{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T06:03:00Z","timestamp":1780293780372,"version":"3.54.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral Health"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Dental fear and anxiety (DFA) can profoundly impact on children's oral health and pose challenges for dental care providers due to behavioural issues. This 18-month cohort study aimed to investigate the changes in the prevalence and levels of DFA among preschool children towards dental examination in a familiar kindergarten setting and different potential risk factors that may influence the changes in dental fear levels among preschool children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Parental questionnaires consisting the child's demographic information, oral health status, socio-economic background, previous dental experiences, parental and child self-reported DFA were administered. During each biannual review, the children underwent examinations for plaque scores and dental caries. Their DFA was evaluated based on behaviours and perceived pain levels both before and immediately after the clinical examination using Frankl Scale (FBRS) and Venham Scale (VBRS). The children's perceived pain levels were self-assessed using Wong-Baker Faces Pain Scale (WBFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 300 healthy kindergarten children aged 2\u20135 years were enrolled, with 209 children being reviewed at 18 months. A notable increase in children's cooperativeness pre-operatively and post-operatively over time was observed when assessed using FBRS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and VBRS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), but not for self-rated WBFS. Following multiple imputation, children with higher dft and dt scores were significantly associated with pre-operative uncooperative behaviours. Other sociodemographic factors, clinical findings, or reported dental fear and anxiety (DFA) by parents and children were not significantly linked to uncooperative behaviours either pre-operatively or post-operatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of DFA among preschool children towards dental examination in familiar kindergarten settings decreased significantly over time, suggesting the positive impact of repeated, non-threatening dental encounters. Past caries experience and untreated dental decay remained as significant factors associated with DFA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/froh.2026.1806157","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T05:31:45Z","timestamp":1780291905000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The change in dental fear and anxiety toward dental examinations among preschool children in Hong Kong. 18-months longitudinal study"],"prefix":"10.3389","volume":"7","author":[{"given":"Phoebe Pui Ying","family":"Lam","sequence":"first","affiliation":[{"name":"Paediatric Dentistry, The University of Hong Kong","place":["Pokfulam, Hong Kong, SAR China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarrah S. F. S.","family":"Almarzouq","sequence":"additional","affiliation":[{"name":"Paediatric Dentistry, The University of Hong Kong","place":["Pokfulam, Hong Kong, SAR China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Yiu","sequence":"additional","affiliation":[{"name":"Paediatric Dentistry, The University of Hong Kong","place":["Pokfulam, Hong Kong, SAR China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1111\/ipd.12712","article-title":"Prevalence of dental anxiety in children and adolescents globally: a systematic review with meta-analyses","volume":"31","author":"Grisolia","year":"2021","journal-title":"Int J Paediatr Dent"},{"key":"B2","doi-asserted-by":"publisher","first-page":"103632","DOI":"10.1016\/j.jdent.2021.103632","article-title":"Estimated prevalence of dental fear in adults: a systematic review and meta-analysis","volume":"108","author":"Silveira","year":"2021","journal-title":"J Dent"},{"key":"B3","doi-asserted-by":"publisher","first-page":"104841","DOI":"10.1016\/j.jdent.2024.104841","article-title":"Global prevalence of early childhood dental fear and anxiety: a systematic review and meta-analysis","volume":"142","author":"Sun","year":"2024","journal-title":"J Dent"},{"key":"B4","first-page":"119","article-title":"Dental anxiety, child-oral health related quality of life and self-esteem in children and adolescents: a systematic review and meta-analysis","volume":"38","author":"Alharbi","year":"2021","journal-title":"Community Dent Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"184","DOI":"10.22514\/jocpd.2024.020","article-title":"A study on related factors affecting dental fear in preschool children","volume":"48","author":"Peng","year":"2024","journal-title":"J Clin Pediatr Dent"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2827","DOI":"10.3390\/ijerph17082827","article-title":"Dental fear and anxiety of kindergarten children in Hong Kong: a cross-sectional study","volume":"17","author":"Yon","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e9154","DOI":"10.7717\/peerj.9154","article-title":"Dental fear association between mothers and adolescents-a longitudinal study","volume":"8","author":"Wong","year":"2020","journal-title":"PeerJ"},{"key":"B8","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12903-018-0553-z","article-title":"Children's dental fear and anxiety: exploring family related factors","volume":"18","author":"Wu","year":"2018","journal-title":"BMC Oral Health"},{"key":"B9","first-page":"150","article-title":"Should the parent remain with the child in the dental operatory?","volume":"29","author":"Frankl","year":"1962","journal-title":"J Dent"},{"key":"B10","first-page":"195","article-title":"Interval rating scales for children\u2019s dental anxiety and uncooperative behavior","volume":"2","author":"Venham","year":"1980","journal-title":"Pediatr Dent"},{"key":"B11","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/S0304-3959(00)00375-4","article-title":"Smiling face as anchor for pain intensity scales","volume":"89","author":"Wong","year":"2001","journal-title":"Pain"},{"key":"B12","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1177\/00220345690480041801","article-title":"Development of a dental anxiety scale","volume":"48","author":"Corah","year":"1969","journal-title":"J Dent Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"816","DOI":"10.14219\/jada.archive.1978.0394","article-title":"Assessment of a dental anxiety scale","volume":"97","author":"Corah","year":"1978","journal-title":"Journal of the American Dental Association (1939)"},{"key":"B14","first-page":"432","article-title":"A screening device: children at risk for dental fears and management problems","volume":"49","author":"Cuthbert","year":"1982","journal-title":"ASDC J Dent Child"},{"key":"B15","doi-asserted-by":"publisher","first-page":"105356","DOI":"10.1016\/j.jdent.2024.105356","article-title":"Effectiveness of glass-ionomer sealant versus fluoride varnish application to prevent occlusal caries among preschool children over 18\u201324 months\u2014a randomised controlled trial","volume":"150","author":"Lam","year":"2024","journal-title":"J Dent"},{"key":"B16","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3109\/00016356408993968","article-title":"Periodontal disease in preganancy. 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