Birth Order and its Effect on Children’s Dental Anxiety and Behavior during Dental Treatment

The Open Dentistry Journal 06 June 2023 RESEARCH ARTICLE DOI: 10.2174/18742106-v17-2305300-2022-120



To investigate the association between dental anxiety and birth order among children seeking dental treatment at King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia.


A total sample of 306 children aged 6-12 years were enrolled in a cross-sectional descriptive study. Demographic background data on the family and childbirth order were collected using a validated questionnaire. The Abeer dental anxiety scale (ADAS) was used to assess the dental anxiety level, while the Frankl scale was used to assess behavior during dental treatment. Binary Regression analysis was carried out to evaluate the effect of sociodemographic factors on the child’s anxiety and behavior according to the ADAS and Frankl scale, respectively.


The childbirth order had a significant effect on the anxiety score ( p<0.0001). The ADAS score in middle-born children was statistically significantly lower than that of only children, first-borns and last-borns ( p=0.018). Further, there was a statistically significant effect of childbirth order on behavior according to the Frankl scale ( p<0.0001).


The presence of siblings and childbirth order are significant indicators of children’s behavior and anxiety during dental treatment. This study provides valuable information that can help pediatric dentists plan behavior management for children.

Keywords: Birth order, Dental anxiety, Behavior, Abeer dental anxiety scale, Frankl scale, Anxiety score.
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