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

Effect of audio and virtual reality distraction on the dental anxiety of children with mild intellectual disability

BACKGROUND AND AIM

Intellectual disability, is a neurodevelopmental disorder that typically manifests early in childhood and consists of both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. It can be categorized into mild, moderate, severe, and profound based on its severity. Cognitive impairment may be observed predominantly in children with intellectual disabilities. Marked deficits in areas of learning, planning, communication, social participation, and personal independence in children with mild intellectual disabilities make behavior guidance and communication a challenge during dental treatments. The aim was to evaluate and compare the use of two different distraction tools, audio, and virtual reality (VR) on the dental anxiety of children with mild intellectual disability during dental treatment.

METHODS

Twenty children diagnosed with mild intellectual disability were equally divided into two groups. A cross-over study design consisting of two appointments 1 month apart was employed. In the first appointment, audio and VR distractions were provided to participants in Groups 1 and 2, respectively, and the distraction tools provided to the participants were interchanged in the second appointment. A trained observer recorded physiological parameters (pulse rate and oxygen saturation) and observational parameters (Venham's anxiety rating scale) during both appointments at three-time intervals. Statistical intra-group and inter-group comparison analyses were performed using Friedman's and Mann-Whitney U tests.

RESULTS

A decrease in pulse, increase in oxygen saturation levels, and a decrease in Venham's Anxiety Rating Scores (statistically significant p < .05 / highly significant p < .01) was observed on introducing the distraction techniques in Groups 1 and 2 in both appointments. A statistically non-significant difference (p > .05) in physiological and observational parameters was observed between Groups 1 and 2 in both appointments.

CONCLUSION

Audio and VR distraction techniques can be employed for behavior guidance in children with mild intellectual disability during restorative dental procedures.

Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis

BACKGROUND

Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12.

METHOD

A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses.

RESULT

A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children.

CONCLUSIONS

The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.

Can Music Decrease Anxiety and Pain During Dental Implant Surgery? A Randomized Clinical Trial

PURPOSE

Music has proven to be an effective tool in the management of anxiety during some surgical procedures. The aim of this study was to test the effect of baroque (BM) and classical era music (CM) as a nonpharmacological therapy on the control of anxiety and pain levels among patients undergoing dental implant placement surgery.

METHODS

A randomized controlled clinical trial of patients attending a dental clinic was conducted. Patients with psychiatric disorders were excluded. Twenty six patients of Spanish nationality requiring single-tooth dental implant were included. Each patient was assigned to 1 of the 3 experimental groups, which acted as an independent variable: Group I (n = 8) listened to BM; Group II (n = 10) listened to CM; and Group III (n = 8) did not listen to music and was the control group (C). The dependent variables were divided into physiological variables and psychological variables. The physiological dependent variables analysed were systolic and diastolic blood pressure, heart rate, and oxygen saturation, recorded at 4 different times during surgery. The Kruskal-Wallis test compared each of these variables between the 3 experimental groups. The psychological dependent variable analyzed was the degree of anxiety, measured by the self-completed Modified Dental Anxiety Scale and Visual Analog Scale (measured before and after surgery). The Wilcoxon statistical test compared degree of anxiety before and after surgery. In all cases, the level of statistical significance was set at P < .05.

RESULTS

The mean age of the sample was 46.5 ± 10.6 (range, 24-69 years), 50% male and 50% female. Statistically significant differences in degree of anxiety before and after surgery were found in the BM (P = .027, confidence interval [CI] = 0.146-6.104; BM before = 4.25 ± 3.91 and BM after = 1.13 ± 1.45) and CM groups (P = .044, CI = 0.161-3.039; CM before = 3.10 ± 2.88 and CM after = 1.50 ± 1.43) and were not found in group C (P = .180, CI = 1.104-3.604; C before = 2.63 ± 3.62 and C after = 1.38 ± 1.99). When comparing the perceived pain after the intervention among the 3 groups (C, BM, and CM), no significant differences were observed between them (P = .319; CI = -0.58-1.96; C = 0.75 ± 1.75, BM = 1.25 ± 1.75, and CM = 1.70 ± 1.70).

CONCLUSION

Listening to BM and CM reduces anxiety in patients undergoing dental implant placement surgery. Musical flow should be applied in this practice.

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

A Study on the Personality Traits and Their Influencing Factors of Children from Poor Families from the Perspective of Psychological Education

The problem of poor children’s psychological development has been widely concerned by governments all over the world. At present, the research results of poor children’s psychological development show that poor children mainly have cognitive, mental health, and behavioral problems. This paper studies the personality traits and their influencing factors of children from poor families from the perspective of psychological education. By giving the definition of children from poor families and poor families, this paper analyzes the psychological development of poor children, analyzes the personality traits and influencing factors of children from poor families from the perspective of psychological education, obtains the standard scores of 16 personality traits and their dimensional personality factors and personality factors, and uses the clustering method to realize the difference analysis of personality characteristics of various samples. From the perspective of quantitative psychological education, this paper analyzes the correlation between personality traits and influencing factors of children from poor families in order to provide basis and reference for the government and society to implement targeted poverty alleviation and cut off the intergenerational transmission of poverty.