Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children

BACKGROUND: This study assessed anticipatory dental anxiety levels among 8- to 12-year-old children based on subjective and physiological measures and their correlation. The variations in anxiety based on sex, age, temperament, and academic performance were evaluated. METHODS: An observational study was conducted in 60 children recruited from the waiting room over a 6-month period. The operator recorded subjective anxiety in the children using a novel visual facial anxiety scale. The operator also noted the demographic details and child's temperament using the nine dimensions of the Thomas and Chess criteria, and graded children as “easy,” “slow to warm-up,” and “difficult.” The academic performance of the children was graded (parental ratings) on a five-point Likert scale. Physiological variables (heartrate [HR], oxygen saturation[SpO(2)], and blood pressure [BP]) were recorded by another evaluator. The correlation between anxiety levels and physiological variables was also assessed. The effects of age, sex, temperament, and academic performance on anxiety were evaluated. RESULTS: The study included 60 children aged 8–12 years, including 36 boys and 24 girls. Seventy percent of children had mild to moderate levels of pre-extraction anxiety, while 30% of children demonstrated high anxiety. A significant positive correlation was noted between anxiety levels and HR (r(s) = 0.477, P < 0.001(*)) and systolic BP (r(s) = 0.294, P < 0.05), while a significant but inverse correlation was observed with SpO(2) (r(s) = −0.40, P < 0.05). Anxiety did not influence diastolic BP. Children with difficult temperament and poor academic performance had significantly higher anxiety. CONCLUSION: A high percentage (70%) of children aged 8–12 years had mild to moderate anxiety prior to the extraction procedure. Increased HR, systolic BP, and reduced SpO(2) were significantly associated with high levels of anticipatory dental anxiety. Pre-extraction anxiety was significantly related to the temperament and scholastic performance.