Children's behavior pattern and behavior management techniques used in a structured postgraduate dental program

Barriers to Using Advanced and Pharmacological Behavior Management Techniques: A Survey of Pediatric Dentists in Jeddah, Saudi Arabia

Aim

In this study, we assessed the use of advanced pharmacological behavior management techniques (BMTs) among pediatric dentists in Saudi Arabia and the barriers to their clinical application.

Materials and Methods

This cross-sectional study used a self-administered electronic survey that targeted members of the Saudi Society of Pediatric Dentistry. The questionnaire included questions on five techniques of advanced and pharmacological behavior management recommended by the American Academy of Pediatric Dentistry. Descriptive statistics, frequency, Chi-square test, and Fisher's exact test were used to present the outcomes and independent variables.

Results

A total of 57 pediatric dentists completed the survey. Nitrous oxide (N2O) sedation, general anesthesia (GA), and protective stabilization were used regularly by pediatric dentists in 70.2%, 68.4%, and 56.1% of the participants, respectively. A few participants reported using oral (14.0%) or intravenous (IV) sedation (10.5%) regularly. The most common barriers to using these techniques were either dentists' discomfort or the non-availability of the equipment/drugs.

Conclusions

The most common method used by pediatric dentists was N2O inhalation sedation, followed by GA and protective stabilization. The participants' use of pharmacological BMTs, including IV and oral sedation, was relatively low.

Variation in the Use of Basic Behavioral Management Techniques in General and Pediatric Dental Practice: A Cross-sectional Study

Aim:

Basic guidance on nonpharmacological behavioral management techniques in dental practice is fundamental for the effective treatment of pediatric patients. The aim of this study was to compare the use of basic nonpharmacological behavior guidance in general and specialist pediatric dentists and to evaluate the perceived difference in their effectiveness across hospital clinics in Jeddah, Saudi Arabia.

Material and Methods:

A cross-sectional study with a nonpurposive sample of 179 registered general and pediatric dentists in the Saudi Dental Society based in Jeddah in 2019. Participants were contacted and asked to complete a validated questionnaire. The first section of the questionnaire comprised questions on demographic data and the second section investigated the frequency of the use of various behavioral management techniques. Descriptive statistics (frequency and percentages) and inferential statistics were used.

Results:

A total of 109 participants completed the survey; 52 were general dentists and 57 were pediatric dentists. The techniques tell–show–do ( P = .018), positive reinforcement ( P = .004), distraction ( P = .001), and nonverbal communication ( P = .001) were used more frequently by pediatric dentists than general dentists, and there were statistically significant differences. Also, pediatric dentists reported that the techniques tell–show–do ( P = 0.035), positive reinforcement ( P = .026), distraction ( P = .011), and nonverbal communication ( P = .007) were highly effective more often than general dentists did.

Conclusions:

Statistically significant differences were found between general and pediatric dentists in the use of basic behavioral management techniques. Broadly, general dentists used fewer behavior guidance techniques compared to pediatric dentists. More pediatric dentists reported that behavioral management techniques were effective in comparison to general dentists.

Management of Post-Traumatic Dental Care Anxiety in Pediatric Dental Practice-A Clinical Study

BACKGROUND

It is important to avoid giving children traumatic dental experiences that induce post-traumatic dental care anxiety (PTDA) in clinical dental practices. The aim of this study was to evaluate whether non-pharmacological behavior management procedures can effectively reduce the use of pharmacological behavior management in children who have PTDA and are referred for regular dental treatments under general anesthesia (GA) and sedation.

METHODS

This clinical study consisted of two groups. The treatment group involved 20 healthy children aged 4-14 with PTDA and also those referred by other institutions for dental treatment with/without GA. The control group was sampled retrospectively from the patient records and involved 20 healthy uncooperative children aged 4-14 with PTDA who had been treated under GA.

RESULTS

The number of multiple appointments was significantly higher in the treatment group than in the control group. Only 25% of children in the treatment group underwent GA and the rest (75%) were managed with non-pharmacological management techniques. Nine (60%) children who were treated with minimally invasive techniques did not require GA.

CONCLUSIONS

It is important to treat children as much as possible without causing PTDA by using appropriate behavior management techniques. This study emphasizes the usefulness of thoroughly employing non-pharmacological behavior management methods before directing a child with PTDA for dental treatment under pharmacological behavior management, which can prevent the over-utilization of sedation and GA.

Relationship of Blood Group with Level of Cooperation of Pediatric Dental Patients

Acquaintance with the behavior of children in dental office setting is highly important in treatment success. People with different blood groups often have different behaviors. Thus, the blood group may aid in prediction of behavior of pediatric dental patients. This study is aimed at assessing the relationship of the blood group with level of cooperation of pediatric dental patients. This cross-sectional study was conducted on 130 children between 4 and 6 years of age. The blood group of children was recorded according to their identification card or by collecting an intraoral blood sample during pulpotomy and using the respective kit. To assess the level of cooperation of children, their behavior was videotaped during the procedure, and the videos were assessed by two pedodontists. The behavior of children was scored according to the Venham scale. Data were analyzed by SPSS 26 and Chi-square, Fisher's exact test, and Mann–Whitney U test. The blood group was A in 35.7%, B in 5.8%, AB in 3.2%, and O in 53.5%. Children with blood group O had maximum cooperation (52.6) while those with blood group B had minimum cooperation. Pairwise comparisons of the groups regarding the Venham scale revealed significant differences between blood groups A and B (P = 0.0001) and also B and O (P = 0.005). Pairwise comparisons of the groups regarding the level of cooperation also revealed significant differences between blood groups A and B (P = 0.0001) and B and O (P = 0.019). Blood group B may be correlated with certain behavioral traits such as dental fear and anxiety and the resultant poor cooperation.

Does the Efficacy of Behavior Management Techniques Differ Between Children From Single-Child and Multi-Child Families?: A Quasi-Experimental Study

Aim

Behavior management techniques (BMTs) efficiently deliver dental treatment to children with dental anxiety. The objective of this quasi-experimental study was to examine whether the efficacy of BMTs applied for the improvement of compliance in pediatric patients differs between children 3–10-year-olds from single-child and multi-child families.

Materials and Methods

In this quasi-experimental, 197 caregiver-child couples were divided into two groups: single-child group (116 couples) and multi-child group (81 couples). Children's pre- and post-treatment anxiety levels were measured by facial mood scale (FMS) and Frankl Behavior Rating Scale (FBRS), respectively.

Caregivers' dental anxiety was measured by the Chinese version of the Modified Dental Anxiety Scale (MDAS), which was included in the self-designed questionnaire. Data were analyzed by using the Mann-Whitney U-test, chi-square tests, and binary multivariate regression analysis.

Results

There was no statistically significant difference in the demographic characteristics of the children between the two groups. BMTs were found to be capable of reducing children's dental anxiety (CDA): the compliance rate was 45.69–88.79% in the single-child group and 44.44–85.79% in the multi-child group pre- and post-BMTs, but there was no significant difference in the change of compliance between the two groups (p > 0.05). In the subgroup analysis, parenting style (odds ratio [OR] = 0.054, p < 0.05) and father's education (OR = 8.19, p < 0.05) affected the varies of children's compliance in the single-child group. In contrast, in the multi-child group, gender (OR = 8.004, p < 0.05) and mother's occupation (OR = 0.017, p < 0.05) were associated with these changes in compliance.

Conclusions

In this study, BMTs were proved to be beneficial in improving compliance in 3- to 10-year-olds children in dental treatment. Though there was no significant difference in the change of compliance between children from single-child and multi-child families, different associated factors may affect the two groups. Therefore, the related family factors should be taken into account when professionals manage each child's behavior in dental practice.

Cheiloscopy and Dactyloscopy as Behavior Assessment Tool in Dental Settings: A Cross-sectional Study

Purpose

Assessment of children's behavior in the dental setting and its correlation with thumb print and lip print.

Materials and methods

The behavior pattern, lip print pattern, and thumb print pattern of 518 children aged 5–12 years were recorded in their first dental visit. The behavior pattern, lip print pattern, and thumb print pattern were determined using Frankl's Behavior Rating Scale, Tsuchihashi's classification, and Cummin's classification, respectively. The data were tabulated according to the classified criteria and statistically analyzed.

Results

It was observed that positive and definitely positive Frankl Behavior was associated with the children bearing an arch pattern of thumb print, whereas their lip pattern had no association with their behavior pattern, particularly in dental sittings.

Conclusion

Thumb print pattern can aid as a behavior marker before a child's first dental appointment and this can prove beneficial for both the child and the clinician in providing a high quality of dental care and modify behavior for future dental appointments.

How to cite this article

Navit S, Pramanik S, Khan SA, et al. Cheiloscopy and Dactyloscopy as Behavior Assessment Tool in Dental Settings: A Cross-sectional Study. Int J Clin Pediatr Dent 2021;14(2):238–242.

Role of attachment style in prediction of behavior of 3 to 6-year-old children

PURPOSE

Efficient communication with children is the basis of pediatric dentistry and is a prerequisite for provision of pediatric dental care. Prediction of the behavior of children and their reaction to therapeutic procedures is a challenge for many pediatric dentists. This study aimed to assess the attachment styles of children to predict their behavior during a dental visit.

METHODS

The participants included 117 healthy children aged 3 to 6 years presented to the Department of Pediatric Dentistry, Tehran University of Medical Sciences, in 2017-2018. A postgraduate dental student examined the children. The parents were requested to fill out the Kinship Center attachment questionnaire (KCAQ) regarding their children, while waiting in the waiting room. The children who met the inclusion criteria in the first visit were scheduled for a dental procedure in the second visit. Another postgraduate student of pediatric dentistry assessed the behavior of children during the dental procedure according to the designed questionnaire and based on the Frankl scale. A third examiner along with the second examiner evaluated the behavior of children on a random basis to determine the inter-examiner agreement. Data were analyzed using the Chi-squared test, t test, Pearson's correlation coefficient, and linear regression.

RESULTS

The results showed that 67.5% of the children were cooperative, including 54.7% of boys. The mean age of children was 5.1 ± 0.95 years. Also, 80.3% of children had secure and 19.7% had insecure attachment styles (11.97% insecure avoidant and 7.69% insecure ambivalent). A significant association existed between the insecure ambivalent attachment style and child-dentist communication. A significant inverse correlation was also noted between the total score of the questionnaire and parent-child separation in dental office.

CONCLUSIONS

The current findings revealed no significant difference in the attachment styles of cooperative and uncooperative children. Significant associations only existed between the insecure ambivalent attachment style and child-dentist communication, and also between mother-child separation and secure attachment style. Thus, the children's behavior in dental office cannot be predicted based on their attachment style.

Comparative Evaluation of Effectiveness of Tell-Play-Do, Film Modeling and Use of Smartphone Dental Application in the Management of Child Behavior

Aim

To evaluate the effectiveness of three different behavioral modification techniques: tell-play-do (TPD), film modeling, and use of smartphone dental app in the management of child behavior.

Settings and design

Seventy-five children aged between 6 years and 9 years who were on their first dental visit were randomly divided into three groups. The study was conducted into two visits.

Materials and methods

First visit: group I-children watched a film containing various dental procedures performed on a child model followed by oral prophylaxis; group II-TPD techniques were introduced with dental instruments imitating various playing objects followed by oral prophylaxis; group III-children were asked to use mobile dental application followed by oral prophylaxis. Second visit: After 7 days interval, all the children were subjected to class I restorative treatment using glass-ionomer cement. In both visits, the heart rate (HR), facial image scale (FIS) score, and Venham's pictorial index (VPI) score were evaluated before the intervention, after the intervention of behavior modification technique, and during the dental procedure.

Statistical analysis used

One-way ANOVA test followed by the post hoc Tukey test was used to compare HR and the Kruskal-Wallis test was used to compare the FIS and VPI of all three groups.

Results

The average HR, FIS, and VPI scores were significantly lower among children who received TPD intervention compared to those who received film modeling intervention and mobile dental application.

Conclusion

Tell-play-do technique is more effective in reducing children's fear and anxiety for dental treatment. Tell-play-do can be a functional alternative method to tell-show-do (TSD) and modeling techniques during dental treatment.

How to cite this article

Kevadia MV, B Sandhyarani, Patil AT, et al. Comparative Evaluation of Effectiveness of Tell-Play-Do, Film Modeling and Use of Smartphone Dental Application in the Management of Child Behavior. Int J Clin Pediatr Dent 2020;13(6):682-687.

Effect of Three Behavior Guidance Techniques on Anxiety Indicators of Children Undergoing Diagnosis and Preventive Dental Care

Objective(s): To assess the effect of three behavior guidance techniques on anxiety indicators of children undergoing diagnosis and preventive dental care. Study Design: Sixty-three subjects (7-9 years) were divided into three groups as per the behavior guidance technique namely tell-show-do, live and filmed modeling (using Tablet Computer) to receive diagnostic (Oral examination & radiographic assessment using intraoral periapical radiographs) and preventive dental care (Oral prophylaxis and topical fluoride application). Anxiety indicators-Facial Image Scale (FIS) scores and heart rate were recorded before, during and after diagnosis/preventive treatment. Three-way repeated measures ANOVA with post-hoc analysis was performed at significance of p-value < 0.05. Results: There was a statistically significant difference in the anxiety indicators of children under the influence of different behavior guidance approaches undergoing diagnosis/preventive treatments except for mean heart rate of children while oral examination. Multiple comparison results reveal that the mean FIS scores and heart rate of children with modeling techniques were significantly better as compared to tell-show-do technique with no significant difference between the two modeling techniques. Conclusion: This study suggests that the modeling techniques (filmed and live) seem to be an efficient behavioral guidance approach for children aged 7-9 years undergoing routine diagnosis and preventive dental care as compared to tell-show-do technique.

Comparison of three behavior modification techniques for management of anxious children aged 4-8 years

Background

An inability to cope with threatening dental stimuli, i.e., sight, sound, and sensation of airotor, manifests as anxiety and behavioral management problems. Behavior modification techniques involving pre-exposure to dental equipment will give children a first-hand experience of their use, sounds, and clinical effects. The aim of this study was to compare the techniques of Tell-Show-Play-doh, a smartphone dentist game, and a conventional Tell-Show-Do method in the behavior modification of anxious children in the dental operatory.

Methods

Sixty children in the age group of 4-8 years, with Frankl's behavior rating score of 2 or 3, requiring Class I and II cavity restorations were divided into three groups. The groups were Group 1: Tell-Show-Play-doh; Group 2: smartphone dentist game; and Group 3: Tell-Show-Do technique and each group comprised of 20 children. Pulse rate, Facial Image Scale (FIS), Frankl's behavior rating scale, and FLACC (Face, Leg, Activity, Cry, Consolability) behavior scales were used to quantify anxious behavior. Operator compliance was recorded through a validated questionnaire.

Results

The results showed lower mean pulse rates, lower FIS and FLACC scores, higher percentage of children with Frankl's behavior rating score of 4, and better operator compliance in both the Tell-Show-Play-doh and smartphone dentist game groups than in the conventional Tell-Show-Do group.

Conclusion

The Tell-Show-Play-doh and smartphone dentist game techniques are effective tools to reduce dental anxiety in pediatric patients.

Evaluation of children's dental anxiety levels at a kindergarten and at a dental clinic

This study evaluated the dental anxiety levels of preschool children at a kindergarten and at a dental clinic. The anxiety levels of ninety 4-6-year-old (4.99 ± 0.81) preschool children were evaluated according to pulse rates, the facial image scale (FIS), the Venham picture test (VPT), and the Frankl behavior rating scale. The children's mothers were asked to complete the state-trait anxiety inventory (STAI) forms 1 and 2 (STAI 2 and STAI 2). The sample t-test, Mann-Whitney U test, and Pearson's correlation test were used. A statistically significant difference was observed between the children's pulse rates when measured at the dental clinic and those when measured at the kindergarten (p < 0.001). Although the results were not statistically significant, more negative facial expressions were observed in the children at the dental clinic than in those at the kindergarten when assessed using FIS and VPT (p = 0.090 and p = 0.108, respectively). There was a statistically significant correlation between the transient anxiety levels (STAI 1) of mothers and the VPT scores of their children evaluated at the dental clinic (r = 0.506, p < 0.001). The continuous anxiety level of the mothers of males was found to be significantly higher (p = 0.033) than that of the mothers of females (STAI 2). Although the children had been informed about dentistry and were introduced to a dentist at the kindergarten, their anxiety levels seemingly increased as they arrived at the dental clinic. The significant increase observed in the children's pulse rates was a physical indicator that their anxiety levels had increased. It can be concluded that the children felt more anxious at the dental clinic that at the kindergarten.

Dental anxiety and fear among a young population with hearing impairment

BACKGROUND AND AIM

Dental fear and anxiety is a major barrier for dental care provision. Identifying anxious patients can help dental professionals manage them appropriately. The study aimed at assessing dental fear and anxiety among a deaf population in Cluj-Napoca, Romania and their associated and contributing factors.

METHOD

In this cross sectional study 165 deaf participants were invited to complete a questionnaire comprising three sections. The first section contained questions about social and economical status, the second comprised a Romanian version of the Modified Dental Anxiety Scale (MDAS) while part three was the Dental Fear Survey (DFS). Data was introduced and analyzed with the Statistical Package for Social Sciences (SPSS) program, version 20.0 (SPSS Inc., Chicago, Illinois, USA).

RESULTS

Thirty four point nine percent (34.9%) of respondents were found to be insignificantly anxious, 59.7% were moderately or extremely anxious with 5.3% being identified with dental phobia based on the MDAS scores. Mean total score for dental anxiety on the MDAS scale was 13.7. Patients suffering from a prior negative experience were found to be more anxious (p<0.05).

CONCLUSIONS

Dental fear and anxiety is widespread in the deaf communities. Higher percentages were observed among women and people with a previous traumatic dental experience.

Application of Behavior Management Techniques for Paediatric Dental Patients by Tanzanian Dental Practitioners

Background:

Management of children’s behavior is an integral component of pediatric dental practice.

Objective:

To investigate the oral health care providers’ awareness, use and factors for choice of behavior management techniques when attending paediatric dental patients.

Methods:

A cross-sectional study among dental practitioners in Dar es Salaam, Tanzania. Data collection was done through interview using a structured questionnaire. The recorded information included: awareness and application of behavior management techniques (BMT) when attending a child dental patient, factors influencing choice of a particular technique, socio-demographics, level of professional training, working experience and facility profile. Using SPSS program version 18, frequency distributions and cross tabulations analyses were performed.

Results:

74 dental practitioners participated in the study, of whom 49 (66.2%) were males and 44 (59.5%) were graduates. Most participants were aware of the behavior management techniques, ranging from 100% for Tell-Show-Do to 86% for distraction. A small proportion (9.5%) reported to have adequate skills, all of them were graduates. The use of universally accepted BMTs was reported by 65% of experienced practitioners, 61% of graduates, 59% of those reporting to have received formal training and all of those reporting to have fair/inadequate skills to apply BMTs (p= 0.01).

Conclusion:

Most participants were aware of BMTs, although few acknowledged having adequate skills to apply the techniques. They use BMTs during treatment of paediatric dental patients and their choice of the technique is mainly influenced by children’s factors.

Use of general anaesthesia in paediatric dentistry: barriers to discriminate between true and false cases

PURPOSE

The use of general anaesthesia (GA) has shown significant increase in child dental patients. This study aimed to assess whether behaviour management strategies can be the effective methods for decreasing the need for GA and its over-utilisation in paediatric dentistry.

METHODS

The patients (n = 240) aged 3-6 years old were selected from referrals by paediatric dentists (PD) or general dentists (GD) for dental treatment under GA. Each child's behaviour during first and subsequent appointments was assessed using the Frankl Behaviour Rating Scale. A first visit included clinical examination and fluoride therapy. In all sessions, a hierarchy of anxiety-reducing behaviour guidance strategies was implemented over nine steps in a logical treatment order.

RESULTS

Overall, 47.5% of children referred for dental treatments under GA were retrained to be treated routinely. False referrals were significantly higher in GD compared to PD group. 80.0% of the referred children by PD and 6.7% of those referred by GD were true GA cases and still needed GA. 20.1% of retrained children and 67.4% of true GA cases received conscious sedation. There was no significant change in the frequency of children considered uncooperative as the years of experience increased among GD, while this value was significant for PD.

CONCLUSIONS

The findings may highlight the importance of using behaviour management techniques thoroughly prior to referring an uncooperative child for treatment under GA, and may discourage its over-utilisation. Specifically, these skill sets and their efficient practice should be improved among general dentists.

Minimally invasive treatment of dental caries in primary teeth using an Er:YAG Laser

INTRODUCTION

Maintaining deciduous teeth as long as possible represents a goal in pediatric dentistry and avoids a plethora of health problems. Er:YAG carious decay treatment may help for prevention as well as during the curative processes.

MATERIALS AND METHODS

An Er:YAG laser was used to ablate 30 carious lesions on primary teeth. Diagnosis being conventionally dressed, treatment was conducted in respect of the following parameters: Er:YAG laser (Lite Touch, Syneron): output power from 300 mJ (enamel) to 200 mJ (dentine), frequency 20 Hz, sapphire tip (diameter 1.3 mm), air water spray ratio 8 (39 ml/min), pulse duration 50 µsec., theoretical fluence ranging from 15.08 J/cm(2) for dentin to 22.61 J/cm(2) for enamel. Then cavity depth was controlled (observation + probe). Glass-ionomer cement (GC Fuji Triage capsule) or flowable composite resin or compomer were used to fill the cavities. Children's acceptance to Er-YAG laser treatment was evaluated. According to predefined criteria, each case was followed up for one month after treatment and then with further monthly follow-ups for one year.

RESULTS

Clinical cases illustrate the validity of this clinical approach. The benefit of laser dental treatment has been shown to be the greatest in children. However, the lack of studies evaluating laser ablation capability in primary teeth restrains the adoption of this technology. The interaction between the Er:YAG laser and primary enamel and dentin depends on the composition of the tissues - a higher presence of water and lower presence of minerals- comparative to the permanent enamel and dentin. Thus, photoablation of primary enamel and dentin requires lower energy. This study shows that the laser parameters used (300 mJ/20 Hz for enamel and 200 mJ/20 Hz for dentin) are efficient enough for the ablation of tissues of deciduous teeth and moreover demonstrates to be well accepted by young patients.

Parental attitude toward behavioral management techniques in dental practice with schoolchildren in Kuwait

OBJECTIVE

The objective of this study was to evaluate the parental attitude toward different management techniques used during dental treatment of schoolchildren in Kuwait.

SUBJECTS AND METHODS

One hundred and eighteen parents who accompanied their children to the clinics of Hawally School Oral Health Program in Kuwait participated in this study. The parents viewed a videotape which showed scenes of different behavioral management techniques (BMTs) and then completed a questionnaire.

RESULTS

Positive reinforcement, effective communication, tell-show-do, distraction, modeling and nonverbal communication were considered as the most approved techniques. Hypnosis and parental separation were moderately approved techniques. Voice control, nitrous oxide sedation, protective stabilization (physical restraint), general anesthesia, hand-over-mouth technique and conscious sedation were the least approved techniques. A majority (99%) of parents regarded the use of various BMTs as a key factor for successful dental care for their children. Acceptance of each BMT was not related to parental age, gender, nationality, educational level or occupation.

CONCLUSION

Most parents preferred the nonpharmacological techniques to pharmacological techniques. Techniques employing drugs and restraint were considered as least acceptable. Further studies comparing the effectiveness of various BMTs are required.