The Effect of Previous Dental Visits and Socioeconomic Level on Dental Fear and Anxiety Among Duhok City Primary School Children and its Relation to Oral Health Status

Background: Dental fear and anxiety (DFA) are common emotional challenges among children. These psychological responses can persist into adulthood and impact oral health by discouraging regular dental visits, leading to disease progression, and reliance on emergency treatment. Aim: This study assessed dental fear and anxiety among Duhok primary school children and their association with oral health, socioeconomic status, and dental visit history. Material and Methods: A cross-sectional study was conducted involving 420 randomly selected students from 10 primary schools located in socioeconomically diverse areas of Duhok city. DFA was assessed using the Index of Dental Anxiety and Fear (IDAF-4C+, a standardized child dental anxiety questionnaire and its relation to previous dental visits and socioeconomic level. Oral health status was evaluated based on WHO criteria for DMFT (Decayed, Missing, and Filled Teeth) in permanent teeth and DMFT (decayed, missing, filled teeth) in primary teeth, along with the Plaque Index. Data analysis was performed using SPSS software. Results: 62.6% of children had no or little DFA, 26.4% had low fear, 6.9% had moderate, and 4.0% had high fear. No statistically significant differences were found between DFA and DMFT (p = 0.126), DMFT (p = 0.956), or plaque index (p = 0.439). DFA was significantly associated with school location (p = 0.046) and prior dental visits (p = 0.027). Children attending western (higher socioeconomic) schools and those who had never visited a dentist before exhibited higher levels of DFA. Conclusion: Low to moderate levels of DFA were found among children in Duhok city. Which related to school location and previous dental visits, with no effect on the oral health status. These findings highlight the effect of socioeconomic environment and dental visit experience on the DFA level. Keywords: Dental fear, Dental anxiety, oral health, socioeconomic status, children