The effect of parental presence on the anxiety during first dental treatment in children

OBJECTIVE

The aim of this study was to evaluate the effect of parental presence on dental anxiety in children during dental treatments.

MATERIALS AND METHODS

The study was conducted with 194 children between January-April, 2020. The children were randomly divided into two subgroups. Children in group-I were treated in parent's presence (pp), and in group-II in parent's absence (pa). The Wong-Baker FACES Pain Rating Scale (WBFPS) and The Modified Dental Anxiety Scale (MDAS) were used for subjective measurements, whereas the objective measurement was performed by measuring the heart rate.

RESULTS

The mean age of 194 children was 6.26 ± 1.15 years, ranging from 5-8 years of age. The mean MDAS score of all children was 15.1 ± 4.72. No significant correlations were found in terms of dental anxiety between the children's gender and age with heart rate, WBFPS and MDAS scores. Preoperative WBFPSscores (6.83 ± 1.04 pp and 7.01 ± 0.93 pa) were higher than postoperative scores (5.34 ± 2.11 pp and 5.74 ± 2.04 pa), with no statistically significant difference. Although there was no statistically significant results, the paediatric dentist observed a deterioration in the children's behavior throughout the sessions in group-II compared to children in group-I.

CONCLUSIONS

Parental presence has no statistically significant effect on dental anxiety in children during dental treatments.

Sedation of children undergoing dental treatment

BACKGROUND

Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. This is the second update of the Cochrane Review first published in 2005 and previously updated in 2012.

OBJECTIVES

To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 22 February 2018); MEDLINE Ovid (1946 to 22 February 2018); and Embase Ovid (1980 to 22 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. We excluded cross-over trials.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted, in duplicate, information regarding methods, participants, interventions, outcome measures and results. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. Cochrane statistical guidelines were followed.

MAIN RESULTS

We included 50 studies with a total of 3704 participants. Forty studies (81%) were at high risk of bias, nine (18%) were at unclear risk of bias, with just one assessed as at low risk of bias. There were 34 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Studies were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data for the primary outcome (behaviour) was possible for studies investigating oral midazolam versus placebo only. There is moderate-certainty evidence from six small clinically heterogeneous studies at high or unclear risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 1 mg/kg is associated with more co-operative behaviour compared to placebo; standardized mean difference (SMD) favoured midazolam (SMD 1.96, 95% confidence interval (CI) 1.59 to 2.33, P < 0.0001, I2 = 90%; 6 studies; 202 participants). It was not possible to draw conclusions regarding the secondary outcomes due to inconsistent or inadequate reporting or both.

AUTHORS' CONCLUSIONS

There is some moderate-certainty evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is a need for further well-designed and well-reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.

Behavior guidance: that was then but this is now

Pediatric dentistry has evolved. Seasoned pediatric dentists believe that patients, parents, and behavior techniques have changed over their practice lifetimes. The purpose of this article is to provide dentists with a framework in which to adapt to the changes in society. Understanding cultural diversity, current societal values, technology and media influences, and contemporary parenting philosophies is essential to fostering communication with patients and their families. Building and honing behavior guidance skills are part of the process by which dentists help turn child patients into fearless adult patients with excellent oral health. This article reviews basic techniques and offers practical examples of implementing these in daily practice. The discussion also addresses changing parental and societal acceptance of various techniques and dentists' responsibility for informed consent regarding the risks and benefits of advanced behavior guidance techniques. Treating a patient from childhood to adulthood is the ultimate opportunity for the dentist to play a vital role in advancing the health and wellness of another human being.

Pharmacologic management for pediatric dental patients in the 21st century

Most children are able to cooperate during conventional, in-office dental treatment using traditional, communicative behavior guidance techniques that are carefully selected and applied to the developmental needs of a particular child. Children who are unable to cooperate during conventional treatment due to a lack of psychological or emotional maturity and/or the existence of a mental, physical, or medical disability may require pharmacologic techniques such as procedural sedation or general anesthesia to complete rehabilitative dental treatment. Patient safety dictates that careful preparation and robust case selection processes guide clinical decision-making related to pharmacologic behavior guidance. Before using these techniques, the sedation provider must demonstrate an adequate understanding of these techniques, from definitions and best practices to case selection and patient safety. This article presents essential information-with an emphasis on best practices and patient safety-for dentists who are considering pharmacologic behavior guidance for the children they treat.

Influence of Ethnicity on Parental Preference for Pediatric Dental Behavioral Management Techniques

Purpose: The purpose of this study was to determine how ethnicity influences parental acceptability of behavior management techniques (BMTs) used during dental treatment of children. This is the first known study to compare ethnic differences in acceptance levels of the BMTs. Methods: Parental acceptance of 10 BMTs (tell-show-do, voice control, non-verbal communication, positive reinforcement, distraction, parental presence/absence, nitrous oxide, protective stabilization, sedation, and general anesthesia) was rated using a visual analogue scale (VAS) after watching vignettes of each technique. Parental preferences were stratified by ethnicity and analyzed. Results: Among the 104 parents (21 Caucasians, 29 Hispanics, 30 Asians, and 24 African Americans) who qualified and completed the study, we observed that, overall, non-invasive techniques (positive reinforcement and tell-show-do) were most accepted by parents, while invasive techniques (voice control and protective stabilization) were least accepted (P<0.001). Within each ethnicity, there were significant differences between the BMTs (P<0.001). Additionally, conscious sedation was the only BMT to show a significant difference between the ethnic groups (P=0.047), with Asian parents having a lower mean score than Caucasian and Hispanic parents. Conclusions: Our results suggest that considering the ethnic/cultural differences of patients and their parents is an instrumental component for pediatric dentists to provide quality care to children patients.

Reliability and validity of a newly proposed classification system for categorisation of parental behaviour (CCPB) in the dental setting

AIM

To evaluate the reliability and validity of a newly proposed classification system for categorisation of parental behaviour (CCPB) in the dental setting.

METHODS

Parents of patients aged 5-14 years were included. 127 parents were evaluated and rated on two scales: Parental Cooperation Scale (PCS; 1-4) and CCPB (0-5) by two trained examiners during the initial interaction of the parent with the examiners at their first visit in the dental setting. Kappa Score measurement of agreement was used to assess the inter-rater reliability. Spearman's rho correlation was used to assess the correlations between PCS and CCPB.

RESULTS

The Kappa score between independent raters was 0.774 (substantial agreement) and Spearman's rho correlation coefficient was 0.778, which was statistically significant (p < 0.001).

CONCLUSIONS

The CCPB refers to the same domain as the PCS and was found to be a reliable tool to be used in future research.

Parental Presence/Absence in the Dental Operatory as a Behavior Management Technique: A Review and Modified View

INTRODUCTION

Parental presence/absence in the dental operatory (also called: Parent-in-parent-out technique) is an extremely controversial aspect of the nonpharmacological BMTs. Historically, dentists used to exclude parents from dental operatory to avoid their interference with the dentist's aptitude to build a rapport and relationship with the child, hence increasing the child management problems by disrupting treatment and making the dentist unfocused and uncomfortable.

AIM

The purpose of this article is to review and emphasize on the importance of parental presence/absence in the dental operatory, especially in a certain age group, as a behavior management technique (BMT) in pediatric dentistry, and to present a modified view of this technique.

RESULTS

This article reviews the current literature concerning behavior management in pediatric dentistry. It includes a medline database search and review of the comprehensive textbooks in pediatric dentistry. Some recommendations were based on the opinions of experienced researchers and clinicians.

CONCLUSION

Parent-in-parent-out technique in dental operatory is advocated to gain emotional support and avoid the effect of traumatic separation, especially in younger children or special health-care needs patients.

CLINICAL SIGNIFICANCE

The parent-in-parent-out technique in dental operatory is underused, or misused. This article clarifies the proper use of this technique along with a minor modification to it to make it more effective on young apprehensive dental patients.

Consideration of childhood psychological factors at dental appointment

OBJECTIVE

Introduction: Paediatric dentistry is a special field of dental practice. The scope of professional activities within this field covers not only high level of expertise and technical skills tailored to the needs of young patients, but requires searching and creating positive psychological environment and communicative management of each child in order to improve daily service methods. The aim of this study is to identify and describe the main psychological characteristics of the age developmental periods of child's personality that dental professionals should regard dealing with the paediatric patients.

PATIENTS AND METHODS

Materials and methods: The study involved 124 paediatric participants aged 2,5 - 15 years, who were referred to get specialized dental care at the Department of Paediatric Dentistry at the Municipal Paediatric Dentistry Hospital, Poltava. We have collected and identified behavioural patterns of children of all age groups during their contacts with dentists at the dental offices as well as studied the characteristics of childhood psyche age periods through the available literature. The data obtained were thoroughly As a result of the analysis of the obtained data, the principles for managing paediatric patients' behaviour at the dental office have been elaborated and introduced into the practice.

RESULTS

Results: Outer evaluation of the children's activities performed is perceived by children as an assessment of personality, so any negative doctor's remark can provoke anxiety, irritability, and discomfort, apathy. Therefore, the paediatric specialists should remain attentive to physical and emotional indicators of stress when dealing with young patients.

CONCLUSION

Conclusions: Hence, among the key tasks of a paediatric dentist is to create the friendliest and most comfortable conditions for small patients, where they have the opportunity to play toys and receive little gifts for patience and courage.

Oral Health Literacy as a Predictor of Dental Anxiety in Parents of Children Undergoing Dental Treatment

PURPOSE

The purpose of this cross-sectional study was to evaluate the association between parents' dental anxiety (DA) and independent variables.

METHODS

One hundred sixty-eight dyads of parents and six- to 12-year-old children who were undergoing treatment at a university pediatric dentistry clinic were recruited. Two examiners evaluated parents' DA and oral health literacy (OHL) using the Brazilian version of Corah's dental anxiety scale and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), respectively. Children's DA was reported by parents through the dental anxiety question (DAQ). Demographic data was also collected. A single examiner used the decayed, missing, and filled permanent teeth and primary teeth (DMFT/dmft) indices to assess the children's oral health status. The data analysis involved univariate and multivariate Poisson regression.

RESULTS

In the multivariate regression, higher levels of parents' DA were associated with a household income equal to or less than the Brazilian monthly minimum wage (prevalence ratio [PR]=4.9; 95 percent confidence interval [CI]=2.1 to 11.7) and a lower degree of OHL (PR=1.68; 95 percent CI=1.01 to 2.8). Associations between parents' DA and children's DA and DMFT/dmft index were not found.

CONCLUSION

Parents' dental anxiety was related to a low household income and low oral health literacy.

Provider Appearance: A Survey of Guardian and Patient Preference

PURPOSE

The purposes of this study were to: (1) assess children's preferences for their pediatric dentist's attire; (2) assess guardians' preferences for their child's pediatric dentist's attire; and (3) determine which attributes are associated with different types of attire. This was a cross-sectional descriptive study using survey methodology with patients and parents who attended the pediatric dental clinic at Virginia Commonwealth University, Richmond, Va., USA.

METHODS

A total sample of 100 guardians and 97 pediatric patients completed the computer-based questionnaire. Four subjects posed for photographs wearing various combinations of attire (professional, casual, white coat, scrubs).

RESULTS

Among guardians, 56 percent reported preferring a provider in scrubs, with white coat the second most preferred attire (39 percent) for their children. For pediatric patients, scrubs were still most often selected, but at a lower rate (43 percent), and the white coat remained the second most preferred (37 percent).

CONCLUSIONS

Children and parents have strong perceptions and preferences regarding their dentists' attire.

Do baby teeth really matter? Changing parental perception and increasing dental care utilization for young children

INTRODUCTION

Parent/caregivers' inability to recognize the importance of baby teeth has been associated with inadequate self-management of children's oral health (i.e. lower likelihood of preventive dental visits) which may result in dental caries and the need for more expensive caries-related restorative treatment under general anesthesia. Health behavior theories aid researchers in understanding the impact and effectiveness of interventions on changing health behaviors and health outcomes. One example is the Common-Sense Model of Self-Regulation (CSM) which focuses on understanding an individual's illness perception (i.e. illness and treatment representations), and subsequently has been used to develop behavioral interventions to change inaccurate perceptions and describe the processes involved in behavior change.

METHODS

We present two examples of randomized clinical trials that are currently testing oral health behavioral interventions to change parental illness perception and increase dental utilization for young children disproportionately impacted by dental caries in elementary schools and pediatric primary care settings. Additionally, we compared empiric data regarding parent/caregiver perception of the chronic nature of dental caries (captured by the illness perception questionnaire revised for dental: IPQ-RD constructs: identity, consequences, control, timeline, illness coherence, emotional representations) between parent/caregivers who did and did not believe baby teeth were important.

RESULTS

Caregivers who believed that baby teeth don't matter had significantly (P<0.05) less accurate perception in the majority of the IPQ-RD constructs (except timeline construct) compared to caregivers who believed baby teeth do matter.

CONCLUSION

These findings support our CSM-based behavioral interventions to modify caregiver caries perception, and improve dental utilization for young children.

Relationship Between Salivary Cortisol Levels and Children's Behavior During a Dental Examination

PURPOSE

To correlate the salivary cortisol levels in children attending a university dental clinic with their behavior during the dental appointment.

METHODS

A prospective study was conducted with 43 seven- to 10-year-old children whose behavior during the dental appointment was assessed using the Frankl scale. Participants were divided into two groups: (1) cooperative children; and (2) uncooperative children. All children had four saliva samples collected as follows: prior to the dental examination (S1); shortly after the dental examination (S2); 30 minutes after waking up in the morning after the day of the appointment (S3); and in the afternoon, 24 hours after the dental appointment (S4). Salivary cortisol levels were measured by the chemiluminescent assay method. Statistical analysis included the Friedman and the Wilcoxon signed rank tests.

RESULTS

For the cooperative group, salivary cortisol levels were significantly lower at S1 (P=0.004), S2 (P=0.006), and S4 (P=0.001) compared to S3. For the uncooperative group, salivary cortisol levels were significantly higher at S1 compared to S2 (P=0.005).

CONCLUSIONS

Uncooperative children presented high levels of salivary cortisol prior to and shortly after the dental appointment. The period anticipating the consultation was considered highly stressful.

Dental Management Considerations in a Pediatric Patient with Moyamoya Disease

Moyamoya disease is a rare progressive cerebral arteriopathy associated with risk of ischemic and hemorrhagic brain complications. The dental care of affected individuals should be performed in a pain- and stress-free manner to decrease the chance of occurrence of episodes of hypocapnia, hypercapnia, hypotension, hypovolemia, and hypothermia. Dental treatment may be provided in an outpatient dental setting or in a hospital setting, but both venues require interdisciplinary collaboration to ensure safe delivery of patient care. In cases of general anesthesia, the perioperative management must be well-coordinated between dental clinicians and anesthesiologists to minimize the risk of adverse events. The purposes of this paper are to present the case of an eight-year-old Asian male with Moyamoya disease, and to discuss important aspects of his dental, behavioral, and medical management.

[Dental treatment of fearful children: subjection, denyal or -guidance?]

Dental treatment anxiety is a common fear among children. The dental health care provider is faced with difficult dilemmas about ensuring good oral health for these children in general daily practice. The indicated treatment usually exceeds the capacity of the frightened child, but when treatment is not performed, the child is at risk of serious general health problems and its quality of life could diminish. This article provides an overview of the aetiology of dental treatment anxiety in children. In addition, the dental practitioner is provided with insight into the possibilities that allow him/her to enhance the treatability of the child and reduce anxiety to such an extent that the indicated dental care can be provided. Psychotherapy and cognitive-behavioural techniques, as well as pharmacological therapies, are currently considered the most acceptable and successful treatments for anxiety and phobia. The dental care provider will have to determine a well-motivated and carefully considered course of treatment, always keeping in mind the individual context of the child.

Influence of maternal anxiety on child anxiety during dental care: cross-sectional study

CONTEXT AND OBJECTIVES:

Anxiety is usually classified as a disorder of neurotic nature and is often related to contexts of stress, which may include worries, motor tension and autonomic hyperactivity. The aim of this study was to assess the influence of mothers' anxiety on their children's anxiety during dental care.

DESIGN AND SETTING:

Analytical cross-sectional study conducted at in a private dentistry school in the south of Brazil.

METHODS:

Convenience sampling was used. All mothers of children undergoing treatment were invited to participate in this study. Data to investigate anxiety related to dental treatment among the children were collected through applying the Venham Picture Test (VPT) scale. For the mothers, the Corah scale was applied. A self-administered sociodemographic questionnaire with questions about demographic, behavioral, oral health and dental service variables was also used.

RESULTS:

40 mother-child pairs were included in the study. The results showed that 40% of the children were anxious and 60% of the mothers were slightly anxious. Local anesthesia was the procedure that caused most anxiety among the mothers, making them somewhat uncomfortable and anxious (60%). Family income higher than R$ 1,577.00 had an influence on maternal anxiety (75.6%). Maternal anxiety had an influence on child anxiety (81.3%).

CONCLUSION:

Most of the children showed the presence of anxiety, which ranged from fear of dental care to panic, inferring that maternal anxiety has an influence on children's anxiety. Dental procedures did not interfere with the mothers' anxiety, but caused positive feelings, whereas they affected the children more.

An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences

The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

Saudi dental students' perceptions of pediatric behavior guidance techniques

BACKGROUND

Dental students receive theoretical and clinical training in pediatric behavioral guidance techniques at university. Therefore, the content of the educational course and the degree of training in behavioral techniques may have an impact on the students' perceptions and practice of such techniques. The purpose of this study was to evaluate Saudi dental students' perceptions of behavior guidance techniques used in pediatric dentistry, and to assess the changes in their perceptions after 1 academic year of a didactic and clinical educational course.

METHODS

This longitudinal study was carried out once at the beginning and once at the end of the 2013/2014 academic year at the College of Dentistry, King Saud University in Riyadh, Saudi Arabia. A questionnaire measuring the perceived acceptability of behavior guidance techniques was completed by 78 fourth-year dental students before and after a pediatric dental course. Acceptability ratings were scored on a 5-point Likert scale and compared and evaluated in relation to demographic data. Paired t-test and one-way analysis of variance were used for the statistical analyses.

RESULTS

Before the course, the highest scores were for reinforcement and desensitizing techniques and the lowest were for aversive and communicative techniques. After the course, statistically significant increases were found in the acceptability of aversive techniques (voice control and hand-over-mouth), all pharmacological techniques, and modeling. Most communicative techniques and clinical situations were also rated as significantly more acceptable. Statistically significant decreases in acceptability ratings were found in promising a toy, and immobilization by staff or a parent. Immobilization using a papoose board, modeling, the presence of parents during the child's treatment, and most communicative techniques were rated as significantly more acceptable by male students than female students.

CONCLUSIONS

In general, Saudi dental students rated most basic behavior guidance techniques as acceptable. An educational course, including didactic and clinical components, improved their acceptability ratings, and had a considerable influence on their perceptions of behavior guidance in pediatric dentistry.

[Knowledge of oral hygiene amongst adolescents in Lombardy, Italy]

The study evaluated oral hygiene knowledge among a group of 12-year-old students in Lombardy, Italy (n=182). Two different questionnaires were administered, respectively to adolescents and to their parents. Results indicate a low level of general knowledge on this topic. Factors influencing knowledge include the number of learning sources and yearly access to a dental clinic. The described situation highlights the need to implement school-based educational interventions.

[DETERMINATION OF THE STATE OF MICROCIRCULATION BY MEANS OF COMPUTER CAPILLAROSCOPY IN CHILDREN SEDATED WITH RETENTION OF CONSCIOUSNESS IN OUTPATIENT PEDIATRIC DENTAL TREATMENT]

Dental treatment of infants and pre-school children is challenging because of high rate of dental fear General anesthesia is the only option for behavioral control in this age group. In case of minor medical procedure physical restrain is also used often enough aggravating the fear An alternate method for comfortable treatment is monitored conscious sedation (MCS). Standard techniques of monitoring do not always provide accurate determination of stress level in children since the external stress manifestations may appear non-significant and unobtrusive. Computer capillaroscopy (CC) allows real time evaluation of early functional disorders at the microlevel and of anesthesia efficiency in vivo.

OBJECTIVE AND METHODS

The research involved 298 children. 256 of them were treated under MCS and 42 constituted reference group treated without MCS. The groups were also divided into subgroups according to age: 0-3 and 3-6 year olds. Therapeutic and surgical treatment features were analyzed separately. MCS was conducted by means of intramuscular injection of midazolam in dosages of 0.1, 0.15, and 0.2 mg per kg. BIS, arterial blood pressure, heart rate, respiratory rate, and SpO2 were monitored at 4 stages while the following microcirculation parameters were recorded by CC: density of capillary net, the size of arterial, venous and transitional microcirculation links (ML), linear and volume bloodflow velocity, perfusion balance. The obtained data were statistically processed and analyzed with the use of Statistica Stat Soft 8.0 software.

CONCLUSIONS

Children undergoing dental treatment without MCS are affected by stress. The degree of stress in surgical patients was noted to be significantly higher The absence of physiological parameters changes in children treated without MSC is not a proof of the absence of stress. The dose of 0.15 mg per kg is optimal for the comfortable level of MSC. The increase of midazolam-dose over 0.15 mg per kg is not associated with further reduction of stress. The obtained data is true for both age categories.

Life course experiences and lay diagnosis explain low-income parents' child dental decisions: a qualitative study

OBJECTIVE

This study aimed to better understand low-income parents' child dental care decisions through a life course approach that captured parents' experiences within the social context of poverty.

METHODS

We conducted 43 qualitative life history interviews with 10 parents, who were long-term social assistance recipients living in Montreal, Canada. Thematic analysis involved interview debriefing, transcript coding, theme identification and data interpretation.

RESULTS

Our interviews identified two emergent themes: lay diagnosis and parental oral health management. Parents described a process of 'lay diagnosis' that consisted of examining their children's teeth and interpreting their children's oral signs and symptoms based on their observations. These lay diagnoses were also shaped by their own dental crises, care experiences and oral health knowledge gained across a life course of poverty and dental disadvantage. Parents' management strategies included monitoring and managing their children's oral health themselves or by seeking professional recourse. Parents' management strategies were influenced both by their lay diagnoses and their perceived ability to manage their children's oral health. Parents felt responsible for their children's dental care, empowered to manage their oral health and sometimes forgo dental visits for their children because of their own self-management life history.

CONCLUSION

This original approach revealed insights that help to understand why low-income parents may underutilize free dental services. Further research should consider how dental programs can nurture parental empowerment and capitalize on parents' perceived ability to diagnose and manage their children's oral health.

Parental perceptions of dental visits and access to dental care among disabled schoolchildren in Kuwait

The objective of this study was to describe dental visiting habits and access to dental care among the disabled schoolchildren in Kuwait. A total of 308 parents of children with a physical disability (n = 211), Down syndrome (n = 97) and teachers, who had normal children (n = 112) participated in the study. Less than one-fourth (21%) of the disabled children and 37% of the normal children had never visited a dentist (p = 0.003). Majority of Down syndrome (72%) and physically disabled children (59%) received curative dental care compared to 47% of normal children (p = 0.016). A bigger proportion of disabled children (42%) visited the dentist due to tooth ache than the normal ones (25%) (p < 0.01). Only 9.6% of Down syndrome children perceived no barriers to seek the dental care compared to 26.2% of physically disabled and 32.2% of normal children (p = 0.008). Difficulty to get an appointment was the most common perceived barrier to dental care by parents of Down syndrome children and the normal children (37.3%). Parents of disabled children considered difficulty in cooperation as a more important barrier to treatment (34.7%) than the parents of normal children (20.3%). Larger proportion of parents of normal children (82%) rated the present dental services as excellent/good compared to 52% of the parents of disabled children (p < 0.001). Toothache and curative treatment need were the main reasons for dental visits among disabled children. Regular dental check-ups and preventive oral health care should be encouraged for comprehensive coverage of the national school oral health program for the disabled in Kuwait.

Oral health-related quality-of-life in Swedish children before and after dental treatment under general anesthesia

OBJECTIVE

This study evaluated oral health-related quality-of-life (OHRQoL) in children and families before and after dental treatment under general anesthesia because of severe caries or molar-incisor hypomineralization (MIH).

MATERIALS AND METHODS

A consecutive sample of the parents/caregivers of children (3-14 years) in need of treatment under general anesthesia participated in the study. The children were divided into two groups: 3-6 years and 7-14 years. The 49-item questionnaire that was administered before and after general anesthesia comprised the Child Oral Health Quality of Life-components of the Parental-Caregivers Perception Questionnaire (P-CPQ), the Family Impact Scale (FIS) and two global questions concerning oral health and general well-being. The P-CPQ domains were Oral symptoms, Functional limitations, Emotional well-being and Social well-being. The FIS items assessed impact on family life.

RESULTS

In both age groups, a significant decrease (p < 0.001) occurred in overall P-CPQ and the Oral symptoms, Functional limitations and Emotional limitations domains of the P-CPQ. Mean values for the Social well-being domain decreased significantly in the older (p < 0.05) but not the younger age group. Mean values for FIS decreased significantly in the younger (p < 0.001) and the older (p < 0.05) age groups.

CONCLUSIONS

Dental treatment of severe caries or MIH, performed under general anesthesia, had an immediate effect on the oral health-related quality-of-life in the children in this study and a positive impact on the family situation.

Attitudes and preferences of parents about being present in the dental operatory

PURPOSE

To determine if there was an association between the type of dental procedure being performed on children and parental desire to be present in the operatory.

METHODS

Parents (N=339) whose children had dental appointments at a university pediatric dental clinic or affiliated practices in Southern Nevada completed a survey. Parents identified attitudes/preferences associated with five commonly conducted pediatric dental procedural scenarios. Data were analyzed using chi-square tests (P=.05).

RESULTS

Most respondents (N=339) were female (N=248) and/or Hispanic (N=204), had a household income of less than $50,000 annually (N=251), and a high school education. The primary reason (78 percent) parents wanted to be present during their child's dental treatment was comfort. Most parents wanted to observe exams/X-rays (70 percent), sedation procedures (69 percent), fillings and crowns (66 percent), extractions (64 percent), and physical restraint (61 percent). Only 38 percent of parents would be content with the dentist unilaterally deciding about their presence in the operatory.

CONCLUSIONS

Parents in this study expressed a preference to remain with their child during any dental treatment. Practitioners are encouraged to consider their presence customary and establish office policies and protocols that beneficially involve parents in the pediatric patient's care.

[Evaluation of psychological methods for determining the degree of psychological stress in children in dentistry]

The article deals with results of comparative evaluation of system of assessment of children's fear and anxiety in dentistry (SDS test) and other objective and subjective methods for assessing anxiety in pediatric patients. We studied 381 pediatric patients aged from 3 to 7 years. The aim of the study was to prove validity mathematical derived FCD test as a technique of anxiety detection in dentistry. During the study following subjective test were used: MAS, DAS, mYPAS, VAS, STAI, STAIC, EASI, PHBQ, and some history data and stress factors were also considered. Objective data used were vital signs (hemodynamics and respiratory rate). Test SDS has strong correlation with YALE, MAS, DAS, STAIlich, VAS and other parameters such as age, sex, person which is responsible for bringing up a child and so on.

[Sedation with midazolam for ambulatory pediatric dentistry]

OBJECTIVE

To improve the quality of dental treatment in children by using combined anaesthesia technique including local anaesthesia and conscious sedation, and to assess the effectiveness of conscious sedation for younger children undergoing dental treatment.

METHODS

The study included 208 children aged 14-88 months who received dental treatment for tooth decay and its complication under combined anaesthesia. Midazolam was used as sedative medication. Sedation level was assessed by visual scale and BIS-monitoring. ANI-monitoring was also used for pain sensitiveness evaluation. Results All 208 children were successfully treated under combined anaesthesia which showed satisfactory sedation rates both by visual scale and and BIS-monitoring values. While mean patient age was 39 months 20.6% were younger than 24 months. These data are extremely valuable as according to literature review conscious sedation in early infancy remains controversial.

CONCLUSIONS

Our results proved conscious sedation to be effective in younger children undergoing dental treatment thus representing important alternative for general anaesthesia and providing a basis for later behavior management.

Barriers to pediatricians' adherence to American Academy of Pediatrics oral health referral guidelines: North Carolina general dentists' opinions

PURPOSE

The purposes of this study were to: (1) assess knowledge, attitudes, and behaviors of North Carolina general dentists (GDs) regarding American Academy of Pediatrics (AAP) dental referral guidelines; and (2) determine factors that influence pediatricians' ability to comply with AAP guidelines.

METHODS

One thousand GDs were surveyed to determine barriers toward acceptance of physician referrals of infants and toddlers. The primary outcome using ordered logistic regression was GDs' acceptance of children described in five case scenarios, with different levels of risk and oral health status.

RESULTS

GDs believed pediatricians should refer patients at risk for caries to a dentist. While 61 to 75 percent of GDs were willing to accept low caries risk referrals of infants and toddlers, only 35 percent would accept referrals when caries was present. Predictors of referral acceptance were correct knowledge about AAP guidelines (OR=2.0, 95%CI=1.2-3.3), confidence in providing preventive care to infants and toddlers (OR=2.6, 95%CI=1.3-4.9), and agreement that parents see importance in dental referrals (OR=2.1, 95% CI=1.2-3.6).

CONCLUSIONS

This study identified factors influencing acceptance of pediatrician referrals for the age one dental visit among North Carolina GDs and highlighted challenges pediatricians face in referring young children for dental care.

Maternal anxiety and child fear during dental procedures: a preliminary study

PURPOSE

The purpose of this study was to assess the levels of dental fear, state anxiety, and physiological distress in children and their mothers during pediatric dental procedures and to investigate the associations between these variables.

METHODS

Forty children and their mothers who visited six pediatric dental clinics in Tokyo, Japan, participated in this study. Dental fear was assessed using the dental subscale of the Children's Fear Survey Schedule (CFSS-DS) and the Dental Fear Survey. Children completed the pre- and post-treatment State-Trait Anxiety Inventory for Children-State (STAIC-S), and mothers completed the State-Trait Anxiety Inventory-State (STAI-S). Pre- and post-treatment salivary alpha amylase (sAA) levels were measured to assess physiological distress. Paired t tests and Pearson's correlation coefficients were used for statistical analyses.

RESULTS

State anxiety scores and sAA levels significantly differed between pre- and post-treatment in mothers (P=.007 and P<.02, respectively) but not in children. Pretreatment STAI-S scores in mothers were correlated with CFSS-DS scores in children (r=.348, P<.03), but pretreatment STAI-S and STAIC-S scores were not.

CONCLUSIONS

Maternal anxiety before children's dental treatment was significantly associated with children's dental fear.

How do parents look after children's teeth? A qualitative study of attitudes to oral health in the early years

This study aimed to examine how parents and carers of pre-school children care for their children's teeth. Twelve in-depth interviews were conducted with mothers of pre-school children at a children's centre in Bristol. The interviewees were aged between 29 and 37 years, and the number of children in the families ranged from one to four, with their age range spanning four weeks to 11 years. Using a grounded theory approach, transcribed interviews were coded and analysed until several themes emerged from the data. The study identified an overarching theme of parents' belief that oral health care for their children was common sense, which was a key factor influencing advice seeking from professionals. Sub-themes were the difficulties in establishing home oral healthcare routines and a lack of knowledge of when to register their child with a dentist. Advice was often given inconsistently and parents experienced difficulties accessing services, with many not seeking advice and information pro-actively. The study concluded that some parents are missing out on important early information, advice and care around oral health for their young children.

Infant and toddler oral health: attitudes and practice behaviors of North Carolina dental hygienists

The purpose of this study was to evaluate the knowledge, comfort, practice behaviors, and perceived barriers of dental hygienists in North Carolina regarding their delivery of oral health preventive services to infants and toddlers. A questionnaire was mailed to 2,000 dental hygienists randomly selected from the North Carolina Board of Dental Examiners database. The response rate was 43 percent. The majority of the respondents were female and worked in private practice. Forty-two percent reported that they delivered preventive care to infants/toddlers (action stage of readiness). Of the 58 percent who reported not delivering care, two-thirds were contemplating caring for this population (contemplation stage), but only 10 percent of these were very likely to make changes in the next six months. Those with higher comfort levels and fewer perceived practice constraints were more likely to be in the action stage. Although these dental hygienists may be willing to consider providing care, they perceived a lack of continuing education opportunities, unfamiliarity with pediatric guidelines, and their current practice situation as significant barriers. Strategies to increase comfort and diminish practice constraints for North Carolina dental hygienists should be considered to improve access to oral health care for infants and toddlers. Teaching strategies in dental hygiene education that include both didactic and clinical experiences in treating infants and toddlers could be beneficial.

Post-operative pain and anxiety related to dental procedures in children

AIM

To determine post-operative pain in children following treatment in the dental chair and its relation to dental anxiety.

METHODS

A group of 125 children, aged 5 to 18 years, attending for dental treatment had their pain recorded post-operatively using the revised version of the Faces Pain Scale (FPS-R) and the Visual Analogue Scale (VAS). Baseline anxiety scores were also recorded using the Modified Child Dental Anxiety Scale (faces) (MCDASf).

RESULTS

The mean MCDASf score was 20.1. Post-operative pain was reported in 62% of children at 2 hours, 51% at 4, and 47% at 6 hours. The surgical subgroup reported the most pain (79%), whereas the conservative treatment for primary teeth group reported the least pain (37%). Anxious patients (MCDASf > = 17) were more likely to report pain than less anxious patients at 2 (p=0.02) and 6 (p=0.03) hours post-operatively.

CONCLUSION

Dental procedures are associated with post-operative pain in children. Anxious patients are more likely to report pain.

Factors affecting psychological stress in children who cooperate with dental treatment: a pilot study

AIM

Few studies have examined psychological stress and personal anxiety in children exhibiting cooperative behaviour during dental treatment. We assessed psychological stress and personal anxiety during dental treatment in cooperative children, and investigated the influence of various factors.

MATERIALS AND METHODS

We measured pre- and post-treatment salivary alpha amylase (sAA) levels of 28 children aged 8-13 years and their parents. Children completed the State-Trait Anxiety Inventory for Children (STAIC); their parents completed the STAI. The IA group included children whose sAA levels increased >10%, whereas the DA group included children whose sAA levels decreased >10%. We used regression models to calculate the power of variables to predict children's psychological stress.

RESULTS

The mean anxiety trait score in the IA group was significantly higher than in the DA group (t-test, P = 0.021). For children with higher STAIC-Trait scores, the OR for increasing sAA was 1.16 (95% CI [1.02-1.31]). Parental or treatment factors did not significantly contribute to incremental sAA levels in children.

CONCLUSION

Well-behaved children with high anxiety traits may experience high stress levels during dental treatment; however, parental and dental treatment factors may not affect psychological stress in these children.

Caregivers' satisfaction with pediatric dental care in a university clinical setting in North Philadelphia

The aims of this study were twofold: to describe different aspects of caregiver satisfaction with pediatric dental treatment provided at a dental school clinic and to explore differences in satisfaction by caregivers' demographics and compliance with their children's appointments. A cross-sectional study was conducted in two phases. In Phase I, a convenience sample of caregivers (n=100) eighteen years of age and older whose children had been receiving dental care in Philadelphia, Pennsylvania, were invited to complete a self-administered dental satisfaction questionnaire. In Phase II, sociodemographic data and the child's reason for visit were extracted from axiUm. Descriptive analyses stratified by sociodemographic variables were conducted. Results indicated that almost half of the caregivers reported feeling concerned about pain at the dental office. Those with the lowest levels of education and income reported feeling the most concern about pain at the dental office, as well as sometimes avoiding bringing their child to the dentist because of their fear of pain and not complying with scheduled dental appointments for the child. Operational aspects related to access and motivational aspects such as fear of pain when seeking dental treatment were identified as barriers to treatment.

Dentist's views on a province-wide campaign promoting early dental visits for young children

INTRODUCTION

The Canadian Dental Association recommends that children have their first visit to a dental professional no later than 12 months of age. In 2010, the Manitoba Dental Association launched the Free First Visit (FFV) program to increase access to early visits in the province. The purpose of the study reported here was to survey dentists about their views on the FFV program and to gain an understanding of their attitudes and practice patterns relating to the oral health of infants and toddlers and first dental visits.

METHODS

A survey was mailed to registered general and pediatric dentists in Manitoba according to a modified Dillman methodology. Dentists were asked about their views on the FFV, their knowledge of early childhood oral health and the timing of first dental visits. Descriptive statistics, bivariate analyses and logistic regression analyses were performed. A p value of 0.05 or less was considered significant.

RESULTS

The overall response rate was 63.2% (375 eligible responses out of 593 surveys mailed). The majority of respondents were men (255/373 [68.4%]), and most respondents were general dentists (355/372 [95.4%]). A total of 63.5% (231/364) felt that the FFV program improved access to care, 64.6% (223/345) believed that public awareness of young children's oral health has increased, and 76.2% (266/349) thought that the FFV initiative should continue past the planned end date of March 31, 2013. On average (± standard deviation), respondents thought that the first dental visit should occur at 18.1 ± 10.0 months, but in their practices, they actually recommended a slightly older age (18.9 ± 10.4 months). Compared with results from a previous survey, conducted in 2005, dentists who responded to this survey recommended that children have their first visit at a significantly younger age. A greater proportion of dentists reported seeing children 12-23 months of age in their practices than in the past (81.9% vs. 73.7%).

CONCLUSIONS

A majority of dentists who responded to the survey approved of the FFV program and thought it should continue. Although these dentists recommended early first dental visits, the average age recommended by respondents was 6 months later than the target age of 12 months. It appears that, over time, dentists are becoming more aware of prevention and management techniques relating to infants and toddlers.

Knowledge of dentists in the management of traumatic dental injuries in Ankara, Turkey

PURPOSE

This study was designed to assess dentists' knowledge of emergency treatment of traumatic dental injuries (TDIs) in Ankara, Turkey.

MATERIALS AND METHODS

A total of 154 questionnaires were evaluated. The first part of the questionnaire consisted of questions regarding personal information. The second part was composed of 12 closed-ended questions related to knowledge of how to manage different types of TDIs in children. The questionnaires were answered by 133 general dental practitioners (GDPs) and 21 specialists. The survey data were statistically analysed using the chi-square test and ttest to assess dentists' knowledge.

RESULTS

The results show that when the answers were compared, lower numbers of correct answers were noted for questions related to splinting time for avulsed teeth and appropriate treatment for complicated crown-fractured deciduous incisors with large pulp exposure. Greater numbers of correct answers were observed for questions related to the storage medium, systemic antibiotic usage for avulsed teeth and appropriate treatment for intruded primary teeth. The mean number of correct answers from specialists was not significantly greater than that from GDPs (P > 0.05).

CONCLUSION

In conclusion, this survey showed a low level of knowledge of TDI management among the participants and highlights the need to improve dentists' knowledge of TDI treatment protocols.

Diagnostic and restorative behaviour in Dutch dentists’ paediatric dental care

AIM

This was to assess if Dutch dentists have comparable attitudes in providing diagnosis and consecutive dental treatment in children. Prevention, radiographic diagnostics and restorative care were compared in four consecutive age groups [<6 years old, 6-8, 9-11, 12-17].

METHODS

In a cross-sectional study calculations were made using the financial records of one of the largest Dutch health insurance companies. After Medical Ethics approval all dental records of 4,500 dentists over a period of three consecutive years were used to calculate correlations and odds ratios, using early treatment, oral diagnosis, preventive approach and the use of local analgesia as basic independent variables.

RESULTS

Early diagnosis based on the use of radiographs in children younger than 6 years increased the likelihood of direct restorative care 2.8 times and the likelihood of restorative care in future age groups 2.2, 2.0 and 1.6 times respectively. Early radiographs increased the likelihood of diagnostics in consecutive older groups by 3.7, 3.4 and 1.9 times respectively.

CONCLUSION

An early diagnostic approach based on radiographs in paediatric dental care seems to be indicative for dentists' pattern of dealing with older children. This child-centred approach is limited to a small number of dentists.

Predictive factors for child behaviour in the dental environment

AIM

This was to evaluate the potential factors that influence behaviour in the paediatric dentistry environment of children aged 48 to 68 months who have never before been to a dentist.

STUDY DESIGN

Cross sectional.

METHODS

Child behaviour was evaluated using the Frankl scale during both clinical examination procedures and prophylaxis. All mothers of the 118 children investigated underwent a test to assess their anxiety (Manifest Anxiety Scale-MAS) and responded to a questionnaire on the medical history of the child as well as socioeconomic factors. The children were given a test to assess their anxiety (Venham Picture Test-VPT).

STATISTICS

The statistical tests adopted were the Chi-squared test and both simple and multiple unconditional logistic regression.

RESULTS

Children with high anxiety, those had previously experienced toothache and those had behaved uncooperatively during prior medical experiences, had a greater probability of behaving uncooperatively during their first dental consultation.

CONCLUSIONS

Dental professionals can identify the presence of predictive factors for child behaviour prior to the first clinical examination by including relevant questions in the dental and medical history, thereby facilitating a more positive initial contact between paediatric dentists and their patients.

An exploratory study of pregnant women's knowledge of child oral health care in New Zealand

BACKGROUND

To be maximally effective, oral health preventive strategies should start at birth. There appear to be few reports on pregnant women's knowledge of oral health care for their developing children.

OBJECTIVES

This exploratory study assessed Dunedin expectant mothers' knowledge of the oral health care of their future children.

METHODS

A questionnaire was developed to assess expectant mothers' knowledge of child oral health and appropriate prevention strategies. Three public Lead Maternity Carer (LMC) organisations and 30 private individual LMCs were asked to distribute the questionnaire to their clients attending appointments during a one-month period. Questions focused on the mother's knowledge of oral health practices for their future children, including oral hygiene and access to dental care.

RESULTS

Fewer than half of the participants thought they had enough information about their child's oral health needs. One-quarter thought that toothbrushing should not start until after two years of age. The majority thought their child should not be seen by a dental professional until this age, while one-fifth did not think their child should be seen until four years old. Poorer child oral health knowledge was found in first-time mothers, younger women, those from low-SES groups, and those who were not New Zealand (NZ) Europeans.

CONCLUSIONS

A substantial number of participants were unaware of how to provide appropriate oral health care for their children despite the available information. This lack of awareness needs to be taken into account when designing oral health promotion strategies for parents of very young children.

Parents' presence in the operatory during their child's dental visit: a person-environmental fit analysis of parents' responses

PURPOSE

The purpose of this study was to explore whether parents' satisfaction with their child's treatment and their attitudes concerning the dental visit are affected by the fit between their desire to be present/absent during their child's dental treatment and whether they were actually present/ absent. In addition, this study explored the effects of child variables (age, gender, ethnicity, and prior experiences with dental treatment) and parent variables (age, gender, and prior own dental experiences) on parents' desire to remain/not remain with their child.

METHODS

Survey data were collected with paper-pencil surveys from 239 parents at the beginning and at the end of their child's dental appointment. The survey contained questions concerning the parents' preferences for being with their child in the operatory and their evaluations of the dental visit.

RESULTS

Parents whose experiences concerning being in the operatory matched their wishes were more satisfied and had more positive attitudes concerning the dental visit vs parents whose experiences and wishes did not match. The older the parents were, the more they wanted to accompany the child into the operatory.

CONCLUSIONS

The fit between the parents' desire to be present/absent during their child's treatment and the actual situation they encountered was significantly related with the parents' satisfaction and attitudes related to their child's dental visit.

Validity and reliability of the Early Childhood Caries Perceptions Scale (ECCPS) to assess health beliefs related to early childhood caries prevention among primary caregivers of children under 5 years of age

Primary caregivers' child oral health care beliefs and practices are major factors in the prevention of Early Childhood Caries (ECC). This study assessed the validity and reliability of a newly-developed scale--the Early Childhood Caries Perceptions Scale (ECCPS)--used to measure beliefs regarding ECC preventive practices among primary caregivers of young children. The ECCPS was developed based on the Health Belief Model. The construct validity and reliability of the ECCPS were examined among 254 low-socioeconomic status primary caregivers with children under five years old, recruifed from 4 Bangkok Metropolitan Administration Health Centers and a kindergarten school. Exploratory factor analysis (EFA) revealed a four-factor structure. The four factors were labeled as Perceived Susceptibility, Perceived Severity, Perceived Benefits and Perceived Barriers. Internal consistency measured by the Cronbach's coefficient alpha for those four factors were 0.897, 0.971, 0.975 and 0.789, respectively. The ECCPS demonstrated satisfactory levels of reliability and validity for assessing the health beliefs related to ECC prevention among low-socioeconomic primary caregivers.

Oral healthcare of preschool children in Trinidad: a qualitative study of parents and caregivers

BACKGROUND

Little is known about oral health in early childhood in the West Indies or the views and experiences of caregivers about preventive oral care and dental attendance The aims of this study were to explore and understand parents and caregivers' experience of oral healthcare for their preschool aged children and how, within their own social context, this may have shaped their oral health attitudes and behaviours. These data can be used to inform oral health promotion strategies for this age group.

METHOD

After ethical approval, a qualitative study was undertaken using a focus group approach with a purposive sample of parents and caregivers of preschool children in central Trinidad.Group discussions were initiated by use of a topic guide. Audio recording and field notes from the three focus groups, with a total of 18 participants, were transcribed and analysed using a thematic approach.

RESULTS

Despite some ambivalence toward the importance of the primary teeth, the role of fluoride and confusion about when to take a child for their first dental visit, most participants understood the need to ensure good oral hygiene and dietary habits for their child. Problems expressed included, overcoming their own negative experiences of dentistry, which along with finding affordable and suitable dental clinics, affected their attitude to taking their child for a dental visit. There was difficulty in establishing good brushing routines and controlling sweet snacking in the face of many other responsibilities at home. Lack of availability of paediatric dental services locally and information on oral health care were also highlighted. Many expressed a need for more contact with dental professionals in non-clinic settings, for oral health care advice and guidance.

CONCLUSION

Parents and caregivers in this qualitative study showed generally positive attitudes towards oral health but appear to have encountered several barriers and challenges to achieving ideal preventive care for their child, with respect to healthy diet, good oral hygiene and dental attendance. Oral health promotion should include effective dissemination of oral health information, more practical health advice and greater access to dental care for families with preschool children.

Unmet dental and orthodontic need of children with special healthcare needs in West Virginia

INTRODUCTION

Of children aged 0-17 years in the USA, an estimated 11 203 616 (15.1%; 95% CI: 14.8, 15.3) are Children with Special Health Care Needs (CSHCN). The state of West Virginia, the heart of Appalachia, has a land mass which is 97.65% rural with previously identified high overall dental need and oral health disparities. It is home to an estimated 70 609 CSHCN, or 18.5% (95% CI: 17.0, 19.9) of the state's children in 2009-2010. The purpose of this study was to determine the parent/guardian's perceived unmet dental care need of CSHCN in West Virginia.

METHODS

Data from the National Survey of Children with Special Health Care Needs was used to determine prevalence. A telephone survey of 59 941 parents/guardians of CSHCN (1149 from West Virginia) for the dental interview was conducted in 2009-2010.

RESULTS

Nationwide, 26.7% (25.9, 27.5) of parents/guardians reported their CSHCN had dental care or orthodontia needs other than preventive care. In West Virginia, the perceived dental care or orthodontia needs other than preventive dental care need was 26.5% (22.2, 30.0). Unmet national dental care need other than preventive dental care was 5.4% (5.0, 5.9) and in West Virginia 5.0% (2.4, 7.5).

CONCLUSIONS

CSHCN have significant unmet dental needs. Parents/guardians in West Virginia reported similar unmet need compared with national reporting. Policies to address the health care of CSHCN should include dental needs. The clinical implications are that CSHCN have a variety of needs, including orthodontia. The benefits of orthodontic referrals should be considered in treatment planning options for CSHCN.

Sedation of children undergoing dental treatment

BACKGROUND

Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective.

OBJECTIVES

To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry.

SEARCH METHODS

Electronic searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were conducted for relevant trials and references up to 4th August 2011. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched.

SELECTION CRITERIA

Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. Crossover trials were excluded.

DATA COLLECTION AND ANALYSIS

Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. The Cochrane Collaboration statistical guidelines were followed.

MAIN RESULTS

Thirty-six studies were included with a total of 2810 participants. Thirty trials (83%) were at high risk of bias and six (17%) were at unclear risk of bias. There were 28 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Trials were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data was possible for studies investigating oral midazolam vs placebo only. There is weak evidence from five small clinically heterogeneous trials at high risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 0.75 mg/kg is associated with more co-operative behaviour compared to placebo; standardised mean difference (SMD) favoured midazolam (SMD 2.98, 95% confidence interval (CI) 1.58 to 4.37, P < 0.001, I² = 91%), which translates to an increase of approximately 1.8 points on the six-point Houpt behaviour scale. There is very weak evidence from two trials which could not be pooled that inhalational nitrous oxide is more effective than placebo.

AUTHORS' CONCLUSIONS

There is some weak evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is very weak evidence that nitrous oxide inhalation may also be effective. There is a need for further well designed and well reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.

Salivary alpha amylase and cortisol levels in children with global developmental delay and their relation with the expectation of dental care and behavior during the intervention

The purpose of this study was to analyze the alpha-amylase (sAA) and cortisol levels in children with Global developmental delay (GDD) before and after dental treatment and its association with the children's behavior during treatment. The morning salivary cortisol levels and activity of sAA of 33 children with GDD were evaluated before and after dental treatment and were compared to 19 healthy children. The behavior of children with GDD during dental care was assessed by the Frankl scale. Children with GDD showed lower levels of sAA activity than healthy children, but this result was not significant. The salivary cortisol levels were similar between GDD and healthy children. GDD children showed increased levels of sAA (but not cortisol) prior to the dental treatment as compared to the post-treatment phase. GDD children who showed less favorable behavior during dental care had higher levels of sAA and salivary cortisol than GDD children with more favorable behavior, but only the sAA results were significant. In conclusion, GDD children show hyperactivity of the SNS-axis in anticipation of dental treatment which indicates the need for strategies to reduce their anxiety levels before and during dental care.

[Use of the visual-analogue scales for the assessment of the anxious stress in dental practice in children]

The purpose of this observation-randomized study was to compare the effectiveness of the visual-analogue scale (VAS) for children to assess the level of anxiety and a comparison of it with such methods, as the test-scoring systems in children in the dental practice. In the study participated 156 children, with an average age of 5.8 years, divided into 2 groups on the grounds of possibility of alone treatment in the dental chair Children, dental sanation of which was carried out under general anaesthesia were the main group, the control group included children treated independently. VAS of anxiety is an objective and useful technique for determining the degree of fear in children in the studied age category. The method is simple and has a high degree of correlation with other test-scoring systems. The largest degree of correlation we noted with mYPAS at the stage of primary visits, a day after the manipulation the VAS of anxious had more reliability in comparison with the STAIC.