Validation of child drawing hospital scale (CD:H) and the place of the drawing in the evaluation of dental anxiety

Aim: Dental anxiety is a heightened state of unease that develops due to fears due to dental treatment and cannot be fully expressed. Our study aimed to perform a Turkish validation study of the CD: H and evaluate the dental anxiety and pain experienced during the treatment by drawing. Materials and Methods: Pediatric patients between the ages of 4-13 and whose clinical and radiographic examinations were completed, applied to the Department of Pediatric Dentistry of Tokat Gaziosmanpaşa University Faculty of Dentistry between 2018-2020, were included in the study. The study was carried out in two stages. Following the translation of the CD: H Scale into Turkish and linguistic-cultural validation, the behaviors of pediatric patients during treatment were evaluated with the Frankl Behavior Rating Scale, the pain they experienced during treatment with the Wong Baker Face Rating Scale, and their anxiety levels were evaluated with the pictures drawn by the patients at the end of the treatment. The data were analyzed with IBM SPSS v23 and the significance level was taken as p <0.05. Results: Within the scope of the scale's reliability-validity study, the Intra-Class Correlation Coefficient (ICC) was evaluated with test-retest consistency. For section A (ICCA = 0.948; p <0.001), section B (ICCB = 0.844; p <0.001), section C (ICCC = 0.729; p <0.001) and total score (ICC Total = 0.936; p <0.001) reliability was found to be positive and strong level correlation. The test-retest consistency coefficient was 0.967 (p <0.001). In evaluating dental anxiety according to gender, anxiety of boys was higher than girls. As the patients' pain levels increased during treatment, their behaviors changed from positive to negative (p = 0.016; r = -0.219). Pain levels increased as the patient's age decreased (p = 0.987; r = -0.002). As the patients' dental anxiety increased, their behavior during treatment increased from positive to negative (r = -0.118; r = -0.113). As the pain level felt by the patients during the treatment increased, their dental anxiety increased (p>0.05). Conclusion: The Turkish version of the CD: H Scale is a reliable and valid scale that can be used to evaluate the dental anxiety of pediatric patients who need Turkish speaking dental treatment. Key words: Child Drawing Hospital Scale (CD: H), dental anxiety, dental pain, validation