Evaluation of treatment related fear using a newly developed fear scale for children: "Fear assessment picture scale" and its association with physiological response

Evaluation of the effect of dental anxiety on vital signs in the order of third molar extraction

BACKGROUND

Dental anxiety is a prevalent concern affecting patients undergoing various dental procedures, particularly surgical interventions. Understanding the impact of patients' anxiety levels on their physiological responses during dental surgeries, such as third molar impaction surgery, is crucial for optimizing patient care and outcomes. Therefore, this study aimed to investigate the effect of patients' anxiety levels on vital signs during third molar teeth impaction surgery.

METHODS

A cross-sectional study was conducted, including 45 randomly selected, healthy patients. Demographic information was recorded after obtaining consent from the patients prior to surgical intervention. Preoperative anxiety levels were determined using the Modified Dental Anxiety Scale (MDAS). Pupil measurements were taken from the patients before surgery, at 10 min after the surgery began, and at 10 min after the surgery ended. Systolic (SBP) and diastolic (DBP) blood pressure, pulse rate, temperature, and haemoglobin oxygen saturation (SpO2) values were recorded.

RESULTS

The MDAS test results were statistically significantly higher in women compared to men (p < 0.001). Positive correlations were observed between MDAS score and both preoperative pulse rate (r = 0.344, p = 0.021) and SpO2 level during the operation (r = 0.462, p = 0.001). However, no significant correlations were found between MDAS and DBP (p = 0.575), SBP (p = 0.176), fever (p = 0.238), or pupil diameter (p = 0.338).

CONCLUSIONS

Third molar impaction surgery induces anxiety in adult patients 20 years and older. Vital sign monitoring provides information about the patient's emotional state, both before and during the procedure. Since anxiety causes changes in vital signs during dental procedures, it is important to follow these findings to have an idea about the general condition of the patients.

Impact of dental anxiety on dental caries and salivary alkaline phosphatase in children across different nutritional statuses

Dental anxiety is a familiar problem among children, which may affect their oral health. This cross-sectional study aimed to evaluate dental anxiety during the first dental examination in relation to dental caries and salivary alkaline phosphatase, taking into account the nutritional status of children. Eighty-two children (45 boys and 37 girls), aged six to eight years old (average 6.96), were recruited from public clinics in Baghdad city. Participants were divided into the anxious and the non-anxious groups according to physiological measures (oxygen saturation and heart rate) before the first dental treatment. The weight and height of each child were measured to determine the nutritional status (normal weight, overweight, and obese). Dental caries (prevalence and severity) in children with different nutritional statuses were recorded using dmf, DMF, and the guidelines outlined by Manjie et al. Saliva was collected to analyze salivary alkaline phosphatase. No statistically significant differences were observed between anxious and non-anxious children in means of dmf and DMF indices (teeth and surfaces) in primary and permanent teeth (p>0.05) in the three nutritional status groups. However, non-anxious children exhibited a higher mean of d1 (initial enamel caries) compared to anxious children, with statistical significance (p<0.05) observed only in normal-weight children. Salivary alkaline phosphatase was not significantly different between the two groups. In conclusion, dental anxiety did not appear to significantly impact caries development in primary teeth or salivary alkaline phosphatase levels in children with varying nutritional statuses. Anxiety reduced the initial enamel caries in normal-weight children.

Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients

Aim

To evaluate the effectiveness of the audiovisual distraction (AVD) technique and filmed modeling (FM) on anxiety and fear in pediatric dental patients.

Materials and methods

This experimental in vivo study was conducted on 80 subjects of age-groups 5-8 years coming to the Department of Pediatric and Preventive Dentistry for their first dental visit. Study subjects were subjected to noninvasive restorative treatment under AVD in group I, FM in group II, and a combination of AVD and FM in groups III and IV (control 0). To assess the level of pre and postoperative anxiety and fear, various biological parameters like pulse rate, oxygen saturation, body temperature, respiratory rate, and salivary cortisol estimation along with facial image scale (FIS), and fear assessment picture scale (FAPS) were used.

Results

Group III (a combination of AVD and FM) came out to be better than other experimental groups and control groups in reducing dental anxiety and fear in pediatric dental patients.

Conclusion

A combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique.

Clinical significance

A child's disruptive behavior due to dental anxiety causes difficulty in delivering effective dental treatment. Thus, a child's behavior management is of paramount importance in the pediatric dental setup. Nonpharmacological behavior management techniques, that is, a combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique to reduce dental anxiety and fear in pediatric dental patients.

How to cite this article

Jamil F, Khan SY, Jindal MK. Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients. Int J Clin Pediatr Dent 2023;16(4):598-602.

Comparison of Pain and Anxiety Level Induced by Laser vs Rotary Cavity Preparation: An In Vivo Study

Aim

To evaluate and compare the pain perception, anxiety level, and acceptance of Er,Cr:YSGG laser (2780 nm) with a conventional rotary method during cavity preparation in children.

Materials and methods

In a randomized controlled trial, using split-mouth design thirty 6- to 12-year-old children with 60 carious molars were examined. In one quadrant, cavity was prepared conventionally by airotor while, in the other quadrant, Er,Cr:YSGG laser was used. Anxiety was assessed by measuring pulse rate using a fingertip pulse oximeter, while the pain was measured on the Wong-Baker Faces Pain Rating Scale. After the cavity preparation by both the methods, the child was asked about the preference for future treatment of a carious lesion.

Results

Pulse rate was found significantly higher in the airotor group but no significant difference in pulse rate was found in the laser group when compared to the baseline pulse rate. The mean value of pain in the airotor group was slightly higher than the laser group. Fifty-seven percent of children preferred Er,Cr:YSGG laser for cavity preparation in the future.

Conclusion

During cavity preparation, Er,Cr:YSGG laser comes out to be more effective and acceptable, as it is less anxiety-provoking and may cause less pain when compared with the airotor.

Clinical significance

Er,Cr:YSGG laser helps the children to remain calm during the cavity preparation.

How to cite this article

Alia S, Khan SA, Navit S, et al. Comparison of Pain and Anxiety Level Induced by Laser vs Rotary Cavity Preparation: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(6):590-594.

The reassuring role of music associated with the personality traits of children during dental care: a randomized clinical trial

AIM

The objective of this study was to analyze the reassuring role of music associated with the personality traits of children during dental care.

METHOD

The study involved a randomized crossover clinical trial with 34 children, aged from 4 to 6 years, who exhibited two carious lesions on the occlusal surfaces of the molars. The children were divided into two groups: (G1) first tooth restoration intervention session with music, second session without music; and (G2) first tooth restoration intervention session without music, second session with music. The first consultation was to perform a clinical examination, and the second and third to perform modified Atraumatic Restorative Treatment (mART). Symphony No. 40 by Mozart was played via headphones. Pulse rate (PR) was measured using a pulse oximeter. The Brazilian version of the Eysenck Personality Questionnaire-Junior (EPQ-J) was used to measure the children's personality. For statistical analysis, descriptive, Chi-square, and Wilcoxon tests were carried out.

RESULTS

The G1 group exhibited a lower PR at the time of the intervention during the second consultation compared to the third consultation (p = 0.012). The G2 group exhibited a lower PR at the time of the intervention during the third consultation compared to the first consultation (p = 0.002). The majority of the children with a low level of extraversion presented with higher PR (p = 0.005).

CONCLUSION

Music could reduce the PR among children during dental intervention. Children with low extraversion showed a tendency towards a higher PR without music during dental care.

Could a Certain Sitting Position Reduce the Pain Experienced by a Child? The Benefits of Parental Holding and an Upright Position

Intravenous injection is the most feared medical procedure and gives rise to an experience of mild to severe pain in children. Unrestrained pain has a negative effect on the child. Pain management in the form of a convenient sitting position is needed by children who undergo intravenous injection procedures. This study aims to determine the effect of parental holding and an upright position on children's pain during intravenous injection procedures. The study used the Randomized Clinical Trial method involving 34 respondents, aged 1-4 years, who were included in the intervention and control group. The result of a Mann-Whitney U test analysis showed a significant difference in the pain score between the intervention and control groups (p value = .000; α = .05). The parental holding and upright position can be applied as a nonpharmacological pain management strategy for children who undergo intravenous injection procedures.

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.