'I Would Rather Be Having My Leg Cut off Than a Little Needle': A Supplementary Qualitative Analysis of Dentally Anxious Children's Experiences of Needle Fear

Enhancing Pediatric Dental Care: The Influence of Virtual Reality

OBJECTIVE

 The purpose of this study was to assess the effects of virtual reality (VR) in reducing pain and anxiety levels in children. The study also compared active and passive distraction methods using VR during the delivery of inferior alveolar nerve blocks (IANBs) in dental procedures in children.

MATERIAL AND METHODS

 The study comprised 45 preschool patients, aged between 4 and 6 years, with no prior dental anesthetic experience. The participants were randomly assigned to three groups based on the sort of management style: Group A used the tell-show-do technique, Group B engaged in passive distraction by watching cartoons using a VR headset, and Group C participated in active distraction by playing games using a controller with the VR headset. Pain and anxiety were evaluated using physiological measurements, namely by analyzing the variations in blood pressure, heart rate, and oxygen saturation before and after the administration of IANB. Psychological assessments were conducted using the Wong-Baker faces scale, Modified Dental Anxiety scale questionnaires, and Revised Face, Legs, Activity, Cry and Consolability scale after administering IANB.

RESULTS

 The physiological outcomes revealed no statistically significant differences in blood pressure and oxygen saturation. However, there was a statistically significant increase in the heart rate in group A compared with groups B and C. In terms of psychological measurements, groups B and C exhibited a significant improvement in pain experience and a decrease in anxiety.

CONCLUSION

 This study concluded that VR reduced pain and anxiety levels in its passive and active forms.

Comparing the technical quality and clinical outcomes of root canal treatment on immature permanent incisors in children: a retrospective evaluation of three bioceramic plug materials

PURPOSE

To assess the technical quality and clinical outcomes of non-surgical endodontic treatment of immature permanent incisor teeth with three different bioceramic plug materials and highlight variables which may influence treatment and quality outcomes.

METHODS

This cross-sectional analysis forms part of a retrospective service evaluation of the technical quality and clinical outcome of orthograde root canal treatment carried out in the Paediatric Dentistry Department of Charles Clifford Dental Hospital (United Kingdom). Twenty-five cases were identified chronologically, using the electronic patient record system, for three bioceramic plug materials: Mineral Trioxide Aggregate (MTA), Biodentine, and TotalFill Putty. All radiographs were analysed using standard conditions. Intra- and inter-examiner agreement was calculated using Kappa and weighted Kappa tests. Data were collected using a data collection tool, entered into Microsoft Excel, and analysed using descriptive statistics, exploratory analysis with Chi-squared tests, and multivariable analyses (logistic regression).

RESULTS

At 12-month review, the success rate for each apexification material was MTA (84%), Biodentine (88%), and TotalFill Putty (92%). MTA had the highest frequency of post-operative coronal discolouration, with Biodentine most associated with apical extrusion. A number of variables and trends that affect the clinical outcome were identified, including the presence of pre-operative resorption, the number of operators involved in treatment, the number of appointments to complete treatment, as well as how non-use of local anaesthetic during apical plug placement had no adverse effect on technical quality or clinical outcome.

CONCLUSIONS

MTA, Biodentine, and TotalFill Putty are highly effective apexification materials which produce excellent clinical outcomes. As such, logistical and situational factors, such as continuity of care from operators with increased levels of experience, skill and ability, rather than material choice, may be more prognostic regarding the technical quality and clinical outcome of immature endodontic treatment. Further high-quality evidence is required.

Children's Perceptions of Dental Experiences and Ways to Improve Them

This qualitative study explored children's perceptions of their dental experiences and their acceptability of the CARD™ (Comfort, Ask, Relax, Distract) system, adapted for the dental setting as a means to mitigate dental fear and anxiety (DFA). A purposive sample of 12 participants (7 males) aged 8-12 years receiving dental care at the Paediatric Dental Clinic, University of Toronto, was recruited. Virtual one-on-one interviews were augmented with visual aids. Participants were oriented to and asked about their perceptions of various dental procedures. Data were deductively analyzed, according to the Person-Centered Care framework (PCC). Four themes were identified: establishing a therapeutic relationship, shared power and responsibility, getting to know the person and empowering the person. Children emphasized the importance of clinic staff attributes and communication skills. They expressed a desire to engage more actively in their own care and highlighted the positive influence of pre-operative education and preparation. Participants found the CARD™ system to facilitate opportunities for self-advocacy in their dental care.

Virtual Reality Reduces Pediatric Anxiety During Food Allergy Clinical Trials: A Pilot Randomized, Pragmatic Study

Phlebotomy procedures required in food allergy (FA) diagnosis and clinical trials often induce fear and anxiety for pediatric patients. The primary aim of this study was to determine whether virtual reality (VR) applications were effective in reducing anxiety for pediatric FA patients undergoing phlebotomy during FA clinical trials. Secondary aims assessed fear, pain, procedural compliance, and adverse events. Participants undergoing phlebotomy were enrolled and randomized to a VR group or standard of care (SOC) group for this prospective pilot randomized, pragmatic study. Participants in the VR group played interactive applications on a customized Samsung Gear VR headset and those in the SOC group received the standard of care. Participants' anxiety, fear, and pain were assessed with the Children's Anxiety Meter, Children's Fear Scale, and FACES pain scale pre, during, and post phlebotomy procedure. Compliance was assessed using the modified Induction Compliance Checklist during the procedure and compared between two groups. Forty-nine participants were randomized to VR (n = 26) and SOC (n = 23) groups. Although both the VR and SOC groups experienced a decrease in anxiety and fear from pre- to post-procedure, those in the VR group experienced less anxiety and fear during the procedure than SOC participants. Similarly, both groups experienced an increase in pain from pre- to post-procedure; however, the VR group reported less pain during the procedure than SOC. Fewer symptoms of procedural non-compliance were reported in the VR group. Interactive VR applications may be an effective tool for reducing fear, anxiety, and pain during phlebotomy for FA clinical trials.