Motivating parents to prevent caries in their young children

BACKGROUND

The authors conducted a study to compare the effect of a motivational interviewing counseling treatment with that of traditional health education on parents of young children at high risk of developing dental caries.

OVERVIEW

The authors enrolled in the study parents of 240 infants aged 6 to 18 months and randomly assigned them to either a motivational interviewing, or MI, group or a traditional health education (control) group. Parents in the control group received a pamphlet and watched a video. Parents in the MI group also received the pamphlet and watched the video; in addition, they received a personalized MI counseling session and six follow-up telephone calls.

RESULTS

After one year, children in the MI group had .71 new carious lesions (standard deviation, or SD, = 2.8), while those in the control group had 1.91 (SD = 4.8) new carious lesions (t[238] = 2.37, one-tailed, P < .01).

CONCLUSIONS

MI is a promising approach that should receive further attention.

CLINICAL IMPLICATIONS

MI may lead parents and others to better accept dental recommendations about preventing caries in their children.

Atraumatic perspectives of ART: psychological and physiological aspects of treatment with and without rotary instruments

Atraumatic Restorative Treatment, ART, is a method of minimal caries intervention that uses only hand instruments. The aim of the present study was to explore a possible difference between the extent of discomfort experienced during dental treatment according to the ART approach and a method using rotary instruments. The study was performed in Indonesia. A total of 403 children were randomly divided in two groups. In each child, one class II restoration in a deciduous molar was made. One group received treatment using rotary instruments (750 r.p.m.). The other group was treated according to the ART approach. Glass ionomer cement was used for restoration in both groups. Discomfort scores were determined using both physiological measurements (heart rate) and behavioral observations (Venham) on specific moments during the treatment. Venham scores showed a marked difference between the two groups at most time points. Heart rate measurements were different at deep excavation. Also, a clear relation between Venham scores and heart rate measurements could be found at all time points. Confounding could be shown for operating dentist, gender of the patient and initial anxiety, not for age. No effect modification could be shown. It can be concluded that children treated according to the ART approach using hand instruments alone experience less discomfort than those treated using rotary instruments.

The Children's Fear Survey Schedule-Dental Subscale in Japan

OBJECTIVES

The aims of this research are to examine the reliability and validity of the Japanese version of the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS), and to examine the responses of children in the dental setting and in the community.

METHODS

The CFSS-DS was translated into Japanese and administered to three samples. The first sample comprised 134 child patients aged 8-15 years, of whom 100 were assigned for test-retest analysis, and the behavior of the remaining 34 additional children were rated during their dental appointments, and compared with their questionnaire results. A second sample of 532 child patients aged 8-15 years, completed the CFSS-DS and also one additional item measuring fear of returning to the dentist. A third sample of 1250 school children aged 8-15 years was surveyed using the CFSS-DS and the additional item measuring fear of returning to the dentist.

RESULTS

The Japanese version of the CFSS-DS showed good internal consistency (alpha=0.91) and test-retest reliability (r=0.90), as well as good criterion validity assessed by the relationship with actual child behavior (r(s)=0.51). It also showed good construct validity assessed by correlation with willingness to return to the dentist. Fear levels were higher in the school sample than in the clinic sample (27.7 versus 24.6). Girls reported more fear than boys (26.2 versus 23.2 in the clinic sample, and 30.7 versus 24.8 in the school sample). Injections, choking, having a stranger touch them, and drilling were the most common fears. Factor analyses demonstrated a factor pattern similar to the results found in other cultures.

CONCLUSION

The results suggest that the CFSS-DS is reliable and valid and operates in Japan as it does in other cultures.

Orthodontic treatment need and self-perception of 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools

AIM

To determine the self-perception and need for orthodontic treatment in young sensory [visual (VI) and hearing (HI)] impaired children attending special schools in Riyadh, Saudi Arabia. Also, to determine if gender and social class background influence the rating and self-perception of malocclusion among the children.

LOCATION

Riyadh, Saudi Arabia.

DESIGN

A prospective study on orthodontic treatment need in sensory impaired children.

SUBJECTS

Seventy-seven VI, 210 HI, and 494 control (C) children aged 11-16 years.

METHOD

The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) was determined using the standard 10 pictures for the C group and HI with a modified version (tactile graphic) for VI. The dental health component (DHC) and AC of IOTN were used to allocate each child to no need, borderline need and definite need for treatment subgroups.

RESULTS

Sixty-five per cent of VI, 21.8 per cent HI, and 18.7 per cent of the C were perceived to be in need of orthodontic treatment. However, 55.8 VI, 43 per cent HI and 34 per cent C were rated for treatment need based upon the AC. The difference between the examiner and the child's rating of treatment need was found to be statistically significant among the HI and control children (P < 0.001).

CONCLUSION

The VI children who were scored for treatment by the examiner as having need for treatment had similar perceptions of their treatment need irrespective of their social background. Male VI children had a higher DHC score, but both VI and HI males had a higher normative and self-perceived need based on AC.

Investigation of lay knowledge of the management of avulsed permanent incisors

The prognosis of replanted avulsed permanent incisors depends largely on prompt and appropriate emergency management. The aim of this study was to investigate lay knowledge and attitudes in this respect. Postal questionnaires were sent to all physical education teachers, school nurses and secretaries, attendants in swimming baths and leisure centres and to 220 parents of teenage children in a defined area of North West England. The overall questionnaire response rate was 86.9%. Knowledge of methods of dealing with this problem was generally inadequate in both parents and the other groups. Although 53.6% of respondents claimed to have received first aid training only 3.1% could remember dental injuries being included. There was evidence that dental health education in this field can be effective, since the highest mean knowledge score was found in the 11.5% of respondents who recalled receiving advice from sources such as posters, magazines and newspapers. More than 80% of the respondents stated that they would not want to replant an avulsed incisor themselves, the main reason being lack of knowledge and training. It is suggested that there is a need for potentially effective dental health education in relation to this problem.

General dental practitioners' views on the use of stainless steel crowns to restore primary molars

AIM

To ascertain general dental practitioners' views on the use of stainless steel (pre-formed metal) crowns to restore carious primary molars.

METHOD

Ninety-three general dental practitioners were selected at random from those practising in Lancashire, Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition. Before the interview participants recorded the care they would provide for a case scenario, describing a child with a carious lesion that the British Society of Paediatric Dentistry (BSPD) guidelines indicate should be treated with a stainless steel crown.

RESULTS

In answering the case scenario only six (7%) of the dentists reported that they would fit a stainless steel crown. Of the 93 dentists interviewed 71% knew of the BSPD guidelines, but only 18% had ever fitted a stainless steel crown in general practice. Reasons given for not using stainless steel crowns were they are inappropriate for many children, time consuming to fit, difficult to manipulate, expensive, and ugly.

CONCLUSION

The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice.

Patient and parent understanding of informed consent in orthodontics

In both medical and dental settings, researchers have found that patients do not adequately comprehend the information given during informed consent discussions, especially the less educated, low-income patients. Because of the importance of patient compliance with orthodontic treatment regimens, this study examined patient and parent understanding of the child's Phase I orthodontic treatment in a public dental clinic with ethnically diverse, low-income patients. Interviews were conducted with 29 children (ages 6-12) and their parents or guardians at the orthodontic case presentation appointment. The orthodontist explained the reasons for treatment, the orthodontic procedures to be used, the risks, the alternatives, and patient and parent responsibilities during treatment; the session was audiotaped. Interviews were conducted immediately after this discussion and the results compared with the orthodontists' presentations. In general, both children and parents recalled significantly fewer reasons for treatment (1.10, 1.66, and 2.34 items, respectively), procedures (1.55, 1.59, and 2.45, respectively), risks associated with treatment (0.66, 1.48, and 4.66, respectively), and responsibilities of the child during treatment (2.21, 2.07, and 3.38, respectively) than what the orthodontist had told them. They were also less likely to recall the reasons, procedures, and risks that were most frequently cited by the orthodontist. These findings raise concerns about the effectiveness of current informed consent techniques with public health populations, especially the low recall rates within 30 minutes of the case presentations. Low recall of risks by children and their parents, particularly for critical risks such as relapse, caries, and periodontal problems, raises concerns about treatment compliance, success, and more importantly, the effectiveness of the informed consent process itself. Future research should focus on methods to improve the informed consent process among children undergoing orthodontic treatment in a low-income population.

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors

OBJECTIVE

The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment.

DESIGN

A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK.

METHODS

The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results. Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not.

CONCLUSION

Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated.

The Dental Subscale of the Children's Fear Survey Schedule: a factor analytic study in The Netherlands

The Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) is a well-known instrument for assessing dental fear in children. Previous studies have shown that the scale has acceptable reliability and validity. Factor analysis using scores of a group of Finnish schoolchildren resulted in three factors. No other data on the factor structure have been published. In order to report on the factor structure of the Dutch parental version of the CFSS-DS, the present study was undertaken. Factor analysis using scores from a group of Dutch children (n= 150) demonstrated a factor pattern fairly similar to the results found in the Finnish study. Three factors were found: 1) fear of highly invasive dental procedures, 2) fear of less invasive aspects of treatment and 3) fear of medical aspects. Considering that almost all items load substantially (> or =0.20) on more than one factor, it seems that one primary underlying dimension exists: fear of invasive treatment aspects. The CFSS-DS is proposed as a reliable, one-dimensional measure of dental fear.

Administering local anaesthesia to paediatric dental patients -- current status and prospects for the future

Fear-related behaviours have long been recognized as the most difficult aspect of patient management and can be a barrier to good care. Anxiety is one of the major issues in the dental treatment of children, and the injection is the most anxiety-provoking procedure for both children and adults. There is a constant search for ways to avoid the invasive, and often painful, nature of the injection, and to find more comfortable and pleasant means for anaesthesia before dental procedures.

OBJECTIVE

The purpose of the present review is to summarize relevant data on topics connected with the administration of local anaesthesia.

METHODS

The review will survey the current available methods, viz. electronic anaesthesia, lidocaine patch, computerized anaesthesia (the Wand), and the syrijet as well as the conventional injection, used for paediatric patients.

CONCLUSIONS

Usually new techniques for locally anaesthetizing dental patients are tested on adults. However, despite recent research in the field, the injection remains the method of choice. It is necessary to continue to conduct studies using new techniques on adults and children, so that a more acceptable technique can be found.

The effect of sociodemographic factors on dental anxiety in children seen in a suburban Nigerian hospital

OBJECTIVE

This paper attempts to determine the sociodemographic factors that relate to dental anxiety in suburban African children.

METHODS

A short form of the Dental subscale of the Child Fear Survey schedule (DFSS_SF) was administered to 81 patients (first time attendees at the clinic) between the ages of eight and 13 years. The psychometric scale was used after determining its reliability and validity to ensure that it was culturally appropriate. Age, gender, sociodemographic status were also recorded. The dental anxiety score distribution, its threshold level as well as the relationship between the sociodemographic variables and patients' anxiety were determined.

RESULTS

There was no statistically significant association between age (P = 0.856), gender (P = 0.124), socio-economic status of the children (P= 0.12) and level of dental anxiety. However, a statistically significant relationship did exist between the type of school the child attended and the anxiety level (P = 0.009). Also, 18 (14.8%) of the children were found to have high anxiety levels.

CONCLUSIONS

Further studies involving larger non-clinic samples are needed to examine the issues raised by the findings of this study.

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.

Music distraction--its efficacy in management of anxious pediatric dental patients

Managing the anxiety of pediatric dental patient has long been the purview of dentists over many years. Various techniques have been used with moderate and variant success rates over the last few years. The main aim of this study was to ascertain if music distraction is an effective means of managing anxiety in pediatric dental patients. Forty children aged between 4 and 8 years were selected for the study. The assessment of anxiety was done using Venham's picture test, Venham's anxiety rating scale, pulse rate, and oxygen saturation during different treatment visits. The values were statistically analyzed and it was concluded that audio distraction did decrease the anxiety level in pediatric dental patients, but not to a very significant level.

An evaluation of four methods of assessing the behaviour of anxious child dental patients

The aim of this study was to evaluate four behavioural scales which have been used to assess anxious children during dental treatment: The Frankl (F), Houpt (H), Visual Analogue (VAS) and Global Rating (GR) scales. The study measured the agreement on three of the scales (F, H and VAS) between two judges expert in the management of anxious children and also between four other dentists. The operating dentists scored each visit using the fourth scale (GR). Twenty-nine anxious children aged 3-16 years who had been referred to a specialist clinic were included in the study, and 64 separate visits were recorded on videotape. The two-judge panel evaluated the children's behaviour on all 64 visits, and the four-judge panel evaluated a 12-visit segment. Comparisons within and between the two-judge and four-judge panels showed close agreement on the Visual Analogue and Houpt scales but not on the Frankl scale. There was significant correlation between the Global Rating scale and the Visual Analogue, Houpt and Frankl scales.

Increasing access to dental care for medicaid preschool children: the Access to Baby and Child Dentistry (ABCD) program

OBJECTIVE

Washington State's Access to Baby and Child Dent stry (ABCD) Program, first implemented in Spokane County in 1995, offers extended dental benefits to participating Medicaid-enrolled children and higher fees for certified providers. This study aimed to determine the program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge.

METHODS

The study used a posttest-only comparison group design. Trained interviewers conducted telephone interviews with 465 parents of chi dren ages 13 to 36 months (49% ABCD, 51% Medicaid-enrolled children not in ABCD). One year later, 282 of 465 parents completed a follow-up survey. Utilization and expenditures were calculated from Medicaid claims.

RESULTS

Forty-three percent of children in the ABCD Program visited a dentist in the follow-up year, compared with 12% of Medicaid-enrolled children not in the ABCD Program. An ABCD child was 5.3 times as likely to have had at least one dental visit as a child not in the program. ABCD children were 4 to 13 times as likely to have used specific dental services. Parents of ABCD children were more likely to report having ever tried to make a dental appointment, less likely to report that their children were fearful of the dentist, and were more satisfied, compared to parents of non-ABCD children.

CONCLUSION

The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.

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.

Associations between dental anxiety, dental treatment due to toothache, and missed dental appointments among six to eight-year-old Danish children: a cross-sectional study

The aims of this study were to estimate the prevalence of missed dental appointments among Danish children at 6 to 8 years of age and to examine the association between dental anxiety, dental treatment due to toothache, and missed dental appointments in a population-based cross-sectional study. The study was conducted in four municipalities in the County of North Jutland, Denmark, and included a total of 1,235 children (response rate 74.1%). Data on missed dental appointments and toothache were obtained from dental records, and data on dental anxiety from the Children's Fear Survey Schedule-Dental Subscale. Overall, 37.7% of children missed one or more dental appointments, while 17.7% missed two or more appointments. These proportions did not differ by age or gender. Among children with dental anxiety, the adjusted OR for an association with two or more missed dental appointments was 1.32 (95% CI: 0.72-2.40), and among children who had dental treatment due to toothache, the adjusted OR of two or more missed dental appointments was 2.61 (95% CI: 1.63-4.18).

Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children

The aim of this study was to compare the behavioral reaction of children who receive local anesthesia with a traditional syringe with the behavioral reaction of children who receive local anesthesia with a computerized device (Wand) and to differentiate between the reactions of highly anxious children with those displaying low anxiety. One hundred and twenty-five children aged 4-11 yr were randomly allocated to receive local anesthesia with the Wand or a traditional injection. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Two independent observers scored videotapes of the anesthesia in 15-s intervals. The occurrence of muscle tension, crying, verbal protest, movement, and resistance was registered and a score was given on the Venham distress scale. The mean injection time with the Wand was four times as long as with the traditional syringe. During the first 15 s of the injection, low-anxious children receiving local anesthesia with the Wand displayed less muscle tension, less verbal protest and less movement than children receiving local anesthesia with the traditional syringe. Within the high-anxious group no differences were found. It was concluded that low-anxious children seem to benefit from the use of the Wand instead of the traditional syringe in receiving local anesthesia.

Cooperation during dental treatment: the Children's Fear Survey Schedule in Japanese children

OBJECTIVE

The aim of this study was to evaluate dental fear and cooperation during dental treatment using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS).

METHODS

From the behaviour assessment of regular patients of the Pediatric Dental Clinic in Niigata University Dental Hospital (aged 5-12 years old), the patients were classified into two groups: uncooperative and cooperative. CFSS-DS questionnaires were sent to a total of 295 patients, 186 of which were returned, 61 from the uncooperative group and 125 from the cooperative group.

RESULTS

In the uncooperative and the cooperative groups, the CFSS-DS mean total scores were 31.79 and 24.02 (P < 0.05), respectively, and the ratios of the patients whose scores were equal to or more than 35 were 36.1 and 11.2%, respectively. Fear of 'injections' and 'the dentist drilling' had high scores in both groups.

CONCLUSIONS

The results indicated that there are many uncooperative patients with low dental fear and cooperative patients with high dental fear.

Non-pharmacological approaches to behaviour management in children

This review examines a number of non-pharmacological approaches to the management of dental anxiety and its manifestations among children and young people. The article concludes with recommendations regarding the use of non-pharmacological approaches.

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.

A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management

OBJECTIVE

The aim of the present study was to determine the validity of subjective anxiety assessment and the outcomes of management of children receiving operative dental treatment.

SETTING

The study was conducted at the Departments of Sedation and Child Dental Health, Newcastle Dental Hospital, Newcastle upon Tyne, UK.

SUBJECTS AND METHODS

One hundred children and adolescents aged between 8 and 15 years participated in the study. Clinicians subjectively allocated 50 children for treatment with local analgesia alone (low anxiety), and identified 50 children who had the potential to benefit from nitrous oxide and oxygen sedation (high anxiety). Participants then completed the State-Trait Anxiety Inventory for Children (STAIC), the Venham Picture Test (VPT) and the Child Fear Survey Schedule-Dental Subscale (CFSS-DS). A global rating scale classified behaviour during dental treatment.

RESULTS

State anxiety and dental fear prior to treatment were significantly higher in children allocated to receive inhalation sedation (P = 0.004 and P = 0.005, respectively). There was no significant difference in trait anxiety or post-treatment state anxiety between the two groups (P = 0.69 and P = 0.06, respectively). Only 11% displayed 'negative' behaviour during treatment: 82% of this group represented those allocated to receive sedation.

CONCLUSION

Children receiving inhalation sedation were significantly more anxious prior to treatment than children receiving treatment with local analgesia alone. The findings support the subjective assessment of anxiety in children; however, objective anxiety measures may assist clinicians in identifying specific fears, which may ultimately aid patient management.

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.

Assessing change in the family impact of caries in young children after treatment under general anaesthesia

OBJECTIVE

To examine the properties, validity and responsiveness of the Family Impact Scale in a consecutive clinical sample of patients undergoing dental treatment under general anaesthesia.

MATERIALS AND METHODS

A consecutive clinical sample of parents/caregivers of children receiving dental treatment under general anaesthesia provided data using the Family Impact Scale (FIS) component of the COHQOL(©) Questionnaire. The first questionnaire was completed before treatment, the follow-up questionnaire 1-4 weeks afterward. Treatment-associated changes in the FIS and its components were determined by comparing baseline and follow-up data.

RESULTS

Baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up). All FIS items showed large relative decreases in prevalence, the greatest seen in those relating to having sleep disrupted, blaming others, being upset, the child requiring more attention, financial difficulties and having to take time off work. Factor analysis largely confirmed the underlying factor structure, with three sub-scales (parental/family, parental emotions and family conflict) identified. The parental/family and parental emotions sub-scales showed the greatest treatment-associated improvement, with large effect sizes. There was a moderate improvement in scores on the family conflict sub-scale. The overall FIS showed a large improvement.

CONCLUSION

Treating children with severe caries under general anaesthesia results in OHRQoL improvements for the family. Severe dental caries is not merely a restorative and preventive challenge for those who treat children; it has far-reaching effects on those who share the household and care for the affected child.