Dental anxiety in children: the role of family structure and parenting, language environment, and social-evaluative anxiety
Year: 2026
Type: article
Abstract: Relevance . Difficulty establishing rapport with anxious patients remains a significant challenge in dental practice. This can lead patients to refuse examination or treatment, compromising the quality of outpatient care. Dental anxiety is common in children and adolescents. It involves not only concerns about invasive procedures and pain but also fear of crying, losing self-control, or being judged negatively by parents or dental staff. These concerns are especially important in multilingual, culturally diverse clinical settings, where ethnocultural and family contexts need to be considered. Objective . To assess how dental anxiety is associated with family structure and parenting, language environment, and sociocultural context by comparing its procedural and social-evaluative components. Materials and methods . This multicenter cross-sectional study included 500 children who received dental care at clinical sites affiliated with Kadyrov Chechen State University between January 5 and April 9, 2026. Children were eligible if they were 5–10 years old, attended an outpatient dental visit, and had a completed study form. Duplicate records, incomplete forms, and cases in which the child’s responses on the main scale could not be assessed were excluded. An investigator-developed study form comprised five sections: demographics, seven anxiety items, preferences, the Frankl Behavior Rating Scale, and a parent interview. Families were classified as nuclear or patriarchal using a standardized section of the observation form, based on parents’ reports of family composition and adults’ day-to-day involvement in childrearing. The procedural index captured fear of pain, injections, and the sound of the dental drill; the social-evaluative index captured fear of crying and being seen as frightened. Data were analyzed using the Mann–Whitney, Kruskal–Wallis, chi-square, and Wilcoxon tests and linear regression. Mean scores for both anxiety components and the difference between the social-evaluative and procedural scores were also calculated. Results . The mean procedural score was 2.54±0.75, compared with a mean social-evaluative score of 3.18±0.77 ( p <0.001). Procedural anxiety predominated in nuclear families (3.32±0.67 vs 2.14±0.56), whereas social-evaluative anxiety predominated in patriarchal families (3.45±0.56 vs 2.34±0.63); p <0.001. Differences by first language and origin were no longer significant after adjustment for family type. A patriarchal family structure was an independent predictor of social-evaluative anxiety (B = 1.29; 95% confidence interval, 1.15–1.43; p <0.001), whereas a nuclear family structure was an independent predictor of procedural anxiety (B = −1.05 for patriarchal families; 95% confidence interval, −1.21 to −0.89; p <0.001). Frankl Behavior Rating Scale scores did not differ between family types ( p =0.642). Among boys, preferences for parental presence differed by family type ( p =0.042): 45.5% of boys from nuclear families asked for a parent to stay, compared with 28.4% of boys from patriarchal families. Conclusion. In some children, dental anxiety is driven by fear of showing weakness in front of others and being judged negatively. Family structure and parenting explain anxiety profiles better than language or origin. This supports viewing ethnicity as a secondary sociocultural marker rather than a biological determinant of behavior. Whether a parent stays in the treatment room should depend on individual preferences rather than a blanket policy of parental presence or absence.
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7225908359