Diagnóstico da ansiedade odontológica infantil: uma análise das evidências, desenvolvimento de itens para novos instrumentos e de material educativo para seu manejo clínico

Abstract

This thesis consists of four articles (A1-A4) and a technical product (PT) that will be presented separately: (A1) Objective: to observe the evidence of correlation between objective and subjective methods for assessing dental anxiety. Methodology: A systematic review was conducted, defining the eligibility criteria in patients (P): individuals in the dental environment; index test (I): subjective methods; reference test (R): objective methods; outcome (O): correlation between methods. QUADAS-2 assessed the risk of bias. Random effects meta-analyses calculated pooled correlation coefficients (r). Correlations were classified as weak (r = 0.1 to 0.3); moderate (0.31 to 0.5); strong (0.31 to 0.5). GRADE assessed the certainty of the evidence. Results: 29 studies were included (22 in the meta-analysis). The risk of bias was mainly “unclear” due to methodological limitations. Weak correlations were observed between subjective methods applied by the Dental Anxiety Scale (DAS); Dental Anxiety ScaleRevised (DAS-R); Modified Dental Anxiety Scale (MDAS); Short version of the Dental Anxiety Inventory (S–DAI) and the objective verified by heart rate (r 0.15 [0.08, 0.21], p < 0.001, I2 = 56%) and the subjective methods applied by CFSS-DS; DAS; Modified Child Dental Anxiety Scale (MCDAS); MDAS and the objective verified by alphaamylase (r 0.25 [0.11, 0.38], p < 0.001, I2 = 43%). The subjective methods Abeer Children Dental Anxiety Scale (ACDAS); DAS; MCDAS; MDAS showed a moderate correlation with the objective verified by cortisol (r 0.40 [0.33, 0.47] p < 0.001, I2 = 72%). The certainty of the evidence was very low. Conclusion: Overall, low to moderate correlations were found between objective and subjective methods, with very low certainty of evidence. (A2) Objective: to conduct an exploratory and critical analysis of the studies and tests applied to evaluate the psychometric properties of the Dental Subscale of Children’s Fear Survey Schedule (CFSS-DS). Methodology: a scientometric review was conducted, evaluating parameters such as country, publication periods, and original language used in the adaptation. In addition to the psychometric tests applied to the CFSS-DS, compliance with the categories for obtaining validity evidence was also evaluated. Results: The psychometric properties of the CFSS-DS were analyzed in 18 countries, with the highest number of publications between 2012 and 2024, with English being the most widely used language in the adaptations. The main tests applied were Cronbach’s alpha and Principal Component Analysis, which are not very robust approaches. Furthermore, of the five parameters of validity evidence, a maximum of two were achieved by most studies, indicating a low accumulation of evidence for the scale. Conclusion: Over the past four decades, the psychometric properties of the CFSS-DS have been evaluated in 18 countries, mainly based on the original English version. The analyses were largely superficial, with limited coverage of the validity evidence categories. (A3) Objective: to verify the evidence of validity based on the internal structure of the CFSS-DS. Methodology: the reliability of the scale was assessed considering McDonald’s ω (ω> 0.70= satisfactory) as a parameter of internal consistency, and Item Response Theory was applied by the Graded Ratings Scale Model in a sample of children aged 7 to 12 years old in Rio de Janeiro. Results: ω = 0.86 was observed; item 14 presented adjustment problems and items 3, 6, 7, 12, and 13 presented discrimination problems. Conclusion: the scale presented satisfactory internal consistency, but the inconsistencies of some items indicate the need for reformulation. (A4) Objective: to develop instruments for comprehensive assessment of dental anxiety in children. Methodology: initially, focus groups with pediatric dentists were conducted and recorded. The central themes were defined considering the intended structure for the instruments; the recordings of the focus groups were transcribed and coded to generate the items. The items generated were then evaluated for Content Validity Coefficient (CVC). Results: A total of 24 pediatric dentists participated in six focus groups. A battery of instruments was structured based on the following themes: 1) child (cognitive, physiological/emotional, and behavioral domains); 2) caregivers; 3) professional. The coding generated 35, 7, and 9 items for each instrument, respectively. The CVC after two rounds of judgment was acceptable for all instruments. Conclusion: The study developed a preliminary battery of three instruments with acceptable initial evidence of content validity. (PT) Objective: to develop and disseminate material with accessible tools for managing dental anxiety in children. Methodology: After a literature review, an e-book was developed, which followed the stages of theoretical structuring; layout; evaluation of clarity, comprehension and evidence of content validity by dental surgeons; and dissemination. Results: nine techniques were selected for the e-book, including acupressure and aromatherapy. After being evaluated, the e-book showed good properties in terms of clarity, comprehension and evidence of content validity, and was then published in the Pantheon Repositório Institucional da UFRJ. Conclusion: the ebook was a satisfactory strategy for disseminating accessible tools for managing children’s dental anxiety.