Prevalence of Dental Anxiety and the Influence of Various Factors in Children Age 12 to 18 Years in Zagreb, Croatia

Background/Objectives: Children who experience high levels of dental anxiety often show poor cooperation during dental visits, which compromises treatment outcomes and which leads to a vicious cycle with poor outcomes for oral health and caries prevention. The purpose of this study is to analyse the prevalence of dental anxiety in a sample of clinical subjects in children, and to examine possible correlations with other factors as well as the longitudinal nature of anxiety. Methods: This cross-sectional and longitudinal part study was conducted on a sample of 150 children aged 12 to 18 years in the city of Zagreb and Zagreb County. The MDAS (Modified Dental Anxiety Scale) scale was used to collect data related to dental anxiety at three-time intervals; before the procedure (T1), after the procedure (T2) and after a period of 3 months (T3). Results. Significant differences between the MDAS before and after the procedure were found, in the sense that dental anxiety decreased in the majority of children (p< 0.001). The MDAS test result was 9.79 for the T1 period, and 8.03 for the T2 period, which belongs to the mild anxiety group. There are statistically significant differences between individual time points T1, T2, T3 (p< 0.001), and these differences are significant between T1 and T2 (p=0.045), and T1 and T3 (p=0.012), while between T2 and T3 the differences are not statistically significant (p=0.616). At T1, most children had mild dental anxiety (55.3%), moderate (41.3%) and severe dental anxiety (3.3%). At T2, most children had mild dental anxiety (77.2%) and moderate (22.8%), with no severe dental anxiety. Financial impact on dental service use was statistically associat-ed with dental anxiety at T1 (p=0.015), and at T1-T2 period (p=0.032). The long period since the last visit to the dentist also showed significance for T1 (p=0.003) and T2 (p=0.014). The "urgent pain" showed a statistical correlation with the period T2-T1 (p=0.023). The greatest decrease in the dental anxiety scale T2-T1 was in subjects who had a doctorate/master's degree in their family, high income in family, regular dental check-ups within 3 months, brushing their teeth several times a day for over 2 minutes with horizontal brushing tech-nique, use of dental floss and fluoridated toothpaste, no active caries lesions, no bad habits, and use of drinking water and rarely eating sweets. Conclusions: Most of the children in this study have mild to moderate anxiety, and it de-creases after the therapeutic procedure. Increased dental anxiety is associated with urgent dental procedures/urgent pain and irregular check-ups that are longer than 3 months. Bet-ter oral hygiene and oral status, higher socioeconomic status, and a low cariogenic diet in-fluence the level of dental anxiety among children.