Neighborhood opportunity, white matter, and cognition in a large pediatric neuroimaging study.

Dental anxiety is highly prevalent among children and poses significant challenges to dental care, with nearly one in five children exhibiting disruptive behaviors that compromise cooperation, prolong treatment, and increase clinical risks. Poorly managed anxiety also contributes to avoidance of dental care, worsening oral health and reinforcing fear-related behaviors, highlighting the need for reliable assessment and management strategies in pediatric dentistry []. Dental anxiety is a multifactorial condition influenced by psychological, environmental, and biological factors, including personality traits, previous negative experiences, and misconceptions about dental procedures [–]. Anxiety and behavior during dental treatment are commonly assessed using observational tools such as the Frankl scale and self-report measures like the Visual Analogue Scale (VAS) []. Although useful, these methods are inherently subjective, relying on clinician judgment or the child’s ability to express distress, and may not accurately reflect internal anxiety states. Consequently, objective and quantifiable measures are needed to complement traditional assessments [, ]. Dental procedures can elicit marked autonomic nervous system (ANS) responses, making physiological monitoring particularly relevant in children []. Psychophysiology examines interactions between psychological states and physiological processes and has benefited from advances in autonomic neuroscience and biofeedback-based interventions [, ]. Common physiological responses to dental stress include alterations in heart rate (HR), heart rate variability (HRV), galvanic skin response (GSR), and other autonomic indicators [, ]. HRV and GSR provide non-invasive, real-time measures of autonomic activity: GSR reflects sympathetic arousal, while HRV captures sympatho-vagal balance through frequency-domain indices (VLF, LF, HF, LF/HF ratio) and time-domain measures such as SDNN and PNN50 [–]. HRV has been supported by many anxiety disorder studies as a candidate biomarker indicating changes in psychological symptoms. HF is often regarding as parasympathetic-specific indices whereas LF indicates more sympathetic activity than HF [].