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

Non-pharmacological interventions for reducing dental anxiety in pediatric dentistry: a network meta-analysis

BACKGROUND

Child dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators.

METHODS

A thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration's bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610.

RESULTS

The study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate.

CONCLUSION

In this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future.

Effectiveness of virtual reality glasses versus white noise on dental anxiety in children with attention-deficit hyperactivity disorder: A randomised controlled clinical trial

BACKGROUND

Management of children with attention-deficit hyperactivity disorder (ADHD) can be challenging due to their disruptive behaviour. Basic behaviour management techniques (BMTs) may not be sufficient, and adjunctive strategies such as virtual reality (VR) glasses or white noise can be employed.

AIM

To assess and compare the effectiveness of VR, white noise and basic BMTs on dental anxiety and behaviour of children with ADHD.

DESIGN

Forty-eight children with ADHD were recruited for this parallel, three-armed randomised controlled clinical trial, which involved three visits at one-week intervals, including examination, preventive measures and restorations. Children were randomly divided into three groups: VR, white noise and basic BMTs. Outcome measures were Faces Image Scale (FIS), Heart Rate (HR) and Venham's Behaviour Rating Scale (VBRS).

RESULTS

No significant difference was found between the groups in FIS scores. White noise group had a significantly lower mean HR than control group in all visits. Scores of VBRS in VR and white noise groups were significantly lower than those in the control group during the restorative visit.

CONCLUSIONS

VR and white noise could be beneficial in managing dental anxiety and improving behaviour in children with ADHD and could be used as adjunctive strategies to basic BMTs.

The efficacy of iatrosedation and music listening techniques in attenuating dental anxiety in patients undergoing dental crown preparation: A randomized clinical trial

Dental anxiety is a common problem encountered in dental clinics that affects both patients and dentists. Adequate management of dental anxiety is critical for optimal treatment outcomes for the patient. This study aims to assess the efficacy of two anxiety-reduction techniques (iatrosedation and music listening) for dental crown preparation in adult patients. In this clinical trial, 60 patients were randomly assigned to three groups: Group 1, iatrosedation; Group 2, music listening; and Group 3, control. Patients in all three groups underwent dental crown preparation. To measure the anxiety levels of the patients, heart rate was calculated using a pulse oximeter, and verbal rating scale scores were assessed. One-way analysis of variance, post hoc analysis, and Spearman's correlation were used to compare the mean values of the three groups. Significant differences were observed in the heart rate and verbal rating scale scores among individuals in the study groups. A more substantial reduction in anxiety levels was found in patients exposed to iatrosedation (Group 1), which was followed by music listening (Group 2). Recorded heart rate and verbal rating scores were the highest in the control group patients. The iatrosedation technique significantly reduced dental anxiety for patients undergoing dental crown treatment; however, music listening was less effective than iatrosedation. Educating patients regarding the dental care they are about to receive is vital for reducing their anxiety.

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.

Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children

Background

Many behavior management techniques are employed to reduce the anxiety associated with dental procedures in children. One of the most commonly used methods comprises audiovisual distraction using virtual reality (VR) eyeglasses. In this study, an innovative device, a periorbital eye massager (PEM), is compared with VR to evaluate dental anxiety in children.

Materials and methods

in this study, 22 children were divided into two groups, that is, group I consisting of PEM and group II consisting of VR. The participants were instructed to wear the device and then subjected to dental restorative procedures. After completion of the procedure, anxiety was measured using a validated questionnaire by the children and by using the modified behavior pain scale by the second investigator. Also, physiological parameters like heart rate and oxygen saturation were evaluated before and after a dental procedure.

Results

The results were statistically insignificant for group I and group II when a validated questionnaire and modified behavior pain scale were used to measure the dental anxiety of children. Also, the data also shows no significant difference in heart rate and oxygen saturation between the two groups.

Conclusion

The innovative PEM can also be used as an effective behavior management tool in managing dental anxiety in children, as there was no statistically significant difference between PEM and VR.

Clinical significance

As a pediatric dentist, the methods for administering a patient present a novel challenge because behavior management varies from patient to patient. As a result, the prospects for augmenting various techniques of behavior therapy for pediatric patients are limitless.

How to cite this article

Gala UP, Kalaskar R. Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children. Int J Clin Pediatr Dent 2024;17(1):48-53.

Effect of Biofeedback-Based Interventions on the Psychological Outcomes of Pediatric Populations: A Systematic Review and Meta-analysis

We performed a systematic and meta-analytic review of biofeedback-based interventions on psychological outcomes among pediatric populations. The literature search for this study was conducted in eight databases, including PubMed, the Cochrane Library, Scopus, CINAHL, Embase (OVID), Web of Science, PsycINFO (all via Ovid SP), and Google Scholar. The methodological quality of the studies was assessed using the Critical Appraisal Checklists for experimental and quasi-experimental studies that was developed by the Joanna Briggs Institute. We analyzed the effects of biofeedback-based interventions on psychological outcomes in the pediatric population by following the Preferred Reporting System for Systematic Reviews and Meta-Analysis. This systematic review and meta-analysis included nine studies with a total sample size of 658 children. In this study, EEG, EMG, and heart rate variability biofeedback were utilized to treat psychological symptoms in children. All studies focused on anxiety, with only one studying depression. As a result, it was found that all types of biofeedback effectively reduced children's anxiety levels. It was recommended that biofeedback-based interventions should be used to reduce children's anxiety.