Dental anxiety, child-oral health related quality of life and self-esteem in children and adolescents: a systematic review and meta-analysis

Amjad Alharbi (Lead / Corresponding author), Ruth Freeman, Gerry Humphris

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
9 Downloads (Pure)


Aim: To identify the directions, strength and associations between dental anxiety, COHRQoL and self-esteem in children and adolescents.

Basic Research Design: PRISMA guidelines were followed and the review registered (PROSPERO CRD42019140037). MEDLINE, Cochrane Library, Scopus, Science Direct, CINAHL, Joanna Briggs Institute (JBI), Grey Literature Report, and British Library EThOS using MeSH terms and keywords were searched. Three reviewers examined the abstracts of all articles, excluded duplicates and those not meeting inclusion criteria. All full-text papers were read by all reviewers. Meta-analysis association data including Pearson's or Spearman's correlation coefficient were extracted and effect sizes estimated.

Results: Twelve papers met the inclusion criteria, 7 assessed the relationship between child dental anxiety and COHRQoL; four between COHRQoL and self-esteem and one between child dental anxiety and self-esteem. Significant relationships were found between COHRQoL and the other child-related outcomes measures. An inverse relationship was shown for dental anxiety and COHRQoL. The meta-analysis found small associations between child dental anxiety and COHRQoL and moderate associations between COHRQoL and self-esteem. High heterogeneity between COHRQoL and self-esteem was noted. The association between child dental anxiety and self-esteem was limited. No source reported associations between all three variables.

Conclusion: The studies were of varying quality and the degree of heterogeneity meant that only limited conclusions were possible. There is a need for high-quality evidence to underpin intervention designs to promote COHRQoL and self-esteem to reduce child dental anxiety.

Original languageEnglish
Pages (from-to)119-126
Number of pages8
JournalCommunity Dental Health
Issue number2
Early online date28 May 2021
Publication statusPublished - Jun 2021


  • Child dental anxiety
  • Child oral health-related quality of life
  • Self-esteem
  • child/adolescents
  • Child/adolescents
  • Dental anxiety
  • Oral health-related quality of life

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • General Dentistry


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