Published online Aug 26, 2014. doi: 10.13105/wjma.v2.i3.64
Revised: May 27, 2014
Accepted: June 27, 2014
Published online: August 26, 2014
AIM: To validate the Arabic version of abeer children dental anxiety scale.
METHODS: Two ethical approvals for this study were obtained from United Arab Emirates, Ministry of Health and Dubai Health Authority; reference number: 2011/57. The Abeer children dental anxiety scale (ACDAS) was translated from English to Arabic by the native speaker chief investigator, and then back translated by another native speaker in Dubai (AS) to ensure comparability with the original one. Part C of ACDAS was excluded for the schoolchildren because those questions were only applicable for children at the dentist with their parents or legal guardian. A total of 355 children (6 years and over) were involved in this study; 184 in Dubai, 96 from the Religious International Institute for boys and 88 from Al Khansaa Middle School for girls. A sample of 171 children was assessed for external validity (generalizability) from two schools in different areas of London in the United Kingdom.
RESULTS: Receiver operating characteristic curve showed that the cut-off ≥ 26 for ACDAS gave the optimal results for sensitivity = 90% (95%CI: 81.2%- 95.6%), and specificity = 86.6% (95%CI: 78.2%- 92.7%), with AUROC = 0.93 (95%CI: 0.90-0.97). Cronbach’s Alpha (α) was 0.90 which indicated good internal consistency. Results of the external validity assessing the agreement between ACDAS and dental subscale of the children's fear survey schedule was substantial for the East London school (κ = 0.68, 95%CI: 0.53-0.843); sensitivity = 92.9% (95%CI: 82.7%-98.0%); specificity = 73.5% (95%CI: 55.6%-87.1%) and almost perfect for the Central London school (κ = 0.79; 95%CI: 0.70-0.88); sensitivity = 96.4% (95%CI: 81.7%-99.9%); specificity = 65.9%, (95%CI: 57.4%-73.8%).
CONCLUSION: The Arabic ACDAS is a valid cognitive scale to measure dental anxiety for children age 6 years or over.
Core tip: The Abeer children dental anxiety scale (ACDAS) scale is different from existing scales as it is the first dental anxiety scale for children which correlate dental anxiety with cognitive status. It can recognise the stimuli for dental anxiety in a logical order, and has questions concerning the expectation of the child’s legal guardian about the behaviour of the child before the treatment, whether the child has any previous dental treatment experience and the dentist’s rating for the child’s behaviour at the end of the treatment at the same visit. Finally, when assessing the external validity of the binary ACDAS, it was shown that its results compared favourably with those of the main study (κ = 0.79, sensitivity = 96.4%, specificity = 65.9%) when applied to children in a different London school (κ = 0.68, sensitivity = 92.9%, specificity = 73.5%). Therefore, ACDAS was shown to work well in two different locations with different children, which suggests that it is a generalisable scale. Based on the findings of this study, it is proposed that the ACDAS encompasses the required criteria for the gold standard dental anxiety scale for children.