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Zhao F, Zhang N, Wu Y, Dou Z, Cao B, Luo Y, Lu Y, Du L, Xiao S. What influences the close contact between health care workers and patients? An observational study in a hospital dental outpatient department. Am J Infect Control 2024:S0196-6553(24)00579-0. [PMID: 38964659 DOI: 10.1016/j.ajic.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/23/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Dental outpatient departments, characterized by close proximity and unmasked patients, present a considerable risk of respiratory infections for health care workers (HCWs). However, the lack of comprehensive data on close contact (<1.5m) between HCWs and patients poses a significant obstacle to the development of targeted control strategies. METHODS An observation study was conducted at a hospital in Shenzhen, China, utilizing depth cameras with machine learning to capture close-contact behaviors of patients with HCWs. Additionally, questionnaires were administered to collect patient demographics. RESULTS The study included 200 patients, 10 dental practitioners, and 10 nurses. Patients had significantly higher close-contact rates with dental practitioners (97.5%) compared with nurses (72.8%, P < .001). The reason for the visit significantly influenced patient-practitioner (P = .018) and patient-nurse (P = .007) close-contact time, with the highest values observed in prosthodontics and orthodontics patients. Furthermore, patient age also significantly impacted the close-contact rate with nurses (P = .024), with the highest rate observed in patients below 14 years old at 85% [interquartile range: 70-93]. CONCLUSIONS Dental outpatient departments exhibit high HCW-patient close-contact rates, influenced by visit purpose and patient age. Enhanced infection control measures are warranted, particularly for prosthodontics and orthodontics patients or those below 14 years old.
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Affiliation(s)
- Fangli Zhao
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, PR China; School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, PR China
| | - Nan Zhang
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, PR China
| | - Yadi Wu
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, PR China; School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, PR China
| | - Zhiyang Dou
- Department of Computer Science, The University of Hong Kong, Hong Kong, China
| | - Bing Cao
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, PR China
| | - Yingjie Luo
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, PR China; School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, PR China
| | - Yan Lu
- Hospital-Acquired Infection Control Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Li Du
- Hospital-Acquired Infection Control Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China
| | - Shenglan Xiao
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, PR China; School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, PR China.
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Quail KR, Ward CL. Using Non-Violent Discipline Tools: Evidence Suggesting the Importance of Attunement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7187. [PMID: 38131738 PMCID: PMC10742770 DOI: 10.3390/ijerph20247187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Training in non-violent discipline is important to prevent violence against children and ensure that their caregivers remain a safe base for them. This paper aims to deepen understanding of non-violent discipline by exploring attunement as a mechanism in the effectiveness of non-violent discipline tools. Attunement describes the sensitive responsiveness of caregivers towards their children and has been found to be central to the formation of secure attachment bonds and development of self-regulation. It includes understanding or being "in tune with" the child's needs and signals, matching these with appropriate responses. The objective of this paper is to explore attunement in relation to non-violent discipline. Peer-reviewed systematic reviews previously included in a systematic overview of evidence on non-violent discipline options were screened for information relevant to attunement. All reviews were published in English between 1999 and 2018 and offered evidence on at least one non-violent discipline tool. Although no reviews explicitly addressed attunement, evidence was found suggesting its importance in the use and effectiveness of discipline methods. Research directly investigating attunement in discipline is needed.
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Affiliation(s)
- Karen R. Quail
- Department of Psychology, Faculty of Humanities, University of Cape Town, Cape Town 7700, South Africa;
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Aburas S, Pfaffeneder-Mantai F, Hofmann A, Meller O, Schneider B, Turhani D. Dentophobia and dental treatment: An umbrella review of the published literature. SPECIAL CARE IN DENTISTRY 2023; 43:163-173. [PMID: 35700448 DOI: 10.1111/scd.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
AIMS Dentophobia is a well-know kind of phobia and psychological problem in dentistry. Although patients might suffer from severe oral pain and have serious health complications, dentophobia is still posing a threat to oral healthcare and remains an unresolved worldwide phenomenon. According to estimates, up to 80% of the general population are affected by this condition. Dentophobia is an unpleasant problem with serious consequences not only for patients but also for dentists and the public health system in general. This umbrella review provides a comprehensive overview of the various aspects of dentophoia as addressed in the published literature, and the current level of knowledge concerning their treatment. METHODS AND RESULTS Based on 35 reviews of the published literature, addressing various aspects of dentophobia and published between 2008 and 2021, this umbrella review was written. The search was based on the PubMed and PsycINFO databases. The extraction was structured by open coding and each aspect of the subject analyzed according to Ritchie and Lewis. CONCLUSION We conclude that the evidence concerning the efficacy of the various interventions is still rather weak and there is an obvious need for further research, because of the yet and unresolved challenges and the lack of standardised guidelines to deal with patients with dentophobia.
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Affiliation(s)
- Sarmad Aburas
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Krems/Donau, Austria
| | - Florian Pfaffeneder-Mantai
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Krems/Donau, Austria
- Division for Chemistry and Physics of Materials, Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems/Donau, Austria
| | - Alina Hofmann
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Krems/Donau, Austria
| | - Oliver Meller
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Krems/Donau, Austria
| | - Benedikt Schneider
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Krems/Donau, Austria
| | - Dritan Turhani
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Krems/Donau, Austria
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Modabber M, Campbell KM, McMurtry CM, Taddio A, Dempster LJ. Children's Perceptions of Dental Experiences and Ways to Improve Them. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111657. [PMID: 36360385 PMCID: PMC9688229 DOI: 10.3390/children9111657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023]
Abstract
This qualitative study explored children's perceptions of their dental experiences and their acceptability of the CARD™ (Comfort, Ask, Relax, Distract) system, adapted for the dental setting as a means to mitigate dental fear and anxiety (DFA). A purposive sample of 12 participants (7 males) aged 8-12 years receiving dental care at the Paediatric Dental Clinic, University of Toronto, was recruited. Virtual one-on-one interviews were augmented with visual aids. Participants were oriented to and asked about their perceptions of various dental procedures. Data were deductively analyzed, according to the Person-Centered Care framework (PCC). Four themes were identified: establishing a therapeutic relationship, shared power and responsibility, getting to know the person and empowering the person. Children emphasized the importance of clinic staff attributes and communication skills. They expressed a desire to engage more actively in their own care and highlighted the positive influence of pre-operative education and preparation. Participants found the CARD™ system to facilitate opportunities for self-advocacy in their dental care.
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Affiliation(s)
- Melika Modabber
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1X3, Canada
| | - Karen M. Campbell
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1X3, Canada
| | - C. Meghan McMurtry
- Department of Psychology, The University of Guelph, Guelph, ON N1G 2W1, Canada
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Laura J. Dempster
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1X3, Canada
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Aarvik RS, Svendsen EJ, Agdal ML. Held still or pressured to receive dental treatment: self-reported histories of children and adolescents treated by non-specialist dentists in Hordaland, Norway. Eur Arch Paediatr Dent 2022; 23:609-618. [PMID: 35763246 PMCID: PMC9338127 DOI: 10.1007/s40368-022-00724-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/03/2022] [Indexed: 12/19/2022]
Abstract
Aim This study aimed to estimate the prevalence of a self-reported history of restraint in children and adolescents when receiving dental care by non-specialist dentists and to assess differences in dental fear and anxiety (DFA), intra-oral injection fear, and trust in dentists between patients with and without a self-reported history of restraint. Methods An electronic cross-sectional survey was distributed to all 9 years old (n = 6686) and 17 years old (n = 6327) in the Public Dental Service in Hordaland County, Norway, in 2019. For statistical evaluation, we generated descriptive statistics and Mann–Whitney U tests. Results The response rate ranged between 43.5 and 59.9% for the different questions. The prevalence of a self-reported history of being held still against one’s will during dental treatment and pressured to undergo dental treatment against one’s will was 3.6% and 5.1%, respectively. In general, these patients reported higher DFA, and higher intra-oral injection fear compared with those without such histories of restraint. Patients who had reported being held still against their will during dental treatment had significantly higher distrust in dentists than those who did not report restraint (p < 0.001). Conclusion To feel pressured to receive dental treatment and to be held still against one’s will overlap with the concepts of psychological and physical restraint. Patients with a self-reported history of restraint recorded significant differences in DFA, intra-oral injection fear, and trust in dentists compared to those who did not report restraint. Future studies should explore the role that restraint may play in relation to a patient’s DFA, intra-oral injection fear, and trust in dentists.
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Affiliation(s)
- R S Aarvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 2b, 0373, Oslo, Norway. .,Oral Health Centre of Expertise in Western Norway, Bergen, Norway.
| | - E J Svendsen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 2b, 0373, Oslo, Norway.,Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - M L Agdal
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Patient-self-reported history of restraint among 17-year-olds: a retrospective study of records by non-specialist dentists in the public dental service in Hordaland, Norway. Eur Arch Paediatr Dent 2022; 23:475-484. [PMID: 35536447 PMCID: PMC9167190 DOI: 10.1007/s40368-022-00710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/09/2022] [Indexed: 10/28/2022]
Abstract
PURPOSE The primary purposes were to examine dental records of Norwegian adolescents' with and without self-reported history of restraint for information about oral health (DMFT), total scheduled time in the Public Dental Service (PDS) (dental appointments, cancelled and missed appointments), and reluctant behaviour and/or dental fear and anxiety (DFA). Another purpose was to explore their dental records for information recorded by the dentist concerning the use of restraint. METHODS Data on patient-self-reported history of restraint and DFA were collected in a population-based cross-sectional survey of 17-year-olds in the PDS in Hordaland, Norway, 2019. Patients were divided into two groups: self-reported restraint group (N1 = 26) and self-reported non-restraint group (N2 = 200). Data on oral health and dental treatment, total scheduled time of the PDS, reluctant behaviour or DFA, and information on the use of restraint were extracted from the dental records written by non-specialist dentists using a pre-set protocol covering the period from 2002 to 2019. RESULTS A total of 206 dental records were analysed. Adolescents with self-reported history of restraint (n1 = 18) had higher DMFT and greater descriptions of reluctant behaviour and/or DFA, and total scheduled time compared with the self-reported non-restraint group (n2 = 188). The use of restraint was recorded in the dental records of one patient from the self-reported restraint group and in two patients from the self-reported non-restraint group. CONCLUSIONS The adolescents with self-reported history of restraint had higher DMFT, higher scheduled time attending the PDS, and had more descriptions of reluctant behaviour and/or signs of DFA compared with the self-reported non-restraint group. The patient records contained limited information concerning restraint, and there were significant discrepancies between patient-self-reported history of restraint and the recording of restraint by the dentist in the patients' records.
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Rienhoff S, Splieth CH, Veerkamp JSJ, Rienhoff J, Krikken JB, Campus G, Wolf TG. Hypnosis and Sedation for Anxious Children Undergoing Dental Treatment: A Retrospective Practice-Based Longitudinal Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050611. [PMID: 35626788 PMCID: PMC9139918 DOI: 10.3390/children9050611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/05/2022] [Accepted: 04/21/2022] [Indexed: 12/11/2022]
Abstract
To assess whether the treatment of children with oral midazolam and pediatric hypnosis techniques can improve the compliance in consecutive sessions, a retrospective longitudinal practice-based observational study was designed and carried out. A total of 311 children between 3 and 12 years of age were treated under hypnosis and sedation with midazolam (0.40 mg/kg body weight). Treatments were performed in one to a maximum of three sessions. A total of 183 children received one, 103 received two and 25 children received three treatment sessions. The behavior of the children during the sessions was examined by means of the Venham score. The self-evaluation of the children was based on the Wong−Baker Scale. Child behavior using midazolam and hypnosis techniques showed little difference and good compliance between the sessions. Venham scores did not increase significantly regarding total treatment from the first (0.99 ± 1.41) to the second (1.17 ± 1.39) and to the third session (1.27 ± 1.20) (p > 0.05). However, considering the highest Venham scores that occurred in each case, the behavior of the children worsened significantly (p < 0.01) during the three treatment sessions, from 1.37 ± 1.31 (first) to 1.87 ± 1.74 (second) to 2.32 ± 1.33 (third). In 6.11% of the children, treatment was discontinued in the first session (n = 19), 0.96% in the second (n = 3) and 0% in the third. Treatment with low-dose midazolam, combined with hypnosis techniques, showed to be an effective option for dental treatment in children. Within the limitations of the current study, and with consideration of highest possible compliance, no more than two treatment sessions for pediatric dental treatment should be performed.
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Affiliation(s)
- Sabine Rienhoff
- Pediatric Dental Practice, D-30177 Hannover, Germany; (S.R.); (J.R.)
| | - Christian H. Splieth
- Department of Preventive and Pediatric Dentistry, Center for Oral Health, Ernst Moritz Arndt University Greifswald, D-17475 Greifswald, Germany;
| | | | - Jan Rienhoff
- Pediatric Dental Practice, D-30177 Hannover, Germany; (S.R.); (J.R.)
| | - Janneke B. Krikken
- Snoet Kindermondzorgcentrum, Pediatric Dental Practice, NL-1061 Amsterdam, The Netherlands;
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland;
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, I-07100 Sassari, Italy
- Correspondence: ; Tel.: +41-31-632-2580
| | - Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland;
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, D-55131 Mainz, Germany
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Hu S, Mok BYY, Tok WW, Wong ML, Hong CHL. Teaching pediatric behavior management in student dentists with constructive video feedback from faculty. J Dent Educ 2021; 85:1870-1878. [PMID: 34383296 DOI: 10.1002/jdd.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/08/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE The range of child behaviors encountered in real-life situations far exceeds that of any classroom-based simulated scenarios. For such reasons, clinical training with real-time clinical supervisor's feedback is optimal for learner-centricity. This study aimed to objectively evaluate the effect of video feedback on the student dentist's ability to manage behaviors in children. METHODS Third-year dental student volunteers were randomly allocated to two groups: control and intervention. They were video recorded for three pediatric dental treatment sessions and received standard feedback for all sessions. Additionally, the intervention group received two constructive 1-on-1 feedback sessions after the first and second video sessions. Students' application of behavior management techniques for all recorded treatment sessions was scored with a study-specific objective scale (maximum score: 20; larger score indicating better performance) by two independent and blinded evaluators. A self-administered student questionnaire elicited subjective feedback on the intervention. RESULTS There was a significant difference (p = 0.008) between behavior management scores when comparing all pre-intervention sessions (10.74 ± 3.55) and all post-intervention sessions (13.57 ± 2.96). The intervention significantly improved these techniques: 1. Providing specific feedback - positive reinforcement and descriptive praise (p = 0.006) and 2. Distraction - Using imagination with stories and singing (p = 0.035). The feedback sessions (4.29 ± 0.54) were perceived to be significantly (p = 0.032) more effective than having the students view the videos on their own (3.76 ± 0.87). CONCLUSION Video feedback improved the behavior management scores of student dentists. The faculty feedback sessions were found by student dentists to improve confidence and the techniques for managing children.
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Affiliation(s)
- Shijia Hu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Betty Yuen Yue Mok
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Wee Wah Tok
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Anderson NC, Zhou Y, Humphris G. How are emotional distress and reassurance expressed in medical consultations for people with long-term conditions who were unable to receive curative treatment? A pilot observational study with huntington's disease and prostate cancer. Pilot Feasibility Stud 2021; 7:119. [PMID: 34082819 PMCID: PMC8176610 DOI: 10.1186/s40814-021-00833-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Objective It is unclear whether how people with long-term conditions express distress, and how clinicians respond, influences perceptions of consultation outcomes. The pilot study examined emotional distress and reassurance in consultations with people whose long-term conditions (at the time of consultations) were treated using active surveillance or symptom management (as no curative treatment was suitable). Methods An observational pilot study was conducted involving consultations between people with long-term conditions and their respective clinician. Consultations between three clinicians (two Huntington’s Disease; one Prostate Cancer) and 22 people with long-term conditions (11 Huntington’s Disease; 11 Prostate Cancer) were audio-recorded. Participants also completed an expanded Consultation and Relational Empathy (CARE) Measure. Two researchers coded sessions using Verona Coding Definitions of Emotional Sequences (VR-CoDES/VR-CoDES-P). Code frequencies were calculated, t tests performed between conditions, and Pearson’s correlations performed for associations between CARE responses and clinician utterances. Results People with long-term conditions expressed emotional distress on average 4.45 times per session, averaging 1.09 Concern and 3.36 Cue utterances. Clinicians responded with more explicit (2.59) and space-providing (3.36), than non-explicit (1.86) and space-reducing (1.09), responses per session. Clinicians expressed spontaneous reassurance on average 5.18 times per session, averaging 3.77 Cognitive and 1.5 Affective reassurance utterances. Huntington’s Disease consultations featured significantly more 'Cues', 'Concerns' and 'Overall' 'Emotional Distress', and 'Cognitive' and 'Overall' ‘Reassurance'. Conclusion Emotional distress was expressed more using hints than explicit concern utterances. Clinicians predominantly explicitly explored distress rather than providing information/advice and provided advice using spontaneous cognitive reassurance. People with Huntington’s Disease expressed more concerns and received more reassurance, indicating different needs between conditions. Future research is required to explore emotional distress and reassurance in a larger sample of participants and long-term condition types, and how the practical implications of these findings may be used to enhance outcomes of consultations. Trial registration N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00833-z.
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Affiliation(s)
- Niall C Anderson
- School of Medicine, University of St Andrews, St. Andrews, KY16 9TF, UK.
| | - Yuefang Zhou
- School of Medicine, University of St Andrews, St. Andrews, KY16 9TF, UK
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St. Andrews, KY16 9TF, UK
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Using process drama to explore the causes of dental anxiety in primary-school children. Eur Arch Paediatr Dent 2021; 22:869-877. [PMID: 33893625 PMCID: PMC8526446 DOI: 10.1007/s40368-021-00623-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/29/2021] [Indexed: 11/05/2022]
Abstract
Background Drama and role play can be unlisted as methods to allow children to view problems from a range of different perspectives that may differ from their own experience. Application of drama technique to assess the cause of dental fear and anxiety in a school setting is novel. Aim The aim of this study was to engage primary school children in the core investigation via participatory arts methodologies, namely, process drama to gain understanding of the causes of dental anxiety. Design Sixty-three children, aged 7–10 years from three primary schools participated in this study. A 90-min drama workshop was carried in each school. The children were encouraged to identify the causes of dental anxiety using key concepts from process drama. The sessions were audio-recorded and transcribed. Results Four key concepts emerged: (1) fear of the unknown; (2) unpleasant sensory experience; (3) society’s perception and portrayal of the dentist; and (4) learnt negative associations with the dentist. Within each four key concepts, two sub-themes were identified. Conclusions Role-playing and use of drama are a novel application and can reveal a considerable amount of information from the child’s perspective on the cause of dental fear and anxiety.
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Buldur B. Batman or Joker? A mixed-method approach to understanding children's perceptions of dentists. Eur J Oral Sci 2021; 129:e12787. [PMID: 33829562 DOI: 10.1111/eos.12787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 01/21/2023]
Abstract
It is important to understand children's perceptions of dentists in order to improve child-dentist communication. The aim of this mixed-methods study was to develop and validate a conceptual model of individual determinants of children's perceptions of dentists. A total of 1014 children completed an oral health behaviour form, a metaphor form, the Children's Fear Survey Schedule-Dental Subscale, the Dental Trust Scale, and the Early Childhood Oral Health Impact Scale. A conceptual model, which included five endogenous and two exogenous variables, was developed and validated. Qualitative (metaphor analysis) and quantitative (path analysis) analyses were conducted. The metaphors that were used to describe dentists were classified into seven conceptual categories: chaotic and unlovable; scary; artistic; protective and alleviative; restorative; scientific; and educative. Better oral health behaviours, greater trust in dentists, and lower dental anxiety were associated with positive perceptions of dentists. Oral health behaviours, trust in dentists, and dental anxiety had the strongest direct effects on perceptions of dentists, but age had the strongest indirect effect. The developed model should help dentists to understand pathways between children's individual determinants and perceptions of dentists. Coupled with behaviour management, this understanding can be an important part of improving dental visit behaviours and fostering positive post-visit attitudes among children.
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Affiliation(s)
- Burak Buldur
- Department of Pediatric Dentistry, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
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O'Grady A, Gray-Burrows K, Tahmassebi J. Inside the waiting room: process drama and dramatic distancing for involving children in research on dental anxiety. Arts Health 2021; 14:149-164. [PMID: 33651666 DOI: 10.1080/17533015.2021.1894465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Dental anxiety in children is a major health concern. Process drama adopts distancing techniques that allow children to examine the possible causes of dental anxiety safely and with authority. Using this method to inform paediatric dentistry is novel and could be adopted in other fields where children experience health-related anxiety.Methods: A 90-minute process drama workshop was conducted in three primary schools in Batley,West Yorkshire. Sixty-three children participated in the study. Sessions were audio-recorded, transcribed and thematic analysis conducted.Results: Four key concepts emerged: 1) Fear of the unknown; 2) Unpleasant sensory experience; 3) Society's perception and portrayal of the dentist and 4) Learnt negative associations with the dentist.Conclusion: Process drama offers a novel approach to develop an understanding of dental anxiety in children. It elicits critical insights from a child's perspective and offers a participatory model for engaging children in health research on sensitive issues.
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Affiliation(s)
- Alice O'Grady
- School of Performance and Cultural Industries, University of Leeds, Leeds, UK
| | - Kara Gray-Burrows
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, Leeds, UK
| | - Jinous Tahmassebi
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, Leeds, UK
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Grisolia BM, Dos Santos APP, Dhyppolito IM, Buchanan H, Hill K, Oliveira BH. Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses. Int J Paediatr Dent 2021; 31:168-183. [PMID: 33245591 DOI: 10.1111/ipd.12712] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/23/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time. AIM To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence. DESIGN Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879). RESULTS Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents. CONCLUSION DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.
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Affiliation(s)
- Barbara Monteiro Grisolia
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University - UERJ, Rio de Janeiro, Brazil
| | - Ana Paula Pires Dos Santos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University - UERJ, Rio de Janeiro, Brazil
| | - Izabel Monteiro Dhyppolito
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University - UERJ, Rio de Janeiro, Brazil
| | - Heather Buchanan
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Kirsty Hill
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - Branca Heloisa Oliveira
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University - UERJ, Rio de Janeiro, Brazil
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Reich SM, Ochoa W, Gaona A, Salcedo Y, Espino Bardales G, Newhart V, Lin J, Díaz G. Disparities in Caregivers' Experiences at the Dentist With Their Young Child. Acad Pediatr 2019; 19:969-977. [PMID: 30904582 PMCID: PMC6828576 DOI: 10.1016/j.acap.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand the experiences of diverse families when taking their young children to the dentist and to document their prevalence. METHODS An exploratory sequential design was used. First, 4 focus groups (N = 33) comprised of low-income female caregivers of children under 6 years of age were conducted in English and Spanish. Discussions centered around facilitators and barriers to taking children to the dentist. Themes derived from the groups were then used to create a survey that was given to 1184 caregivers in English, Spanish, or Vietnamese. RESULTS Thematic coding of focus groups found little support for typically reported barriers to pediatric oral health care utilization (eg, transportation, cost, knowledge); instead, caregivers reported negative experiences (eg, restraint, separation) as barriers. In the surveys, 66% of caregivers reported being separated from their children, 25% reported that their children were restrained (53.7% for cleanings), 26% of children were given sedating medication for cleanings, and 22% of the caregivers reported experiences that made them not want to return to the dentist. The prevalence of these experiences differed significantly among Latino, Asian, and Caucasian families and for annual incomes under or above $50,000. CONCLUSIONS Families with lower incomes and/or from ethnic and linguistic minority groups were more likely to report negative experiences at the dentist than higher income and Caucasian families. These data document the high prevalence of negative experiences and suggest ethnic, financial, and linguistic disparities in the quality of experiences. More research is needed on the role of dentists in facilitating or hindering oral health care utilization among diverse families.
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Affiliation(s)
- Stephanie M Reich
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz),.
| | - Wendy Ochoa
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | - Amy Gaona
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | - Yesenia Salcedo
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | | | - Veronica Newhart
- Department of Health Informatics (V Newhart), University of California, Irvine
| | - Joyce Lin
- Department of Human Development and Family Studies (J Lin), Purdue University, Lafayette, Ind
| | - Guadalupe Díaz
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
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Chapman HR, Kirby-Turner N. Psychological Intrusion - An Overlooked Aspect of Dental Fear. Front Psychol 2018; 9:501. [PMID: 29719519 PMCID: PMC5913370 DOI: 10.3389/fpsyg.2018.00501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 03/26/2018] [Indexed: 12/12/2022] Open
Abstract
Dental fear/anxiety is a widely recognised problem affecting a large proportion of the population. It can result in avoidance and/or difficulty accepting dental care. We believe that psychological intrusion may play a role in the aetiology and maintenance of dental fear for at least some individuals. In this narrative review we will take a developmental perspective in order to understand its impact across the lifespan. We will consider the nature of 'self,' parenting styles, the details of intrusive parenting or parental psychological control, and briefly touch upon child temperament and parental anxiety. Finally, we draw together the supporting (largely unrecognised) evidence available in the dental literature. We illustrate the paper with clinical examples and discuss possibly effective ways of addressing the problem. We conclude that psychological intrusion appears to play an important role in dental fear, for at least some individuals, and we call for detailed research into the extent and exact nature of the problem. A simple means of identifying individuals who are vulnerable to psychological intrusion would be useful for dentists.
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Affiliation(s)
- Helen R. Chapman
- School of Psychology, University of Lincoln, Lincoln, United Kingdom
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16
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Jamali Z, Najafpour E, Ebrahim Adhami Z, Sighari Deljavan A, Aminabadi NA, Shirazi S. Does the length of dental procedure influence children's behavior during and after treatment? A systematic review and critical appraisal. J Dent Res Dent Clin Dent Prospects 2018; 12:68-76. [PMID: 29732024 PMCID: PMC5928478 DOI: 10.15171/joddd.2018.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/07/2018] [Indexed: 01/27/2023] Open
Abstract
The aim of this systematic review was to investigate the effect of treatment duration on children’s behavior and/or anxiety in the dental setting. To this end, a systematic search was conducted in Pubmed/Medline and Scopus from 1970 to march 2017 for English language articles that assessed the relationship between dental treatment duration or length, and fear/anxiety or behavior in children aged <12 with no confounding medical and/or psychological history and neuro-psychiatric disabilities. Four studies investigating the effect of treatment duration on children’s behavior during and/or after treatment were included. None of the reviewed studies investigated the effect of treatment duration on children’s dental anxiety or fear. There was a general tendency towards deterioration of children’s behavior with an increase in treatment duration. In conclusion, our results undermine the validity of current suggestions about the appropriate treatment duration. Further clinical trials are needed to establish appropriate treatment duration for more effective behavioral management of pediatric patients during dental proce-dures.
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Affiliation(s)
- Zahra Jamali
- Assistant Professor, Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ebrahim Najafpour
- Associate Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ziya Ebrahim Adhami
- Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Sighari Deljavan
- Associate Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Asl Aminabadi
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Sajjad Shirazi
- Researcher and Lecturer, Dental and Periodontal Research Center, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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17
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Porritt J, Morgan A, Rodd H, Gupta E, Gilchrist F, Baker S, Newton T, Creswell C, Williams C, Marshman Z. Development and evaluation of the children's experiences of dental anxiety measure. Int J Paediatr Dent 2018; 28:140-151. [PMID: 29436092 DOI: 10.1111/ipd.12315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Existing measures of children's dental anxiety have not been developed with children or based on a theoretical framework of dental anxiety. AIM To develop the children's experiences of dental anxiety measure (CEDAM) and evaluate the measure's properties. DESIGN The measure was developed from interviews with dentally anxious children. Children recruited from a dental hospital and secondary school completed the CEDAM and Modified Child Dental Anxiety Scale (MCDAS). A subgroup of children completed the CEDAM before and after receiving an intervention to reduce dental anxiety to examine the measure's responsiveness. Rasch and Classical test analyses were undertaken. RESULTS Children were aged between 9 and 16 years (N = 88 recruited from a dental hospital and N = 159 recruited from a school). Rasch analysis confirmed the measure's unidimensionality. The CEDAM correlated well with the MCDAS (rho = 0.67, P < 0.01) and had excellent internal consistency (Cronbach's alpha = 0.88) and test-retest reliability (ICC = 0.98). The CEDAM was also able to detect changes in dental anxiety following the intervention (baseline mean = 22.36, SD = 2.57 and follow-up mean = 18.88, SD = 2.42, t(df = 37) = 9.54, P < 0.01, Cohen's d = 1.39). CONCLUSIONS The results support the reliability, validity and responsiveness of the CEDAM. Initial findings indicate it has potential for use in future intervention trials or in clinical practice to monitor children's dental anxiety.
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Affiliation(s)
- Jenny Porritt
- Department of Psychology, Sociology, and Politics, Sheffield Hallam University, Sheffield, UK
| | - Annie Morgan
- Paediatric Dentistry Department, Charles Clifford Dental Hospital, Sheffield, UK
| | - Helen Rodd
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Ekta Gupta
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Fiona Gilchrist
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Sarah Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Tim Newton
- Oral Health Services Research and Dental Public Health, King's College London, London, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Christopher Williams
- Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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18
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Oliveira MA, Vale MP, Bendo CB, Paiva SM, Serra-Negra JM. Influence of negative dental experiences in childhood on the development of dental fear in adulthood: a case-control study. J Oral Rehabil 2017; 44:434-441. [PMID: 28386938 DOI: 10.1111/joor.12513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the factors associated with high dental fear among Brazilian university students, especially the effect of a negative dental experience in childhood. This paired case-control study was conducted at the Universidade Federal de Minas Gerais in Brazil. Dental, psychology and mathematics students were divided into cases (high fear) and controls (low fear), defined by cluster analysis, according to the items of the Dental Fear Survey (DFS). Cases (n = 65) and controls (n = 260) participants were paired (1:4) by gender, undergraduate course and social vulnerability. The students self-reported the DFS and a questionnaire about oral health. Descriptive analysis, bivariate and multivariate conditional logistic regression were used as statistical tests with a significance level of 5%. The multivariate model showed that students who reported negative dental experiences in childhood (OR = 2·97; 95% CI: 1·44-6·14), toothache in the last 12 months (OR = 11·31; 95% CI: 4·79-26·68), discomfort during dental treatment (OR = 5·36; 95% CI: 2·53-11·36) and poor self-evaluation of oral health (OR = 3·82; 95% CI: 1·61-8·11) were more likely to have high dental fear. Negative dental experiences in childhood influence dental fear in adulthood. Oral health education should be addressed among university students to reduce dental fear.
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Affiliation(s)
- M A Oliveira
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - M P Vale
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - C B Bendo
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - S M Paiva
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - J M Serra-Negra
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
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Morgan AG, Rodd HD, Porritt JM, Baker SR, Creswell C, Newton T, Williams C, Marshman Z. Children's experiences of dental anxiety. Int J Paediatr Dent 2017; 27:87-97. [PMID: 27376925 DOI: 10.1111/ipd.12238] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dental anxiety is common among children. Although there is a wealth of research investigating childhood dental anxiety, little consideration has been given to the child's perspective. AIM This qualitative study sought to explore with children their own experiences of dental anxiety using a cognitive behavioural therapy assessment model. DESIGN Face-to-face, semi-structured interviews were conducted with dentally anxious children aged 11-16 years. The Five Areas model was used to inform the topic guide and analysis. Data were analysed using a framework approach. RESULTS In total, 13 children were interviewed. Participants described their experiences of dental anxiety across multiple dimensions (situational factors and altered thoughts, feelings, physical symptoms, and behaviours). Participants placed considerable value on communication by dental professionals, with poor communication having a negative influence on dental anxiety and the dentist-patient relationship. CONCLUSIONS This study confirms the Five Areas model as an applicable theoretical model for the assessment of childhood dental anxiety. Children provided insights about their own dental anxiety experiences that have not previously been described.
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Affiliation(s)
- Annie G Morgan
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Helen D Rodd
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jenny M Porritt
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK
| | - Sarah R Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tim Newton
- Population and Patient Health, Dental Institute, King's College London, London, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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20
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Porritt J, Rodd H, Morgan A, Williams C, Gupta E, Kirby J, Creswell C, Newton T, Stevens K, Baker S, Prasad S, Marshman Z. Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety. JDR Clin Trans Res 2017; 2:23-37. [PMID: 28879243 PMCID: PMC5576043 DOI: 10.1177/2380084416673798] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.
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Affiliation(s)
- J. Porritt
- Department of Psychology, Sociology, and Politics, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - H. Rodd
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - A. Morgan
- Paediatric Dentistry Department, Charles Clifford Dental Hospital, Sheffield, UK
| | - C. Williams
- Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Administration Building, Gartnavel Royal Hospital, Glasgow, UK
| | - E. Gupta
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - J. Kirby
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - C. Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights, Reading, Berkshire, UK
| | - T. Newton
- Oral Health Services Research & Dental Public Health, King’s College London, Denmark Hill Campus, Caldecot Road, London, UK
| | - K. Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, UK
| | - S. Baker
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - S. Prasad
- Derbyshire Community Health Services, Long Eaton Dental Clinic, UK
| | - Z. Marshman
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
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Beyond the drugs: nonpharmacologic strategies to optimize procedural care in children. Curr Opin Anaesthesiol 2016; 29 Suppl 1:S1-13. [PMID: 26926330 DOI: 10.1097/aco.0000000000000312] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of nonpharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue, and procedural sedation. RECENT FINDINGS Based both on well-established theoretical frameworks as well as an increasing body of scientific evidence NPS need to be regarded an inextricable part of procedural comfort care. SUMMARY Procedural comfort care must always start with a child-friendly, nonthreatening environment in which well-being, confidence, and self-efficacy are optimized and maintained. This requires a reconsideration of the medical spaces where we provide care, reduction of sensory stimulation, normalized professional behavior, optimal logistics, and coordination and comfort-directed and age-appropriate verbal and nonverbal expression by professionals. Next, age-appropriate distraction techniques and/or hypnosis should be readily available. NPS are useful for all types of medical and dental procedures and should always precede and accompany procedural sedation. NPS should be embedded into a family-centered, care-directed policy as it has been shown that family-centered care can lead to safer, more personalized, and effective care, improved healthcare experiences and patient outcomes, and more responsive organizations.
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Determining Cut-Off Points for the Dental Fear Survey. ScientificWorldJournal 2015; 2015:983564. [PMID: 26491721 PMCID: PMC4602336 DOI: 10.1155/2015/983564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/13/2015] [Indexed: 12/27/2022] Open
Abstract
Objective. To determine a high fear cut-off point score for the Dental Fear Survey (DFS) using a single-item self-report questionnaire. Methods. The DFS, a 20-item questionnaire assessing fear of dental treatment, was completed by 1,256 participants with a mean age of 22.3 years (SD = 5.1). Another self-report questionnaire was used to collect data on previous dental experiences. A high fear cut-off point score was determined by calculating the receiver operating characteristic (ROC) curve for the DFS. Descriptive statistics and multinomial logistic regression were calculated; a significance level of p < 0.05 was used for all tests. Results. The ROC curve indicated that a DFS score ≥53 corresponds to a sensitivity of 88.9% and a specificity of 92.5%. Most participants (n = 895; 71.5%) reported no fear of going to the dentist. There was significant association between DFS score and fear assessed with the question “Are you fearful of going to the dentist?” (p < 0.001). Conclusion. A cut-off point of 53 on the DFS total score represents the best compromise between sensitivity and specificity and can be used to predict high dental fear.
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23
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Zhou Y, Humphris GM. Reassurance and distress behavior in preschool children undergoing dental preventive care procedures in a community setting: a multilevel observational study. Ann Behav Med 2015; 48:100-11. [PMID: 24311016 DOI: 10.1007/s12160-013-9566-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated. PURPOSE This study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting. METHODS Nurse-child interactions (n = 270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables. RESULTS Child distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior. CONCLUSIONS The use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention ( ClinicalTrials.gov number: NCT00881790).
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Affiliation(s)
- Yuefang Zhou
- School of Medicine, University of St Andrews, St Andrews, Fife, KY16 9TF, Scotland, UK,
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Mejàre IA, Klingberg G, Mowafi FK, Stecksén-Blicks C, Twetman SHA, Tranæus SH. A systematic map of systematic reviews in pediatric dentistry--what do we really know? PLoS One 2015; 10:e0117537. [PMID: 25706629 PMCID: PMC4338212 DOI: 10.1371/journal.pone.0117537] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/26/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. METHODS A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. RESULTS Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. CONCLUSION There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.
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Affiliation(s)
| | - Gunilla Klingberg
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Frida K. Mowafi
- Swedish Council on Health Technology Assessment, Stockholm, Sweden
| | - Christina Stecksén-Blicks
- Department of Odontology, Section for Pediatric Dentistry, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Svante H. A. Twetman
- Department of Odontology, Section for Cariology, Endodontics, Pediatric Dentistry and Clinical Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofia H. Tranæus
- Swedish Council on Health Technology Assessment, Stockholm, Sweden
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Dentists’ self-perceived stress and difficulties when performing restorative treatment in children. Eur Arch Paediatr Dent 2015; 16:341-7. [DOI: 10.1007/s40368-014-0168-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
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Nelson TM, Huebner CE, Kim A, Scott JM, Pickrell JE. Parent-reported distress in children under 3 years old during preventive medical and dental care. Eur Arch Paediatr Dent 2014; 16:283-90. [PMID: 25514877 DOI: 10.1007/s40368-014-0161-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study examined factors related to young children's distress during preventive oral health visits. Additionally, associations between parent-reported child behaviour during the dental visit and during previous medical visits were tested. METHODS One hundred twenty-two children under 3 years of age enrolled in a government insurance programme for low-income children were seen for examination, prophylaxis, and fluoride application at a university-based dental clinic. Child distress was rated by parents on a numerical rating scale. RESULTS The average age of children enrolled was 23.5 ± 7.3 months. The majority (55.7 %) were judged to have little or no distress pre-examination. Mild or no distress during the examination was reported for 42.6 % of the children and severe distress was reported for 39.4 %. Intensity of distress during the examination was not associated with the child's age, gender, dental health, or previous experience with dental care. Distress was also unrelated to the caregiver's education level or own dental health. Intensity of distress was associated with the child's pre-dental examination distress and distress during prior medical examinations and injections. CONCLUSIONS Dental professionals can better anticipate child distress by assessing children before a dental examination and enquiring about previous medical experiences. Strategies to prepare parents and alleviate distress may help children cope with the preventive dental visit.
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Affiliation(s)
- T M Nelson
- Department of Pediatric Dentistry, University of Washington, 6222 NE 74th Street, Seattle, WA, 98115, USA,
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Humphris GM, Zhou Y. Prediction of nursery school-aged children who refuse fluoride varnish administration in a community setting: a Childsmile investigation. Int J Paediatr Dent 2014; 24:245-51. [PMID: 24750483 DOI: 10.1111/ipd.12068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Young children of pre-school age may find a minimal intervention (fluoride varnish application) difficult to tolerate. AIM To determine the significant predictors for refusing a fluoride varnish application from child, parental and nurse behaviour factors. DESIGN Data included videos from 238 children (52% female, aged 3-5 years) receiving a fluoride varnish application in a Scottish nursery school setting. The St Andrews Behavioural Interaction Scheme (SABICS) was used for video coding and retrieved child refusal status, initial anxious behaviour, and nurse behaviour. A parental survey collected parent's dental anxiety [Modified Dental Anxiety Scale (MDAS)] and the child's home behaviour [Strengths and Difficulties Questionnaire (SDQ)]. Child demographics, dental status, and previous varnish application experience were recorded. Multivariate binary logistic regression was applied to predict child refusal of the varnish application. RESULTS The response rate was 79%. Twelve children refused. The significant predictors of varnish refusal included initial anxious child behaviour (β = 5.14, P = 0.001), no previous varnish application (β = -3.89, P = 0.04), and no nurse praise (β = -1.06, P = 0.02). Information giving (P = 0.06) and reassurance (P = 0.08) were borderline significant. CONCLUSION Initial anxiety behaviour, previous varnish experience, and not using praise by the nursing staff predicted fluoride varnish application refusal.
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Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract 2013; 23:295-301. [PMID: 24356305 PMCID: PMC5586885 DOI: 10.1159/000357223] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 11/17/2013] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The aim of this review was to explore the peer-reviewed literature to answer the question: 'Why are people afraid of the dentist?' METHOD Relevant literature was identified by searching the following on-line databases: PubMed, PsycInfo, the Cochrane Library and Google Scholar. Publications were extracted if they explored the causes and consequences of dental fear, dental anxiety or dental phobia. RESULTS The research evidence suggests that the causes of dental fear, dental anxiety or dental phobia are related to exogenous factors such as direct learning from traumatic experiences, vicarious learning through significant others and the media, and endogenous factors such as inheritance and personality traits. Each individual aetiological factor is supported by the evidence provided. CONCLUSIONS The evidence suggests that the aetiology of dental fear, anxiety or phobia is complex and multifactorial. The findings show that there are clear practical implications indicated by the existing research in this area: a better understanding of dental fear, anxiety and phobia may prevent treatment avoidance.
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Affiliation(s)
- Laura Beaton
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
| | - Gerry Humphris
- Health Psychology, School of Medicine, University of St Andrews, St Andrews, UK
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The behaviour of preschool children receiving fluoride varnish application in a community setting. Br Dent J 2013; 215:E11. [PMID: 24113989 DOI: 10.1038/sj.bdj.2013.990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The behaviour of young children receiving mildly invasive dental preventive procedures in a community setting warrants more extensive research due to limitations in the literature.Objectives To document the behavioural profile of preschool children undergoing a preventive oral health intervention (fluoride varnish application) and to investigate this behaviour across children with different previous experience of the procedure, ages and initial anxiety states. METHOD Nurse-child interactions were video recorded and child behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency was measured and presented diagrammatically, followed by independent sample non-parametric tests to distinguish behavioural group differences. RESULTS Three hundred and three interactions were coded out of 456 recorded application sessions. 'Nonverbal agreement' behaviour was observed most frequently compared to disruptive behaviours. Younger preschool children tended to exhibit 'interact with instrument' behaviour more frequently than older children regardless of whether they had had previous application experience. Children who showed signs of initial anxiety were likely to display more disruptive behaviours during the later stage of the procedure compared with non-anxious children. CONCLUSIONS Dental staff working with preschool children are recommended to use encouragement-centred strategies to promote nonverbal cooperative behaviours in children. In addition, procedure instruments could be considered as a tool to gain child cooperation. Evidence of an autocorrelation effect of child behaviour was found, indicating that the early presentation of child behaviour predicted the behaviour of the child at later stages.
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Davies EB, Buchanan H. An exploratory study investigating children's perceptions of dental behavioural management techniques. Int J Paediatr Dent 2013; 23:297-309. [PMID: 23163933 DOI: 10.1111/ipd.12007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Behaviour management techniques (BMTs) are utilised by dentists to aid children's dental anxiety (DA). Children's perceptions of these have been underexplored, and their feedback could help inform paediatric dentistry. AIM To explore children's acceptability and perceptions of dental communication and BMTs and to compare these by age, gender, and DA. DESIGN A total of sixty-two 9- to 11-year-old school children participated in the study. Children's acceptability of BMTs was quantified using a newly developed Likert scale, alongside exploration of children's experiences and perceptions through interviews. anova and t-tests explored BMT acceptability ratings by age, gender, and DA. Thematic analysis was used to analyse interviews. FINDINGS Statistical analyses showed no effect of age, gender, or DA upon BMT acceptability. Children generally perceived the BMTs as acceptable or neutral; stop signals were the most acceptable, and voice control the least acceptable BMT. Beneficial experiences of distraction and positive reinforcement were common. Children described the positive nature of their dentist's communication and BMT utilisation. CONCLUSION Dental anxiety did not affect children's perceptions of BMTs. Children were generally positive about dentist's communication and established BMTs. Children's coping styles may impact perceptions and effectiveness of BMTs and should be explored in future investigations.
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Affiliation(s)
- E Bethan Davies
- Institute of Mental Health, The University of Nottingham, Nottingham, UK.
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Zhou Y, Forbes GM, Macpherson LMD, Ball GE, Humphris GM. The behaviour of extended duties dental nurses and the acceptance of fluoride varnish application in preschool children. Br Dent J 2012; 213:603-9. [PMID: 23257809 DOI: 10.1038/sj.bdj.2012.1133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 11/09/2022]
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Zhou Y, Cameron E, Forbes G, Humphris G. Development of a novel coding scheme (SABICS) to record nurse-child interactive behaviours in a community dental preventive intervention. PATIENT EDUCATION AND COUNSELING 2012; 88:268-276. [PMID: 22301062 DOI: 10.1016/j.pec.2012.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 12/22/2011] [Accepted: 01/04/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To develop and validate the St Andrews Behavioural Interaction Coding Scheme (SABICS): a tool to record nurse-child interactive behaviours. METHODS The SABICS was developed primarily from observation of video recorded interactions; and refined through an iterative process of applying the scheme to new data sets. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen's Kappa. Discriminant validity was assessed using logistic regression. RESULTS The SABICS contains 48 codes. Fifty-five nurse-child interactions were successfully coded through administering the scheme on The Observer XT8.0 system. Two visualization results of interaction patterns demonstrated the scheme's capability of capturing complex interaction processes. Cohen's Kappa was 0.66 (inter-coder) and 0.88 and 0.78 (two intra-coders). The frequency of nurse behaviours, such as "instruction" (OR = 1.32, p = 0.027) and "praise" (OR = 2.04, p = 0.027), predicted a child receiving the intervention. CONCLUSIONS The SABICS is a unique system to record interactions between dental nurses and 3-5 years old children. It records and displays complex nurse-child interactive behaviours. It is easily administered and demonstrates reasonable psychometric properties. PRACTICE IMPLICATIONS The SABICS has potential for other paediatric settings. Its development procedure may be helpful for other similar coding scheme development.
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Affiliation(s)
- Yuefang Zhou
- School of Medicine, University of St Andrews, Fife, KY16 9TS Scotland, UK.
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