Relationship Between Dental Fear and Behavior during Anesthesia Induction in Children Undergoing Dental General Anesthesia
Abstract
Background: The duration of anesthesia can be associated with psychological consequences, behavioral outcomes, decreased verbal IQ, emergence delirium, and learning disabilities.
Methods: In this study, a total of 80 pediatric patients between the ages of 3 and 5 years were enrolled. This study was a cross-sectional study investigating the baseline fear level and behavior during anesthesia induction. The instruments used included the Venham Picture Test (VPT) and the Pediatric Anesthesia Behavior Score (PABS) questionnaire. The ethical considerations were observed in the research [IR.MEDILAM.REC.1404.203]. The data obtained from this research were entered into SPSS software, version 16, and data analysis was performed.
Results: The findings showed a mean (SD) dental fear score for those who had visited a clinical psychologist was 4.76±0.94, whereas for those who had not visited a clinical psychologist, the mean (SD) score was 6.67±0.85 (P=0.000). Furthermore, among the children who had been visited by a clinical psychologist, 18 of them (22.50%) were in the “Happy” group, and none of them were in the “Angry” group. Also, a significant relationship was observed between dental fear and pediatric anesthesia behavior. Specifically, patients with higher levels of dental fear obtained lower pediatric anesthesia behavior scores.
Conclusion: For improving children’s behavior during dental treatments requiring anesthesia, focusing on reducing maternal anxiety and also providing a referral to clinical psychology before treatment can be a highly effective approach. Furthermore, consistent with the findings, the child’s dental fear is a strong predictor of the manifestation of behavioral problems during anesthesia.
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[25] Sarafi M, Azimi B, Karimian M, Ebrahimisaraj G. Assessment of Clinical Characteristics of Patients with Penetrating Abdominal Trauma. Arch Anesth Crit Care. 2025; 11(4):509-512.
[26] Azimi B, Sarafi M, Karimian M, Ebrahimisaraj G. Comparison of Patterns and Outcomes of Patients with Penetrating and Blunt Abdominal Trauma: A Retrospective Study. Govaresh. 2025; 30(1):25-9.
[27] Kalbassi S, Samadzadeh Etehadi S, Azimi MR. Investigating the Extent of mRNAs of the Genes Associated with Apoptosis and OGG1 in the Gingival Connective Tissue of Patients Suffering from Chronic Periodontitis and Diabetes Mellitus. Asian Pac J Cancer Prev. 2026; 27(1):47-52.
[28] Agarwal M, Das UM. Dental anxiety prediction using Venham Picture test: a preliminary cross-sectional study. J Indian Soc Pedod Prev Dent. 2013; 31(1):22-4.
[29] Krishnappa S, Srinath S, Vishwanath SK, Bhardwaj P, Singh R. Evaluation of facial image scale and Venham picture test used to assess dental anxiety in children. J Indian Assoc Public Health Dent. 2013; 11(3):31-5.
[30] Venham LL, Gaulin-Kremer E. A self-report measure of situational anxiety for young children. Pediatr Dent. 1979; 1(2):91-6.
[31] Prayunanto E, Widyastuti Y, Sari D. The association of modified Yale perioperative anxiety scale and pediatric anesthesia behavior on postoperative emergence delirium in children: A prospective cohort study. Bali J Anesthesiol. 2023; 7(2):88-93.
[32] Bayón G, Stiernhufvud F, Ribas-Pérez D, Biedma Perea M, Mendoza Mendoza A. Parental Anxiety Disorders and Their Impact on Dental Treatment in Children Aged 4 to 13 Years: A Cross-Sectional Observational Study. J Clin Med. 2025; 14(6):1869.
[33] Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V. Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent. 2013; 6(1):12-5.
[34] Varmazyar A, Taram S, Rohani ZR. Dental Fear of Children and Its Relationship with Caries Experience. J Dent Sch Shahid Beheshti Univ Med Sci. 2021; 39(1):28-32.
[35] Talo Yildirim T, Dundar S, Bozoglan A, Karaman T, Dildes N, Acun Kaya F, et al. Is there a relation between dental anxiety, fear and general psychological status? PeerJ. 2017; 5:e2978.
[36] Wu T, Liu W, Chen Z, Huang J, Ye Y, Dai L. Association between children's dental anxiety and parental acceptance of dental general anesthesia: a cross-sectional study. J Clin Pediatr Dent. 2025; 49(2):126-136.
[2] Hossinzade M, Khademi A, Mahmodalalo m, Farshbafmanisefat F. The Effectiveness of Classical Cognitive Behavioral Therapy on Behavioral Adaptation, Anxiety and Dental Fear of children. Iran J Rehabil Res Nurs. 2023; 10(1):32-41.
[3] Saiwan MJ, Al-showaily JS. Psycho-educational programs: Enhancing coping strategies and mitigating anxiety in chemotherapy patients. Babcock Univ Med J. 2025; 8(2):360-77.
[4] Siwan MJ, Huusein HA. Proneness to anxiety and depression among middle school students: Does emotion expression matter. Soc Sci. 2022; 12(2):7205-12.
[5] 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.
[6] Shishesaz A, Yazdani R. Relation of maternal dental fear and anxiety with child’s dmft/DMFT. J Dent Med. 2021; 33(4):240-8.
[7] Ghandharimotlagh M, Fotouhi F, Ghandharimotlagh B, Jouya H. Evaluation of dentistry fear in 3-8 years old children referred to Shahid Sadoughi Dental School in Yazd. Iran J Pediatr Dent. 2019; 15(1):29-40.
[8] Baghi SA, Amareh M, Heirat R, Hajivandi A, Aalizadeh Y. Evaluation of relationship between the children's dental fear and cooperation during dental treatment with the parents’ general health. Iran J Pediatr Dent. 2018; 13(2):37-42.
[9] Hoseinzadeh R, Bayat Far Y, Babadi F. Investigating the Association between Fear of Dentistry and Satisfaction with Medical Services in Ahvaz Jundishapur School of Dentistry. Jundishapur Sci Med J. 2024; 23(4):323-40.
[10] 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.
[11] Zarebidoki F, Bahrololoomi Z, Hazeri Baqdad Abad M, Salari F, Zarebidaki Z. Relationship between Emotional Intelligence and Parenting Style with Dental Fear and Anxiety in Children Aged 6 - 15 Years. JSSU. 2024; 32(3):7673-85.
[12] Daneshvar SH, Azizi S. The relationship between dental fear and cooperation of children during dental treatments with their parents’ general health. Dentistry 3000. 2021; 9(1):118-26.
[13] Baakdah RA, Turkistani JM, Al-Qarni AM, Al-Abdali AN, Alharbi HA, Bafaqih JA, et al. Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study. BMC Oral Health. 2021; 21(1):186.
[14] Kong X, Song N, Chen L, Li Y. Non-pharmacological interventions for reducing dental anxiety in pediatric dentistry: a network meta-analysis. BMC Oral Health. 2024; 24(1):1151.
[15] Cianetti S, Paglia L, Gatto R, Montedori A, Lupatelli E. Evidence of pharmacological and non-pharmacological interventions for the management of dental fear in paediatric dentistry: a systematic review protocol. BMJ Open. 2017; 7(8):e016043.
[16] 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.
[17] Beringer RM, Segar P, Pearson A, Greamspet M, Kilpatrick N. Observational study of perioperative behavior changes in children having teeth extracted under general anesthesia. Paediatr Anaesth. 2014; 24(5):499-504.
[18] Jiang R, Ni J, Chen J, Wang Z, Cheng Y, Li C. The Impact of Anesthesia Duration on Postoperative Cognitive and Behavioral Outcomes in Pediatric Patients: A Meta-analysis. J Perianesth Nurs. 2026; 41(2):471-82.
[19] Malarbi S, Stargatt R, Howard K, Davidson A. Characterizing the behavior of children emerging with delirium from general anesthesia. Paediatr Anaesth. 2011; 21(9):942-50.
[20] Khalighi E, Tarjoman A, Abdi A, Borji M. The prevalence of delirium in patients in Iran: a systematic review and meta-analysis. Future Neurol. 2019; 14(4):FNL34.
[21] Arai YC, Kandatsu N, Ito H, Sato Y, Satake Y, Mizutani M, et al. Induction and emergence behavior of children undergoing general anesthesia correlates with maternal salivary amylase activity before the anesthesia. Acta Anaesthesiol Scand. 2008; 52(2):285-8.
[22] Khodadadi E, Mohammadpour M, Motamedian SR, Kouhestani F. Failure Rate of Pediatric Dental Treatment under General Anesthesia. Dent J (Basel). 2018; 6(3):25.
[23] Lim SN, Kiang L, Manohara R, Tong HJ, Nair R, Hong C, et al. Interim therapeutic restoration approach versus treatment under general anaesthesia approach. Int J Paediatr Dent. 2017; 27(6):551-7.
[24] Amin MS, Bedard D, Gamble J. Early childhood caries: recurrence after comprehensive dental treatment under general anaesthesia. Eur Arch Paediatr Dent. 2010; 11(6):269-73.
[25] Sarafi M, Azimi B, Karimian M, Ebrahimisaraj G. Assessment of Clinical Characteristics of Patients with Penetrating Abdominal Trauma. Arch Anesth Crit Care. 2025; 11(4):509-512.
[26] Azimi B, Sarafi M, Karimian M, Ebrahimisaraj G. Comparison of Patterns and Outcomes of Patients with Penetrating and Blunt Abdominal Trauma: A Retrospective Study. Govaresh. 2025; 30(1):25-9.
[27] Kalbassi S, Samadzadeh Etehadi S, Azimi MR. Investigating the Extent of mRNAs of the Genes Associated with Apoptosis and OGG1 in the Gingival Connective Tissue of Patients Suffering from Chronic Periodontitis and Diabetes Mellitus. Asian Pac J Cancer Prev. 2026; 27(1):47-52.
[28] Agarwal M, Das UM. Dental anxiety prediction using Venham Picture test: a preliminary cross-sectional study. J Indian Soc Pedod Prev Dent. 2013; 31(1):22-4.
[29] Krishnappa S, Srinath S, Vishwanath SK, Bhardwaj P, Singh R. Evaluation of facial image scale and Venham picture test used to assess dental anxiety in children. J Indian Assoc Public Health Dent. 2013; 11(3):31-5.
[30] Venham LL, Gaulin-Kremer E. A self-report measure of situational anxiety for young children. Pediatr Dent. 1979; 1(2):91-6.
[31] Prayunanto E, Widyastuti Y, Sari D. The association of modified Yale perioperative anxiety scale and pediatric anesthesia behavior on postoperative emergence delirium in children: A prospective cohort study. Bali J Anesthesiol. 2023; 7(2):88-93.
[32] Bayón G, Stiernhufvud F, Ribas-Pérez D, Biedma Perea M, Mendoza Mendoza A. Parental Anxiety Disorders and Their Impact on Dental Treatment in Children Aged 4 to 13 Years: A Cross-Sectional Observational Study. J Clin Med. 2025; 14(6):1869.
[33] Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V. Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent. 2013; 6(1):12-5.
[34] Varmazyar A, Taram S, Rohani ZR. Dental Fear of Children and Its Relationship with Caries Experience. J Dent Sch Shahid Beheshti Univ Med Sci. 2021; 39(1):28-32.
[35] Talo Yildirim T, Dundar S, Bozoglan A, Karaman T, Dildes N, Acun Kaya F, et al. Is there a relation between dental anxiety, fear and general psychological status? PeerJ. 2017; 5:e2978.
[36] Wu T, Liu W, Chen Z, Huang J, Ye Y, Dai L. Association between children's dental anxiety and parental acceptance of dental general anesthesia: a cross-sectional study. J Clin Pediatr Dent. 2025; 49(2):126-136.
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How to Cite
1.
Soltanmohammadi M, Kazempour M. Relationship Between Dental Fear and Behavior during Anesthesia Induction in Children Undergoing Dental General Anesthesia. Arch Anesth & Crit Care. 2026;.
