Dental Anxiety Among Children Living in an Orphanage Compared to Children Living with Both of Their Parents in Saudi Arabia: A Case–Control Study

Background/Objectives: Dental anxiety (DA) is a well-known obstacle affecting dental care in children. Children living in orphanages are a special population with healthcare needs. The aim of the study was to assess DA among children living in orphanages compared to those living with both biological parents. Methods: This frequency-matched case–control study included 61 children living in orphanages in Jeddah city and 122 age- and gender-matched peers living with both parents in Jeddah, Saudi Arabia. Demographic and background data, including medical history, dental visit history, and Adverse Family Experiences (AFEs), were completed by the caregiver. Dental anxiety was assessed subjectively using the self-reported Abeer Children Dental Anxiety Scale (ACDAS) and objectively by the Venham Clinical Anxiety Rating Scale (VCARS). Results: The prevalence of children with DA in the study sample among those living in orphanages was 18%. AFEs were significantly higher among children living in orphanages (96.7% vs. 32%, p < 0.001). ACDAS and VCARS showed fewer children with DA living in orphanages compared to children living with both parents. Logistic regression showed that living in orphanages decreased the adjusted odds ratio (AOR) of dental anxiety according to ACDAS (AOR = 0.36; p = 0.06) and VCARS (AOR = 0.43, p = 0.040). Conclusions: Although children living in orphanages presented with lower DA than those living with both parents, this may point to differences in emotional expression rather than true emotional state. Clinicians should not rely only on behavioral observations when treating institutionalized children.