Behavioural and physiological outcomes of biofeedback therapy on dental anxiety of children undergoing restorations: a randomised controlled trial

Feasibility, acceptability, and perceived effectiveness of weighted blankets during paediatric dental care

BACKGROUND

Weighted blankets are one method to provide deep pressure touch sensations, which are associated with a calming effect on the nervous system. Weighted blankets have been reported to elicit a calming effect during stressful dental encounters and routine prophylactic visits in older adolescents and adults. Preliminary research suggests that weighted blankets are safe and feasible for children in both hospital and home settings; this, however, has not yet been examined in a paediatric dental environment.

AIM

To examine the feasibility, acceptability, and perceived effectiveness of a weighted blanket during paediatric dental care.

DESIGN

This cross-sectional study examined child, caregiver, and dentist-reported responses to survey questions asking about their experience with the weighted blanket during care (n = 20 each per child and caregiver group, n = 9 dentists).

RESULTS

The use of a weighted blanket is feasible, acceptable, and appropriate as reported by caregivers and dentists (means ≥ 4.70 on the Feasibility of Intervention, Acceptability of Intervention, and Intervention Appropriateness Measures). Few problems were described, and all groups overwhelmingly responded with enthusiasm, noted the blanket's potential for future use, and perceived that a weighted blanket improved care (means ≥ 4.10).

CONCLUSIONS

Study findings support the feasibility and acceptability of using a weighted blanket during a routine, noninvasive paediatric dental care.

Oral-Health-Related Quality of Life and Anxiety in Orthodontic Patients with Conventional Brackets

The aim of this study was to evaluate the oral-health-related quality of life (OHRQoL) and anxiety levels of adult patients undergoing orthodontic treatment with fixed multibracket appliances.

MATERIALS AND METHODS

The study was carried out at the Dental Clinic of the University of Salamanca in 2021. It included 120 adult patients between 19 and 45 years of age undergoing orthodontic treatment with conventional metal brackets. The data collection instruments chosen were the state-trait anxiety inventory (STAI) to assess anxiety levels and the OHIP-14 questionnaire to measure the OHRQoL. Anxiety levels and OHRQoL were analyzed one month after starting treatment.

RESULTS

The mean age was 31.7 years ± 6.5 years; 68 patients were women (56.7%) and 52 were men (43.3%). Psychological disability was the dimension of the OHIP-14 questionnaire that was found to have the greatest impact (3.20 ± 1.08) on patients, as compared to the dimension of disability, which had the lowest impact on the oral-health quality of life (0.37 ± 0.56). The mean total score of the OHIP-14 questionnaire was 11.93 (±2.19). There was no statistically significant influence from either sex or age on the anxiety and oral-health quality of life of the participants; however, there was a significant relationship between the dimensions of physical disability and anxiety traits.

CONCLUSIONS

The physical disability dimension of the OHIP-14 questionnaire increased the anxiety level of adult patients treated with conventional brackets. The impact of orthodontic treatment on adult patients may negatively influence their levels of anxiety.

Effectiveness of biofeedback relaxation and audio-visual distraction on dental anxiety among 7- to 12-year-old children while administering local anaesthesia: A randomized clinical trial

BACKGROUND

Local anaesthesia (LA) administration provokes dental anxiety in children. BrightHearts is a biofeedback relaxation application designed to reduce anxiety in children during painful procedural interventions.

AIM

To compare the effectiveness of biofeedback relaxation (BR) and audio-visual (AV) distraction on dental anxiety among 7- to 12-year-old children while administering LA.

DESIGN

A total of 70 children requiring dental treatment under LA for three visits were recruited for this single-blinded randomized control trial. They were randomly divided into two equal groups. Group A received BR and Group B received AV distraction during LA delivery in the first two visits, and both groups did not receive any intervention during LA in third visit. Outcomes were measured using heart rate and a cartoon-based anxiety measuring scale (Chotta Bheem-Chutki (CBC) scale).

RESULTS

AV group had statistically significant higher mean heart rates than BR group (P < .001) during needle penetration and post-intervention, respectively. CBC scale showed no statistical differences between the groups.

CONCLUSION

Both the interventions are effective in reducing dental anxiety during LA administration. Based on objective measures, BR is found to be better than AV distraction. Subjective scores, however, show no differences between the two.

Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability

Aim and objective

To analyze the impact of Indian instrumental music on children with intellectual disability (mild) exhibiting dental anxiety during dental procedures using electrical skin resistance measured by a biofeedback machine.

Materials and methods

A total of 20 children of 6-14 years having an intellectual disability (mild) were randomly divided into two groups comprising of 10 each. The study was carried out in a cross-over design, with and without music distraction in two appointments spaced out at a gap of 1 month. The children were subjected to a dental examination, oral prophylaxis, and auditory operative stimuli in both appointments. The electrical skin resistance during each procedure was measured using a galvanic skin response (GSR) biofeedback machine and the values were statistically analyzed using paired and unpaired t-tests.

Results

A statistically significant increase in electrical resistance was observed during music distraction, which indicated an anxiety reduction when music distraction was employed.

Conclusion

The increased electrical skin resistance due to low anxiety proves the positive impact of music distraction in intellectually disabled children.

Clinical significance

Music can be employed as a distraction technique to reduce anxiety in intellectually disabled children.

How to cite this article

Gowdham G, Shetty AA, Hegde A, et al. Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability. Int J Clin Pediatr Dent 2021;14(1):170-174.

Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial

Background

This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration.

Methods

This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4–11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05.

Results

Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group.

Conclusion

External vibration using a Buzzy® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.

An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint

Biofeedback has shown to be a promising tool for the treatment of anxiety; however, several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health, we argue that this is an ideal time to launch a new wave of biofeedback training. In this viewpoint paper, we reflect on the current state of biofeedback training, including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques, and the changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centered approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful.

Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children

Background

This study evaluated the efficacy of virtual reality (VR) distraction and counter-stimulation (CS) on dental anxiety and pain perception to local anesthesia in children.

Methods

A prospective, randomized, single-blinded interventional clinical trial with a parallel design was used. Seventy children 7–11 years old who required local anesthesia (LA) for pulp therapy or tooth extraction were recruited and allocated to two groups with equal distribution based on the intervention. Group CS (n = 35) received CS and Group VR (n = 35) received VR distraction with ANTVR glasses. Anxiety levels (using pulse rate) were evaluated before, during, and after administration of local anesthesia, while pain perception was assessed immediately after the injection. Wong-Baker faces pain-rating scale (WBFPS), visual analog scale (VAS), and Venham's clinical anxiety rating scale (VCARS) were used for pain evaluation. Student's t-test was used to test the mean difference between groups, and repeated measures ANOVA was used to test the mean difference of pulse rates.

Results

Significant differences in mean pulse rates were observed in both groups, while children in the VR group had a higher reduction (P < 0.05), and the mean VCARS scores were significant in the VR group (P < 0.05). Mean WBFPS scores showed less pain perception to LA needle prick in the CS group while the same change was observed in the VR group with VAS scores.

Conclusions

VR distraction is better than CS for reducing anxiety to injection in children undergoing extraction and pulpectomy.

Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials

OBJECTIVE

To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment.

METHODS

Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively.

RESULTS

Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies.

CONCLUSION

There is a very low certainty of evidence that DT can be effective in managing children's/adolescents' dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well-executed RCTs are needed.

The Contribution of Biofeedback Brain Boy Method to the Treatment of Anxiety Disorders

Introduction:

Anxiety management is one of the most important health issues which is being faced by humans today. Biofeedback, as a method of neurophysiology, has been added to the methods recommended for this purpose.

Aim:

The aim of the study was to measure the effectiveness of biofeedback method by using Brain Boy Universal Professional in the treatment of anxiety disorders.

Methods:

The sample of this research study consisted of 50 individuals, suffering from symptoms of anxiety, who underwent biofeedback therapy. For the purposes of this study, the self-administered questionnaire Hamilton Rating Scale for Anxiety was completed by the individuals both before the initiation of the therapy and after individuals had completed ten sessions of treatment with biofeedback.

Results:

Prior to biofeedback, 26% of the participants showed mild to moderate anxiety, 12% a medium severity of anxiety and the remaining 62% severe anxiety. After the completion of 10 sessions of biofeedback, 78% of the participants was found to experience mild to moderate anxiety, 12% a medium severity of anxiety and only 10% of severe anxiety.

Conclusion:

Biofeedback can be a therapeutic method for the treatment of anxiety disorders, giving treatment to patients who do not respond to drugs but also to patients who want to apply to undergo such treatment alongside other therapeutic methods including drugs.

Evaluation of treatment related fear using a newly developed fear scale for children: "Fear assessment picture scale" and its association with physiological response

Introduction:

Dental treatment is usually a poignant phenomenon for children. Projective scales are preferred over psychometric scales to recognize it, and to obtain the self-report from children.

Aims:

The aims were to evaluate treatment related fear using a newly developed fear scale for children, fear assessment picture scale (FAPS), and anxiety with colored version of modified facial affective scale (MFAS) - three faces along with physiologic responses (pulse rate and oxygen saturation) obtained by pulse oximeter before and during pulpectomy procedure.

Settings and Design:

Total, 60 children of age 6–8 years who were visiting the dental hospital for the first time and needed pulpectomy treatment were selected. Children selected were of sound physical, physiological, and mental condition. Two projective scales were used; one to assess fear - FAPS and to assess anxiety – colored version of MFAS - three faces. These were co-related with the physiological responses (oxygen saturation and pulse rate) of children obtained by pulse oximeter before and during the pulpectomy procedure.

Statistical Analysis Used:

Shapiro–Wilk test, McNemar's test, Wilcoxon signed ranks test, Kruskal–Wallis test, Mann–Whitney test were applied in the study.

Results:

The physiological responses showed association with FAPS and MFAS though not significant. However, oxygen saturation with MFAS showed a significant change between “no anxiety” and “some anxiety” as quantified by Kruskal–Wallis test value 6.287, P = 0.043 (<0.05) before pulpectomy procedure.

Conclusions:

The FAPS can prove to be a pragmatic tool in spotting the fear among young children. This test is easy and fast to apply on children and reduces the chair-side time.