Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia

The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study

Aim

The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N₂O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC).

Materials and methods

A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N₂O IHS) and TII (after N₂O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N₂O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N₂O IHS.

Results

There were significant differences in the dental anxiety level in child patients after administration of N₂O IHS, and it also showed an increased rate of acceptance of dental treatment.

Conclusion

This study showed that N₂O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects.

Clinical significance

Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N₂O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior.

How to cite this article

Kunta S, Arora RV, Jain R, et al. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):302-307.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Dental procedures cause stress in children with cerebral palsy?

Background

To evaluate the level of stress during dental care in children and preadolescents with cerebral palsy through biological and psychological parameters.

Material and Methods

A total of 38 children aged 7 to 12 years were divided into two groups: one with 18 children with cerebral palsy and the other with 20 healthy children (control group). Saliva was noninvasively collected before and after dental care to analyze salivary biomarkers. The Frankl Behavior Scale and the Facial Image Scale were applied.

Results

After the dental procedure, cortisol levels were significantly higher (p = 0.02) in the cerebral palsy group than in the control group. Salivary alpha-amylase was not significantly different between groups. Regarding psychological parameters, anxiety was significantly higher (p = 0.00012) in the cerebral palsy group than in the control group.

Conclusions

There was a change in physiological parameters (salivary cortisol and salivary alpha-amylase) and in psychological parameters (Frankl Behavioral Scale and Facial Image Scale) in patients with cerebral palsy, who exhibited higher stress and anxiety levels than did children without cerebral palsy. Key words:Ortisol, physiological stress, dental care, cerebral palsy, dental treatment anxiety.

Dental Fear and Anxiety of Kindergarten Children in Hong Kong: A Cross-Sectional Study

Objectives: The objectives of this cross-sectional study were to investigate the fear level of kindergarten children in the general population during dental outreach in a familiar kindergarten setting, and to explore the factors associated with the dental fear of kindergarten children. Method: Consecutive sampling method was used to select kindergarten children aged 3 to 5 to participate in a questionnaire survey and an outreach service. A behavioural observation type of instrument for dental fear and anxiety assessment-Frankl Behaviour Rating Scale (FBRS)-was chosen to investigate the fear level of the children. Bivariate analyses between various factors and children's dental fear and anxiety were carried out using Chi-square test. Results: A total of 498 children participated in this study. Almost half (46%) of the children have had caries experience, and the mean dmft score was 2.1 ± 3.4. The prevalence of dental caries was 32%, 43%, and 64% in the 3-, 4- and 5-year-olds, respectively. Only 4% of the children scored negatively for dental fear and anxiety (95% CI 2.3%-5.7%). Children at three years of age displayed more dental fear and anxiety than children of older ages, but the difference in dental fear and anxiety among the genders and caries status was not statistically significant. Most of the children (92%) brushed daily, but only 20% of them used toothpaste. Most (85%) of them had never visited the dentist, and over 70% of them were mainly taken care by their parents. High levels of positive and cooperative behaviour and low levels of fear were found in this population. No statistical significance was found between the child's dental fear and any factors except age. Conclusion: Children generally displayed low fear or anxiety levels in a dental outreach consisting of a non-invasive oral examination and preventive treatment in a familiar kindergarten setting. Conducting regular outreach dental services to kindergartens by providing oral examination and simple remineralisation therapies could be a promising strategy to not only control childhood caries, but also manage and reduce dental fear and encourage long term dental attendance in line with the medical model.