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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.

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

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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).

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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.

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Correspondence to Ana Clara Ferreira Paiva.

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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).

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