The use of relaxation and distraction to reduce psychological stress during dental procedures

A comparative evaluation of the effects of white noise, brown noise, and pink noise on dental anxiety of pediatric patients undergoing dental extraction treatment: A randomized control study

BACKGROUND

Audio-analgesia is one of the unexplored aspects of behavior management in pediatric dentistry, and recently, there have been many new inclusions in shades of noise that were previously just limited to white noise, like brown noise and pink noise.

AIM

The aim of the study was to evaluate and compare the effectiveness of white noise, brown noise, and pink noise on dental anxiety in pediatric patients undergoing primary tooth extraction.

STUDY SETTINGS AND DESIGN

Multiarm, triple-blinded, parallel-group randomized controlled trial.

MATERIALS AND METHOD

Forty children belonging to the age group of 8-12 years having their first dental visit with primary teeth indicated for extraction were included in our study. We evenly divided the 40 children into four groups: Group A (white noise), Group B (pink noise), Group C (brown noise), and Group D (cartoon music), which served as the control. We assessed the patient's anxiety using Venham's Picture Test and a pulse oximeter, as well as their pain using the Visual Analog Scale (VAS) both preoperatively and postoperatively. We also noted changes in the patient's pulse after administering local anesthesia.

RESULTS

All groups have shown significant differences in dental anxiety and pain, preoperatively and postoperatively, but pink noise was found to be effective even in maintaining pulse rate intraoperatively.

CONCLUSION

In pediatric dentistry, audio distraction is an innovative, noninvasive, and effective behavior management technique that can effectively manage dental anxiety in children.

REGISTRATION

The Clinical Trials Registry of India (CTRI) has prospectively registered the study under the CTRI number CTRI/2024/01/061679.

Child Dental Patient\'s Anxiety and Preference for Dentist\'s Attire: A Cross-sectional Study

Aim and objective

Initial perceptions of physicians can affect the level of comfort. Creating a strong rapport on the child's first visit helps to create a comfortable atmosphere. Child-friendly clothing of the dentists might possibly contribute to the dentist's empathy. Different attires may evoke different feelings. Hence, the purpose of the study was to assess the children's preferences for dentist's attire and its relation with anxiety.

Materials and methods

Eighty children aged 5-12 years were included in the study. Five photographs of dentists wearing different attires were placed in the same order for every child. The child was asked to look at the photographs and decide which dentist they would prefer to take care of them. A facial image scale was used to evaluate the child's anxiety level. The children were asked to point at which face they felt almost like at that moment.

Results

42.7% of males and 38.5% of females chose child-friendly attire. The least preferred by males was a pink apron (7.5%) compared with females (28.1%). Whereas the blue apron was least preferred by females (5.1%) compared with males (20%). A Chi-square test was done to access the association between dental anxiety and the dental attire the children chose, where statistically significant (0.030) results were found. Anxious children were found to prefer child-friendly attire.

Conclusion

Although the view that children are fearful of the white coat was not found, the concept of child-friendly attire might be more appropriate for anxious children and enhance an easy first communication with them.

How to cite this article

Sujatha P, Nara A, Avanti A, et al. Child Dental Patient's Anxiety and Preference for Dentist's Attire: A Cross-sectional Study. Int J Clin Pediatr Dent 2021;14(S-2):S107-S110.

Demographics, Practising Arrangements, and Standards: Survey among New Zealand Dentists

BACKGROUND

To determine the demographic profile and practising arrangements of general dentists in New Zealand.

METHODS

A questionnaire comprising 19 sections with 125 questions was distributed via mail to 351 general dentists in New Zealand who were selected, at random, from the Dental Council of New Zealand's 2016 register.

RESULTS

Two hundred and four questionnaires were returned, of which 188 were usable giving a response rate of 53.5%. The majority of the respondents (63.5%) were male and practice principals (56.8%). Fifty-nine percent of the practices were located in city or town centres with a wide geographic distribution. Sole practitioners accounted for 24.1% of respondents, with the mean number of dentists per practice being 3.2. The majority of respondents (71.6%) attended five or more continuing professional development courses in the past year. Ninety-one percent of respondents used a computerized management system, and 95.3% used the Internet. The use of nickel-titanium endodontic files (83.9%) and digital imaging (82.2%) was the most frequently cited clinical innovations. Articaine was the most popular local anaesthetic of choice.

CONCLUSIONS

Dentistry is an ever-changing profession, with evidence that NZ dentists continue to develop, learn, and embrace advancements in technologies to supply high-quality evidence-based treatment.

Does watching a video on third molar surgery increase patients' anxiety level?

OBJECTIVE

To identify the effects of watching live taping of third molar removal on patients' anxiety levels before and after extraction.

STUDY DESIGN

This study was based on a prospective, cross-sectional, observational investigation of the different patient education techniques about the effect of third molar removal on patients' anxiety level. A total of 333 patients were randomized into three groups: two study groups (for group 1, basic information was given verbally; for group 2, which was the study group, basic information was given verbally and through a movie on third molar extraction); and a control group (basic information was given verbally; it did not include information on operative procedures and recovery). Anxiety levels were assessed by using the Dental Anxiety Scale (DAS) and the Spielberger State-Trait Anxiety Inventory (STAI). Pain was assessed with a visual analog scale. Statistical analysis was performed with SPSS 16.0.

RESULTS

Group 2 patients were significantly more anxious before the surgical procedure, and the most significant decreases in DAS and STAI scores were observed in that group. The age, surgery time, and education level were not correlated with anxiety or pain levels; however, female patients had high levels of anxiety (P < .05).

CONCLUSION

Preoperative multimedia information increases the anxiety of patients undergoing third molar surgery.

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.

Effect of 'Perceived control' in management of anxious patients undergoing endodontic therapy by use of an electronic communication system

BACKGROUND

From time immemorial, fear and anxiety have been associated with dental treatment. Coping with this fear and anxiety has been one of the most vexing problems with which the individual dentist, as well as the profession has had to contend. Hence this study was undertaken to evaluate a new technique for management of such anxious patients.

AIM

The aim of this study is to evaluate the efficacy of using 'Perceived control' for the management of anxious patients undergoing endodontic therapy.

SETTINGS AND DESIGN

'A communication device designed by the author and named as "Touch N' Tell" (Patent no: 234291, Government of India) was installed on the dental chair which helps to create an effective communiqué between the patient and dentist during the dental procedure.

MATERIALS AND METHODS

Sixty anxious patients were selected using Modified Dental Anxiety Scale (MDAS), and were divided into two groups. For group A, the patients were treated along with the use of 'communication system' installed on the dental chair, whereas the patients were managed in a routine manner for Group B. The post operative MDAS scores were recorded for both the groups.

STATISTICAL ANALYSIS

The mean change in anxiety levels was calculated for both the groups. Statistical analysis was done using unpaired t-test.

RESULT AND CONCLUSION

A significant decrease in the mean anxiety levels was observed in the group where 'communication system' was used as a measure of perceived control.

Can We Tune Our Pediatric Patients?

For the pedodontic team, a child’s dental anxiety poses major management problems. Previously, wide variety of aversive techniques have been used with varying success rates to manage anxious child patients. The present trend advocates the use of nonaversive techniques like distraction in the management of anxious pediatric patients. So the aim of this study is to compare the effect of audio distraction with the normal set up operatory. Thirty patients of age between 4 and 8 years were included in the study. Each patient had gone through four dental visits. Anxiety was measured using Venham’s picture test. The values obtained were tabulated and statistical analysis and concluded that audio distraction did decrease the level of anxiety in anxious pediatric dental patients to a significant level during the restorative procedure visit (3rd) and invasive procedure visit (4th).

Behaviour Modification in Dentistry: a Review

The review evaluates the contribution which behaviour modification has made to the outstanding behavioural problems in dentistry: the treatment and management of the fear of routine conservation; the prevention of tooth and gum disease; the management of acute operative pain and chronic facial pain.

Investigations of dental fear and operative pain have been limited perhaps too much to patients, especially children, who attend for dental treatment. Behaviour modification has yet to help adequately those patients who avoid dentists and who may be the most acutely afraid and the most intolerant of dentistry. More adequate contributions here could be made if behavioural sciences were much more satisfactorily taught in dental undergraduate and postgraduate curricula than at present.

Useful contributions to preventive dentistry have already been made. The successful treatment of chronic facial pain will have to depend, at least in part, on a more adequate understanding of the psychophysiological mechanisms of the complaint. The nature of the placebo effect in treatment here also needs to be more thoroughly understood.

Dental fear in adults: a meta-analysis of behavioral interventions

OBJECTIVES

The aim of this meta-analytic and systematic quantitative approach is to examine the effects of behavioral interventions for dental anxiety and dental phobia.

METHODS

Eighty studies were identified where dental fear treatment with behavioral methods was evaluated. Thirty-eight of 80 met entry criteria and were included in a meta-analysis.

RESULTS

The calculated effect sizes (ESs) for self-reported anxiety after intervention indicate positive changes in 36 of the 38 studies and no changes in two. The overall ES = 1.8 (95% CI: 1.6, 1.8). The percent of subjects with post-treatment dental visits in the first 6 months post-treatment varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, is 1.4 (95% CI: 1.3, 1.6). The homogeneity analysis indicates that the studies cannot be adequately described in one ES. The reported percentage of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, is 1.2 (95% CI: 0.99, 1.4).

CONCLUSIONS

Despite extensive heterogeneity, changes in self-reported anxiety represent medium to large ESs. Patients signing up for a behavioral intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance ( >4 years after treatment) is 77%.

Referrals to a secondary care dental clinic for anxious adult patients: implications for treatment

OBJECTIVES

This study aimed to determine the methods suggested by general dental practitioners for management of patients with dental anxiety whom they refer to a dental hospital setting, the treatment modalities eventually used with such patients and the relationship between patients previous sedation experience and the current referral.

METHODS

Consecutive referral letters (n = 125) for management of patients with dental anxiety over a 16 month period were analysed for content, including reason for referral and suggested treatment modalities. Patient records were also examined for previous sedation experience.

RESULTS

From 115 referrals eligible for analysis, the dentists requested management of anxiety using pharmacological methods in 113 referrals with only two referrals mentioning psychologically-based treatments. In secondary care, 29% of the adult referrals opted for dental treatment using psychological techniques alone.

CONCLUSIONS

In spite of the efficacy of psychological treatments for dental anxiety, primary and secondary care dentists appear not to be suggesting or promoting their use for patients with dental anxiety. Further research into the availablility of, and barriers to accessing the full range of services for those with dental anxiety, including patient perspectives, needs to be undertaken.

Distraction reduces self-reported physiological reactions to blood donation in novice donors with a blunting coping style

OBJECTIVE

Vasovagal reactions experienced by some blood donors (eg, faintness, lightheadedness, and dizziness) have been shown to be related to a decreased likelihood of future blood donations. This study evaluated the efficacy of audiovisual distraction as a means of reducing self-reported physiological reactions in first-time blood donors. Because interventions that are consistent with an individual's preferred coping style have been shown to be more effective at reducing physiological and psychological responses to stressful medical procedures, coping style (monitoring vs. blunting) was assessed as a possible moderating variable.

METHODS

First-time blood donors were randomly assigned to one of two conditions: audiovisual distraction or no-treatment control. Participants in the distraction group donated blood at an American Red Cross blood drive while watching a three-dimensional video presentation on a personal visor and headset. The control group donated blood according to standard American Red Cross procedures. Score on a self-reported measure of physiological reactions completed immediately after donation served as the dependent variable.

RESULTS

Individuals who typically use blunting coping strategies to cope with stress reported an attenuation of vasovagal reactions to blood donation in the distraction vs. the control condition (t(49) = 2.29, p < .05), whereas donors who prefer a monitoring coping style did not benefit from distraction.

CONCLUSIONS

Among first-time blood donors, audiovisual distraction may be an effective means of reducing vasovagal reactions in donors who prefer to cope with stress using such strategies as distraction, denial, and reinterpretation.

Liaison psychiatry and psychology in dentistry

Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much inappropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing disability cannot be satisfactorily explained as a result. There are other patients who are preoccupied by physical symptoms or by their appearance. In others, anxiety may manifest itself as a phobia, or a dysmorphic concern about certain aspects of their appearance. This article reviews the role of liaison psychiatry and psychology in dentistry.

Ameliorating adults' acute pain during phlebotomy with a distraction intervention

This study evaluated the effectiveness of a distraction intervention on subjects' perceptions of pain. During phlebotomy, 96 adults received either usual care or used a kaleidoscope as a distraction. After phlebotomy they rated their level of experienced pain with each of three instruments: Wong-Baker FACES Pain Scale, pain visual analogue scale, and Present Pain Intensity Scale. Statistical analyses revealed significantly lower perceptions of experienced pain among subjects using the kaleidoscope and concurrent validity for using the FACES Pain Scale with adults. Because the distraction intervention is effective, inexpensive, and easy to implement, its routine use during phlebotomy is recommended.

Periodontal implications: anxiety

1. Monitoring significantly improves patient outcomes. 2. Observing and communicating with the patient is the most important means of monitoring the patient's status during sedation. 3. Monitoring of ventilations along with the assessment of oxygen saturation via a pulse oximeter is significant in preventing hypoxemia. 4. The use of supplemental oxygen is recommended. 5. Monitoring of blood pressure and pulse is highly recommended for assessing hemodynamic status. 6. Use of electrocardiograms is recommended for the patients with cardiovascular disorders.

Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use

The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.

Skin conductance, Marlowe-Crowne defensiveness, and dental anxiety

The present study assesses the relationship between self-reported dental anxiety (Dental Anxiety Inventory, Dental Anxiety Scale, and Duration of Psychophysiological Fear Reactions), electrodermal activity (skin-conductance level and frequency of spontaneous responses), and Marlowe-Crowne defensiveness. All measurements were made twice. The first session was scheduled immediately before a semi-annual dental check-up (stress condition), and baseline measurements were made two months later without the prospect of a dental appointment. Subjects were male dental patients who regularly attended a university dental clinic and a clinic for Special Dental Care. The main findings were that the low anxious-high defensive-scoring (Marlowe-Crowne Denial subscale) university patients showed significantly higher skin-conductance levels and frequency of nonspecific fluctuations than the low anxious-low defensive-scoring subjects. Besides, the conductance values of the low anxious-high defensive-scoring subjects resembled those of the high anxious-low defensive-scoring patients of the clinic for Special Dental Care, the baseline frequency of nonspecific fluctuations excepted.

Some problems of dental treatment. Part 1. Patient anxiety: some correlates and sex differences

An analysis of questionnaire data obtained from 110 adult patients attending the Dental Department of the Lower Hutt Hospital and four private dental practices in Lower Hutt and Wellington, New Zealand indicates that patient treatment anxiety is more severe in women than men and that it is correlated with patients' descriptions of dental treatment. Altogether, survey findings indicate that treatment anxiety has adverse effects and that, with few exceptions, it results directly or indirectly from unpleasant experiences during dental treatment. Two of the most common of such experiences are evidently pain arising from the stimulation of sensitive tissue and oral injections. The eradication of treatment anxiety is therefore heavily dependent on the unobtrusive induction of profound analgesia prior to painful procedures.

Illness behaviour and anxiety in dental patients

The Authors evaluate the influence of illness behaviour (measured by IBQ) on patients' delay in seeking dental treatment for caries or periodontal pathology, and the relationship with anxiety (measured by STAI) and with social--demographic and clinical data. One hundred patients were studied. Delay in coming for a dental visit is influenced by family habit, level of education and fear experienced. The 'late' patients present significantly higher scores for denial on the IBQ. More serious pathology is in relation with greater denial. Anxiety is positively correlated with the IBQ scales dysphoria, hypochondria, disease conviction, irritability and inversely with denial.

Effectiveness of a videotaped behavioral intervention in reducing anxiety in emergency oral surgery patients

This study evaluated the effectiveness of a videotaped behavioral treatment program in reducing dental anxiety in emergency oral surgery patients. It compared a videotaped placebo program and a no-treatment control condition. Anxiety, measured for two periods during the study (an anticipatory phase just before oral surgery and a post oral surgery phase), was evaluated by means of self-report, physiological, and behavioral observation measures. Results revealed significant treatment group as well as Group X Sex interaction effects for the heart rate index of physiological arousal. Results also revealed that the treatment program was reported by subjects to be significantly more helpful than the placebo program. Overall, these results suggest that a short, videotaped behavioral intervention can have a positive effect on the oral surgery patient, and that the sex of the subject may be an important variable to be incorporated in evaluating the effectiveness of this type of treatment program.

Personality traits of patients suffering extreme dental anxiety

In order to investigate the relationship between dental anxiety and some personality traits, a group of 103 patients suffering extreme dental anxiety and therefore enrolled in a special treatment program were compared with controls sampled at random. The mean scores of the controls on dental anxiety measurements and on questionnaires dealing with personality traits were transformed into 50 with standard deviation equal to 10 to make them mutually comparable, and these subsequently were used as reference points, from which the likewise transformed mean scores of the anxiety group have to differ substantially if both groups stem from different populations. The mean scores were tested for difference with ANOVA. It appears that the anxious patients are more neurotic, i.e. more unstable, than the controls. Moreover, the patients feel themselves more uncertain with regard to having control, are less decisive, have a lower self-esteem, are less inclined to act and are, in general, anxious persons. These findings may have implications for selecting the most appropriate approach for amelioration of their anxiety or support of their coping capacity.

Electrodermal activity, dental anxiety, and fear of dentistry in a group of parenteral drug addicts

The present study was undertaken in order to evaluate whether electrodermal activity was a useful tool with which to measure dental anxiety in a group of drug addicts. Electrodermal activity was compared to the subjects' self-reported feelings during ordinary dental treatment sessions. In the first part of the study the level of electrodermal activity during treatment sessions was videotaped and recorded on paper by means of a polygraph. The patients were interviewed using a semi-structured questionnaire dealing with the addicts' dental anxiety and fear. In connection with the interviews the addicts completed Corah's Dental Anxiety Scale (CDAS). There was no recognizable pattern in electrodermal activity when this was compared with the patients' feelings during the treatments. Median CDAS was 9.5. In the second part of the study, electrodermal activity was recorded on the polygraph only. This group also completed a CDAS questionnaire. No correlation between the patients' self-reported highest level of anxiety and level of electrodermal activity, number of fluctuations or amplitude in relation to specific dental stimuli was found; agreement was found in two, three and none of 10 cases respectively. Median CDAS was 10.0. It could be concluded that, although the study revealed apprehension and situational anxiety among the addicts, no correlation to electrodermal activity was found. This discrepancy between the physiological and cognitive data probably reflects the uncertainty of these measures under the given circumstances.

Long-term effects of two different treatments for dental fear and avoidance

Follow-up clinical studies of treatment for dental fear and avoidance behavior are infrequent in the literature. The present investigation reports follow-up results over more than two years from 84 out of 99 patients treated for dental fear in a Swedish community-based dental fear clinic. Broad-based behavioral therapy (BT) or general anesthesia (GA), both in combination with adjusted conventional dental treatment, were used. The frequency of patients' attendance for regular dental care after two years was unchanged or even somewhat increased and was significantly higher in those who had received the BT therapy. Most patients stated that they had no problems after leaving the dental fear clinic. Among patients reporting such problems, the change of dentist was most frequently reported. The level of dental anxiety as measured by Corah's DAS was still at a low level, in spite of a slight increase over the two years since initial therapy.

Research in clinical process and outcome methodology: psychophysiology, systematic desensitization and dental fear

Eleven dental phobics were treated with a modified systematic desensitization procedure which included EMG biofeedback and videotaped scene presentations. During treatment, multiple psychophysiological recordings as well as subjective and psychometric assessments of mood were made. Intraindividual correlations between process variables were, to a large extent, idiosyncratic. Variance in treatment outcome could be accounted for by change-over treatment sessions of psychometrically assessed mood (R2 = .76) alone or in combination with change-over treatment sessions of minimum heart rate (R2 = .84). The process variable correlation patterns indicate a need for much more multivariate methodological research.

Usefulness of two psychometric scales in Swedish patients with severe dental fear

Dental fears and other fears were assessed in 67 patients with dental fear with the Corah Dental Anxiety Scale (CDAS), the Geer Fear Scale (GFS), and a behavioral dentist's rating scale (DR). Patients were selected because of extreme initial dental fear (n = 20), favorable response to treatment for dental fear (n = 23). CDAS change paralleled behavioral change (DR), supporting the usefulness of CDAS in assessing dental fear. GFS scores did not change in either group but were higher among patients who did not respond to treatment for dental fear; these findings are discussed in terms of treatment outcome prediction and treatment specificity.

Demand effects for desensitization and two placebos in a dental fear context

Forty-five subjects sampled two sessions of a prototype desensitization treatment, two sessions of the Modified Avoidance Response Placebo or two sessions of Pseudotherapy. Each subject simulated the effects on dental fear of the experimental regimen to which he was exposed. Each subject also rated the credibility of the sampled regimen. Both the simulation data and the credibility ratings showed the Modified Avoidance Response Placebo to be the preferred control for "nonspecifics" in dental-fear desensitization experiments.