Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2013  |  Volume : 31  |  Issue : 1  |  Page : 22--24

Dental anxiety prediction using Venham Picture test: A preliminary cross-sectional study

M Agarwal, UM Das 
 Department of Pedodontics, Maaruti Dental College, Bangalore, Karnataka, India

Correspondence Address:
M Agarwal
Department of Pedodontics, Maaruti Dental College, Bangalore, Karnataka


Anxiety or fearfulness affects a child«SQ»s behavior, and to a large extent, determines the success of a dental treatment. It is essential to identify anxious children at the earliest age possible rather than simply deal with them later. It is crucial that every effort be made to ensure a positive experience for each child patient. Appropriate acknowledgment of patient«SQ»s anxiety can solidify their confidence and allows the pediatric dentist an informed review of potential management options specific to every individual. In the present cross-sectional study, Venham Picture, a psychometric test, was used to estimate the prevalence of dental anxiety among children in the age group 6-10 years, with and without previous dental experience.

How to cite this article:
Agarwal M, Das U M. Dental anxiety prediction using Venham Picture test: A preliminary cross-sectional study.J Indian Soc Pedod Prev Dent 2013;31:22-24

How to cite this URL:
Agarwal M, Das U M. Dental anxiety prediction using Venham Picture test: A preliminary cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2021 Feb 28 ];31:22-24
Available from:

Full Text


In spite of all advances, fear and distaste of dentistry still lingers.

Anxiety is defined as a nonspecific feeling of apprehension, worry, uneasiness or dread, the source of which may be vague or unknown.

- Trait anxiety - represents general personality features (inherited).

- State anxiety - transient state induced by a certain event or situation.

Child dental anxiety has been a matter of concern for many years [1] because of various handicapping complications associated with it like prolonged chairside time, behavior management problems, and avoidance of dental care. [2] However, its etiology is not entirely understood.

The various schools of psychological thought agree that anxiety is a personality trait, but they have various opinions concerning the origin of this trait. Moreover, several variables in children's backgrounds have been identified as stimuli related to it. [3] Among the non-dental markers are the problems visiting a physician, dental fear in either of the parents, maternal anxiety, and anxiety meeting new people. Four dental markers have been identified: Prior problems during a dental visit, dislike of the dentist, not enough time to dental situations, and fear of injections. [3] Dental anxiety may even originate from lack of dental environment at all. [4]

The impact of first dental visit can influence all future reactions and behavior to dentistry. Sequential dental visits have been shown to have varying effects on psychological and physiological responses that range from improvement in behavior to no change, to increase in negativity, with no consistent marker. [3] Hence, accurate assessment of dental anxiety is very important, with the literature deficient in reports differentiating the effect of prior dental experience and its correlation with child's behavior.

The purpose of this study was to:

Identify the significance of this variable andDetermine if a relationship exists between prior dental experience and children's dental anxiety.

 Materials and Methods

The study was conducted in Bangalore (Karnataka, India).

Sample: 200 children, each 8-10 years old at the time of data collection.

Eligibility criteria

Child should be present on the day of data collection.Child should have adequate physical, psychological, and mental condition.All children were enquired about their previous dental visits and were asked if they would agree to take part in a study investigating how children emotionally feel about dentist, and were subsequently divided into two groups:Group I: 100 children without previous dental experienceGroup II: 100 children with previous dental experience Scale: Venham Picture test [5]

Measures state dental anxietyEasy to administer and scoreConsists of eight cards with pictures of children in various dental situationsThere are two figures on each card, one in which a child appears happy and the other one in which he looks distressedEach child was asked how they would feel about visiting the dentist the next day and to point out the figure they liked the most.

A score was recorded for each card when "high fear" picture was selected and summed to give total out of eightHigher scores indicate greater fear


No. of participants in group I=100No. of boys in group I=34No. of girls in group I=66No. of participants in group II=100No. of boys in group II=51No. of girls in group II=49 Standard error=0.28 Z test was applied to determine the statistical significance of the variable between the two groups (Z=1.07, P value >0.05) [Table 1],[Table 2] and [Table 3]. Hence, no statistically significant relationship was found between group I and group II total Venham Picture test scores.So, this study shows that prior dental experience is not a significant variable for dental anxiety level in school children.{Table 1}{Table 2}{Table 3}


Given the significance of anxiety in practice, it is crucial to assess the prevalence and identify the significance of variables associated with it. [1] Several variables in children's background have been identified as stimuli related to their dental anxiety.

Koenigsberg and Johnston suggested that maternal anxiety is only for child's first visit, after which "previous experience" tends to have more significant weighting. [6] Regarding the relationship between prior dental experience and dental anxiety, previous studies vary in their conclusion. Peretz and Mann reported that dental anxiety scores in all children who had experienced dental procedure in the past were higher than the scores of children who had not. [7] Howitt and Stricker found that child patient arousal decreased with visits. [8]

Koenigsberg and Johnson in two separate studies found either no relationship between anxiety and sequential visits or unchanged responses. [6] Peretz et al. found in their study that age, education, place of birth, and having had previous dental treatment did not influence the mean Dental Anxiety Scores (DAS) of the children. [4] Our study has shown that previous dental exposure did not have significant influence on mean Venham Picture Scale scores of school children and reflects the results of previous studies.

The reasons for the above finding could be the following:

Effective interpersonal communication skills by dental professionalsEffective education and motivation programsIncreased school-based health programsMedia advertisingTechnological advances such as improved local anesthesia and treatment techniquesThe majority of children had low levels of fear; however, a small but significant number showed higher fear.

The reasons identified were

Needle phobia andFear of dentist extracting tooth.Limitations

Small study sampleStudy was conducted in school environmentChildren were unaware of the type of treatment


This study shows that there was no significant difference in the mean Venham Picture test anxiety scores between 8- and 10-year-old children with or without previous dental exposure.

A larger study is needed to better understand the possible association.Hence, this indicates the need to explore further evidence of co-relation of this variable with children's dental anxiety.


1Buchanan H, Niven N. Validation of facial image scale to assess child dental anxiety. Int J Pediatr Dent 2002;12:47-52.
2Brill WA. Child behavior in a private pediatric dental practice associated with type of visits, age and socio economic factors. J Clin Pediatr Dent 2000;25:1-7.
3Klingberg G, Berggen U, Carlsson SG, Noren JG. Child Dental fear: Cause related factors and clinical effects. Eur J Oral Sci 1995;103:405-12.
4Peretz B, Nazarian Y, Bimstien E. Dental anxiety in a student's pediatric dental clinic: Children, parents and students. Int J Pediatr Dent 2004;14:192-5.
5Venhamm LL. The effect of mother's presence on child's response to dental treatment. J Dent Child 1979;46:219-25.
6Koenigsberg SR, Johnson R. Child behavior during three dental visits. J Dent Child 1975;34:197-200.
7Pertz B, Mann J. Dental anxiety among Israeli dental students: A 4 yr longitudinal study. Eur J Dent Educ 2000;4:133-7.
8Howitt JW, Stricker G. Sequential changes in response to dental procedure. J Dent Res 1970;49:1074-7.