September 2009

Objectives: The Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS) is extensively used to assess the level of child dental anxiety. The present study aimed to explore the higher-order factor structure of the parental Chinese version of the CFSS-DS with a large sample of young children in Taiwan. Design: The parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5 to 8- year-old children at kindergartens and elementary schools in Kaohsiung city, Taiwan. Subjects were selected by stratified random sampling. The stratification was done by geographic district, age group, and gender. Participants: The sample was 1,819 children aged 5 to 8 years old. Main outcome measures: A first-order factor analysis was performed using the principal components method with promax rotation, and a second-order factor was obtained by applying the Schmid-Leiman solution (SLS). Results: The present study found three first-order factors, defined as: (1) fear of dental aspects, (2) fear of medical aspects, and (3) fear of potential victimization. The secondorder factor defined as “dental fear” accounted for most of the variance in the second-order factor structure. The results of higher-order factor analysis according to different gender or age levels were identical. Conclusions: A higher-order factor structure consisting of a single second-order factor and three first-order factors was extracted, giving a fuller understanding of the CFSS-DS. The second-order factor structure of Chinese version CFSS-DS was stable and reliable. Key words: Dental fear, Dental Subscale of Children’s Fear Survey Schedule (CFSS-DS), exploratory factor analysis; higher-order factor analysis; Schmid-Leiman solution