Pain and fear in connection to orthodontic extractions of deciduous canines

Effect of low-level laser therapy in wound healing of primary molar teeth extraction

INTRODUCTION

Tooth extraction in children requires attention to wound healing and pain management, which are influenced by patient-related factors and behavioral guidance.

AIM OF THE STUDY

The study aimed to evaluate the effect of LLLT on healing sockets in pediatric patients with bilateral primary molar teeth extraction and determine its impact on pain management.

METHODS

6-10 years of age, systemically healthy, and with atraumatic extraction indications of bilateral primary molar teeth were included in the study (n = 40). In the first session, randomly selected teeth were extracted under local anesthesia. In the control group, only clot formation in the socket was observed and photographed. The other group extractions were performed 2 weeks later. The low-level laser therapy (LLLT) group was treated with a 980 nm wavelength, in a continuous emission mode, 0.5 W power, 300 J of energy, 400 µm tip, 60 s diode laser and photographed. Nonepithelialized surface measurements were performed using ImageJ. Pain assessment was performed using the Wong-Baker Pain Scale. Statistical analyses were performed using SPSS software.

RESULTS

There was a statistically significant difference between the groups in the Wong-Baker values in 3rd day (p < 0.05). In soft tissue healing on the 3rd and 7th day, the nonepithelialized surface of the laser socket was smaller than that of the control group, and the measurement results were found to be statistically significant (p < 0.05).

CONCLUSION

Although LLLT was not found to be very effective in reducing postoperative discomfort after extraction of primary molars, it provided better wound healing in extraction sockets.

Pain, discomfort, and functional impairment after extraction of primary teeth in children with palatally displaced canines - a randomized control trial comparing extraction of the primary canine versus extraction of the primary canine and the primary first molar

CONCLUSION

Primary canines and first molars can be extracted in a way that is associated with relatively low levels of pain and discomfort during and after the procedures. Double extractions induced more pain and discomfort than single extractions, which should be accounted for in the treatment planning.

MATERIAL AND METHODS

Twenty-eight children, aged 9.5-14 years with displaced permanent maxillary canines were randomly assigned for extraction of the primary canine only or the primary canine and the primary first molar. Pain and discomfort were rated on visual analogue scales, and influence on daily activities was assessed by a questionnaire that has been previously tested for reliability and validity. Differences between groups were assessed by independent samples t-tests, Mann-Whitney U-tests or the Fisher's exact test.

OBJECTIVE

To assess pain, discomfort, and functional impairment in children experiencing extraction of primary canine or primary canine and primary first molar as an interceptive treatment for palatally displaced permanent canines.

RESULTS

Tooth extraction was associated with low levels of pain and discomfort on a group level. Extraction of both the canine and the first molar was associated with significantly more pain and discomfort than was the extraction of the canine only. Extractions were associated with chewing problems among one-third to half of the children, otherwise, few children reported any jaw impairment after extraction.

IL-17 and CCR9+α4β7- Th17 Cells Promote Salivary Gland Inflammation, Dysfunction, and Cell Death in Sjögren's Syndrome

Previous studies have evaluated the roles of T and B cells in the pathogenesis of Sjögren's syndrome (SS); however, their relationships with age-dependent and metabolic abnormalities remain unclear. We examined the impacts of changes associated with aging or metabolic abnormalities on populations of T and B cells and SS disease severity. We detected increased populations of IL-17-producing T and B cells, which regulate inflammation, in the salivary glands of NOD/ShiLtJ mice. Inflammation-induced human submandibular gland cell death, determined based on p-MLKL and RIPK3 expression levels, was significantly increased by IL-17 treatment. Among IL-17-expressing cells in the salivary gland, peripheral blood, and spleen, the α4β7 (gut-homing integrin)-negative population was significantly increased in aged NOD/ShiLtJ mice. The α4β7-positive population markedly increased in the intestines of aged NOD/ShiLtJ mice following retinoic acid (RA) treatment. A significant increase in α4β7-negative IL-17-expressing cells in salivary glands may be involved in the onset and progression of SS. These results suggest the potential therapeutic utility of RA in SS treatment.

Pain perception and dental anxiety during periodontal probing in patients visiting community oral health programme: a cross sectional study

Background

Periodontal probing is one of the basic clinical oral examination procedures. It is carried out to assess the severity of gingival and periodontal disease. The experience of pain during probing may discourage patients. So, this study was conducted to estimate the pain perception and dental anxiety experienced during periodontal probing in patients visiting the community oral health programmes of B. P. Koirala Institute of Health Sciences (BPKIHS).

Methods

A cross-sectional study was conducted among 100 participants of community oral health programmes of BPKIHS. Demographic profile, WHO modified Community Periodontal Index (CPI) 2013, Pain perception via Visual Analogue Scale (VAS Scores) and Short Version of Spielberger State-Trait Anxiety Inventory (STAI) Self-evaluation Questionnaire (Y-6 item) were assessed. Mean ± SD and Spearman correlation for pain and anxiety were computed.

Results

Only 10% of the study participants had healthy gingiva and 12% had periodontal pockets. Pain perception and dental anxiety was present in the participants. The participants experienced very little pain (6.75 ± 10.65) during periodontal probing. The overall anxiety score was 13.37 ± 1.81. There was a very weak correlation between the VAS Scores and the anxiety scores of the participants.

Conclusion

This study concludes that pain perception and anxiety are low during periodontal probing. There was no correlation between bleeding on probing with pain and anxiety among the people visiting community oral health programmes of BPKIHS.

Reliability and Validity of the Arabic Version of a Questionnaire Assessing Pain, Discomfort and Related Jaw Function Impairment after Extraction of Primary Teeth in Children

This study aims to translate a previously published English language questionnaire that assessed pain and discomfort after the extraction of primary teeth in children into Arabic, and evaluate its validity and reliability. All participating children (n = 120), aged 9 to 12-years-old, completed the 33-item Arabic version questionnaire after the extraction procedure had taken place. The questionnaire included three parts that were completed at three different times, namely, immediately, the first evening, and one week after the extraction procedure. Internal consistency, content validity, criterion validity, and factor analysis were performed. The results showed a good internal consistency (Cronbach's alpha = 0.83), acceptable criterion validity with a significantly strong correlation with the Visual Analog Scale (VAS), and satisfactory content validity (average content validity index (CVI = 0.90). The final factor model was comprised of four factors with an eigenvalue greater than 1, explaining 70% of the common variance. The identified factors were labeled as follows: Factor 1-analgesic consumption; Factor 2-expression of discomfort from the extraction site; Factor 3-perception of masticatory capability; and Factor 4-pain/discomfort from the dental extraction procedure. Based on the results, a shorter form of the questionnaire had satisfactory psychometric characteristics and can be used with children within the selected age group.

Behavior of Children toward Various Dental Procedures

Introduction

Dental treatment is known to trigger anxiety and fear even in fully grown adults, especially if administration of local anesthesia with a syringe is indicated. This study is aimed to evaluate whether procedures like an extraction and pulpectomy could trigger fear and anxiety in a pediatric patient and also the response of pediatric patients to other treatment modalities. Their perception toward receiving dental treatment as a whole is also evaluated. The effect of conditioning of the environment and the dentist (extractions done in second or third appointments) and its effect in decreasing the anxiety is also evaluated. The aim of the study is to evaluate the behavior of pediatric patients aged 7–17 years in response to various treatment procedures at Saveetha Dental College.

Materials and methods

The behavior of 50 children reporting to Saveetha Dental College, categorized according to the Frankl's behavior rating scale, was recorded before, during, and posttreatment.

Results

Children undergoing extractions and pulpectomies showed the most uncooperative behavior. Sixty percent of patients undergoing extraction and 45% of patients undergoing the pulp therapy showed negative behavior (rating 2) during treatment.

Conclusion

Invasive procedures like extractions and pulpectomies were procedures that brought out negative behavior in pediatric patients, especially during treatment.

How to cite this article

Sivakumar P, Gurunathan D. Behavior of Children toward Various Dental Procedures. Int J Clin Pediatr Dent 2019;12(5):379–384.

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.

Effect of Exposure to Positive Images of Dentistry on Dental Anxiety among 7 to 12 Years Old Children

Aim: To evaluate the effect of exposure to positive images of dentistry on dental anxiety among 7 to 12 years old children.

Materials and methods: Controlled trial. Assessment of anxiety and analysis of data were conducted blind to experimental condition. Assessment of anxiety was carried out in the waiting room prior intervention, postintervention into the operatory during the treatment and again after the completion of treatment. Anticipatory anxiety was recorded by Venham's picture test (VPT).

Participants: Sixty children of 7 to 12 years age group.

Intervention: Participants were randomly assigned to one of two conditions. In both conditions the participant was asked to look at photographs for 2 minutes in the waiting area prior to their appointment. The intervention consisted of viewing positive images of dentistry and dental treatment (study group), the (control group) consisted of neutral images. The assessment of anticipatory dental anxiety was made blind to experimental condition and statistical analysis was conducted blind to group membership. Anticipatory anxiety assessed by the VP T.

Results: A total of 60 subjects participated in the study and were equally and randomly allotted to study group (positive image) and control group (neutral image). The mean anxiety score found at waiting area before intervention, after intervention (OPD) and postoperative was statistically significant in study group. Post hoc comparison of anxiety score in study group showed high statistical significance.

Conclusion: Positive dental images have an effect on reducing anxiety as compared to neutral images when measured by the VPT.

How to cite this article: Gangwal RR, Badjatia SR, Dave BH. Effect of Exposure to Positive Images of Dentistry on Dental

Anxiety among 7 to 12 Years Old Children. Int J Clin Pediatr Dent 2014;7(3):176 -179.

Periotome as an Aid to Atraumatic Extraction: A Comparative Double Blind Randomized Controlled Trial

AIM

The aim of this study was to evaluate the efficacy of periotomes in single rooted nonsurgical tooth extractions.

MATERIALS AND METHODS

A double blind, randomized controlled clinical trial of 100 patients requiring nonsurgical single rooted tooth extractions was performed. The subjects were randomized into the experimental group (underwent extractions with periotome and conventional extraction forceps) or into the control group (subjects underwent extractions using periosteal elevator and conventional extraction forceps). Pain was assessed using visual analogue scale all throughout 7 days postoperatively. Gingival laceration, duration of surgery, number and frequency of analgesics consumed and complications (if present) were also noted.

RESULTS

On inter-group comparison, all the parameters were statistically significant in control group (p < 0.05). Also on pre and post-operative inter-group comparison, statistically significant pain reduction was noted in experimental group (52.8 %) whereas pain increased in control group (65 %).

CONCLUSION

The results of this study suggest that use of periotome may be helpful in reducing post extraction discomfort.

Pain, discomfort, and use of analgesics following the extraction of primary canines in children with palatally displaced canines

BACKGROUND. Pain following the extraction of the primary canine in children with palatally displaced canines (PDC) as an interceptive treatment has not been investigated. AIMS. To describe pain, discomfort, dental anxiety, and use of analgesics following the extraction of primary canines in children with PDC. DESIGN. Forty-four children, aged 10-13 with PDC, were included. Pain intensity, discomfort, and analgesic consumption were rated the first evening and 1 week after the extraction of the primary canine. Dental anxiety was assessed pre-extraction, using the dental anxiety scale (DAS). A matched reference group also completed the DAS. RESULTS. No significant differences were found between the study and the reference group regarding the pre-extraction assessments. Post-extraction pain and discomfort was low. The experience of the injection was graded worse than the extraction, and more pain was rated at the evening post-extraction than during the extraction. Analgesics were used only the first evening. High correlation was detected between DAS and pain during injection and extraction. CONCLUSIONS. The experience of pain and discomfort during and after extraction of the primary canines is low, despite that 42% of the children used analgesics. Therefore, appropriate analgesics and recommendation doses pre- and post-extraction should be prescribed.