Parental anxiety disorders and their impact on dental treatment in children aged 4 to 13 years: a cross-sectional observational study

Academic Editor: Takeyasu Maeda Received: 5 February 2025 Revised: 22 February 2025 Accepted: 7 March 2025 Published: 10 March 2025 Citation: Bayón, G.; Stiernhufvud, F.; Ribas-Pérez, D.; Biedma Perea, M.; Mendoza Mendoza, A. Parental Anxiety Disorders and Their Impact on Dental Treatment in Children Aged 4 to 13 Years: A Cross-Sectional Observational Study. J. Clin. Med. 2025,14, 1869. https://doi.org/ 10.3390/jcm14061869 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/). Article Parental Anxiety Disorders and Their Impact on Dental Treatment in Children Aged 4 to 13 Years: A Cross-Sectional Observational Study Gloria Bayón, Fabiola Stiernhufvud, David Ribas-Pérez * , María Biedma Perea and Asunción Mendoza Mendoza Department of Stomatology, Faculty of Dentistry, University of Seville, Avicena Street s/n, 41009 Seville, Spain; [email protected] (M.B.P.); [email protected] (A.M.M.) *Correspondence: [email protected] Abstract: Introduction: Children with dental fear and/or anxiety will use all available means to avoid or delay dental treatment, which can cause a deterioration in their oral health. A close relationship has been demonstrated between parents’ fear and/or anxiety about the dentist and the development of dental anxiety in children. Objective: Our aim is to evaluate the anxiety of children’s parents and the factors that influence the prediction of anxiety and children’s behavior, as well as its impact on the risk of caries. Method: This is a descriptive cross-sectional study. For data collection, scientifically validated questionnaires were used for parents (n= 101) and children (n= 101). Statistical analysis was performed using the Chi2 test, the independent sample t test, and the Mann–Whitney test. Results: A direct relationship (p= 0.095) was found between the Corah test and the Venham test, as well as statistical significance (p= 0.035) between the STAI-Trait and the Venham test. The type of treatment the child is going to undergo is a determining factor in parental anxiety. A total of 85% of the patients exhibited positive behavior regardless of the degree of parental anxiety. Conclusions: The relationship between the anxiety of the parent and the child was very limited and restricted to specific cases; direct associations were found between the oral state of the child and the anxiety of the parents. Keywords: dental anxiety; dental fear; caries index; dental treatment 1. Introduction Fear and anxiety are correlated emotional states. Fear is the reaction generated by a real or imminent danger and is linked to the stimulus that produces it; therefore, it is an objective reaction. On the other hand, anxiety is the anticipatory state of a future danger that has not yet occurred and that we do not know will occur; it is considered a “subjective fear”, as there is no apparent cause that generates it [ 1 , 2 ]. These emotional processes are, to a certain extent, essential to the human affective repertoire because they enhance performance in motor, physiological, and cognitive tasks. In this context, they will be considered adaptive phenomena. However, when these emotions exceed levels that are considered “normal” and compromise an individual’s performance of daily activities, they will be considered pathologies [3]. Dental anxiety is defined as a feeling of apprehension about dental treatment [ 4 ]. It is an excessive, negative, and unreasonable emotional state experienced by patients before, during, or after dental treatment [ 5 ]. In contrast, dental fear refers to an unpleasant emotional reaction to specific threatening stimuli that occur in situations associated with dental treatment [5]. J. Clin. Med. 2025,14, 1869 https://doi.org/10.3390/jcm14061869 J. Clin. Med. 2025,14, 1869 2 of 14 Childhood behavior associated with dental anxiety and fear has been one of the great challenges in pediatric dentistry. The emotional state of the child during dental treatment can create difficulties in terms of its evaluation due to, among other things, the child’s immaturity in communicating his feelings [6]. Currently, there is a high percentage of generalized dental anxiety in the population. It is estimated that 264 million people suffer from anxiety, a prevalence that has increased by up to 15% from 2005 to 2015 as a result of population growth and an increase in life expectancy [ 7 ]; it is recognized by the World Health Organization (WHO) as a true pathology [ 8 – 10 ]. In Spain, according to the latest report (December 2020) from the primary care clinical database (BDCAP) [ 11 ], anxiety is the most frequent mental health problem in the Spanish population, affecting 88.4% of women and 45.2% of men aged between 35 and 84 years. There are multiple factors that cause or trigger dental anxiety, namely, the age and sex of the patient [ 5 , 12 , 13 ], the dental treatment to which he or she will be subjected [ 14 ], the teaching style and family structure [ 15 ], the number of siblings and their birth order [ 16 ], and the anxiety of the parents or progenitors. Therefore, it is important to inform and guide parents about the oral health of their children and the influence of their feelings on those of the child. Less anxious children tend to accept more easily the procedures to which they will be subjected, which allows for the success of the dental treatment [17]. It has been shown that by carrying out tests on dental anxiety prior to treatment, it is possible to identify patients who suffer from this disorder, thereby allowing for greater cooperation and a reduction in the anxiety levels of these patients. However, very few professionals carry out this type of testing before dental treatment, since most rely on their experience and intuition to assess a patient’s dental anxiety level. In contrast, pediatric dentists have been shown to be more successful in identifying anxious and non-anxious pediatric patients, leading to better outcomes when performing these types of treatments on children [18–20]. In the current literature, there are different scales to assess the anxiety of guardians or parents, namely, the Corah Dental Anxiety Scale [ 21 , 22 ] and its variant, the Modified Corah Dental Anxiety Scale (MDAS) [ 23 ], the Early Childhood Oral Health Impact Scale (ECOHIS) [24], and/or the Dental Anxiety Inventory (IDATE) [25]. On the other hand, dental anxiety in children can be assessed using the Children’s Fear Survey Schedule (CFSS) [ 26 ], designed by Scherer and Nakamura to study the distribution and etiology of dental fear in children, and/or the Venham Clinical Anxiety Rating Scale [27,28] , which consists of a series of cartoon figures representing various emotional states. This approach allows the child to identify with each of the situations shown, resulting in a simple yet valid and reliable scale of the child’s response to situational stress. The aim of the present study is to establish the possibility of a relationship between the emotional state of the parents and the child’s behavior during dental practice, as well as the risk of caries that the child presents. 2. Materials and Methods 2.1. Design and Sample of This Study A descriptive cross-sectional study was carried out with 202 patients, including 101 guardians or parents and 101 children aged between 4 and 13 years, who attended the pediatric dentistry services of a private clinic located in the south of Badajoz (Spain). This age range is justified since a minimum level of knowledge is necessary on the part of the child to be able to answer the questions in the questionnaire. J. Clin. Med. 2025,14, 1869 3 of 14 In the statistical analysis, the proposed sample will be adjusted, and a 95% confidence interval will be proposed with a 5% margin of error; the data may be modified according to the circumstances for a better adaptation of the work. 2.2. Data Collection Following approval by the ethics committee of the Andalusian Government, inclusion and exclusion criteria will be established, and data collection will be out; questionnaires and anxiety scales that have already been scientifically researched and previously translated into Spanish, with high reliability, easy application, and low cost will be used. Data collection will be carried out through interviews with parents or guardians, as well as interviews and clinical–radiographic examinations of children. These will be part of the dental procedure that the patient will undergo and will also serve to determine the caries index (dft/DMFT, as required) of each patient, thus helping us understand its influence on the level of anxiety. Reading the information sheet and signing the informed consent by parents or legal guardians was essential for participation in this research study. 2.3. Dental Anxiety in Children The scales used to verify dental anxiety in children are as follows: ➢ Venham Clinical Anxiety Rating Scale [ 27 , 28 ]: Performed on children between the ages of 4 and 8 years, inclusive. From each illustration, the patient must choose one of the figures, which will determine their emotional state. ➢ Child and Adolescent Fear Scale (CFSS) [ 26 ]: Designed by Scherer and Nakamura to study the distribution and etiology of dental fear in children. This test will be performed on patients over 8 years of age. ➢ Frankl Behavior Scale [ 29 ]: In 1962, Frankl devised a behavior scale to study children’s reactions to being separated from their parents in the dental office. For this reason, Frankl analyzed children’s behavior in each of the circumstances involved in a first visit (clinical examination, X-ray, prophylaxis, etc.) and a treatment visit (anesthesia injection, cavity preparation, filling, etc.), classifying the patients according to their behavior as definitely positive, slightly positive, slightly negative, or definitely negative. ➢ Collection of vital signs: The pulse will be recorded, with the help of a Homiee Pulse Oximeter ® , and, using the North Carolina Behavior Scale [ 30 ], parameters will be analyzed, including the movements of the legs and arms, the presence of crying, and any oral and/or physical resistance from the child. 2.4. Dental Anxiety in Guardians or Parents The scales used to verify dental anxiety in guardians or parents are as follows: ➢ Modified Corah Dental Anxiety Scale (MDAS) [ 23 ]: There are several methods for measuring dental anxiety, one of them being the Modified Corah Dental Anxiety Scale [ 23 ], which was later expanded and modified. Each question presents five alternative responses evaluated on a scale from 1 to 5, indicating the absence of anxiety and the highest level of anxiety, respectively. The score ranges from 5 (no anxiety) to 25 (high anxiety). ➢ The Early Childhood Oral Health Impact Scale (ECOHIS) [ 24 ]: In order to verify the mother’s perception in relation to her children, we used the ECOHIS, or the Early Childhood Oral Health Impact Scale [ 24 ]. According to the WHO, this scale includes a section on child impact (domains of symptoms, function, psychology, and self-image/social interaction) and a section on family impact (domains of distress and family function). The questionnaire contains 13 questions, whose answers include J. Clin. Med. 2025,14, 1869 4 of 14 (a) never, (b) almost never, (c) occasionally, (d) often, (e) very often, and (f) I do not know. In addition, 2 extra questions were added to the questionnaire so that parents could rate their children’s general and oral health. ➢ Inventory of Anxiety (IDATE) [ 25 ]: It consists of two scales obtained from a questionnaire designed to measure two different anxiety concepts: state anxiety (state A) and trait anxiety (trait A). The trait anxiety scale consists of 20 statements that require subjects to describe how they feel in general. The state anxiety scale also consists of 20 statements from individuals to indicate how they feel at a specific time. For each statement, the subject must select one of the four alternatives to indicate how he or she feels: not at all; a little; enough; and a lot (on the state A scale); or almost never; sometimes; frequently; and almost always (on the trait A scale). These questionnaires were re-adapted by the examiner, eliminating questions that were not considered appropriate for this study and limiting the questionnaire to 10 general statements (state A) and 10 specific ones (trait A), while also adding several questions during the treatment visits. MDAS [ 23 ] and the IDATE [ 25 ] will be filled out on 3 occasions by the parents (first visit and first and last day of treatment), while the ECOHIS questionnaire [ 24 ] and the fear test [ 26 ], given to children over 8 years old, will only be filled out during the first visit, as they consist of more generalized questions. The level of anxiety of the parents or guardians in relation to the type of treatment that the child will undergo will also be analyzed in order to assess whether the parents’ anxiety varies depending on the type of treatment to be carried out. 2.5. Caries Analysis The caries examination was carried out by a single calibrated operator through visual and radiographic examination, which was subsequently recorded in an odontogram. The calibration was carried out according to the guidelines described by the WHO [ 31 ], where the indices used to analyze dental caries consider the tooth as a unit. Thus, patients who have only temporary dentition will be assigned the cod index, while those who have permanent dentition will be assigned the DMFT index. Therefore, those who have mixed dentition will be assigned the cod and DMFT indices independently, depending on the pieces present. The risk of caries will be determined according to the table of caries severity indicators provided by the WHO [32]. 3. Results The sample consisted of 101 adults (parents or guardians) and 101 children between 4 and 13 years of age who were eligible for dental treatment; the mean age of the study population was 6.4 years. Of the total sample, 46.5% were boys and 53.5% were girls, with the following age distribution (Figure 1): J. Clin. Med. 2025,14, 1869 5 of 14 J. Clin. Med. 2025, 14, x FOR PEER REVIEW 5 of 14 Figure 1. Age distribution of the sample According to their age, most of the patients had primary dentition (DT) (45.5%) or mixed dentition (DM) (53.5%), and only one had permanent dentition (DP). For the 100 children with DT or DM, where the evaluation of the cod index was possible, a mean of 6.7 ± 2.7 was obtained. For the 55 children with DM or DP, the mean DMFT was 0.4 ± 0.9, as shown in Table 1. Table 1. Caries risk distribution according to the type of dentition. DENTITION Category Total N Total % Temporal N Temporal % Mixed N Mixed % Permanent N Permanent % Total 101 100.0% 46 100.0% 54 100.0% 1 100.0% Low 1 1.0% 1 2.2% 0 0.0% 0 0.0% Moderate 10 9.9% 10 21.7% 0 0.0% 0 0.0% High 17 16.8% 16 34.8% 0 0.0% 1 100.0% Very high 19 18.8% 19 41.3% 0 0.0% 0 0.0% Low/Very low 3 3.0% 0 0.0% 3 5.6% 0 0.0% Mod./Very low 8 7.9% 0 0.0% 8 14.8% 0 0.0% Alto/Very low 10 9.9% 0 0.0% 10 18.5% 0 0.0% Very high/Very low 30 29.7% 0 0.0% 30 55.6% 0 0.0% Very high/Low 3 3.0% 0 0.0% 3 5.6% 0 0.0% The risk of caries in children with DT is very high in 76.1% of cases. In the analysis of parental anxiety, 67.3% of parents are classified as having “low” anxiety, and 31.7% are classified as having “moderate” anxiety. Only one parent presents “high” anxiety, according to the ECOHIS. As in the Corah and IDATE tests, neither parent exhibits a pathological state of anxiety. In the analysis of anxiety and behavior in children, the fear test (CFSS > 8 years) reveals that 30.8% of patients are classified as having “no fear” and 69.2% as having “little fear”. Similarly, in the Venham test (<8 years), 96.6% are classified as “non-anxious” children. Regarding children’s behavior, according to the Frankl scale, most of the children exhibited very positive behavior during the interventions (first visit to the dentist, T1; first treatment visit, T2; and second treatment visit, T3) (Table 2). 12.9 16.8 31.7 15.8 9.9 7.9 212 0 10 20 30 40 % Age 4 5 6 7 8 9 10 12 13 Figure 1. Age distribution of the sample. According to their age, most of the patients had primary dentition (DT) (45.5%) or mixed dentition (DM) (53.5%), and only one had permanent dentition (DP). For the 100 children with DT or DM, where the evaluation of the cod index was possible, a mean of 6.7 ± 2.7 was obtained. For the 55 children with DM or DP, the mean DMFT was 0.4 ± 0.9, as shown in Table 1. Table 1. Caries risk distribution according to the type of dentition. DENTITION Category Total N Total % Temporal N Temporal % Mixed N Mixed % Permanent N Permanent % Total 101 100.0% 46 100.0% 54 100.0% 1 100.0% Low 1 1.0% 1 2.2% 0 0.0% 0 0.0% Moderate 10 9.9% 10 21.7% 0 0.0% 0 0.0% High 17 16.8% 16 34.8% 0 0.0% 1 100.0% Very high 19 18.8% 19 41.3% 0 0.0% 0 0.0% Low/Very low 3 3.0% 0 0.0% 3 5.6% 0 0.0% Mod./Very low 8 7.9% 0 0.0% 8 14.8% 0 0.0% Alto/Very low 10 9.9% 0 0.0% 10 18.5% 0 0.0% Very high/Very low 30 29.7% 0 0.0% 30 55.6% 0 0.0% Very high/Low 3 3.0% 0 0.0% 3 5.6% 0 0.0% The risk of caries in children with DT is very high in 76.1% of cases. In the analysis of parental anxiety, 67.3% of parents are classified as having “low” anxiety, and 31.7% are classified as having “moderate” anxiety. Only one parent presents “high” anxiety, according to the ECOHIS. As in the Corah and IDATE tests, neither parent exhibits a pathological state of anxiety. In the analysis of anxiety and behavior in children, the fear test (CFSS > 8 years) reveals that 30.8% of patients are classified as having “no fear” and 69.2% as having “little fear”. Similarly, in the Venham test (<8 years), 96.6% are classified as “non-anxious” children. Regarding children’s behavior, according to the Frankl scale, most of the children exhibited very positive behavior during the interventions (first visit to the dentist, T1; first treatment visit, T2; and second treatment visit, T3) (Table 2). J. Clin. Med. 2025,14, 1869 6 of 14 Table 2. Child behavior according to the Frankl scale. FRANKL SCALE Category N % FRANKL T1 Total 101 100.0% Def. positive 85 84.2% Lig. positive 14 13.9% Lig. negative 2 2.0% FRANKL T2 Total 101 100.0% Def. positive 91 90.1% Lig. positive 10 9.9% FRANKL T3 Total 101 100.0% Def. positive 85 84.2% Lig. positive 15 14.9% Lig. negative 1 1.0% As for crying and limb movement, an increase was found as the treatment progressed (Table 3). Table 3. Relationship between VENHAM in children and pulse/manifestations: results of Pearson correlation coefficient (r), Chi2 test, and Fisher’s exact test. * pvalue < 0.05. r; p-Value Chi2/Fisher; p-Value PULSE T1 r= 0.06; p= 0.575 p= 0.801 T2 r= −0.01; p= 0.919 p= 0.838 T3 r= −0.09; p= 0.411 p= 0.819 CRYING T1 p= 0.193 T2 p= 1.000 T3 p= 0.003 * ARM MOV. T1 p= 0.385 T2 p= 0.501 T3 p= 0.105 LEG MOV. T1 p= 0.279 T2 p= 1.000 T3 p= 0.084 ORAL RESIST. T1 p= 1.000 T2 p= 1.000 T3 p= 1.000 PHYSICAL RESIST. T1 p= 1.000 T2 p= 1.000 T3 p= 1.000 When relating the different tests carried out on the guardians to the tests and data collected from the children, only a weak correlation (r = 0.18; p= 0.0095) was detected between the anxiety of the guardians (Corah) and that of the children (Venham < 8 years) at the first visit (Figure 2). As with the correlation between Venham and STAI-Trait at the third visit, where statistical significance is reached (p= 0.035), it can only be assessed as “weak” (r = 0.22). The higher the parents’ trait anxiety score, the higher the children’s Venham score at the last treatment visit (Figure 3). J. Clin. Med. 2025,14, 1869 7 of 14 J. Clin. Med. 2025,14, x FOR PEER REVIEW 7of 14 Figure 2. Relationship between parental Corah test and children Venham test at the first visit. As with the correlation between Venham and STAI-Trait at the third visit, where statistical significance is reached (p = 0.035), it can only be assessed as ”weak” (r = 0.22). The higher the parents’ trait anxiety score, the higher the children’s Venham score at the last treatment visit (Figure 3). Figure 3.Relationship between parental STAI-trait test test and children Venham test at the third visit. The type of treatment is significantly associated with a higher level of anxiety among the parents, as shown in the following table (Table 4): Figure 2. Relationship between parental Corah test and children Venham test at the first visit. J. Clin. Med. 2025,14, x FOR PEER REVIEW 7of 14 Figure 2. Relationship between parental Corah test and children Venham test at the first visit. As with the correlation between Venham and STAI-Trait at the third visit, where statistical significance is reached (p = 0.035), it can only be assessed as ”weak” (r = 0.22). The higher the parents’ trait anxiety score, the higher the children’s Venham score at the last treatment visit (Figure 3). Figure 3.Relationship between parental STAI-trait test test and children Venham test at the third visit. The type of treatment is significantly associated with a higher level of anxiety among the parents, as shown in the following table (Table 4): Figure 3. Relationship between parental STAI-trait test test and children Venham test at the third visit. The type of treatment is significantly associated with a higher level of anxiety among the parents, as shown in the following table (Table 4): J. Clin. Med. 2025,14, 1869 8 of 14 Table 4. Relationship between ECOHIS of parents and treatments: results of independent samples t test and Mann–Whitney test. * pvalue < 0.05. t; p-Value MW; p-Value OBTURATION T2 p= 0.207 p= 0.189 T3 p= 0.049 * p= 0.189 PULPOTOMY T2 p= 0.803 p= 0.834 T3 p= 0.181 p= 0.625 PULPECTOMY T2 p= 0.327 p= 0.573 T3 p= 0.050 p= 0.040 * EXODONTIA T2 p< 0.001 * p= 0.008 * T3 p= 0.038 * p= 0.024 * According to ECOHIS, 83.3% of parents reported “moderate-high anxiety” if a tooth extraction was performed, compared to only 29.5% otherwise. Pulpectomy also increased the rate of anxiety in three of the parents interviewed (Table 5). Table 5. Relationship between CORAH of parents and treatments: results of independent samples t test and Mann–Whitney test. * pvalue < 0.05. t; p-Value MW; p-Value OBTURATION T2 p= 0.324 p= 0.527 T3 p= 0.536 p= 0.471 PULPOTOMY T2 p= 0.553 p= 0.328 T3 p= 0.222 p= 0.046 * PULPECTOMY T2 p= 0.147 p= 0.097 T3 p= 0.509 p= 0.449 EXODONTIA T2 p= 0.583 p= 0.665 T3 p= 0.856 p= 0.785 According to Corah, 90% of parents experienced “moderate or greater anxiety” when the treatment to be performed was a pulpotomy. In another case, only 50.6% experienced this level of anxiety. Regarding the STAI-State/STAI-Trait, significant relationships were found at the second treatment visit, when the treatment to be performed was a filling or a pulpectomy, as shown in the following table (Table 6): Table 6. Relationship between STAI-Parent traits and treatments: results of independent samples t test and Mann–Whitney test. * pvalue < 0.05. t; p-Value MW; p-Value OBTURATION T2 p= 0.010 * p= 0.365 T3 p= 0.513 p= 0.634 PULPOTOMY T2 p= 0.985 p= 0.728 T3 p= 0.763 p= 0.455 PULPECTOMY T2 p= 0.042 * p= 0.506 T3 p= 0.416 p= 0.132 EXODONTIA T2 p= 0.588 p= 0.813 T3 p= 0.596 p= 0.875 Regarding the risk of caries, although statistical significance is not reached, a weak correlation is suggested between the cod index and the ECOHIS score; in a direct sense, the higher the ECOHIS, the higher the caries rate (Table 7). Table 7. Relationship between cod, DMFT, risk of caries in temporary dentition, TD, and mixed DM of children and ECOHIS of parents: results of Pearson correlation coefficient (r) and Spearman (rS). r; p-Value rS; p-Value dft r = 0.19; p= 0.056 -- DMFT r = 0.12; p= 0.395 -- DT risk -- rS = 0.02; p= 0.888 DM risk -- rS = 0.13; p= 0.365 The risk of caries in DT (cod), is significantly correlated with the Corah score of the parent, as shown in the following figure (Figure 4): J. Clin. Med. 2025,14, 1869 9 of 14 J. Clin. Med. 2025, 14, x FOR PEER REVIEW 9 of 14 Table 7. Relationship between cod, DMFT, risk of caries in temporary dentition, TD, and mixed DM of children and ECOHIS of parents: results of Pearson correlation coefficient (r) and Spearman (rS). r; p-Value rS; p-Value dft r = 0.19; p = 0.056 -- DMFT r = 0.12; p = 0.395 -- DT risk -- rS = 0.02; p = 0.888 DM risk -- rS = 0.13; p = 0.365 The risk of caries in DT (cod), is significantly correlated with the Corah score of the parent, as shown in the following figure (Figure 4): Figure 4. Caries risk in DT according to CORAH Parents Anxiety Scale. Regarding the risk of caries vs. STAI-State, no relevant correlation was found. However, regarding the STAI-Trait, a higher risk of caries was found in DM if the parents scored higher on the STAI-Trait (Table 8). Table 8. Relationship between dft, DMFT, risk of caries in temporary dentition, TD, and mixed DM of children and STAI-Trait of parents: results of Pearson correlation coefficient (r) and Spearman (rS). * p value < 0.05. r; p-Value rS; p-Value dft r = 0.07; p = 0.483 -- DMFT r = 0.10; p = 0.462 -- DT risk -- rS = −0.03; p = 0.865 DM risk -- rS = 0.28; p = 0.040 * 4. Discussion In our study, we have shown that guardians or parents with fear or anxiety about the dentist can transmit these unconstructive emotions to their children. This can affect the child’s behavior during visits to the dentist (especially during the first visit), but not the child’s development of anxiety or fear symptoms; a weak relationship was observed between the child’s anxiety and that of the parents when we compared the different tests 5.6 22.2 27.3 50 27.3 16.7 22.2 45.5 83.3 0 25 50 75 100 % Muy alto Alto Moderado Bajo Slight/Null Moderate High/Severe Very high High Moderate Slight Figure 4. Caries risk in DT according to CORAH Parents Anxiety Scale. Regarding the risk of caries vs. STAI-State, no relevant correlation was found. However, regarding the STAI-Trait, a higher risk of caries was found in DM if the parents scored higher on the STAI-Trait (Table 8). Table 8. Relationship between dft, DMFT, risk of caries in temporary dentition, TD, and mixed DM of children and STAI-Trait of parents: results of Pearson correlation coefficient (r) and Spearman (rS). *pvalue < 0.05. r; p-Value rS; p-Value dft r = 0.07; p= 0.483 -- DMFT r = 0.10; p= 0.462 -- DT risk -- rS = −0.03; p= 0.865 DM risk -- rS = 0.28; p= 0.040 * 4. Discussion In our study, we have shown that guardians or parents with fear or anxiety about the dentist can transmit these unconstructive emotions to their children. This can affect the child’s behavior during visits to the dentist (especially during the first visit), but not the child’s development of anxiety or fear symptoms; a weak relationship was observed between the child’s anxiety and that of the parents when we compared the different tests conducted during each visit to the dentist. However, given the small sample size, we cannot reject the null hypothesis. Petróvic et al. (2024) [ 33 ] also show, in their study, that the emotional state of the parents will influence the child’s behavior, either positively or negatively; however, this will not result in less or greater anxiety for the dentist, at least not in all cases. On the contrary, the studies by Rames et al. (2024) [ 34 ] and Besiroglu et al. (2024) [ 35 ] show that children’s nervousness during dental treatment is mainly caused by the mother’s anxiety. Greater fear and anxiety are found in young children than in adolescents, despite the fact that the latter may have been exposed to more traumatic dental episodes previously [ 17 , 36 ]. These results also coincide with our study, in which the majority of patients who underwent the CFSS were not afraid of the dentist. In contrast, despite the data obtained from this test, the question that generated the greatest fear in patients (>8 years old) was the one related to “needles and injections”. This coincides with the Corah scale administered to