Antonio Crego and his colleagues assessed the children's fear of the dentist, any bad experiences they'd had, their personality, their relatives' fear and, most importantly for this study, their "cognitive vulnerability". This last measure looked at how much the children had feelings of uncontrollability (e.g. feeling trapped), unpredictability (not knowing what will happen), dangerousness (expecting pain) and disgustingness (expecting it to turn their stomach) about a visit to the dentist. The mothers and fathers answered the same questionnaires.


As you'd expect, all the non-cognitive factors were associated with the children's dental fear. So having a bad experience, having a more fearful temperament and having fearful parents were all associated with being more scared of the dentist. But none of these were as strongly related to the children's fear as their cognitive vulnerability, which explained an additional 20 per cent of variation in fear levels.


Particularly striking was the finding that a bad experience was no longer associated with children's dental fear once cognitive vulnerability was taken into account. The implication is that a bad experience only leads children to fear the dentist if it increases their feelings of uncontrollability, dangerousness and so forth. Of the various components of children's cognitive vulnerability, it was perceived disgustingness that was most strongly related to their fear of the dentist.


Another finding was an association between children's cognitive vulnerability and their parents' cognitive vulnerability. Although there's no proof here that the parents are passing their thinking style onto their children, the researchers said this could reflect a kind of "cognitive transfer" among family members. This suggests that interventions aimed at reassuring children may need to target parents too.


Some further curiosities - the dental fear of children younger than 13 was more closely associated with their father's fear; for teenagers over 13, their fear was tied more with their mother's fear. Overall, cognitive vulnerability was more strongly associated with dental fear in teenagers, perhaps because of their increasingly mature thought processes.


Crego and his colleagues said their "cognitive approach may help explain why some children develop dental fear problems after suffering a negative dental experience and how dental anxiety is passed from parents to children."



Crego, A., Carrillo-Diaz, M., Armfield, J., and Romero, M. (2013). Applying the Cognitive Vulnerability Model to the analysis of cognitive and family influences on children's dental fear. European Journal of Oral Sciences DOI:


Author weblink:

From BPS Research Digest