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Measures of treatment need

Measures of dental fear treatment need should be used to determine the need for dental treatment based on potential dental care impairment, potential for adverse effect on oral health and deviation from normal dental fear levels determined for the community. The instrument should be used for planning treatment for individual patients and should also be valuable for community based studies when there is a need to plan for resource allocation to priority groups.

Presently, there are no existing measures specifically focusing on measuring treatment needs in an individual or a population. Identification of treatment needs for individuals are oftentimes based on subjective assessment by dentists. Such deductions are made from expressed behaviours by the child.

Ideally, the measure should not summarise scores as a summary would imply that the different items highlighted in the measure affect the need for treatment. These factors then become confounding.

There is presently no report discussing the community treatment need for dental fear based on scientific evaluation processes. No tools presently that can do this. A tool that may be able to identify the need for treatment of dental fear should be able to decipher that the traits present would predispose the child to increased risk of socio-psychological disturbances. Such a tool may need to have objective methods of determining this so as to enhance uniformity in the application of the measure.

Measures of treatment outcome

This measure provides an initial estimate of how far a case deviates from the normal and the differences between scores before and after treatment. This difference reflects the degree of improvement thereby providing a quantitative and reproducible measure of the score of success or failure of treatment.

It is often desirable to use the same instrument to measure treatment need and treatment outcome. Though often the same instrument is used to assess the treatment need and treatment outcomes in children managed for dental fear, the instruments were however not designed or validated for that purpose. At best, the instrument measures the degree of residual treatment but this does not sufficiently assess significant differences in treatment efficacy.

Psychological measuring scales which have clustered items based on factor analytic techniques and not just the use of conceptual or logical grouping may help in assessing the pre and post theurapeutic effects of dental fear reduction measures. The CFSS-DS and the DFSS-SF may not be ideal for this purpose as they measure only one dimensional construct of dental fear and uses score summaries for assessing levels of dental fear. The possible limitation of the use of psychometric scales with score summation was highlighted by Folayan and Idehen54.

An ideal tool for measuring treatment outcome must therefore be a numerical measure obtained through the measure of dental fear traits that are selected based on their potential for causing psychosocial handicap. It must be able to rank dental fear causing items objectively and reliably. This could possibly be so through the use of a mathematical formula for the estimation of societal norms for dental fear there by differentiating between handicapping and non handicapping dental fear.

Such a developed measure should be used within the context of specialized practice and it could provide the means to compare treatment threshold in different countries thereby serving as a basis for quality assurance standards in the management of dental fear in children. This aspect is important because of the possible effect of culture on dental fear and its expressions55.