Parent-reported distress in children under 3 years old during preventive medical and dental care

Anxiety, Stress and Coping Patterns in Children in Dental Settings

BACKGROUND

Fear of the dentist and dental treatment is a common problem. It can cause treatment difficulties for the practitioner, as well as severe consequences for the patient. As is known, the level of stress can be evaluated thought electrodermal activity, cortisol measure in saliva, or indirectly by psychometric tests.

AIM

The present study examined the psychological influence of dental interventions on the child as well as coping patterns used for stress diminution.

METHODS

We examined two matched groups of patients: a) children with orthodontic problems (anomalies in shape, position and function of dentomaxillofacial structures) (N = 31, mean age 10.3 ± 2.02) years; and b) children with ordinary dental problems (N = 31, mean age 10.3 ± 2.4 years). As psychometric instruments, we used: 45 items Sarason's scale for anxiety, 20 items simple Stress - test adapted for children, as well as A - cope test for evaluation coping patterns.

RESULTS

Obtained scores confirmed the presence of moderate anxiety in both groups as well as moderate stress level. For Sarason's test obtained scores for the group with dental problems are 20.63 ± 8.37 (from max 45); and for Stress test 7.63 ± 3.45 (from max 20); for the orthodontic group obtained scores are 18.66 ± 6.85 for Sarason's test, while for the Stress test were 7.76 ± 3.78. One way ANOVA confirmed a significant difference in values of obtained scores related to the age and gender. Calculated Student t - test shows non-significant differences in obtained test results for both groups of examinees. Coping mechanisms evaluated by A - cope test shows that in both groups the most important patterns used for stress relief are: developing self-reliance and optimism; avoiding problems and engaging in demanding activity.

CONCLUSION

This study confirmed that moderate stress level and anxiety are present in both groups of patients (orthodontic and dental). Obtained scores are depending on gender and age. As more used coping patterns in both groups are developing self-reliance and optimism; avoiding problems and engaging in demanding activity. Some strategies for managing this problem are discussed.

Early Head Start, Pediatric Dental Use, and Oral Health-Related Quality of Life

The objective of the study was to examine the mediating effect of child dental use on the effectiveness of North Carolina Early Head Start (EHS) in improving oral health-related quality of life (OHRQoL). In total, 479 parents of children enrolled in EHS and 699 parents of Medicaid-matched children were interviewed at baseline when children were approximately 10 mo old and 24 mo later. In this quasi-experimental study, mediation analysis was performed using the counterfactual framework analysis, which employed 2 logit models with random effects: 1) for the mediator as a function of the treatment and covariates and 2) for the outcome as a function of the treatment, mediator, and covariates. The covariates were baseline dental OHRQoL, dental need, survey language, and a propensity score. We used in-person computer-assisted, structured interviews to collect information on demographic characteristics and dental use and to administer the Early Childhood Oral Health Impact Scale, a measure of OHRQoL. Dental use had a mediation effect in the undesired direction with a 2-percentage point increase in the probability of any negative impact to OHRQoL (95% confidence interval [CI], 0.3%-3.9%). Even with higher dental use by EHS participants, the probability of any negative impact to OHRQoL was approximately 8 percentage points lower if an individual were moved from the non-EHS group to the EHS group (95% CI, -13.9% to -1.2%). EHS increases child dental use, which worsens family OHRQoL. However, EHS is associated with improved OHRQoL overall. Knowledge Transfer Statement: Study results can inform policy makers that comprehensive early childhood education programs improve oral health-related quality of life (OHRQoL) for disadvantaged families with young children in pathways outside of clinical dental care. This awareness and its promotion can lead to greater resource investments in early childhood education programs. Information about the negative impacts of dental use on OHRQoL should lead to the development and testing of strategies in dentistry and Early Head Start to improve dental care experiences.

Parent, Dentist, and Independent Rater Assessment of Child Distress During Preventive Dental Visits

PURPOSE

Although typically not painful, preventive dental care can be distressing to young children. A greater understanding of how adults perceive child distress may enable clinicians to improve the patient/parent experience through alignment of values and facilitation of shared decision-making. The purpose of this study was to examine the association between parent, dentist, and independent observer (IO) ratings of child distress during preventive dental procedures.

METHODS

Sixty-five children younger than three years were seen for preventive dental care at a university dental clinic. Parents, dentists, and an IO rated intensity of child distress during four phases of the dental visit: (1) pre-exam; (2) positioning; (3) prophylaxis/exam/fluoride; and (4) post-exam.

RESULTS

The average age of the children was 24.4 months old (±7.2 SD). The prophylaxis/exam/fluoride phase was judged to be most distress inducing. Mean distress ratings for this phase were: 2.30 (parents); 2.47 (dentists); and 3.08 (IO), which was statistically significant (P=.04). The IO ratings were significantly different from parents (for three phases) and dentists (for one phase); no statistically significant differences were noted between parent and dentist ratings for any phase.

CONCLUSIONS

There was a strong agreement between parents' and dentists' ratings of child distress during preventive dental procedures.