Association between children's dental anxiety and parental acceptance of dental general anesthesia: a cross-sectional study

Background: This cross-sectional study was to explore associations between children’s dental anxiety (CDA) and parental acceptance of Dental General Anesthesia (DGA) in Chongqing, China and to provide relevant clinical recommendations. Methods: The study was conducted among 743 parent-child couples. Demographic characteristics, DGA knowledge of parents and parental acceptance of DGA was collected by a self-designed questionnaire. CDA was measured by the Chinese version of the Modified Dental Anxiety Scale (MDAS). Results: More than 70% of the parents were unwilling to accept DGA. After controlling demographic factors, DGA knowledge of parents (odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.12–1.35), parents’ having heard of DGA (OR = 1.23, 95% CI: 1.12–1.35), and children’s experience of general anaesthesia (GA) was more likely (OR = 1.23, 95% CI: 1.12–1.35) to promote parents to accept DGA. Compared to parents of children with medium anxiety (OR = 0.58, 95% CI: 0.36–0.94), parents of children with high or no CDA were more likely to accept DGA. Among children with high CDA, girls’ parents (OR = 2.77; 95% CI: 1.27–6.09), parents whose children had GA experience (OR = 18.78, 95% CI: 4.5–78.05) and fathers with clerical or skilled workers occupation (OR = 3.59, 95% CI: 1.08–11.93) were more likely to accept DGA than others, however, mothers with freelance work (OR = 0.13, 95% CI: 0.03–0.53) and families with low monthly annual household income (<¥5000) were less likely to accept DGA than others. Conclusions: These findings might inform the development of targeted interventions to manage children’s dental anxiety.

Child; Parent; General anesthesia; Dental anxiety; Acceptance

[1] Widiger TA, Hines A. The diagnostic and statistical manual of mental disorders, fifth edition alternative model of personality disorder. Personality Disorders. 2022; 13: 347–355.

[2] Buldur B, Güvendi ON. Conceptual modelling of the factors affecting oral health-related quality of life in children: a path analysis. International Journal of Paediatric Dentistry. 2020; 30: 181–192.

[3] 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 Stomatologica. 2012; 61: 83–89.

[4] Sarapultseva M, Yarushina M, Kritsky I, Ibragimov R, Sarapultsev A. Prevalence of dental fear and anxiety among Russian children of different ages: the cross-sectional study. European Journal of Dentistry. 2020; 14: 621–625.

[5] Liu WY, Dai LN. Investigation and analysis on related factors of children’s dental fear. Journal of Oral Science. 2019; 4: 185–188.

[6] Sari M, Ozmen B, Koyuturk A, Tokay U. A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities. Nigerian Journal of Clinical Practice. 2014; 17: 361–365.

[7] Dai L, Wu T, Hu Y, Li S, Liu W. Does the efficacy of behavior management techniques differ between children from single-child and multi-child families? A quasi-experimental study. Frontiers in Public Health. 2022; 10: 840483.

[8] Fox F, Whelton H, Johnson OA, Aggarwal VR. Dental extractions under general anesthesia: new insights from process mining. JDR Clinical & Translational Research. 2023; 8: 267–275.

[9] Ramazani N. Different aspects of general anesthesia in pediatric dentistry: a review. Iranian Journal of Pediatrics. 2016; 26: e2613.

[10] Taskinen H, Kankaala T, Rajavaara P, Pesonen P, Laitala ML, Anttonen V. Self-reported causes for referral to dental treatment under general anaesthesia (DGA): a cross-sectional survey. European Archives of Paediatric Dentistry. 2014; 15: 105–112.

[11] Djalali Talab Y, Geibel MA. Comparison of parental and practitioner’s acceptance for dental treatment under general anaesthesia in paediatric patients. BMC Pediatrics. 2023; 23: 45.

[12] Quaye AA, Coyne I, Söderbäck M, Hallström IK. Children’s active participation in decision‐making processes during hospitalisation: an observational study. Journal of Clinical Nursing. 2019; 28: 4525–4537.

[13] Coyne I, Amory A, Kiernan G, Gibson F. Children’s participation in shared decision-making: children, adolescents, parents and healthcare professionals’ perspectives and experiences. European Journal of Oncology Nursing. 2014; 18: 273–280.

[14] Buldur B. Pathways between parental and individual determinants of dental caries and dental visit behaviours among children: validation of a new conceptual model. Community Dentistry and Oral Epidemiology. 2020; 48: 280–287.

[15] Liang Y, Neha Dhakal, Girju Rabanshi, Qiu RM,Chen AH, Shen HL. A survey of parents’ acceptance of dental anesthesia in children and factors influencing the acceptance. Journal of Youjiang Medical University for Nationalities. 2021; 43: 387–391.

[16] Jiang HF, Shen L, Qin D, Chai ZW, Wang JH. Survey of parental acceptance of children’s dental treatment under general anesthesia in Chongqing and analysis of influencing factors. Journal of Jinan University (Natural Science and Medicine Edition). 2018; 39: 535–541. (In Chinese)

[17] Al Zoubi L, Schmoeckel J, Mustafa Ali M, Splieth C. Parental acceptance of advanced behaviour management techniques in paediatric dentistry in families with different cultural background. European Archives of Paediatric Dentistry. 2021; 22: 707–713.

[18] Candan M, Kutlu E, Yilmaz Karaman İG. Predictors of parental acceptance towards contemporary behavior management techniques used in pediatric dentistry: a preliminary study on Turkish population. Children. 2023; 10: 1592.

[19] Liu YQ, Zhang Q, Wang Y, Qu X, Zou J. Evaluation of therapeutic effect and health economics of general anesthesia and routine outpatient dental treatment in children with severe early child caries. West China Journal of Stomatology. 2021; 39: 703–708. (In Chinese)

[20] Zhao N, Zeng J, Fan L, Zhang C, Wu Y, Wang X, et al. The effect of alfentanil on emergence delirium following general anesthesia in children: a randomized clinical trial. Pediatric Drugs. 2022; 24: 413–421.

[21] Zhang Q, Deng X, Wang Y, Huang R, Yang R, Zou J. Postoperative complications in Chinese children following dental general anesthesia: a cross-sectional study. Medicine. 2020; 99: e23065.

[22] Deng XY, Zhang YH, Zou J, Zhang Q. Investigation of postoperative complications in children after dental therapy under general anesthesia. West China Journal of Stomatology. 2020; 38: 284–289. (In Chinese)

[23] Yuan S, Freeman R, Lahti S, Lloyd-Williams F, Humphris G. Some psychometric properties of the Chinese version of the modified dental anxiety scale with cross validation. Health and Quality of Life Outcomes. 2008; 6: 22.

[24] Jiang H, Shen L, Qin D, He S, Wang J. Effects of dental general anaesthesia treatment on early childhood caries: a prospective cohort study in China. BMJ Open. 2019; 9: e028931.

[25] Jackson GNB, Robinson PN, Lucas DN, Natarajan A, Gough K, Woolnough M, et al. What mothers know, and want to know, about the complications of general anaesthesia. Acta Anaesthesiologica Scandinavica. 2012; 56: 585–588.

[26] Tao S, Lau EYH. Coparenting and parental involvement during school transition among Chinese mothers and fathers: children’s school liking as a moderator. Frontiers in Psychology. 2021; 12: 769416.

[27] Zhou P, Zhang C, Huang G, Hu Y, Ma W, Yu C. The effect of sevoflurane anesthesia for dental procedure on neurocognition in children: a prospective, equivalence, controlled trial. BMC Pediatrics. 2021; 21: 177.

[28] Clinical Affairs Committee-Behavior Management Subcommittee, American Academy of Pediatric Dentistry. Guideline on behavior guidance for the pediatric dental patient. Pediatric Dentistry. 2015; 37: 57–70.

[29] Boka V, Arapostathis K, Vretos N, Kotsanos N. Parental acceptance of behaviour-management techniques used in paediatric dentistry and its relation to parental dental anxiety and experience. European Archives of Paediatric Dentistry. 2014; 15: 333–339.

[30] Baghdadi ZD, Jbara S, Muhajarine N. Children and parents perspectives on children’s dental treatment under general anesthesia: a narratology from Saskatoon, Canada. European Archives of Paediatric Dentistry. 2021; 22: 725–737.

[31] Baroni DA, Corrêa-Faria P, Anabuki AA, Abreu LG, Costa LR. Nociception associated with pain/distress in young children sedated for dental treatment: a clinical study with objective and subjective measures. European Archives of Paediatric Dentistry. 2023; 24: 255–262.

[32] Chen X, Jin SF, Liu HB. Analysis of possible factors that impact parents to accept dental general anesthesia. Shanghai Journal of Stomatology. 2010; 19: 151. (In Chinese)