Relationship between Psychological Functioning and Pain in Pediatrics Referring for Dental Services
Abstract
Background: Local anesthetic solutions are routinely prescribed in dental procedures to mitigate pain. The aim of this study was to investigate the relationship between psychological functioning in pediatric patients referred for dental services during the administration of local anesthesia.
Methods: The study population comprised pediatric patients referred for dental services who required general anesthesia. Following previous studies, a total of 110 children attending private dental offices were recruited for this investigation. The instruments used included the CFSS-DS questionnaire, MCDAS questionnaire, PASS-20, and VAS tool. Ethical considerations for this research included obtaining the Ethics Code Number [IR.MEDILAM.REC.1404.203], and data analysis was performed using SPSS software, version 18, utilizing appropriate statistical analyses.
Results: Of the sample under investigation, 23.6% were in the 10-year-old age group, and the gender distribution leaned towards males with a frequency of 51.8%. The mean scores (standard deviation) obtained were 41.93±12.37 for the CFSS-DS, 24.18±6.34 for the MCDAS, and 53.6±13.4 for the PASS. Regression analysis indicated that gender had a significant relationship with CFSS-DS and MCDAS scores (p<0.05), but no association was observed with the PASS score (p=0.76). Furthermore, the Chi-square (χ2) test confirmed a statistically significant relationship between all assessment tools (CFSS-DS, MCDAS, PASS) and the variables under examination, including age, history of dental treatment, and history of hospitalization (p<0.05).
Conclusion: Considering the prevalence and adverse psychological consequences arising from the delivery of dental services in the pediatric population, including the manifestation of fear, anxiety, and pain anxiety symptoms, the implementation of targeted preventive interventions and supportive strategies in this domain is strongly recommended.
[1] Bong CL, Ng AS. Evaluation of emergence delirium in Asian children using the Pediatric Anesthesia Emergence Delirium Scale. Paediatr Anaesth. 2009; 19(6):593-600.
[2] Kaviani N, Ahmadi N, Mohebinia H. Compare blood glucose changes in intravenous anesthesia by Propofol and inhalation anesthesia by Isoflurane in children between 4-6 years old that candidate for dentistry treatment under general anesthesia. Iran J Pediatr Dent. 2017; 13(1):11-20.
[3] Ghandehari M, Pourhashemi SJ, Baghayi F, Ghadimi S. Evaluation of effectiveness of educational pamphlet on mother’s awareness about first dental visit in 3-7 year-old children. Iran J Pediatr Dent. 2014; 10(1):7-16.
[4] Messieha Z, Cruz-Gonzalez W, Hakim MI. Retrospective outcomes evaluation of 100 parenteral moderate and deep sedations conducted in a general practice dental residency. Anesth Prog. 2008; 55(4):116-20.
[5] Vacharaksa K, Thongrakard T, Vacharaksa A. Needs of non-pharmacological management versus sedation or general anesthesia for dental treatment in older adults with special needs: A systematic review. Health Policy. 2025; 154:105262.
[6] Vasigh A, Tarjoman A, Borji M. Relationship Between Spiritual Health and Pain Self-Efficacy in patients with Chronic Pain: A Cross-Sectional Study in West of Iran. J Relig Health. 2020; 59(2):1115-25.
[7] Hatefi M, Parvizi R, Borji M, Tarjoman A. Effect of Self-Management Program on Pain and Disability Index in Elderly Men with Osteoarthritis. Anesth Pain Med. 2019; 9(4):e92672.
[8] Mohiuddin I, Setty JV, Srinivasan I, Desai JA. Topical application of local anaesthetic gel vs ice in pediatric patients for infiltration anaesthesia. J Evol Med Dent Sci. 2015; 4(74):12934-40.
[9] Jafar-Tehrani S, Badakhsh SA, Aghaei S. Comparison of pre-cooling and topical anaesthetic in pain perception of palatal injection among pediatric patients. Iran J Pediatr Dent. 2020; 16(1):1-8.
[10] Davoudi A, Rismanchian M, Akhavan A, Nosouhian S, Bajoghli F, Haghighat A, et al. A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures. Anesth Essays Res. 2016; 10(1):13-16.
[11] Wong NSM, Yeung AWK, Li KY, McGrath CP, Leung YY. Non-Pharmacological Interventions for Reducing Fear and Anxiety in Patients Undergoing Third Molar Extraction under Local Anesthesia: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022; 19(18):11162.
[12] Yan X, Yan Y, Cao M, Xie W, O'Connor S, Lee JJ, et al. Effectiveness of virtual reality distraction interventions to reduce dental anxiety in paediatric patients: A systematic review and meta-analysis. J Dent. 2023; 132:104455.
[13] Al-Khotani A, Ajabnoor H, Koshak R, Alshehri SA, Meisha DE. Clinical profiles and treatment outcomes of dental rehabilitation in patients treated under general anesthesia: a comparison between healthy and special healthcare needs children. Front Pediatr. 2025; 13:1550317.
[14] Shayegan A, Makanz VM, Abergel C. Dental Treatment in Children under General Anesthesia: A 24-year Retrospective Study. Int J Clin Pediatr Dent. 2025; 18(9):1134-9.
[15] Blumer S, Costa L, Peretz B. Success of Dental Treatments under Behavior Management, Sedation and General Anesthesia. J Clin Pediatr Dent. 2017; 41(4):308-11.
[16] Huh J, Lee N, Kim KY, Jung S, Cha J, Kim KD, et al. Foreign body aspiration and ingestion in dental clinic: a seven-year retrospective study. J Dent Anesth Pain Med. 2022; 22(3):187-95.
[17] Montana A, Salerno M, Feola A, Asmundo A, Di Nunno N, Casella F, et al. Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature. Int J Environ Res Public Health. 2020; 17(13):4700.
[18] Kabasakal HN, Aydınoğlu S, Günaçar DN. Impact of therapeutic play and music therapy on dental anxiety and pain perception in pediatric patients: a clinical study. Sci Rep. 2026; 16(1):5697.
[19] Helal N, Faran LY, Dashash RA, Turkistani J, Tallab HY, Aldosari FM, et al. The relationship between Body Mass Index and dental anxiety among pediatric patients in Jeddah, Saudi Arabia: a cross-sectional study. BMC Oral Health. 2025; 25(1):609.
[20] Sharath A, Rekka P, Muthu MS, Rathna Prabhu V, Sivakumar N. Children's behavior pattern and behavior management techniques used in a structured postgraduate dental program. J Indian Soc Pedod Prev Dent. 2009; 27(1):22-6.
[21] Jbarah MM, Shetty RM, Walia T, Berdouses E, Hashim R, Yadadi SS, et al. Children’s preferences towards paediatric dentists’ appearance, dental clinic design, and their relationship with dental anxiety. Eur Arch Paediatr Dent. 2026.
[22] Hardin AP, Hackell JM; Committee on Practice and Ambulatory Medicine. Age Limit of Pediatrics. Pediatrics. 2017; 140(3):e20172151.
[23] ten Berge M, Hoogstraten J, Veerkamp JS, Prins PJ. The Dental Subscale of the Children's Fear Survey Schedule: a factor analytic study in The Netherlands. Community Dent Oral Epidemiol. 1998; 26(5):340-3.
[24] Farzanegan P, Ghasempour M, Massoodi A, Shirafkan H. Correlation Between Child's Dental Fear and Anxiety Symptoms and Evaluating Factors Associated With Dental Fear. Health Sci Rep. 2025; 8(5):e70879.
[25] Javadinejad S, Farajzadegan Z, Madahain M. Iranian version of a face version of the Modified Child Dental Anxiety Scale: Transcultural adaptation and reliability analysis. J Res Med Sci. 2011; 16(7):872-7.
[26] Howard KE, Freeman R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paediatr Dent. 2007; 17(4):281-8.
[27] Kreddig N, Rusu AC, Burkhardt K, Hasenbring MI. The German PASS-20 in patients with low back pain: new aspects of convergent, divergent, and criterion-related validity. Int J Behav Med. 2015; 22(2):1.
[28] Paknejad M, Asghari A, Rahiminezhad A, Rostami R, Taheri A. Factorial structure and psychometric properties of The Pain Anxiety Symptoms Scale (PASS-20). J Appl Psychol Res. 2014; 5(3):71-94.
[29] Feili F, Roozegar M. Prevalence of Odontogenic Tumors and Cysts in Iran: A Systematic Review and Meta-analysis. Int J Cancer Manag. 2025; 18(1).
[30] Feili F, Valadbeigi H, Negahdari B, Khooshnod S, Maleki A, Haddadi MH. Injectable hydrogel and its potential therapy for peri-implantitis. Int J Polym Mater Polym Biomater. 2026; 75(3):285-301.
[31] Hashim NT, Rahman MM, Mohammed R, Islam MS, Padmanabhan V, Hossain SJ, et al. Dental Anxiety and Oral Health-Related Quality of Life Among Adults in the United Arab Emirates: A Cross-Sectional Study. Healthcare (Basel). 2026; 14(2):219.
[32] Pouy S, Attari Peikani F, Nourmohammadi H, Sanei P, Tarjoman A, Borji M. Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer. Asian Pac J Cancer Prev. 2018; 19(7):1993-8.
[33] Borji M, Nourmohammadi H, Otaghi M, Salimi AH, Tarjoman A. Positive Effects of Cognitive Behavioral Therapy on Depression, Anxiety and Stress of Family Caregivers of Patients with Prostate Cancer: A Randomized Clinical Trial. Asian Pac J Cancer Prev. 2017; 18(12):3207-12.
[34] Shokri M, Tarjoman A, Borji M, Solaimanizadeh L. Investigating psychological problems in caregiver of pediatrics with cancer: A systematic review. J Child Adolesc Psychiatr Nurs. 2020; 33(4):229-38.
[35] Boka V, Arapostathis K, Kotsanos N, Karagiannis V, van Loveren C, Veerkamp J. Relationship between Child and Parental Dental Anxiety with Child's Psychological Functioning and Behavior during the Administration of Local Anesthesia. J Clin Pediatr Dent. 2016; 40(6):431-7.
[36] Guney SE, Araz C, Tirali RE, Cehreli SB. Dental anxiety and oral health-related quality of life in children following dental rehabilitation under general anesthesia or intravenous sedation: A prospective cross-sectional study. Niger J Clin Pract. 2018; 21(10):1304-10.
[37] Abedi S, Hojati Z, Kohantorabi M, Taheri M, Ebrahimzadeh N. The relationship between dental anxiety and pain perception among patients visiting the dental clinic in Aliabad Katoul, Iran: A cross-sectional study. J Dent Adv Clin Sci. 2025; 1(1):26-31.
[38] Cantekin K, Yildirim MD, Cantekin I. Assessing change in quality of life and dental anxiety in young children following dental rehabilitation under general anesthesia. Pediatr Dent. 2014; 36(1):12E.
[39] Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of Dental Anxiety among Dental Patients in Saudi Arabia. J Int Soc Prev Community Dent. 2017; 7(2):100-4.
[40] Bahrololoomi Z, Sadeghieh T, Maghsoodi N, Pajouhandeh S. Evaluation of Relationship between the Children’s Dental Fear with the Parental State-Trait Anxiety. Jorjani Biomed J. 2021; 9(4):65-73.
[2] Kaviani N, Ahmadi N, Mohebinia H. Compare blood glucose changes in intravenous anesthesia by Propofol and inhalation anesthesia by Isoflurane in children between 4-6 years old that candidate for dentistry treatment under general anesthesia. Iran J Pediatr Dent. 2017; 13(1):11-20.
[3] Ghandehari M, Pourhashemi SJ, Baghayi F, Ghadimi S. Evaluation of effectiveness of educational pamphlet on mother’s awareness about first dental visit in 3-7 year-old children. Iran J Pediatr Dent. 2014; 10(1):7-16.
[4] Messieha Z, Cruz-Gonzalez W, Hakim MI. Retrospective outcomes evaluation of 100 parenteral moderate and deep sedations conducted in a general practice dental residency. Anesth Prog. 2008; 55(4):116-20.
[5] Vacharaksa K, Thongrakard T, Vacharaksa A. Needs of non-pharmacological management versus sedation or general anesthesia for dental treatment in older adults with special needs: A systematic review. Health Policy. 2025; 154:105262.
[6] Vasigh A, Tarjoman A, Borji M. Relationship Between Spiritual Health and Pain Self-Efficacy in patients with Chronic Pain: A Cross-Sectional Study in West of Iran. J Relig Health. 2020; 59(2):1115-25.
[7] Hatefi M, Parvizi R, Borji M, Tarjoman A. Effect of Self-Management Program on Pain and Disability Index in Elderly Men with Osteoarthritis. Anesth Pain Med. 2019; 9(4):e92672.
[8] Mohiuddin I, Setty JV, Srinivasan I, Desai JA. Topical application of local anaesthetic gel vs ice in pediatric patients for infiltration anaesthesia. J Evol Med Dent Sci. 2015; 4(74):12934-40.
[9] Jafar-Tehrani S, Badakhsh SA, Aghaei S. Comparison of pre-cooling and topical anaesthetic in pain perception of palatal injection among pediatric patients. Iran J Pediatr Dent. 2020; 16(1):1-8.
[10] Davoudi A, Rismanchian M, Akhavan A, Nosouhian S, Bajoghli F, Haghighat A, et al. A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures. Anesth Essays Res. 2016; 10(1):13-16.
[11] Wong NSM, Yeung AWK, Li KY, McGrath CP, Leung YY. Non-Pharmacological Interventions for Reducing Fear and Anxiety in Patients Undergoing Third Molar Extraction under Local Anesthesia: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022; 19(18):11162.
[12] Yan X, Yan Y, Cao M, Xie W, O'Connor S, Lee JJ, et al. Effectiveness of virtual reality distraction interventions to reduce dental anxiety in paediatric patients: A systematic review and meta-analysis. J Dent. 2023; 132:104455.
[13] Al-Khotani A, Ajabnoor H, Koshak R, Alshehri SA, Meisha DE. Clinical profiles and treatment outcomes of dental rehabilitation in patients treated under general anesthesia: a comparison between healthy and special healthcare needs children. Front Pediatr. 2025; 13:1550317.
[14] Shayegan A, Makanz VM, Abergel C. Dental Treatment in Children under General Anesthesia: A 24-year Retrospective Study. Int J Clin Pediatr Dent. 2025; 18(9):1134-9.
[15] Blumer S, Costa L, Peretz B. Success of Dental Treatments under Behavior Management, Sedation and General Anesthesia. J Clin Pediatr Dent. 2017; 41(4):308-11.
[16] Huh J, Lee N, Kim KY, Jung S, Cha J, Kim KD, et al. Foreign body aspiration and ingestion in dental clinic: a seven-year retrospective study. J Dent Anesth Pain Med. 2022; 22(3):187-95.
[17] Montana A, Salerno M, Feola A, Asmundo A, Di Nunno N, Casella F, et al. Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature. Int J Environ Res Public Health. 2020; 17(13):4700.
[18] Kabasakal HN, Aydınoğlu S, Günaçar DN. Impact of therapeutic play and music therapy on dental anxiety and pain perception in pediatric patients: a clinical study. Sci Rep. 2026; 16(1):5697.
[19] Helal N, Faran LY, Dashash RA, Turkistani J, Tallab HY, Aldosari FM, et al. The relationship between Body Mass Index and dental anxiety among pediatric patients in Jeddah, Saudi Arabia: a cross-sectional study. BMC Oral Health. 2025; 25(1):609.
[20] Sharath A, Rekka P, Muthu MS, Rathna Prabhu V, Sivakumar N. Children's behavior pattern and behavior management techniques used in a structured postgraduate dental program. J Indian Soc Pedod Prev Dent. 2009; 27(1):22-6.
[21] Jbarah MM, Shetty RM, Walia T, Berdouses E, Hashim R, Yadadi SS, et al. Children’s preferences towards paediatric dentists’ appearance, dental clinic design, and their relationship with dental anxiety. Eur Arch Paediatr Dent. 2026.
[22] Hardin AP, Hackell JM; Committee on Practice and Ambulatory Medicine. Age Limit of Pediatrics. Pediatrics. 2017; 140(3):e20172151.
[23] ten Berge M, Hoogstraten J, Veerkamp JS, Prins PJ. The Dental Subscale of the Children's Fear Survey Schedule: a factor analytic study in The Netherlands. Community Dent Oral Epidemiol. 1998; 26(5):340-3.
[24] Farzanegan P, Ghasempour M, Massoodi A, Shirafkan H. Correlation Between Child's Dental Fear and Anxiety Symptoms and Evaluating Factors Associated With Dental Fear. Health Sci Rep. 2025; 8(5):e70879.
[25] Javadinejad S, Farajzadegan Z, Madahain M. Iranian version of a face version of the Modified Child Dental Anxiety Scale: Transcultural adaptation and reliability analysis. J Res Med Sci. 2011; 16(7):872-7.
[26] Howard KE, Freeman R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paediatr Dent. 2007; 17(4):281-8.
[27] Kreddig N, Rusu AC, Burkhardt K, Hasenbring MI. The German PASS-20 in patients with low back pain: new aspects of convergent, divergent, and criterion-related validity. Int J Behav Med. 2015; 22(2):1.
[28] Paknejad M, Asghari A, Rahiminezhad A, Rostami R, Taheri A. Factorial structure and psychometric properties of The Pain Anxiety Symptoms Scale (PASS-20). J Appl Psychol Res. 2014; 5(3):71-94.
[29] Feili F, Roozegar M. Prevalence of Odontogenic Tumors and Cysts in Iran: A Systematic Review and Meta-analysis. Int J Cancer Manag. 2025; 18(1).
[30] Feili F, Valadbeigi H, Negahdari B, Khooshnod S, Maleki A, Haddadi MH. Injectable hydrogel and its potential therapy for peri-implantitis. Int J Polym Mater Polym Biomater. 2026; 75(3):285-301.
[31] Hashim NT, Rahman MM, Mohammed R, Islam MS, Padmanabhan V, Hossain SJ, et al. Dental Anxiety and Oral Health-Related Quality of Life Among Adults in the United Arab Emirates: A Cross-Sectional Study. Healthcare (Basel). 2026; 14(2):219.
[32] Pouy S, Attari Peikani F, Nourmohammadi H, Sanei P, Tarjoman A, Borji M. Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer. Asian Pac J Cancer Prev. 2018; 19(7):1993-8.
[33] Borji M, Nourmohammadi H, Otaghi M, Salimi AH, Tarjoman A. Positive Effects of Cognitive Behavioral Therapy on Depression, Anxiety and Stress of Family Caregivers of Patients with Prostate Cancer: A Randomized Clinical Trial. Asian Pac J Cancer Prev. 2017; 18(12):3207-12.
[34] Shokri M, Tarjoman A, Borji M, Solaimanizadeh L. Investigating psychological problems in caregiver of pediatrics with cancer: A systematic review. J Child Adolesc Psychiatr Nurs. 2020; 33(4):229-38.
[35] Boka V, Arapostathis K, Kotsanos N, Karagiannis V, van Loveren C, Veerkamp J. Relationship between Child and Parental Dental Anxiety with Child's Psychological Functioning and Behavior during the Administration of Local Anesthesia. J Clin Pediatr Dent. 2016; 40(6):431-7.
[36] Guney SE, Araz C, Tirali RE, Cehreli SB. Dental anxiety and oral health-related quality of life in children following dental rehabilitation under general anesthesia or intravenous sedation: A prospective cross-sectional study. Niger J Clin Pract. 2018; 21(10):1304-10.
[37] Abedi S, Hojati Z, Kohantorabi M, Taheri M, Ebrahimzadeh N. The relationship between dental anxiety and pain perception among patients visiting the dental clinic in Aliabad Katoul, Iran: A cross-sectional study. J Dent Adv Clin Sci. 2025; 1(1):26-31.
[38] Cantekin K, Yildirim MD, Cantekin I. Assessing change in quality of life and dental anxiety in young children following dental rehabilitation under general anesthesia. Pediatr Dent. 2014; 36(1):12E.
[39] Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of Dental Anxiety among Dental Patients in Saudi Arabia. J Int Soc Prev Community Dent. 2017; 7(2):100-4.
[40] Bahrololoomi Z, Sadeghieh T, Maghsoodi N, Pajouhandeh S. Evaluation of Relationship between the Children’s Dental Fear with the Parental State-Trait Anxiety. Jorjani Biomed J. 2021; 9(4):65-73.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Local Anesthesia Dental Services Psychological Functioning | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Soltanmohammadi M, Kazempour M. Relationship between Psychological Functioning and Pain in Pediatrics Referring for Dental Services. Arch Anesth & Crit Care. 2026;.
