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

Enhancing special care dentistry with waiting room based multisensory‑adapted dental environment: A randomized controlled-trial

AIM

To assess the effectiveness of waiting room based multisensory adapted dental environment (SADE) as a novel, non-invasive behavior management technique in alleviating anxiety levels in children with Down syndrome.

MATERIALS AND METHODS

This study was conducted in the Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Nerul, Navi Mumbai. A total of 40 children between 8 and 13 years of age diagnosed with Down syndrome were included in our study. Prior to the first dental evaluation, they were divided equally into two groups using simple randomization via lottery system. Group A (Intervention group): Patients were subjected to a sensory adapted environment (SADE) in the waiting room for 10 min prior to dental evaluation. Group B (Control group): Patients were subjected to a regular dental environment (RDE) in the waiting room for 10 min prior to dental evaluation. Outcome parameters evaluated at baseline and post dental evaluation were anxiety and behavior, using a pulse oximeter and the Modified Venham's Scale respectively. Data were subjected to statistical analysis using SPSS version 21.0 (SPSS Inc. Chicago, IL). The 'p' value < .05 was taken as significant at 95% confidence interval.

RESULTS

Mann-Whitney U test was used to carry out the inter group analysis which showed a significant increase in the heart rate (26.00, p = .00) in Group B and a significant decrease in the Modified Venham Scale score (90.00, p = .001) in Group A. The Wilcoxon Signed ranks test was used to carry out the intra group analysis for which a significant difference between the two time intervals for heart rate (-3.69, p = .00) and Modified Venham Scale score (-1.46, p = .03) was obtained in Group A whereas a significant difference was obtained only in the heart rate (-3.04, p = .002) in Group B.

CONCLUSION

Multisensory-adapted dental environment (SADE) in the waiting room effectively improves behavior, reduces anxiety and sensory discomfort among children with Down syndrome.

Basic behavioral management techniques in paediatric dentistry: A systematic review and meta-analysis

OBJECTIVE

To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in paediatric patients.

DATA SOURCES

Electronic and hand searches were conducted to locate Randomized Controlled Trials (RCTs) reporting on objective and subjective evaluation of anxiety and behavior of children up to 12 years of age. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool (RoB 2.0 Tool), were performed independently and in duplicate for all included studies. Mean differences and standard deviations were used to summarize the data from each study and meta-analyses were conducted with studies of limited heterogeneity.

STUDY SELECTION

A total of 708 papers were identified and screened, 122 retrieved for full text appraisal and 62 finally included. Results suggested that all basic BMTs have acceptable effectiveness on paediatric patients' anxiety, fear and behavior during dental treatment. Meta-analysis showed a statistically significant difference in favor of distraction for subjective anxiety using facial scale (Mean diff.: 2.78; 95% CI: -3.08, -0.53; p=0.005) and Modified Child Dental Anxiety Scale (Mean diff.: 12.76; 95% CI: -6.09, -4.47; p=0.001) and a non-significant difference for heart rate (Mean diff.: 1.70; 95% CI: -6.54, 0.46; p=0.09). Music significantly reduced heart rate when compared to a control comparator, underlining the superiority of the BMT (Mean diff.: 2.71; 95% CI: -3.70, -0.59; p=0.007).

CONCLUSIONS

Limited evidence about efficacy of one technique over another raises important issues on the topic for future research regarding the management of the child patient in the dental setting of the 21^st century.

CLINICAL SIGNIFICANCE

Behavioral management comprises a challenge for clinicians, who need to be familiar with a range of techniques to meet patients' needs at individual level and be flexible in their implementation. Appropriate technique should incorporate patients' personality and parents' active involvement, within the contents of the changes in modern societies.

Effectiveness of Virtual Reality Glasses Digital Screens and Verbal Command as a Method to Distract Young Patients during Administration of Local Anesthesia

Aim and objective

The study investigates the effect and compares three techniques-video-eyeglasses earphone system, Digital screens and verbal methods as distracting technique to assess dental pain reaction in children during administration of local anesthesia (LA).

Materials and methods

Pain or its anticipation can cause fear and anxiety in a child which could complicate further dental treatment. This cross-sectional study consists of 97 children of age-group 4–8 years who required local anesthesia for their dental treatment were selected. Children were randomly allocated into three groups namely- Verbal method (group A), video eyeglass/earphone system (group B) and digital screens (group C). In group A, instructions were given to the patient by the dentist while administering local anesthesia. In group B, VR box was used to show age appropriate videos according to subjects’ choice. In group C, digital screens were placed on dental chair for patient to watch while nerve block was administered. Pain was measured using face, legs, activity, cry, consolability (FLACC) scale behavioral anxiety/pain assessment scale.

Results

FLACC score was found to be significantly different among three groups. The mean FLACC scale score for pain was less in video eyeglass/earphone (1.94) than digital screens (3.67) and highest in Verbal group (6.88).

Conclusion

Video eyeglasses/earphone method proved to be most effective as a distraction method in children and helped in reducing children's disruptive behavior in the dental setting.

Clinical significance

This study was conducted to find a better distraction technique among video eyeglasses/earphone system, digital screens and Verbal command that will make child less apprehensive during administration of local anesthesia.

How to cite this article

Sharma Y, Bhatia HP, Soods S, et al. Effectiveness of Virtual Reality Glasses Digital Screens and Verbal Command as a method to Distract Young Patients during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S143–S147.

Using a cartoon questionnaire to improve consent process in children: a randomized controlled survey

OBJECTIVE

The aim of the study was to evaluate the effectiveness of an audio and animated cartoon questionnaire (AACQ) at improving consent process in child for biospecimen donation.

METHODS

A multi-center randomized and controlled survey was performed at two pediatric hospitals in China from 2019 to 2020. Children aged from 7 to 18 years in the pediatric surgery wards were invited to investigate the participants' willingness and attitudes for donating biospecimens. A total of 264 children, including 119 in the AACQ group and 145 in the TQ group, and 67 parents of children were analyzed. A separate knowledge test was acquired in the questionnaires.

RESULTS

Our findings showed that the response rate of the AACQ group (89.85%) was significantly higher than that of the TQ group (68.44%; p < 0.001). AACQ can improve the child's understanding, increase children's engagement in biospecimen donation, reduced the differences in selected characteristics affecting children understanding, and enhanced their risk awareness of donating biospecimens. We also found that increasing pain and privacy disclosure were the most popular concern among children for the refusal to donate biospecimens.

CONCLUSIONS

AACQ is an effective and standardized tool of content delivery to children from the surgical wards. Children who fully understood of biospecimen donation are suggested to participate in the consent signing.

IMPACT

Using audio and animated cartoon questionnaire is a more effective and standardized tool of content delivery to children. This study expanded the use of an animated cartoon to a children's survey. Audio and animated cartoon questionnaire (AACQ) can improve the child's understanding, increase children's engagement in biospecimen donation compared to text questionnaire (TQ) group, and enhanced their risk awareness of donating biospecimens. More AACQ should be used with children in the future to effectively deliver content to children and improve children's participation in the survey.

The effect of the waiting room's environment on level of anxiety experienced by children prior to dental treatment: a case control study

Background

In addition to visit purpose, one of the environmental factors that can cause anxiety prior to dental treatment includes the waiting room experience, specifically the amount of time spent awaiting treatment and the waiting room environment. The purpose of this study was to compare the effect of the waiting room’s environment on the level of anxiety experienced by children in multisensory and traditional waiting rooms.

Methods

Case control study. Test group waited for treatment in a multisensory waiting room, which consisted of a lighting column that children could touch and climb; as well as, rhythmic music played on loudspeakers. Control group waited for treatment in a traditional waiting room. Study participants were asked to answer the “Venham Picture Test”, a dental anxiety scale, while in the waiting room prior to entering the treatment room. Chi-squared, Fisher’s Exact tests, and linear regression were utilized. A p-value less than 0.05 was considered statistically significant.

Results

No significant difference in dental anxiety scores was found between the test and control groups according to waiting room type (p > .05). Dental anxiety was significantly higher in patients who had longer waiting time prior to treatment (p = 0.019). In addition, dental anxiety was significantly associated with visit purpose (p < .001): children waiting for dental examination or those scheduled for dental treatment with conscious sedation were less anxious than children waiting for emergency treatment.

Conclusions

A sensory adapted waiting room environment may be less important in reducing children’s anxiety prior to dental treatment. Children’s dental anxiety can be reduced by preventing emergency treatments, scheduling routine dental visits and decreasing waiting time.

Trial registration

TRN NCT03197129, date of registration June 20, 2017.

Mental imagery in dentistry: Phenomenology and role in dental anxiety

Dental anxiety is a prevalent problem with marked psychological, physical and public health implications. Based on cognitive theory and evidence, we hypothesized that vivid, sensory image-based cognitions play a role in dental anxiety. A quantitative online survey (N = 306) and qualitative semi-structured interviews (N = 18) found that vivid sensory images were common irrespective of dental anxiety levels, but that their content, associated distress and responses varied. Participants reporting higher anxiety experienced intense and intrusive fear-provoking dental imagery focusing on unpleasant sensations, which were associated with the intrusive recollection of negative past experiences and avoidance of dentistry. Participants with lower anxiety ratings, reported images that were less distressing and centered around reassuring aspects and positive appointment outcomes, potentially acting as protective factors against dental anxiety and facilitating appointment attendance. The inclusion of components aimed at reducing intrusive memories and dental imagery rescripting may help improve interventions for dental anxiety.

Effect of visual distraction on children's anxiety during dental treatment: a crossover randomized clinical trial

AIM

This was to evaluate the effect of visual distraction on anxiety of children during dental treatment.

MATERIALS AND METHODS

This randomized, crossover clinical trial study was conducted on 28 children (aged 4-5 years) randomly divided into two groups of 14 each. Group 1, treatment procedure in the first visit was completed while the patients were watching a cartoon as a visual distraction tool, at the second visit, the procedure was carried out with conventional tell-show-do. Group 2, had visual distraction in their second visit and conventional tell-show-do during the first visit. Treatment procedures were similar in both groups during two sessions. The anxiety level was determined using Venham picture test and pulse rate (PR) at the beginning and the end of each appointment. Patient behaviour was also scored using Frankl behaviour rating scale (FBRS).

RESULTS

Self-reported dental anxiety was reduced significantly by visual distraction (p-value < 0.001) compared to conventional tell-show-do, but it did not change FBRS scores significantly (p-value = 0.24).

CONCLUSION

Use of visual distraction improves self-reported anxiety and decreases PR of children but does not change their behaviour.