Dentists' voice control: Effects on children's disruptive and affective behavior

Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis

BACKGROUND

Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12.

METHOD

A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses.

RESULT

A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children.

CONCLUSIONS

The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.

Development and relationship between the judgment of the speed of passage of time and the judgment of duration in children

This study examined the relationships between the awareness of the speed of the passage of time, the judgment of durations and experiential factors in children aged 4-9 years. They were asked to judge the duration and the speed of the passage of time for different intervals (second and minutes), and to rate their feelings (arousal, happiness, sadness, and task difficulty) during each interval. The results indicated that 8-9-year-olds' judgment of the passage of time is extremely flexible and context-dependent, representing the duration and/or the individual changes in subjective experience (emotion). In contrast, young children's judgment of the passage of time was not related to duration. However, their judgments were not given randomly. They judged that time passed more quickly when they felt happier and more alert. The passage-of-time judgment was therefore initially grounded in emotional and sensory-motor experience, i.e., in their perception of changes (acceleration and deceleration) in self-movement (successions of states and their extension). Therefore, duration judgment and passage-of-time judgment initially develop separately and are later combined when children understand the logical link between speed and duration.

Effectiveness of Virtual Reality Glasses Digital Screens and Verbal Command as a Method to Distract Young Patients during Administration of Local Anesthesia

Aim and objective

The study investigates the effect and compares three techniques-video-eyeglasses earphone system, Digital screens and verbal methods as distracting technique to assess dental pain reaction in children during administration of local anesthesia (LA).

Materials and methods

Pain or its anticipation can cause fear and anxiety in a child which could complicate further dental treatment. This cross-sectional study consists of 97 children of age-group 4–8 years who required local anesthesia for their dental treatment were selected. Children were randomly allocated into three groups namely- Verbal method (group A), video eyeglass/earphone system (group B) and digital screens (group C). In group A, instructions were given to the patient by the dentist while administering local anesthesia. In group B, VR box was used to show age appropriate videos according to subjects’ choice. In group C, digital screens were placed on dental chair for patient to watch while nerve block was administered. Pain was measured using face, legs, activity, cry, consolability (FLACC) scale behavioral anxiety/pain assessment scale.

Results

FLACC score was found to be significantly different among three groups. The mean FLACC scale score for pain was less in video eyeglass/earphone (1.94) than digital screens (3.67) and highest in Verbal group (6.88).

Conclusion

Video eyeglasses/earphone method proved to be most effective as a distraction method in children and helped in reducing children's disruptive behavior in the dental setting.

Clinical significance

This study was conducted to find a better distraction technique among video eyeglasses/earphone system, digital screens and Verbal command that will make child less apprehensive during administration of local anesthesia.

How to cite this article

Sharma Y, Bhatia HP, Soods S, et al. Effectiveness of Virtual Reality Glasses Digital Screens and Verbal Command as a method to Distract Young Patients during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S143–S147.

Perceptions of behavioural guidance techniques for paediatric patients amongst students in a Malaysian dental school

OBJECTIVES

Behavioural guidance (BG) training is an important component of preparing future dentists to manage paediatric patients, who often exhibit cooperation issues during treatment. This study investigated the acceptance of various BG techniques amongst dental students in a Malaysian institution.

METHODOLOGY

A paper-based survey was conducted, classroom-style, on all dental students (Year 1 to Year 5, n = 336, response rate = 84.5%) using a validated questionnaire, developed from previous literature. For each BG technique, students used a visual analogue scale to mark their acceptability score; this figure was later categorised into different acceptance levels. Students' mean acceptability scores and acceptance of each BG technique were consecutively analysed via independent t test and chi-square test (significance level, P < 0.01) using Statistical Package for the Social Sciences software.

RESULTS

Across the academic year, most students cited acceptance of reinforcement techniques (eg positive reinforcement, encouraging child "not to be a coward", promising a toy) and desensitisation methods (eg tell-show-do, music/video distraction, stimulating the child's imagination, using euphemism), but not for aversive interventions (eg hand over mouth, using Papoose Board, active immobilisation) and showing needles (P > 0.01). Percentages of those who accepted communicative techniques involving parents demonstrated significant differences across subjects of different academic years, between pre-clinical and clinical groups of respondents and amongst clinical students. Other techniques with such significant differences, along with low acceptance, included modelling, voice control and disallowing the child to speak.

CONCLUSION

The findings of this study provide useful information for curricular enhancement aimed at equipping dental students with the ability to apply appropriate and effective BG techniques during patient care.

Let the Children Listen: A First Approximation to the Sound Environment Assessment of Children through a Soundwalk Approach

The urban sound environment is one of the layers that characterizes a city, and several methodologies are used for its assessment, including the soundwalk approach. However, this approach has been tested mainly with adults. In the work presented here, the aim is to investigate a soundwalk methodology for children, analyzing the sound environment of five different sites of Gothenburg, Sweden, from children's view-point, giving them the opportunity to take action as an active part of society. Both individual assessment of the sound environment and acoustic data were collected. The findings suggested that among significant results, children tended to rank the sound environment as slightly better when lower levels of background noise were present ( L A 90 ). Moreover, traffic dominance ratings appeared as the best predictor among the studied sound sources: when traffic dominated as a sound source, the children rated the sound environment as less good. Additionally, traffic volume appeared as a plausible predictor for sound environment quality judgments, since the higher the traffic volume, the lower the quality of the sound environment. The incorporation of children into urban sound environment research may be able to generate new results in terms of children's understanding of their sound environment. Moreover, sound environment policies can be developed from and for children.

Dental anxiety: An understudied problem in youth

Dental anxiety and dental phobia typically emerge during childhood; the associated avoidance of dental care can result in oral health problems and is associated with lower quality of life. In this review, we discuss the definition of dental phobia and dental anxiety and issues related to their differentiation. We then review the literature on dental anxiety and dental phobia, including its prevalence, assessment, and sequalae. Moreover, we provide a synthesis of findings on the etiology and maintenance of dental phobia and propose a comprehensive cognitive behavioral model to guide further study. We also present a systematic qualitative and a quantitative review of the treatment literature, concluding that although we have made strides in learning how to prevent dental anxiety in youth, the methods effective in preventing anxiety may not be equally effective in treating youth with dental phobia. We propose a multidisciplinary approach, including those with expertise in pediatric anxiety as well as pediatric dentistry, is likely required to move forward.

Management of fear and anxiety in the dental clinic: a review

People who are highly anxious about undergoing dental treatment comprise approximately one in seven of the population and require careful and considerate management by dental practitioners. This paper presents a review of a number of non-pharmacological (behavioural and cognitive) techniques that can be used in the dental clinic or surgery in order to assist anxious individuals obtain needed dental care. Practical advice for managing anxious patients is provided and the evidence base for the various approaches is examined and summarized. The importance of firstly identifying dental fear and then understanding its aetiology, nature and associated components is stressed. Anxiety management techniques range from good communication and establishing rapport to the use of systematic desensitization and hypnosis. Some techniques require specialist training but many others could usefully be adopted for all dental patients, regardless of their known level of dental anxiety. It is concluded that successfully managing dentally fearful individuals is achievable for clinicians but requires a greater level of understanding, good communication and a phased treatment approach. There is an acceptable evidence base for several non-pharmacological anxiety management practices to help augment dental practitioners providing care to anxious or fearful children and adults.

The management of dental anxiety: time for a sense of proportion?

Dental anxiety and fear are common and potentially problematic, both for the patient and for the dental team in managing such patients. Furthermore, dental fear still presents a major barrier to the uptake of dental treatment. This article will take as its premise an assumption that anxiety manifests at different levels and that consequently management of dental anxiety involves both assessment and proportionate intervention. Methods for undertaking both assessment and management are outlined.

Systematic review of the effect of dental staff behaviour on child dental patient anxiety and behaviour

OBJECTIVES

To review the literature, of the past 30 years, on the effects of dental staff behaviour on the anxiety and behaviour of child dental patients; especially to determine staff behaviours that reduce anxiety and encourage cooperation of children.

METHODS

A systematic literature review was conducted using PubMed, Web of Science, The Cochrane Library, PsycINFO, Embase and CINAHL.

RESULTS

Initial search returned 31 publications of which 11 fulfilled the criteria for review. Among seven studies that measured anxiety, four used validated measures. Five observational studies coded behaviour using Weinstein et al.'s (1982) coding scheme [1]. An empathic working style and appropriate level of physical contact accompanied by verbal reassurance was found to reduce fear-related behaviours in children. Findings regarding positive reinforcement and dentists' experience increasing cooperative behaviour were inconsistent.

CONCLUSIONS

Measures for anxiety and behaviour varied across studies. Relationships between certain dental staff behaviours and child anxiety/behaviour were reported. However, limited work was identified and research using improved sampling, measurement and statistical approach is required.

PRACTICE IMPLICATIONS

Understanding what routine clinical behaviour of dental staff affects children's dental anxiety/behaviour will inform investigators of how children comply and help staff be aware the significance of their daily behaviour on treatment success.

Review: behaviour management techniques in paediatric dentistry

BACKGROUND

Behaviour management is widely agreed to be a key factor in providing dental care for children. Indeed, if a child's behaviour in the dental surgery/office cannot be managed then it is difficult if not impossible to carry out any dental care that is needed. It is imperative that any approach to behavioural management for the dental child patient must be rooted in empathy and a concern for the well being of each child.

REVIEW

Based on various presentations given at Congresses of the European Academy of Paediatric Dentistry (EAPD), documents reviewing behaviour management prepared by the Clinical Affairs Committee of the EAPD, and written submissions to the Executive Board of the EAPD, a review of the various approaches to the behaviour management of the child dental patient was completed. All aspects of non-pharmacological behavioural management techniques described in the literature over the past 80 years were reviewed.

FINDINGS

There is a very wide diversity of techniques used but not all are universally accepted by specialist paediatric and general dentists. Wide cultural and philosophical differences are apparent among European paediatric dentists that seem difficult to bridge when forming agreed guidelines. Accordingly, this review highlights those behaviour techniques that are universally accepted such as tell, show, do (TSD) or positive reinforcement, but nevertheless describes the most commonly mentioned techniques for which there are descriptions in the literature.

CONCLUSION

A wide variety of behavioural management techniques are available to paediatric dentists which must be used as appropriate for the benefit of each child patient, and which, importantly, must take into account all cultural, philosophical and legal requirements in the country of dental practice of every dentist concerned with dental care of children.

A model of pain and anxiety associated with acute stressors: distress in dental procedures

Many acute stressful experiences are not inherently very harmful, yet are associated with great pain and anxiety. The characteristics and experiences that the person brings to the situation are more important than any objective characteristics of the experience itself in determining how aversive the experience will be. Dental procedures are excellent examples of this type of stressor. Drawing primarily on the literature related to dental procedures, the present article discusses the nature of pain and anxiety in the face of an acute stressor, and presents the dispositional and situational factors that contribute to the perception of an acute stressor as aversive. A model is presented illustrating how the various factors interact. It is argued that, in addition to being descriptive, the model is also prescriptive of measures that may be taken to ameliorate the distress of persons subjected to acute stressors like dental procedures.

Measuring emotion: the Self-Assessment Manikin and the Semantic Differential

The Self-Assessment Manikin (SAM) is a non-verbal pictorial assessment technique that directly measures the pleasure, arousal, and dominance associated with a person's affective reaction to a wide variety of stimuli. In this experiment, we compare reports of affective experience obtained using SAM, which requires only three simple judgments, to the Semantic Differential scale devised by Mehrabian and Russell (An approach to environmental psychology, 1974) which requires 18 different ratings. Subjective reports were measured to a series of pictures that varied in both affective valence and intensity. Correlations across the two rating methods were high both for reports of experienced pleasure and felt arousal. Differences obtained in the dominance dimension of the two instruments suggest that SAM may better track the personal response to an affective stimulus. SAM is an inexpensive, easy method for quickly assessing reports of affective response in many contexts.