Validity and Reliability of the Brazilian Version of the Children’s Experiences of Dental Anxiety Measure (CEDAM)

Santos, Julia Henriques Lamarca dos; Barbosa, Taís de Souza

doi:10.1590/pboci.2026.037

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ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 26 • 2026 • https://doi.org/10.1590/pboci.2026.037 linkcopy

Validity and Reliability of the Brazilian Version of the Children’s Experiences of Dental Anxiety Measure (CEDAM)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To test the validity and reliability of the Brazilian Portuguese version of the Children's Experiences of Dental Anxiety Measure (CEDAM).

Material and Methods: The sample consisted of 80 pairs of parents and 9 to 12-year-old students at a public school in Ubá, Brazil. Children self-applied the CEDAM, Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and Child Perceptions Questionnaire (CPQ_8-10/CPQ_11-14), and were clinically evaluated at school. Parents were interviewed about the child's dental history, the Corah's Dental Anxiety Scale, and the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Criterion validity was assessed using the Mann-Whitney/Spearman's correlation; construct discriminant validity was evaluated using the Mann-Whitney/Kruskal-Wallis test; construct convergent validity was examined using Spearman's correlation; and predictive validity was assessed using multiple logistic regression. The reliability was calculated by Cronbach's alpha and McDonald's omega coefficients.

Results: About 80% had already been to the dentist. Overall, highly fearful children had higher CEDAM mean scores than those who were less afraid, demonstrating criterion validity. In CPQ_8-10 global ratings, those reporting "regular" oral health had the highest CEDAM scores compared to those reporting "very good", showing discriminant validity. For convergent validity, the CEDAM score was positively correlated with the CPQ_8-10 emotional well-being domain. Moreover, significant positive correlations were observed between CEDAM scores and P-CPQ total scores and P-CPQ emotional well-being domain scores. The predictive validity was indicated by the greater chance that younger children with previous experience of dental visits, who had avoided and cried during dental treatment, presented higher CEDAM scores. Cronbach's alpha of 0.93 indicated almost perfect internal consistency of the CEDAM.

Conclusion: The Brazilian Portuguese version of CEDAM proved to be valid and reliable for application in 9 to 12-year-old children. Dental anxiety is more likely to be observed in younger children who have visited the dentist, avoided, and cried during dental treatment.

Keywords:
Dental Anxiety; Child; Surveys and Questionnaires; Data Accuracy; Validation Study.

	Age (in Years)
Variables	9-10	11-12	Total	p-valuec
	N (%)	N (%)	N (%)
Personal Data
Child Sex
Female	20 (50.0)	19 (47.5)	39 (48.8)	0.9636*
Male	20 (50.0)	21 (52.5)	41 (51.3)
Maternal Education Level
≤ 8 years	2 (5.0)	4 (10.0)	6 (7.5)	<0.0001*
> 8 years	38 (95.0)	36 (90.0)	74 (92.5)
Maternal Dental Anxiety [CORAH Score]
No anxious [score: 4 to 5]	14 (35.0)	11 (27.5)	25 (31.3)	0.1995†
Slightly anxious [6 to 10]	18 (45.0)	17 (42.5)	35 (43.8)
Anxious [11 to 15]	8 (20.0)	12 (30.0)	20 (25.0)
Child’s Dental Historya [Answer ‘yes’]
1 - The child has already been hospitalized	3 (7.5)	6 (15.0)	9 (11.3)	<0.0001*
2 - The child has already been to the dentist	31 (77.5)	32 (80.0)	63 (78.8)	<0.0001*
3 - The child let the dentist examine their mouth	28 (90.3)	32 (100.0)	60 (100.0)	<0.0001*
4 - The child allowed the dental treatment	28 (90.3)	30 (93.8)	58 (96.7)	<0.0001*
5 - It was necessary to hold the child for the dental procedure to be performed	8 (25.8)	2 (6.3)	10 (16.7)	<0.0001*
6 - The child has already been anesthetized	9 (29.0)	7 (21.9)	16 (26.7)	0.0047*
7 - The child cried during the dental treatment	12 (38.7)	10 (31.3)	22 (36.7)	0.1249*
8 - The child reports fear of the dentist	12 (38.7)	8 (25.0)	20 (33.3)	0.0497*
9 - You consider that the child is anxious	18 (58.1)	13 (40.6)	31 (51.7)	0.9580*
Clinical Data
Presence of at Least One Decayed Toothb
Yes	14 (35.0)	13 (32.5)	27 (33.8)	0.0245*
No	26 (65.0)	27 (67.5)	53 (66.3)
dmft score
0	10 (25.0)	15 (37.5)	25 (31.3)	0.0045†
1-2	15 (37.5)	11 (27.5)	26 (32.5)
3-4	10 (25.0)	4 (10.0)	14 (17.5)
≥5	5 (12.5)	1 (2.5)	6 (7.5)
Mean (SD)	2.3 (2.1)	1.2 (1.6)	1.8 (2.0)
DMFT Score
0	33 (82.5)	25 (62.5)	58 (72.5)	<0.0001†
1-2	7 (17.5)	10 (25.0)	17 (21.3)
≥3	0 (0.0)	5 (12.5)	5 (6.3)
Mean (SD)	0.2 (0.5)	0.9 (1.4)	0.6 (1.1)
Dental Trauma
Yes	2 (5.0)	3 (7.5)	5 (6.3)	<0.0001*
No	38 (95.0)	37 (92.5)	75 (93.8)
Fluorosis
Normal (DI=0)	37 (92.5)	38 (95.0)	75 (93.8)	<0.0001†
Questionable (DI=1)	2 (5.0)	1 (2.5)	3 (3.8)
Very mild (DI=2)	1 (2.5)	1 (2.5)	2 (2.5)
Gingivitis
Yes	3 (7.5)	3 (7.5)	6 (7.5)	<0.0001*
No	37 (92.5)	37 (92.5)	74 (92.5)

Item	9 to 10 Years			11 to 12 Years			Total			p-value b
	Score 1	2	3	Score 1	2	3	Score 1	2	3
	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)
1	32 (80.0)	5 (12.5)	3 (7.5)	36 (90.0)	3 (7.5)	1 (2.5)	68 (85.0)	8 (10.0)	4 (5.0)	<0.0001
2	32 (80.0)	4 (10.0)	4 (10.0)	36 (90.0)	0 (0.0)	4 (10.0)	68 (85.0)	4 (5.0)	8 (10.0)	<0.0001
3	34 (85.0)	0 (0.0)	6 (15.0)	36 (90.0)	0 (0.0)	4 (10.0)	70 (87.5)	0 (0.0)	10 (12.5)	<0.0001
4	23 (57.5)	14 (35.0)	3 (7.5)	21 (52.5)	18 (45.0)	1 (2.5)	44 (55.0)	32 (40.0)	4 (5.0)	<0.0001
5	12 (30.0)	26 (65.0)	2 (5.0)	18 (45.0)	21 (52.5)	1 (2.5)	30 (37.5)	47 (58.8)	3 (3.8)	<0.0001
6	3 (7.5)	23 (57.5)	14 (35.0)	5 (12.5)	29 (72.5)	6 (15.0)	8 (10.0)	52 (65.0)	20 (25.0)	<0.0001
7	27 (67.5)	13 (32.5)	0 (0.0)	33 (82.5)	7 (17.5)	0 (0.0)	60 (75.0)	20 (25.0)	0 (0.0)	<0.0001
8	8 (20.0)	28 (70.0)	4 (10.0)	19 (47.5)	18 (45.0)	3 (7.5)	27 (33.8)	46 (57.5)	7 (8.8)	<0.0001
9	31 (77.5)	9 (22.5)	0 (0.0)	34 (85.0)	5 (12.5)	1 (2.5)	65 (81.3)	14 (17.5)	1 (1.3)	<0.0001
10	21 (52.5)	19 (47.5)	0 (0.0)	34 (85.0)	6 (15.0)	0 (0.0)	55 (68.8)	25 (31.3)	0 (0.0)	<0.0001
11	33 (82.5)	6 (15.0)	1 (2.5)	38 (95.0)	1 (2.5)	1 (2.5)	71 (88.8)	7 (8.8)	2 (2.5)	<0.0001
12	26 (65.0)	14 (35.0)	0 (0.0)	30 (75.0)	9 (22.5)	1 (2.5)	56 (70.0)	23 (28.8)	1 (1.3)	<0.0001
13	27 (67.5)	8 (20.0)	5 (12.5)	31 (77.5)	5 (12.5)	4 (10.0)	58 (72.5)	13 (16.3)	9 (11.3)	<0.0001
14	20 (50.0)	17 (42.5)	3 (7.5)	30 (75.0)	6 (15.0)	4 (10.0)	50 (62.5)	23 (28.8)	7 (8.8)	<0.0001

CFSS-DS Mean (SD) Scores	CEDAM Score [4-48]
	9-10 Years		11 to 14 Years		Total
	N	%	N	%	N	%
Low Fearful (Score < 32)	14	17.4 (1.6)	15	16.6 (1.4)	29	17.0 (1.5)
High Fearful (≥ 32)	26	22.8 (5.9)	25	20.0 (6.6)	51	21.5 (6.3)
p-valuea		0.0007		0.1754		0.0011
CFSS-DS Xcores		rho = 0.66		rho = 0.44		rho = 0.56
p-valueb		<0.0001		0.0046		<0.0001

	CEDAM Score [0-100]
Variables	9 to 10 Years		11 to 14 Years		Total
	N	Mean (SD)	N	Mean (SD)	N	Mean (SD)
Global Rating of Oral Health
CPQ_8-10
Very good [score 0]	6	29.5 (1.2)a	-	-	-	-
Good [score 1]	16	33.8 (5.3)b	-	-	-	-
Regular [score 2]	18	40.6 (10.2)^c	-	-	-	-
Poor [score 3]	0	-	-	-	-	-
		pa=0.0009
CPQ_11-14
Excellent [score 0]	-	-	14	33.6 (9.8)	-	-
Very good [score 1]	-	-	22	33.5 (4.6)	-	-
Good [score 2]	-	-	4	42.0 (12.1)	-	-
Fair/Poor [score 3 and 4]	-	-	0	-	-	-
				pa=0.2704
P-CPQ
Excellent [score 0]	0		0		0
Very good [score 1]	39	20.6 (5.2)	40	18.8 (5.5)	79	19.7 (5.4)
Good [score 2]	1	-	0	-	1	-
Fair/Poor [score 3 and 4]	0	-	0	-	0	-
		-		-		-
Global Rating of Overall Well-Being
CPQ_8-10
Not at all [score 0]	11	33.3 (4.8)a	-	-	-	-
Very little [score 1]	15	2.0 (0.0)b	-	-	-	-
Some [score 2]	4	3.0 (0.0)b	-	-	-	-
A lot [score 3]	0	-	-	-	-	-
		pa=0.0000
CPQ_11-14
Not at all [score 0]	-	-	40	18.8 (5.5)	-	-
Very little/Some/A lot/Very much [score 1 to 4]	-	-	0	-	-	-
		-		-
P-CPQ (n=80)
Not at all [score 0]	34	20.0 (4.7)	36	19.0 (5.7)	70	19.5 (5.3)
Very little [score 1]	6	26.2 (6.7)	3	17.0 (1.7)	9	23.1 (7.1)
Some [score 2]	0	-	1	-	1	-
A lot/Very much [score 3 to 4]		pb=0.0323		pb=0.9790		pb=0.1191

Variables	No. of Items	Range	Mean (SD)	CEDAM Score
Variables	No. of Items	Range	Mean (SD)	rho	p-value
CPQ _8-10 (n = 40)
Total [0-²⁰]	25	2-22	8.7 (5.4)	0.29	0.0603
Oral symptoms [0-²⁰]	5	1-7	3.8 (1.4)	0.12	0.4472
Functional limitations [0-⁴⁰]	5	0-9	3.3 (2.8)	0.23	0.1415
Emotional well-being [0-148]	5	0-6	1.4 (1.6)	0.41	0.0081
Social well-being [0-²⁴]	10	0-4	0.3 (0.9)	0.27	0.0846
CPQ _11-14 (n = 40)
Total [0-³⁶]	37	0-5	3.7 (2.1)	0.15	0.3247
Oral symptoms [0-³⁶]	6	0-4	1.6 (1.2)	0.12	0.4428
Functional limitations [0-52]	9	0-3	0.7 (0.9)	0.13	0.4236
Emotional well-being [0-132]	9	0-1	0.2 (0.5)	0.05	0.7174
Social well-being [0-²⁴]	13	0	1.3 (0.8)	0.09	0.5397
P-CPQ (n = 80)
Total [0-³²]	33	2-10	4.2 (2.1)	0.30	0.0053
Oral symptoms [0-³²]	6	1-6	1.5 (1.3)	0.13	0.2238
Functional limitations [0-⁴⁴]	8	0-4	0.8 (0.8)	0.16	0.1396
Emotional well-being [¹⁴-⁴²]	8	1-7	1.8 (0.8)	0.31	0.0048
Social well-being [³⁰]	11	0	-	-	-

Independent Variables	Category	OR	95% CI	p-value	VIF	Tolerance
Intercept		0.55	2.06-3.26	0.660	-	-
Age (years)	9-10	0.18	0.38-2.96	0.011	1.22	0.822
Sex	Male	0.36	0.19-2.20	0.100	1.10	0.913
The child has already been to the dentist	Yes	40.08	0.41-6.96	0.027	3.85	0.259
The child allowed the dental treatment	No	19.84	0.09-5.87	0.043	3.93	0.259
It was necessary to hold the child for the dental procedure to be performed	No	0.15	0.20-3.88	0.078	1.99	0.504
The child cried during the dental treatment	Yes	9.13	0.68-3.74	0.005	1.72	0.582

Age	N	Variation of the score [³³]	Floor Effect*	Ceiling Effect†	Mean (SD)	Internal Consistency
Age	N	Variation of the score [³³]	Floor Effect*	Ceiling Effect†	Mean (SD)	Cronbach’s α	McDonald’s ω
9-10 Years	40	14-34	1 (2.5)	0 (0.0)	20.9 (5.5)	0.91	0.91
11-12 Years	40	14-38	1 (2.5)	0 (0.0)	18.8 (5.5)	0.94	0.95
Total	80	14-38	2 (2.5)	0 (0.0)	19.8 (5.6)	0.93	0.93

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[1] CEDAM: Children's Experiences of Dental Anxiety Measure; CFSS-DS: Children's Fear Survey Schedule-Dental Subscale;

[TFN1] ^*
Chi-square independence test; †Chi-square partition test;

[TFN2] ^a
The percentage of questions 3 to 9 was calculated based on the responses to question 2;

[TFN3] ^b
Component “d” (decayed) of dmft/DMFT indexes;

[TFN4] ^c
p-values of the comparisons between values of the total sample.