  2. Williams JG, Higgins JP, Brayne CE. Systematic review of prevalence studies of autism spectrum disorders. Arch Dis Child 2006;91(1):8-15.
  3. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled clinical trials 1986;7(3):177-88.
  4. Gebremedhin EZ, Tadesse G. A meta-analysis of the prevalence of Toxoplasma gondii in animals and humans in Ethiopia. Parasites & Vectors 2015;8:291.
  5. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21(11):1539-58.
  6. Facco E, Gumirato E, Humphris G, Stellini E, Bacci C, Sivolella S, Cavallin F, Zanette G. Modified Dental Anxiety Scale: validation of the Italian version. Minerva Stomatol 2015 Dec;64(6):295-307.
  7. Facco E, Zanette G, Favero L, Bacci C, Sivolella S, Cavallin F, Manani G. Toward the validation of visual analogue scale for anxiety. Anesth Prog 2011;58(1):8-13.
  8. Mobilio N, Gremigni P, Pramstraller M, Vecchiatini R, Calura G, Catapano S. Explaining pain after lower third molar extraction by preoperative pain assessment. J Oral Maxillofac Surg 2011 Nov;69(11):2731-8.
  9. Bellini M, Maltoni O, Gatto MR, Pelliccioni G, Checchi V, Checchi L. Dental phobia in dentistry patients. Minerva Stomatol 2008 Oct;57(10):485-95.
  10. Facco E, Zanette G, Manani G. Italian version of Corah’s Dental Anxiety Scale: normative data in patients undergoing oral surgery and relationship with the ASA physical status classification. Anesth Prog 2008;55(4):109-15.
  11. D’Alessandro G, Alkhamis N, Mattarozzi K, Mazzetti M, Piana G. Fear of dental pain in Italian children: child personality traits and parental dental fear. J Public Health Dent 2016 Jun;76(3):179-83.
  12. Caprioglio A, Mariani L, Tettamanti L. A pilot study about emotional experiences by using CFSS-DS in young patients. Eur J Paediatr Dent 2009 Sep;10(3):121-4.
  13. Rantavuori K, Zerman N, Ferro R, Lahti S. Relationship between children’s first dental visit and their dental anxiety in the Veneto Region of Italy. Acta Odontol Scand 2002 Oct;60(5):297-300.
  14. Bolin AK. Children’s dental health in Europe. An epidemiological investigation of 5- and 12-year-old children from eight EU countries. Swed Dent J Suppl1997;122:1-88.
  15. Aartman IH, van Everdingen T, Hoogstraten J, Schuurs AH. Self-report measurements of dental anxiety and fear in children: a critical assessment. ASDC J Dent Child 1998 Jul-Aug;65(4):252-8, 229-30.
  16. Al-Namankany A, de Souza M, Ashley P. Evidence-based dentistry: analysis of dental anxiety scales for children. Br Dent J 2012 Mar 9;212(5):219-22.
  17. Alvesalo I, Murtomaa H, Milgrom P, et al. The Dental Fear Survey Schedule: a study with Finnish children. The British Paedodontic Society [and] the International Association of Dentistry for Children. Int J Pediatric Dent 1993;3(4):193-8.
  18. Arapostathis KN, Coolidge T, Emmanouil D, Kotsanos N. Reliability and validity of the Greek version of the Children’s Fear Survey Schedule-Dental Subscale. Int J Pediatr Dent 2008 Sep;18(5):374-9.
  19. Armfield JM. How do we measure dental fear and what are we measuring anyway? Oral Health Prev Dent 2010;8(2):107-15.
  20. Bajrić E, Kobašlija S, Jurić H. Reliability and validity of Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS) in children in Bosnia and Herzegovina. Bosn J Basic Med Sci 2011 Nov;11(4):214-8.60.
  21. Buchanan H. Development of a computerised dental anxiety scale for children: validation and reliability. Br Dent J 2005 Sep 24;199(6):359-62; discussion 351;quiz 372.
  22. Carson P, Freeman R. Assessing child dental anxiety: the validity of clinical observations. Int J Paediatr Dent 1997 Sep;7(3):171-6.
  23. Daini S, Errico A, Quinti E, Manicone PF, Raffaelli L, Rossi G. Dental anxiety in adolescent people. Minerva Stomatol 2005 Nov-Dec;54(11-12):647-59.
  24. Desiate A, Fanelli M, Milano V. [“Odontogenic” anxiety. A study of a population of 1500 students from the public schools in the Bari area]. Minerva Stomatol 1997 Apr;46(4):165-73. Italian.
  25. El-Housseiny A, Farsi N, Alamoudi N, Bagher S, El Derwi D. Assessment for the children’s fear survey schedule-dental subscale. J Clin Pediatr Dent 2014 Fall;39(1):40-6.
  26. Esa R, Hashim NA, Ayob Y, Yusof ZY. Psychometric properties of the faces version of the Malay-modified child dental anxiety scale. BMC Oral Health 2015 Mar 10;15:28. doi: 10.1186/s12903-015-0013-y.
  27. Holmes RD, Girdler NM. A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management. Int J Paediatr Dent 2005 May;15(3):169-76.
  28. Honkala S, Al-Yahya H, Honkala E, Freeman R, Humphris G. Validating a measure of the prevalence of dental anxiety as applied to Kuwaiti adolescents. Community Dent Health 2014 Dec;31(4):251-6.
  29. Howard KE, Freeman R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paediatr Dent 2007 Jul;17(4):281-8.
  30. Jones LM, Buchanan H. Assessing children’s dental anxiety in New Zealand. N Z Dent J 2010 Dec;106(4):132-6.
  31. Klaassen M, Veerkamp J, Hoogstraten J.Predicting dental anxiety. The clinical value of anxiety questionnaires: an explorative study. Eur J Paediatr Dent 2003 Dec;4(4):171-6.
  32. Klingberg G. Reliability and validity of the Swedish version of the Dental Subscale of the Children’s Fear Survey Schedule, CFSS-DS. Acta Odontol Scand 1994 Aug;52(4):255-6.
  33. Lalić M, Aleksić E, Milić J, Malešević A, Jovičić B. Reliability and validity of the Serbian version of Children’s Dental Fear Questionnaire. Vojnosanit Pregl 2015 Jul;72(7):602-7.
  34. Lee CY, Chang YY, Huang ST. Higher-order exploratory factor analysis of the Dental Subscale of Children’s Fear Survey Schedule in a Taiwanese population. Community Dent Health 2009 Sep;26(3):183-7.
  35. Lee CY, Chang YY, Huang ST. The clinically related predictors of dental fear in Taiwanese children. Int J Paediatr Dent 2008 Nov;18(6):415-22.
  36. Lopes D, Arnrup K, Robertson A, Lundgren J. Validating the dental subscale of the children’s fear survey schedule using Rasch analysis. Eur J Oral Sci 2013 Jun;121(3 Pt 2):277-82.
  37. Lourenço-Matharu L, Papineni McIntosh A, Lo JW. Predicting children’s behaviour during dental treatment under oral sedation. Eur Arch Paediatr Dent 2016 Aug;17(4):283-284.
  38. Lu JX, Yu DS, Luo W, Xiao XF, Zhao W. [Development of Chinese version of children’s fear survey schedule-dental subscale]. Zhonghua Kou Qiang Yi Xue Za Zhi 2011 Apr;46(4):218-21.
  39. Milgrom P, Jie Z, Yang Z, Tay KM. Cross-cultural validity of a parent’s version of the Dental Fear Survey Schedule for children in Chinese. Behav Res Ther 1994 Jan;32(1):131-5.
  40. Paryab M, Hosseinbor M. Dental anxiety and behavioral problems: a study of prevalence and related factors among a group of Iranian children aged 6-12. J Indian Soc Pedod Prev Dent 2013 Apr-Jun;31(2):82-6.
  41. Patel H, Reid C, Wilson K, Girdler NM. Inter-rater agreement between children’s self-reported and parents’ proxy-reported dental anxiety. Br Dent J 2015 Feb;218(4):E6
  42. Singh P, Pandey RK, Nagar A, Dutt K. Reliability and factor analysis of children’s fear survey schedule-dental subscale in Indian subjects. J Indian Soc Pedod Prev Dent 2010 Jul-Sep;28(3):151-5.
  43. Suprabha BS, Rao A, Choudhary S, Shenoy R. Child dental fear and behavior: the role of environmental factors in a hospital cohort. J Indian Soc Pedod Prev Dent 2011 Apr-Jun;29(2):95-101.
  44. ten Berge M, Veerkamp JS, Hoogstraten J, Prins PJ. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol 2002 Apr;30(2):101-7.
  45. Wogelius P, Poulsen S, Sørensen HT. Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children. Acta Odontol Scand 2003 Jun;61(3):178-83.
  46. Wong HM, Humphris GM, Lee GT. Preliminary validation and reliability of the Modified Child Dental Anxiety Scale. Psychol Rep 1998 Dec;83(3 Pt 2):1179-86.
  47. Yamada MK, Tanabe Y, Sano T, Noda T. Cooperation during dental treatment: the Children’s Fear Survey Schedule in Japanese children. Int J Paediatr Dent 2002 Nov;12(6):404-9.
  48. Zhang HM, Xia B, Wang JH, Xie P, Huang Q, Ge LH. Chinese version of a face version of the modified child dental anxiety scale: transcultural adaptation and evaluation. Zhonghua Kou Qiang Yi Xue Za Zhi 2013 Jul;48(7):403-8.