Anxiety and Phobia in Chidren During Dental Visits


 Anxiety is an emotion similar to fear but arising without any objective source of danger

It is a reaction to unknown danger

It is often defined as a state of unpleasant feeling combined with an associated feeling of impending doom or danger from within rather than from without.

It is a learned process being in response to one’s environment. As anxiety depends on the ability to imagine, it develops later than fear.

Types of Anxiety 

Trait Anxiety

It is a life-long pattern of anxiety as a temperament feature. These children are generally jittery, skittish and hypersensitive to stimuli.

State Anxiety

These are acute situational-bound episodes of anxiety that do not persist beyond provoking situation

Free Floating Anxiety

It is a condition of persistently anxious mood in which the cause of emotion is unknown and many other thoughts or events trigger anxiety

Situational Anxiety

It is only seen in specific situations or objects

General Anxiety

Where the individual experiences a chronic pervasive feeling of anxiousness, whatever may be the external circumstances.

Sub- Types of Anxiety 


This is a process of classic conditioning whereby previously neutral stimuli become the cause for arousal and anxiety by pairing them with pain or the negative experiences of others.


Arousal is in the biological sphere


Here anxiety is concerned with cognition or the way we think. It involves reconstruction of negative experiences rather than positive happenings that account for the arousal of anxiety

Causes of Anxiety 


Fear of unknown is anxiety provoking. In dental clinic, new patient’s anxiety can be due to the uncertainty they feel about what awaits them after initial first appointment checkup.

Previous Learning

In such cases, anxiety is present due to their previous learning experiences of trauma during the first visit or the learning experiences of trauma during the first visit or the learning involved in dental anxiety may have been more indirect, depending upon the experience of other people. Maternal anxiety plays an important role in the child’s anxiety level determinant. A mother with higher anxiety will have a child usually showing a negative behavior as a results of his/her high level of anxiety.

Biological Differences

Some people are more predisposed to become more anxious or to learn about anxiety responses than others due to the innate biological mechanism.

Anxiety Rating Scale

 The patient’s anxiety can be evaluated through the following scales :

1. Pictorial and Response Card

The scale evaluates the child’s fear in the dental set up in different situations such as :

-Appointment with the dentist

 -Waiting for his turn in the dentist’s office

-Dental procedures

-Lying on the bed dreaming about dentist

The scale gives  5 options graded 0 to 4, from relaxed to panic behaviour depicted by various pictures (Relaxed Behaviour)


Uneasy Behaviour


Feeling scared but cooperative

 2-Feeling scared but cooperative

Feeling scared and uncooperative

3-Feeling scared and uncooperative

Physical Restraints

 4-Feeling very scared , uncooperative , requires physical restraint


It is an irritational fear resulting in conscious avoidance of a specific feared object, activity or situation.

It may be defined as  persistant, excessive, unreasonable fear of a specific object ,activity or situation that results in a compelling desire to avoid the dreaded object.

Characteristics of Phobia

  • Being out of proportion to the stimulus or situation(not age appropriate)
  • Cannot be reasoned with
  • Being out of voluntary control
  • Persistent and inadaptable

Types of Phobia

Shelhan (1982) divided anxiety and phobia into 2 major groups :

1. Exogenous (Non-endogenous)

2. Endogenous

Non Endogenous 

This is a psychologically affected group which  involves situation related anticipatory anxiety symptoms such as :

  • Moist palms
  • Fluttery stomach
  • Fine hand tremors
  • Shaky inside
  • Rapid heart beat

These are the symptoms seen when normal individuals are stressed or threatened. The main cause is in the external environment. It is an anxiety or phobia due to a factor “to be produced from the outside”. Thus, the individual can readily identify the etiological agent.


This anxiety is present without any prior warning or the presence of any detectable stress situation. The cause is “to be produced from within”. This type of anxiety has a more severe cluster of symptoms such as :

  • Light headedness or dizziness
  • Difficulty in breathing
  • Parasthesia
  • Hyper-ventilation
  • Chest pain
  • Losing control

Phobia in Childhood 

The most common phobia in childhood is the fear of animals. This usually comes on between the age of 2 and 4 and is gone before the age of 1o years old

Another common phobia is of darkness, a fear experienced by children between the age of 4 and 6 years old. This is most likely due to the imagination of the child as to various creatures lurking out in the dark.

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