{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:40:38Z","timestamp":1790912438312,"version":"4.1.0"},"reference-count":38,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T00:00:00Z","timestamp":1587340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"General Research Fund, Hong Kong","award":["17100019"],"award-info":[{"award-number":["17100019"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objectives: The objectives of this cross-sectional study were to investigate the fear level of kindergarten children in the general population during dental outreach in a familiar kindergarten setting, and to explore the factors associated with the dental fear of kindergarten children. Method: Consecutive sampling method was used to select kindergarten children aged 3 to 5 to participate in a questionnaire survey and an outreach service. A behavioural observation type of instrument for dental fear and anxiety assessment\u2014Frankl Behaviour Rating Scale (FBRS)\u2014was chosen to investigate the fear level of the children. Bivariate analyses between various factors and children\u2019s dental fear and anxiety were carried out using Chi-square test. Results: A total of 498 children participated in this study. Almost half (46%) of the children have had caries experience, and the mean dmft score was 2.1 \u00b1 3.4. The prevalence of dental caries was 32%, 43%, and 64% in the 3-, 4- and 5-year-olds, respectively. Only 4% of the children scored negatively for dental fear and anxiety (95% CI 2.3%\u20135.7%). Children at three years of age displayed more dental fear and anxiety than children of older ages, but the difference in dental fear and anxiety among the genders and caries status was not statistically significant. Most of the children (92%) brushed daily, but only 20% of them used toothpaste. Most (85%) of them had never visited the dentist, and over 70% of them were mainly taken care by their parents. High levels of positive and cooperative behaviour and low levels of fear were found in this population. No statistical significance was found between the child\u2019s dental fear and any factors except age. Conclusion: Children generally displayed low fear or anxiety levels in a dental outreach consisting of a non-invasive oral examination and preventive treatment in a familiar kindergarten setting. Conducting regular outreach dental services to kindergartens by providing oral examination and simple remineralisation therapies could be a promising strategy to not only control childhood caries, but also manage and reduce dental fear and encourage long term dental attendance in line with the medical model.<\/jats:p>","DOI":"10.3390\/ijerph17082827","type":"journal-article","created":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T04:49:38Z","timestamp":1587444578000},"page":"2827","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Dental Fear and Anxiety of Kindergarten Children in Hong Kong: A Cross-Sectional Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4108-1279","authenticated-orcid":false,"given":"Madeline Jun Yu","family":"Yon","sequence":"first","affiliation":[{"name":"Faculty of Dentistry, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6505-198X","authenticated-orcid":false,"given":"Kitty Jieyi","family":"Chen","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry Shiqian","family":"Gao","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duangporn","family":"Duangthip","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward Chin Man","family":"Lo","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8167-0430","authenticated-orcid":false,"given":"Chun Hung","family":"Chu","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,20]]},"reference":[{"key":"ref_1","first-page":"22","article-title":"Relationship between caries prevalence at 5 years of age and dental anxiety at 10","volume":"3","author":"Raadal","year":"2002","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1046\/j.0909-8836.1999.eos107602.x","article-title":"Dental anxiety and dental avoidance among 12 to 18 year olds in Norway","volume":"107","author":"Skaret","year":"1999","journal-title":"Eur. J. Oral. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1034\/j.1600-0528.2002.300203.x","article-title":"Childhood dental fear in the Netherlands: Prevalence and normative data","volume":"30","author":"Veerkamp","year":"2002","journal-title":"Community Dent. Oral. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1590\/S1678-77572009000700015","article-title":"Dental anxiety and pain related to ART","volume":"17","author":"Leal","year":"2009","journal-title":"J. Appl. Oral Sci. Rev. FOB"},{"key":"ref_5","first-page":"1","article-title":"Dental anxiety in Hong Kong preschool children: Prevalence and associated factors","volume":"4","author":"Wong","year":"2017","journal-title":"Adv. Pediatric Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/j.1752-7325.2007.00006.x","article-title":"Prevalence of dental anxiety among 5- to 8-year-old Taiwanese children","volume":"67","author":"Lee","year":"2007","journal-title":"J. Public Health Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1038\/sj.bdj.4810070","article-title":"The relationship between anxiety and dental treatment experience in 5-year-old children","volume":"194","author":"Milsom","year":"2003","journal-title":"Br. Dent. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/BF03262653","article-title":"Changes in children\u2019s dental fear: A longitudinal study","volume":"9","author":"Klaassen","year":"2008","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1080\/00016350310003468","article-title":"Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children","volume":"61","author":"Wogelius","year":"2003","journal-title":"Acta Odontol. Scand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1046\/j.1365-263X.2002.00399.x","article-title":"Cooperation during dental treatment: The children\u2019s fear survey schedule in Japanese children","volume":"12","author":"Yamada","year":"2002","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.pain.2007.09.025","article-title":"Children\u2019s self-reported pain at the dentist","volume":"137","author":"Versloot","year":"2008","journal-title":"Pain"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1007\/s00784-018-2340-2","article-title":"Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia","volume":"22","author":"Yildirim","year":"2018","journal-title":"Clin. Oral Investig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3109\/00016359409029055","article-title":"Reliability and validity of the Swedish version of the dental subscale of the children\u2019s fear survey schedule, CFSS-DS","volume":"52","author":"Klingberg","year":"1994","journal-title":"Acta Odontol Scand."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/S0917-2394(09)70177-6","article-title":"Change in salivary levels of chromogranin A in children by hearing dental air turbine noise","volume":"19","author":"Okano","year":"2009","journal-title":"Pediatric Dent. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/j.1365-263X.2011.01202.x","article-title":"Objective assessment of internal stress in children during dental treatment by analysis of autonomic nervous activity","volume":"22","author":"Uehara","year":"2012","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_16","first-page":"51","article-title":"Assessment of dental anxiety in children: Effect of oral health education","volume":"12","author":"Eden","year":"2008","journal-title":"Balkan J. Stomatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s40723-015-0006-y","article-title":"The evolution of early childhood education policy in Hong Kong","volume":"9","author":"Wong","year":"2015","journal-title":"Int. J. Child. Care Educ. Policy"},{"key":"ref_18","unstructured":"Audit Commission (2013). Pre-Primary Education Voucher Scheme."},{"key":"ref_19","unstructured":"(2011). Oral Health Survey 2011."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Chen, K.J., Gao, S.S., Duangthip, D., Li, S.K.Y., Lo, E.C.M., and Chu, C.H. (2017). Dental caries status and its associated factors among 5-year-old hong kong children: A cross-sectional study. BMC Oral Health, 17.","DOI":"10.1186\/s12903-017-0413-2"},{"key":"ref_21","unstructured":"(2020, March 08). School Dental Care Service, Available online: https:\/\/www.schooldental.gov.hk\/wsmile\/index.htm."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yon, M.J.Y., Gao, S.S., Chen, K.J., Duangthip, D., Lo, E.C.M., and Chu, C.H. (2019). Medical model in caries management. Dent. J., 7.","DOI":"10.3390\/dj7020037"},{"key":"ref_23","unstructured":"(2020, March 08). Community Engagement & Projects. Available online: Facdent.hku.hk\/knowledge-exchange\/community-engagement-and-projects.html."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1177\/0810767","article-title":"Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children","volume":"81","author":"Chu","year":"2002","journal-title":"J. Dent. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/0005-7967(89)90119-8","article-title":"Dental phobias and anxieties: Evidence for conditioning processes in the acquisition and modulation of a learned fear","volume":"27","author":"Davey","year":"1989","journal-title":"Behav. Res. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"12","author":"Altman","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/BF03262650","article-title":"Dental anxiety and behaviour management problems in paediatric dentistry\u2014A review of background factors and diagnostics","volume":"9","author":"Klinberg","year":"2008","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_28","unstructured":"Nowak, A.J., Christensen, J.R., Mabry, T.R., Townsend, J.A., and Wells, M.H. (2019). 24\u2014Behavior guidance of the pediatric dental patient. Pediatric Dentistry, Content Repository. [6th ed.]."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1600-0722.2010.00727.x","article-title":"Can parents and children evaluate each other\u2019s dental fear?","volume":"118","author":"Luoto","year":"2010","journal-title":"Eur. J. Oral Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1038\/sj.bdj.4807661","article-title":"An assessment of dental anxiety in children","volume":"171","author":"Alwin","year":"1991","journal-title":"Br. Dent. J."},{"key":"ref_31","unstructured":"Petersen, P.E., Baez, R.J., and World Health, O. (2013). Oral Health Surveys: Basic Methods, World Health Organization. [5th ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5005\/jp-journals-10005-1397","article-title":"Factors predicting behavior management problems during initial dental examination in children aged 2 to 8 years","volume":"10","author":"Sharma","year":"2017","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_33","first-page":"1532","article-title":"Evaluation of dental anxiety among children visiting paediatric dental department at children hospital","volume":"67","author":"Ahmad","year":"2017","journal-title":"J. Pak. Med Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Yon, M.J.Y., Chen, K.J., Gao, S.S., Duangthip, D., Lo, E.C.M., and Chu, C.H. (2020). An introduction to assessing dental fear and anxiety in children. Healthcare, 8.","DOI":"10.3390\/healthcare8020086"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1600-0528.2009.00521.x","article-title":"Child dental fear as measured with the dental subscale of the children\u2019s fear survey schedule: The impact of referral status and type of informant (child versus parent)","volume":"38","author":"Gustafsson","year":"2010","journal-title":"Community Dent. Oral. Epidemiol."},{"key":"ref_36","first-page":"316","article-title":"Children\u2019s fear and behavior in private pediatric dentistry practices","volume":"26","author":"Baier","year":"2004","journal-title":"Pediatr Dent."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/ipd.12106","article-title":"Reliability and validity of the Chinese version of the children\u2019s fear survey schedule-dental subscale","volume":"25","author":"Ma","year":"2015","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_38","first-page":"70","article-title":"Dental fear and concomitant factors in 3\u20136 year-old children","volume":"6","author":"Salem","year":"2012","journal-title":"J. Dent. Res. Dent. Clin. Dent. Prospect."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/8\/2827\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:09:05Z","timestamp":1760364545000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/8\/2827"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,20]]},"references-count":38,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["ijerph17082827"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17082827","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,20]]}}}