A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management

An Assessment of Oral-Health-Related Quality of Life and Anxiety in Early Adolescents (11-14 Years) at Their First Dental Visit: A Cross-Sectional Study

Background: Knowing the oral-health-related quality of life (OHRQoL) status of pediatric patients would be helpful in analyzing their level of dental anxiety before their first visit to a pediatric dentist. However, few studies have analyzed OHRQoL and anxiety in early adolescent patients. The aim of this study was to describe the OHRQoL and anxiety levels of early adolescents, according to age and sex, at their first dental examination. Methods: A cross-sectional study was conducted on early adolescents (11-14 years old) attending their first dental examination in 2023-2024. OHRQoL was assessed using the Spanish version of the Child Perceptions Questionnaire 11-14 (CPQ-Esp11-14) and anxiety using the State-Trait Anxiety Inventory in Children (STAIC). Results: A total of 130 early adolescents were assessed, with an average age of 12.6 years (±1.06) and an equal sex distribution (65 boys and 65 girls). Among the analyzed sample, the OHRQoL dimension with the highest score was social well-being (15.01 ± 10.7), whereas the oral symptoms dimension (8.6 ± 4.25) had the lowest impact. There were no statistically significant differences between female and male early adolescents in the anxiety state or anxiety-trait dimensions or in the dimension of OHRQoL, except for oral symptoms, which were higher in boys (9.48 ± 4.51 versus 7.72 ± 3.81). Similarly, no significant differences were found based on age regarding anxiety or OHRQoL. Conclusions: Considering the limitations of this study, it can be concluded that higher levels of anxiety negatively impacted the OHRQoL of the early adolescent population studied.

Parental Anxiety Disorders and Their Impact on Dental Treatment in Children Aged 4 to 13 Years: A Cross-Sectional Observational Study

Introduction: Children with dental fear and/or anxiety will use all available means to avoid or delay dental treatment, which can cause a deterioration in their oral health. A close relationship has been demonstrated between parents' fear and/or anxiety about the dentist and the development of dental anxiety in children. Objective: Our aim is to evaluate the anxiety of children's parents and the factors that influence the prediction of anxiety and children's behavior, as well as its impact on the risk of caries. Method: This is a descriptive cross-sectional study. For data collection, scientifically validated questionnaires were used for parents (n = 101) and children (n = 101). Statistical analysis was performed using the Chi2 test, the independent sample t test, and the Mann-Whitney test. Results: A direct relationship (p = 0.095) was found between the Corah test and the Venham test, as well as statistical significance (p = 0.035) between the STAI-Trait and the Venham test. The type of treatment the child is going to undergo is a determining factor in parental anxiety. A total of 85% of the patients exhibited positive behavior regardless of the degree of parental anxiety. Conclusions: The relationship between the anxiety of the parent and the child was very limited and restricted to specific cases; direct associations were found between the oral state of the child and the anxiety of the parents.

Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A Split-Mouth Randomized Crossover Clinical Trial

Materials and Methods

This crossover clinical trial was conducted with eligible 6-8-year-old children requiring bilateral mandibular molar pulpotomy. At the first treatment visit, pulpotomy was performed for 15 children using VR glasses distraction while the other 15 children received a pulpotomy without any VR glasses; this trend was reversed at the second session and pulpotomy was performed for the contralateral tooth. Pulse rate (PR) and Modified Child Dental Anxiety Scale (MCDAS) measured the anxiety levels. Wong-Baker Faces Pain Scale (WBFP) assessed the pain perception before and after the intervention. Data were analyzed by Statistical Package for the Social Sciences version 25 using the Mann-Whitney and χ2 tests.

Results

The mean PR was not significantly different between the two groups. However, the test group showed significantly lower scores of MCDAS (P value = 0.02) and WBFP (P value = 0.001) compared with the control group.

Conclusion

The present results suggest that VR headsets can decrease the level of pain and anxiety of patients during primary mandibular pulpotomy. This trial is registered with IRCT20200315046782N1.

The Prevalence of Dental Fear and Its Relationship to Dental Caries and Gingival Diseases Among School Children in Wardha

Background Children who are afraid of the dentist have terrible behavioral effects, and one of those effects is that they have a preconceived concept that getting treatment would be unpleasant. Such fear and anxiety can lead to avoidance of dental care. These patients must be recognized and their concerns addressed as soon as possible. It is, therefore, important to highlight the connection between the constructs that target the development of dental fear and anxiety, including its outcome in children concerning the prevalence of dental diseases. Aims and objectives To assess the prevalence of dental anxiety and its correlation to dental caries and gingivitis in students in Wardha aged six to 12 years old. Methods Two hundred schoolchildren between the ages of six and 12 were chosen at random, with 100 boys and 100 girls. Children had an oral examination utilizing the decayed, missing, and filled teeth (DMFT) Index as well as the Loe and Silness gingival index (GI), as well as a modified version of the dental fear survey questionnaire. Results In the study population, the prevalence of low to moderate "general dental fear" was 47%, whereas the frequency of high dental fear was 14%. The mean DMFT (1.80 ± 1.76) and GI (1.04 ± 0.52) of boys did not differ substantially from the DMFT (1.94 ± 81.02) and GI (0.97 ± 0.53) of girls (P > 0.05). Conclusion In terms of DMFT and gingival scores, there was not any obvious distinction between male and female children. Additionally, there was no connection found between "general dental fear" and either the DMFT or GI scores. Dental fear scores decreased with increasing age.

Determinants of Clinical Decision Making under Uncertainty in Dentistry: A Scoping Review

Clinical decision-making for diagnosing and treating oral and dental diseases consolidates multiple sources of complex information, yet individual clinical judgements are often made intuitively on limited heuristics to simplify decision making, which may lead to errors harmful to patients. This study aimed at systematically evaluating dental practitioners' clinical decision-making processes during diagnosis and treatment planning under uncertainty. A scoping review was chosen as the optimal study design due to the heterogeneity and complexity of the topic. Key terms and a search strategy were defined, and the articles published in the repository of the National Library of Medicine (MEDLINE/PubMed) were searched, selected, and analysed in accordance with PRISMA-ScR guidelines. Of the 478 studies returned, 64 relevant articles were included in the qualitative synthesis. Studies that were included were based in 27 countries, with the majority from the UK and USA. Articles were dated from 1991 to 2022, with all being observational studies except four, which were experimental studies. Six major recurring themes were identified: clinical factors, clinical experience, patient preferences and perceptions, heuristics and biases, artificial intelligence and informatics, and existing guidelines. These results suggest that inconsistency in treatment recommendations is a real possibility and despite great advancements in dental science, evidence-based practice is but one of a multitude of complex determinants driving clinical decision making in dentistry. In conclusion, clinical decisions, particularly those made individually by a dental practitioner, are potentially prone to sub-optimal treatment and poorer patient outcomes.

Effect of the new needle-free injection system on pain perception and dental anxiety during anesthesia: randomized controlled split-mouth study

Backgrounds

Pain management is one of the most important factors affecting the success of pediatric dentistry. Therefore, new needle- and pain-free local anesthesia techniques have been developed in parallel with technological advancements. The purpose of this study is to compare the pain perception and dental anxiety levels associated with a needle-free injection system (Comfort-in™) and the classic needle method during treatment-required infiltration anesthesia in children.

Methods

This randomized controlled crossover split-mouth clinical study included 94 children who required dental treatment with local anesthesia using a dental needle or needle-free injection system for the bilateral primary molars. The Wong-Baker Scale (WBS) was used to measure pain perception at different times, and the Modified Child Dental Anxiety Scale (MCDAS) was used to measure the anxiety level of the child. A statistical software package was used to process the data. Statistical significance was set at P < 0.05.

Results

There was no significant difference between the needle-free injection system and dental needle method during the induction stage for filling and pulpotomy (P > 0.05). "Pain on postoperative 1st day" was similar in both types of anesthesia (P = 0.750).

Conclusions

The needle-free injection system was as effective as the dental needle method. The Comfort-in™ system was an acceptable alternative for patients during the postoperative period. Understanding how pain management may be provided during local anesthesia administration and a child's fear and anxiety regarding the dentist may lead to better dental compliance.

The effect of socioeconomic aspects and dental history on pediatric patients' dental anxiety

This study aimed to characterize the profile of dental anxiety in pediatric patients, identifying the effect exerted by socioeconomic factors using dental data. A cross-sectional study design with a sample of 120 children aged 7-12 years old was used. Data relating to anxiety levels prior to dental care, socioeconomic aspects (family income, education level, child's school type), and child's dental history (previous dental appointments, previous treatment, caries experience) were collected. Additionally, participants completed the Brazilian version of the Children's Fear Survey Schedule- Dental Subscale (B-CFSS-DS) to assess dental anxiety. Descriptive analyses, chi-squared (X 2 ) tests, and Mann-Whitney U tests were performed, with a significance level of 5%. A total of 51 boys (42.5%) and 69 girls (57.5%) were included. There was no significant difference in dental anxiety between them. However, younger children had higher mean B-CFSS-DS scores (p = 0.036, Mann-Whitney). A higher prevalence of dental anxiety was found in participants from low-income families (p = 0.012, X 2 ) and in patients who did not receive endodontic treatment (p=0.034, X 2 ). Higher mean B-CFSS-DS scores were also observed in participants who did not receive endodontic treatment (p=0.001, Mann-Whitney) compared with those that did receive endodontic treatment. No relationship was found between education level, patient school type, first dental appointment, caries experience, and dental anxiety data. Younger children presented a profile of greater dental anxiety. Socioeconomic factors and dental data exerted some effect on dental anxiety, where children from low-income families and those not subjected to endodontic treatment displayed higher rates of dental anxiety.

Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance

Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.

Evaluation of the ability of dental clinicians to rate dental anxiety

The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of Östergötland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients' levels of dental anxiety on a Visual Analogue Scale. The correlation (r_s ) between the clinicians' and patients' ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians' and patients' ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians' confidence and their ability to rate a patient's dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.

A randomized clinical trial comparing Hall vs conventional technique in placing preformed metal crowns from Sudan

Despite the high success rates of preformed metal crowns (PMCs) in children no randomized clinical trials compare methods of placement and none describe its use in Africa. Our aim was to compare survival and cost-effectiveness of PMCs placed by conventional techniques (CT) and biological Hall techniques (HT) using a prospective randomized control trial in a general dental practice from Khartoum. One hundred and nine and 103 PMCs were placed in randomly selected children (5-8years) with 1–2 carious primary molars using HT and CT respectively and followed for 2 years. Socioeconomic status, periodontal health, occlusion, anxiety, and procedure time were compared using student t-test. Kaplan–Meier survival rates and incremental cost effectiveness ratio (ICER) were compared between CT and HT. CT and HT groups were similar for age, gender, socio-economic status. Survival rates were high (over 90%) for both study arms and not statistically different (p>0.05). Anxiety scores were significantly higher in CT arm after 12 months compared to HT (p<0.001). Clinically, gingival and plaque indices were similar between groups (p>0.05) but occlusions were raised in nearly all subjects in the HT arm (p<0.05). Periodontal health improved, and occlusions adjusted over time in both arms. There were 3 (2.7%) and 6 (5.8%) minor failures, 7 (6.4%) and 6 (5.8%) major failures in HT and CT arms respectively. Mean procedure time was lower in HT (9.1 min) than CT (33.9 min); p<0.001. Mean PMC cost was US$2.45 and US$7.81 for HT and CT respectively. The ICER was US$136.56 more for each PMC placed by CT per life year. We show that PMCs have high survival outcomes in disadvantaged populations similar to results from developed countries. As HT can be carried out by less experienced dental operators and therapists, this biological approach provides a promising cost-effective option to manage caries in developing countries with limited resources.

Trial registration: The trial is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT03640013

Assessment of Efficacy of Virtual Reality Distraction in Reducing Pain Perception and Anxiety in Children Aged 6-10 Years: A Behavioral Interventional Study

Aim

The aim of the present study was to assess the effectiveness of virtual reality distraction on pain perception and state anxiety levels undergoing restorative treatment in children.

Materials and methods

This was an interventional study with 30 children of age 6-10 years came to the Department of Pedodontics and Preventive Dentistry. The intervention was distraction with virtual reality eyeglasses and the parameters considered includes pain perception analyzed subjectively by Wong Baker FACES pain rating scale and objectively by FLACC scale; anxiety was analyzed physiologically by measuring pulse rate and oxygen saturation levels using pulse oximeter. The parameters were recorded before the treatment, i.e., baseline, during and as well as after the restorative treatment procedure. The values noted were tabulated and subjected to appropriate statistical analysis with p value set at 0.05.

Results

The study displayed a very high statistical significance in reduction of pain perception and anxiety levels in all the comparisons made at three time periods, i.e., baseline, during and after treatment procedure (p < 0.0001).

Conclusion

Virtual reality distraction can be considered as a budding distraction tool in the arena of behavior management that helps adapt the child to dental environment and able to deliver qualitative dental care.

Clinical significance

Managing an anxious child is one of the challenging tasks for a pediatric dentist in the day-to-day life. As the world progresses with newer interventions, virtual reality distraction is one among them that has the ability to reduce pain perception and anxiety in children with a positive approach.

How to cite this article

Rao DG, Havale R, Nagaraj M, et al. Assessment of Efficacy of Virtual Reality Distraction in Reducing Pain Perception and Anxiety in Children Aged 6-10 Years: A Behavioral Interventional Study. Int J Clin Pediatr Dent 2019;12(6):510-513.

Barriers and Drawbacks of the Assessment of Dental Fear, Dental Anxiety and Dental Phobia in Children: A Critical Literature Review

OBJECTIVE

Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry.

STUDY DESIGN

A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children.

RESULTS

104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia.

CONCLUSION

The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.

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

OBJECTIVES

Dental anxiety level has been previously associated with oral health status. Since general anesthesia (GA) allows dental treatments to be performed in anxious children with a high number of caries, we aimed to evaluate the dental anxiety levels of these children before and after dental treatments performed under GA.

MATERIALS AND METHODS

Thirty-eight children with high anxiety aged between 35 and 72 months who required multiple dental treatments to be performed under GA were included in the study. Frankl's Behavior Rating Scale, sitting patterns, Facial Image Scale, and Children's Fear Survey Schedule-Dental Subscale (completed by the children's parents) were recorded before and after the dental treatments performed under GA. Pre-treatment and post-treatment biochemical parameters, including cortisol, alpha-amylase, and chromogranin A levels, in saliva and serum samples were also evaluated.

RESULTS

The psychometric scales showed a statistically significant reduction in the post-treatment dental anxiety levels of the children compared with the pre-treatment anxiety levels. Additionally, the biochemical parameters measured in the serum and whole saliva samples showed a decrease after treatments performed under GA.

CONCLUSIONS

Our study results suggest that performing dental treatments under GA can reduce the dental anxiety levels of children with a high number of caries.

State, trait, and dental anxiety in caregivers of individuals with disabilities

PURPOSE

The aim of this study was to compare state anxiety, trait anxiety, and dental anxiety in caregivers of patients with special needs and caregivers of pediatric patients without special needs at dental clinics.

MATERIALS AND METHODS

A quantitative, cross-sectional study was conducted. Data were collected using a semistructured questionnaire. All respondents were older than 18 years of age. Individuals with cognitive impairment and those taking anxiolytics, antidepressants, or sleep-inducing medication were excluded from the study. The sample consisted of 55 caregivers of patients with special needs and 55 caregivers of pediatric dental patients. A questionnaire was administered to determine the sociodemographic profile of the patients based on the 2015 Brazilian Economic Classification Criteria. Anxiety regarding dental treatment was measured using the dental anxiety scale. The state-trait anxiety inventory was used to identify state and trait anxiety levels.

RESULTS

Caregivers of individuals with disabilities had a similar level of anxiety as caregivers of pediatric dental patients. Most caregivers of individuals with disabilities were mothers with an older age and a greater frequency of trait anxiety, especially when these mothers had health problems. State anxiety was associated with a lower education level.

CONCLUSIONS

Higher dental anxiety levels were found among caregivers with a higher level of trait anxiety, independently of the type of patient to which care was given.

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.

Can galvanic skin conductance be used as an objective indicator of children's anxiety in the dental setting?

Background

Assessment of procedural distress is essential at assisting children during invasive dental treatments. This study aimed to determine the validity and reliability of galvanic skin response as a measure for assessment of dental anxiety in children.

Material and Methods

151 children, aged 5-7 years, participated in this study. Similar dental treatments were rendered to all subjects. At the beginning and end of the session, modified child dental anxiety scale (MCDAS), clinical anxiety rating scale (CARS) and galvanic skin response (GSR) were used to determine children’s anxiety.

Results

GSR was significantly correlated with both MCDAS (rs=0.62, p=0.02) and CARS (rs=0.44, p=0.032). The correlation between MCDAS and CARS was also significant (rs = 0.9, P<0.001). Anxiety decreased during the session in both GSR (rs=0.52, p=0.001) and MCDAS scales (rs=0.77, p=0.001). CARS also showed a reduction between the initial and second assessment, but it was not statistically significant (rs=0.12, P=0.36).

Conclusions

The findings suggest that GSR is a reliable and valid measure for assessment of children’s dental anxiety in the clinical context. GSR may help to identify clinically anxious children before dental treatment to provide appropriate interventions.

Key words:Dental anxiety, reliability, validity, galvanic skin response.

Children's experiences of dental anxiety

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.

Effect of a third-generation LED LCU on microhardness of tooth-colored restorative materials

OBJECTIVE

To assess the effects of different modes of a third-generation light-curing unit (LCU) (VALO) on the microhardness of restorative materials.

DESIGN

A microhybrid composite resin (Filtek(™) Z550), a giomer (Beautifil II), a compomer (Dyract eXtra) and a RMGIC (Photac(™) Fil) were used in the study. Three different modes of VALO were tested and a second-generation LCU (Elipar S10) was used as a control. The microhardness (VHN) was measured using a Vickers Hardness tester. Data were analyzed using two-way anova and post hoc Tukey's test (P < 0.05).

RESULTS

The Filtek Z550 group had the highest VHN values followed by Photac Fil, Beautifil II and the Dyract eXtra at both top and bottom surfaces, however the difference between Filtek Z550 and Photac Fil was not statistically significant for the bottom surfaces (P > 0.05). Of the different curing protocols tested, the VALO LCU in Mode 3 resulted in the lowest VHN values at both top and bottom surfaces (P < 0.05).

CONCLUSION

Based on the results of this study, it can be concluded that the high-power mode of the VALO LCU can be recommended for clinical applications especially in pediatric patients, as it can shorten the time required to adequately polymerize resin-based tooth-colored restorative materials.

Assessment of anxiety in patients who undergo surgical procedures for tooth implants: a prospective study

PURPOSE

The purpose of this study is to evaluate general anxiety using the State-Trait Anxiety Inventory (STAI) and dental anxiety using the Corah Dental Anxiety Scale (Corah-DAS) in patients who underwent surgical procedures for dental implants.

METHODS

The study was performed with 55 patients who underwent implant surgery, of whom 37 were treated at a university and 18 were treated at a private office. General anxiety (STAI) and dental anxiety (Corah-DAS) were assessed at three different time points: appointment prior to clinical procedures (T1), day of procedures (just before the procedures; T2), and first post-procedure appointment (T3). The data were analyzed using analysis of variance followed by the Duncan test or Student's t-test.

RESULTS

State anxiety increased on the day of surgery (T2), whereas trait anxiety was higher at T1 (both p < 0.05). Women (n = 41) presented higher state anxiety at T2 than men (n = 14). Patients who were treated at the university (n = 37) exhibited higher state anxiety at both T1 and T3 than patients who were treated in a private practice (n = 18). Individuals with lower dental anxiety at T1 were those who reported having good experiences with dental treatment.

CONCLUSIONS

An increase in state anxiety was observed immediately before surgical procedures, and this increase was more pronounced in females. Although the Corah-DAS has been used as an indicator of dental anxiety, the STAI appears to be more sensitive for the measurement of anxiety. The application of appropriate methods is essential for ascertaining anxiety in patients, which should be considered in oral surgeries.

Acceptability of different caries management methods for primary molars in a RCT

BACKGROUND

More conservative techniques for managing dental caries including 'partial' and 'no caries removal' have been increasingly of interest.

AIM

To compare children's behaviour and pain perception, also technique acceptability (parents and dentists), when approximal dentinal lesions (ICDAS 3-5) in primary molars (3-8-year-olds) were managed with three treatment strategies; conventional restorations (CR), hall technique (HT), and non-restorative caries treatment (NRCT).

DESIGN

Secondary care-based, three-arm parallel-group, randomised controlled trial, with 169 participants treated by 12 dentists.

OUTCOME MEASURES

child's pain perception (Visual Analogue Scale of Faces); behaviour (Frankl scale); and parents' and dentists' treatment opinions (5-point Likert scales).

RESULTS

Children showed more negative behaviour in the CR group (37%) compared to NRCT (21%) and HT (13%) (P = 0.047, CI = 0.41 to 0.52). Pain intensity was rated 'very low' or 'low' in 88% NRCT, 81% HT, and 72% CR (P = 0.11, CI = 0.10 to 0.12). NRCT and HT were 'very easy' or 'easy' to perform for >77% of dentists, compared to 50% in CR group (P < 0.000). There were no statistically significant differences in parents' rating of their child's level of comfort (P = 0.46, CI = 0.45 to 0.48).

CONCLUSIONS

Dentists reported more negative behaviour in CR group. For all techniques, children's pain perception and dentist/parent acceptability were similar.

Dental fear and anxiety in older children: an association with parental dental anxiety and effective pain coping strategies

An association between dental fear and anxiety (DFA) has been confirmed for children younger than 8 years, but this association in older children is less clear. The aim of this study was to fill this knowledge gap by studying DFA in older children and their parents with validated measures. This cross-sectional study, conducted at Community Health Centre Mostar, Bosnia and Herzegovina, included 114 children and their parents. DFA, coping, and sociodemographic variables were studied using Corah Dental Anxiety Questionnaire (CDAS), Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS), Dental Cope Questionnaire, and sociodemographic questionnaire. Maternal CDAS scores had significant positive correlation with child DFA measured with CFSS-DS (r=0.35, P<0.001) and CDAS (r=0.32, P<0.001). Fathers’ CDAS scores were not associated with child CFSS-DS, but showed a moderate correlation with child CDAS (r=0.19, P<0.05). There were no significant differences in children’s fear and anxiety based on age, sex, or socioeconomic variables. Children used internal coping strategies most frequently and external coping strategies were rated by the children as the most effective. We did not find differences in number and type of effective coping strategies in children with high DFA compared with children with low DFA. In conclusion, there is evidence of the coexistence of dental fear in parents and older children. These findings may help to devise interventions that will prevent or alleviate children’s DFA.

Dental subscale of children's fear survey schedule and dental caries prevalence

Objective:

To assess the level of fear of dental procedures among 6-12 year school children and correlate the prevalence of dental caries with their dental fears scores.

Materials and Methods:

The study sample of 444 school children, comprising of 224 girls and 220 boys in the age group of 6-12 years old from a private English medium school were selected. Each student was asked to independently complete a Children's Fear Survey Schedule – Dental Subscale (CFSS-DS) questionnaire. Children having a score of ≥ 38 were included in the “dental fear” group while those scoring <38 were placed in the “without dental fear” group. All dental examinations were performed in the classroom.

Results:

Fear scores were highest for “Injections,” (3.76 ± 0.68) “Choking,” (3.48 ± 0.63) and “Dentist drilling” (2.88 ± 0.69). The overall mean score of CFSS-DS in our study was 37.0 ± 8.89, mean score of DMFT and DMFS were 0.58 ± 0.74 and 0.73 ± 1.09, respectively. Mean score of deft and defs were 4.40 ± 2.34 and 7.28 ± 5.49, respectively.

Conclusion:

The study showed the prevalence of dental fear in 6-12 year old children and there was no statistically significant co-relation between the level of dental fear and dental caries in these children.

Degree of dental anxiety in children with and without toothache: prospective assessment

BACKGROUND

Few prospective studies on the anxiety of children in the dental office have been published.

AIMS

To monitor dental anxiety levels in children with and without previous experience with toothache over a period of six consecutive visits.

DESIGN

A longitudinal study was carried out involving 167 children treated at a public dental service. Levels of anxiety in the dental setting were assessed in children without toothache (G1) and those with toothache (G2) using the modified Venham picture test (VPT). Data acquisition was carried out over a 6-week period, with each child treated in the dental office once a week. Six assessments of anxiety were performed in the waiting room prior to dental treatment.

RESULTS

A significant reduction in anxiety scores occurred between appointments in both groups. In the inter-group comparison, G2 had significantly higher anxiety scores than G1. Although statistically significant reductions in anxiety scores occurred through to the fifth appointment, a tendency toward stagnation in anxiety scores was observed beginning with the fourth appointment.

CONCLUSIONS

Dental anxiety scores were reduced over the course of six appointments. Children with toothache had higher levels of dental anxiety than those that had never experienced toothache.

Dental anxiety in 6-7-year-old children treated in accordance with conventional restorative treatment, ART and ultra-conservative treatment protocols

OBJECTIVE

To test the hypothesis that dental anxiety levels of children treated in accordance with the conventional restorative treatment (CRT) are higher than in children treated with the atraumatic restorative treatment (ART) or ultra-conservative treatment (UCT) protocols.

MATERIALS AND METHODS

In total, 302 children aged 6-7-years old, with at least two dentine carious lesions, constituted the sample. A parallel group study design was used with ART and UCT as test groups and CRT as the control. The treatment was divided into two sessions. In the first session, one carious tooth (class II in a primary molar) was randomly selected and treated according to one of the treatments. All other treatments were performed in the second session. Before the first (FIS Tx-1) and before the second session (FIS Tx-2) the level of dental anxiety was assessed using the Facial Image Scale (FIS). The GLM test and Spearman's Rank Correlation Coefficient were used to analyse the data.

RESULTS

No treatment group effect was observed on the FIS Tx-2 score (p = 0.64). A FIS Tx-1 score (p < 0.0001) effect on the FIS Tx-2 score was observed. The correlation coefficient between FIS Tx-1 and FIS Tx-2 scores was r = 0.30 (p < 0.0001).

CONCLUSION

At the beginning of the second session there was no difference in dental anxiety levels of the children treated in the first session according to the three treatment protocols. A high dental anxiety score before the first session was a predictor of a high dental anxiety score at the second treatment session.

An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children

Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.

Short communication: dental anxiety levels and outcomes of care: a preliminary report on experiences of a sedation assessment clinic

AIM

This was twofold: (1) to report on the type of paediatric patient referred to the sedation assessment clinic at the Glasgow Dental Hospital and School, and (2) to report on the level of anxiety.

METHODS

This was a two-part study. The first part was a retrospective review of case notes to evaluate referral pathways to and from the sedation assessment clinic with regard to a range of variables. The second part was a prospective clinical report of dental anxiety.

RESULTS

It was noted that 31 (67.4%) of patients were initially referred by their general dental practitioner, 7 (15.2%) by community dental surgeons and 8 (17.4%) by hospital dental surgeons. At the initial referral, 4 children (9%) showed symptoms of pain. The majority of patients were from lower social economic areas, as determined by DEPCAT score and exhibiting moderate to high anxiety levels. The children who were referred for general anaesthesia had the highest anxiety scores. Out of a total of 46 patients, five failed to complete treatment within the modality laid out for them at the assessment clinic.

CONCLUSIONS

(1) The patients attending the newly established sedation assessment clinic were mainly high caries risk, socially deprived patients and (2) that the majority of patients were dentally anxious, the most anxious appearing to have been referred for treatment under general anaesthesia.

The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months

Background

Scotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation. This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes for the technique, with conventional restorations.

Methods

General dental practice based, split mouth, randomized controlled trial (132 children, aged 3–10). General dental practitioners (GDPs, n = 17) in Tayside, Scotland (dmft 2.7) placed conventional (Control) restorations in carious primary molars, and Hall Technique PMCs on the contralateral molar (matched clinically and radiographically). Dentists ranked the degree of discomfort they felt the child experienced for each procedure; then children, their carers and dentists stated which technique they preferred. The teeth were followed up clinically and radiographically.

Results

128 conventional restorations were placed on 132 control teeth, and 128 PMCs on 132 intervention teeth. Using a 5 point scale, 118 Hall PMCs (89%) were rated as no apparent discomfort up to mild, not significant; for Control restorations the figure was 103 (78%). Significant, unacceptable discomfort was recorded for two Hall PMCs (1.5%) and six Control restorations (4.5%). 77% of children, 83% of carers and 81% of dentists who expressed a preference, preferred the Hall technique, and this was significant (Chi square, p < 0.0001). There were 124 children (94% of the initial sample) with a minimum follow-up of 23 months. The Hall PMCs outperformed the Control restorations:

a) 'Major' failures (signs and symptoms of irreversible pulpal disease): 19 Control restorations (15%); three Hall PMCs (2%) (P < 0.000);

b) 'Minor' failures (loss of restoration, caries progression): 57 Control restorations (46%); six Hall PMCs (5%) (P < 0.000)

c) Pain: 13 Control restorations (11%); two Hall PMCs (2%) (P = 0.003).

Conclusion

The Hall Technique was preferred to conventional restorations by the majority of children, carers and GDPs. After two years, Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations. The Hall Technique appears to offer an effective treatment option for carious primary molar teeth.

Trial registration number

Current Controlled Trials ISRCTN47267892 – A randomized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth: the Hall technique.