Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The relationship between temperament and dental fear and anxiety: a systematic review



To investigate the relationship between temperament traits and dental fear and anxiety (DFA) in children and adolescents by the means of a systematic review (PROSPERO #CRD42020207578).


The PEO (Population, Exposure, and Outcome) strategy was followed using children and adolescents as the population, temperament as the exposure, and DFA as the outcome. A systematic search for observational studies (cross-sectional, case-control, and cohort) without restrictions on year or language of publication was performed in seven databases (PubMed, Web of Science, Scopus, Lilacs, Embase, Cochrane, and PsycINFO) in September 2021. Grey literature search was performed in OpenGrey, Google Scholar, and in the reference list of included studies. Study selection, data extraction, and risk of bias assessment were carried out independently by two reviewers. The Fowkes and Fulton Critical Assessment Guideline was used to assess methodological quality of each study included. The GRADE approach was performed to determine the certainty of evidence of relationship between temperament traits.


This study recovered 1362 articles, of which 12 were included. Despite the high heterogeneity of methodological aspects, qualitative synthesis by subgroups showed a positive association/correlation between emotionality, neuroticism, and shyness with DFA in children and adolescents. Different subgroups analysis showed similar results. Eight studies were classified as having low methodological quality.


The main shortcoming of the included studies is the high risk of bias and a very low certainty of evidence. Within its limitations, children and adolescents with a temperament-like emotionality/neuroticism and shyness are more likely to present higher DFA.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow diagram.
Fig. 2: Correlation/association between temperament dimensions and DFA.
Fig. 3: Correlation/association between temperament dimensions and DFA by instruments.


  1. Öhman A. Fear and anxiety: overlaps and dissociation. In: Lewis M; Haviland-Jones JM; Barret LF Handbook of Emotions. Chap 44, pp. 709–29. New York: The Guilford Press. 2008.

  2. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: American Psychiatric Association, Washington, DC. 2014.

  3. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent. 2007;17:391–406.

    Article  PubMed  Google Scholar 

  4. Cianetti S, Lombardo G, Lupatelli E, Pagano S, Abraha I, Montedori A, et al. Dental fear/anxiety among children and adolescents. A systematic review. Eur J Paediatr Dent. 2017;18:121–30.

    PubMed  Google Scholar 

  5. Grisolia BM, Santos APP, Dhyppolito IM, Buchanan H, Hill K, Oliveira BH. Prevalence of dental anxiety in children and adolescents globally: a systematic review and meta-analyses. Int J Paediatr Dent. 2020;31:168–83.

    Article  PubMed  Google Scholar 

  6. Morgan AG, Porrit J. Background and prevalence on dental fear and anxiety. In: Campell, C Dental fear and anxiety in pediatric patients. Chap 1, pp. 3–19. Cham: Springer. 2017.

  7. Ramos-Jorge J, Marques LS, Homem MA, Paiva SM, Ferreira MC, Ferreira FO, et al. Degree of dental anxiety in children with and without toothache: prospective assessment. Int J Paediatr Dent. 2013;23:125–30.

    Article  PubMed  Google Scholar 

  8. Colares V, Franca C, Ferreira A, Amorim Filho HA, Oliveira MCA. Dental anxiety and dental pain in 5- to 12-year old children in Recife, Brazil. Eur Arch Paediatr Dent. 2013;14:15–19.

    Article  PubMed  Google Scholar 

  9. Busato P, Garbin RR, Santos CN, Paranhos LR, Rigo L. Influence of maternal anxiety on child anxiety during dental care: cross-sectional study. São Paulo Med J. 2017;135:116–22.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stenebrand A, Boman UW, Hakeberg M. Dental anxiety and symptoms of general anxiety and depression in 15-year-olds. Int J Dent Hyg. 2013;11:99–104.

    Article  PubMed  Google Scholar 

  11. Abanto J, Vidigal EA, Carvalho TS, Sá SNC, Bönecker M. Factors determining dental anxiety in preschool children with severe dental caries. Braz Oral Res. 2017;31:e13.

    Article  PubMed  Google Scholar 

  12. Buss AH, Plomin R. Temperament: early developing personality traits. 193p. New Jersey: Lawrence Erlbaum Associates. 1984.

  13. Pereira PC, Guzzo RSL. Individual differences: temperament and personality; importance of the theory. Rev Estudos de Psicologia. 2002;19:91–100.

    Google Scholar 

  14. Eysenck HJ, Eysenck SBG. Manual of the Eysenck Personality Inventory. pp 26. Kent: Hodder and Stoughton. 1964.

  15. Eysenck HJ. The definition and measurement of psychoticism. Person Individ Diff. 1992;13:757–85.

    Article  Google Scholar 

  16. Quinonez R, Santos RG, Boyar R, Cross H. Temperament and trait anxiety as predictors of child behavior prior to general anesthesia for dental surgery. Pediatr Dent. 1997;19:427–31.

    PubMed  Google Scholar 

  17. Stenebrand A, Boman UW, Hakeberg M. Dental anxiety and temperament in 15-year-olds. Acta Odontol Scand. 2013;71:15–24.

    Article  PubMed  Google Scholar 

  18. Jain A, Suprabha BS, Shenoy R, Rao A. Association of Temperament with dental anxiety and behaviour of the preschool child during the initial dental visit. Eur J Oral Sci. 2019;127:147–55.

    PubMed  Google Scholar 

  19. Toledano M, Osorio R, Aguilera FS, Pegalajar J. Children’s dental anxiety: influence of personality and intelligence factors. Int J Paediatr Dent. 1995;5:23–28.

    Article  PubMed  Google Scholar 

  20. Kim SH, Baik BJ, Kim JG, Yang YM, Kwon BW. Relationship of dental anxiety between child and parent during dental visit. J Korean Acad Pediatr Dent. 2005;32:370–5.

    Google Scholar 

  21. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an update guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, et al. Conducting systematyc reviews of association (etiology): The Joanna Briggs Institute’s approach. Int J Evid Based Health. 2015;13:13–169.

    Article  Google Scholar 

  23. Ouzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan – a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.

    Article  Google Scholar 

  24. Fowkes FG, Fulton PM. Critical appraisal of published research: Introductory guidelines. BMJ. 1991;302:1136–40.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ryan R, Hill S. How to GRADE the quality of the evidence. Cochrane Consumers and Communication Group, available at Version 3.0 December 2016. 2016.

  26. Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB. Delineando a pesquisa clínica: uma abordagem epidemiológica. 2.ed. Porto Alegre: Artmed. 2003.

  27. Venham LL, Murray P, Gaulin-Kremer E. Personality factors affecting the preschool child’s response to dental stress. J Dent Res. 1979;58:2046–51.

    Article  PubMed  Google Scholar 

  28. Liddell A. Personality characteristics versus medical and dental experiences of dentally anxious children. J Behav Med. 1989;13:183–94.

    Article  Google Scholar 

  29. Kronina L, Rascevska M, Care R. Psychosocial factors correlated with children’s dental anxiety. Stomatologija. 2017;19:84–90.

    PubMed  Google Scholar 

  30. Pop-Jordanova N, Sarakinova O, Markovska-Simoska S, Loleska S. Anxiety and personality characteristics in children undergoing dental interventions. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2013;34:93–103.

    PubMed  Google Scholar 

  31. Sermet O. Emotional and medical factors in child dental anxiety. J Child Psychol Psychatry. 1974;15:313–21.

    Article  Google Scholar 

  32. Klingberg G, Broberg AG. Temperament and child dental fear. Pediatr Dent. 1998;20:237–43.

    PubMed  Google Scholar 

  33. Kalra N, Sabherwal P, Tyagi R, Khatri A, Srivastava S. Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children. J Dent Anesth Pain Med. 2021;21:119–28.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Klingberg G, Berggren U, Carlsson SG, et al. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci. 1995;103:405–12.

    Article  PubMed  Google Scholar 

  35. Porrit J, Buchanan H, Hall M, GilCchrist F, Marshman Z. Assessing children’s dental anxiety: a systematic review of current measures. Community Dent Oral Epidemiol. 2013;41:130–42.

    Article  Google Scholar 

  36. Cademartori MG, Cara G, Pinto GS, Costa VPP. Validity of the Brazilian version of the dental subscale of Children’s Fear Survey Schedule. Int J Paediatr Dent. 2019;29:736–47.

    Article  PubMed  Google Scholar 

  37. Brasil. Marco legal: saúde, um direito de adolescentes. Ministério da Saúde, Secretaria de Atenção à Saúde, Área de Saúde do Adolescente e do Jovem. Brasília: Ministério da Saúde, 2007. 60 p.

  38. Klaassen M, Veerkamp J, Hoogstraten J. Predicting dental anxiety. The clinical value of anxiety questionnaires: an explorative study. Eur J Paediatr Dent. 2003;4:171–6.

    PubMed  Google Scholar 

  39. Elm EV, Altamn DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observations Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.

    Article  Google Scholar 

  40. Bedos C, Loignon C. Patient-centered approaches: new models for new challenges. J Can Dent Assoc. 2011;77:b88.

    PubMed  Google Scholar 

  41. Gluyas H. Patient-centered care: improving healthcare outcomes. Nurs Stand. 2015;30:50–7.

    Article  PubMed  Google Scholar 

  42. Song Y, Luzzi L, Brennan DS. Trust in dentist-patient relationship: mapping the relevant concepts. Eur J Oral Sci. 2020;128:110–9.

    Article  PubMed  Google Scholar 

Download references


This study was supported by the Universidade Federal de Minas Gerais (UFMG), the Universidade Federal do Rio de Janeiro (UFRJ) and the Brazilian Coordination of Higher Education of the Ministry of Education (CAPES).

Author information

Authors and Affiliations



All the authors contributed on idea planning and development. ACFP contributed on bibliographic search, data extraction, data analysis, methodological quality assessment, interpretation of results, analysis of certainty of evidence and writing and review of the manuscript. DRC contributed on bibliographic search, data extraction, data analysis, methodological quality assessment, interpretation of results, analysis of certainty of evidence and writing and review of the manuscript. IBF contributed on data analysis and interpretation of the results, writing and review of the final version of the manuscript. MBM contributed on data analysis and interpretation of the results, analysis of certainty of evidence, writing and review of the final version of the manuscript. LCM contributed on data analysis and interpretation of the results, writing and review of the final version of the manuscript. SMP contributed on data analysis and interpretation of the results, writing and review of the final version of the manuscript. CBB contributed on data analysis and interpretation of the results, writing and review of the final version of the manuscript. All authors have revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Ana Clara Ferreira Paiva.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paiva, A.C.F., Rabelo-Costa, D., Fernandes, I.B. et al. The relationship between temperament and dental fear and anxiety: a systematic review. Evid Based Dent 24, 42 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links