Dental anxiety and its association with oral health status and oral health–related behaviors in children and adolescents in Huize County, China: a cross-sectional study

Abstract

To investigate the prevalence of dental anxiety (DA) and its associations with oral health status and oral health-related behaviors among children and adolescents. In this cross-sectional study, we invited 1,737 children and adolescents from 31 classes in Huize County using cluster sampling in December 2025. DA was assessed using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS). Both thresholds of 32 and 38 were used to distinguish DA levels. Dental caries status was assessed by calibrated pediatric dentists. Oral health-related behaviors, self-rated health, and sociodemographics were collected via a questionnaire survey. Generalized estimating equations (GEE) with a Poisson distribution and log link were used to estimate adjusted prevalence ratios (PRs) while accounting for within-class correlation. 1,267 participants aged between 8 and 16 were recruited (response rate: 72.9%). The final models showed that DA was associated with gender, age, toothbrush deterioration, and self-perceived general health status at both thresholds. Additionally, at the threshold of 38, children with emotion-driven sugary consumption habits had higher DA than their peers (PR = 1.48, 95% CI: 1.12, 1.95). At the threshold of 32, children from single-parent families had higher DA than children from nuclear families (PR = 1.15, 95% CI: 1.04, 1.26); children who rated their oral health as "very poor" “poor” or “fair” had higher DA than those with “very good”. Various DA-associated factors were identified using different thresholds, including age, gender, family structure, self-perceived health status, toothbrush deterioration, and emotion-driven snacking habits.

The authors' abstract, as published at the source. BMC Oral Health, 2026 · DOI ↗