Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial

Effect of stress ball use on cannulation-related invasive pain in Hemodialysis patients: a randomized controlled, single-blind study

BACKGROUND

Stress ball usage is one of the non-pharmacological methods that help reduce pain and anxiety by diverting an individual's attention elsewhere.

PURPOSE

This study evaluates the impact of stress ball use on pain levels during cannulation in hemodialysis patients.

METHODS

A single-blind, randomized, controlled design was used. Sixty-four participants were divided into experimental (n = 32) and control groups (n = 32). The experimental group used a stress ball for 3 min before and during cannulation, while the control group received routine care without additional intervention. Pain was assessed using the Visual Analog Scale (VAS) after cannulation across 12 sessions. Statistical significance was set at p < 0.05.

RESULTS

The median VAS score in the intervention group was significantly lower than in the control group. The intervention group showed a significant decrease in VAS scores over 12 sessions (p < 0.01). Stress ball usage had an increasing effect over time (p = 0.016). Overall, median VAS scores differed significantly between groups (p < 0.01).

CONCLUSION

Using stress balls during cannulation reduces pain intensity in hemodialysis patients, with increased effectiveness over multiple sessions. Nurses can recommend stress balls as a simple and cost-effective pain management method.

TRIAL REGISTRATION

This study was retrospectively registered at ClinicalTrials.gov (Registration No: NCT06237738) on 2024-01-12.

Comparative Evaluation of Acupressure, Aromatherapy, and Stress Ball Efficacy in Reduction of Anxiety Levels in Children during Prophylactic and Restorative Procedures

Background

Dental anxiety among pediatric patients needs to be tackled efficiently. Various nonpharmacological interventions, though proven effective, cannot be generalized for all. The use of complementary and alternative medicine has surged globally and is effective in reducing anxiety associated with dental procedures.

Aim

This study aimed to compare the efficacy of acupressure, aromatherapy, and stress ball for reduction of dental anxiety in children during prophylactic and restorative procedures.

Settings and design

Randomized controlled clinical trial.

Materials and methods

The study comprised 160 children aged 8-12 years requiring scaling or restoration on the first visit. The children were randomly allocated to four groups: group I (n = 40)-control, group II (n = 40)-acupressure, group III (n = 40)-aromatherapy, and group IV (n = 40)-stress ball. For all the children, a self-report measure of anxiety [Modified Child Dental Anxiety Scale (MCDAS) and Chota Bheem-Chutki Scale (CBCS)], along with pulse rate, SpO2, and respiratory rate, were recorded at three different time frames. The Frankl scale was used as the behavioral measure for all the children.

Statistical analysis used

Student's t-test and ANOVA test were used to analyze the data.

Results

Aromatherapy showed significant results in all the six parameters used. The MCDAS scores of groups II, III, and IV showed significant mean differences when compared to the control group (p = 0.000). In the Frankl behavior rating scale and SpO2 readings, differences in the aromatherapy and acupressure groups were found statistically significant in comparison with other groups (p = 0.000 and 0.005). Aromatherapy was found statistically significant compared to other groups in parameters like the CBCS and pulse rate. All the three groups showed significant results in the respiratory rate interval.

Conclusion

Aromatherapy was highly effective in reducing anxiety compared to the acupressure and stress ball groups during prophylactic and restorative procedures in children.

How to cite this article

Koyande AP, Pathivada L, Krishna KM, et al. Comparative Evaluation of Acupressure, Aromatherapy, and Stress Ball Efficacy in Reduction of Anxiety Levels in Children during Prophylactic and Restorative Procedures. Int J Clin Pediatr Dent 2025;18(2):210-214.

Assessment of smartphone-based active distraction in association with audioanalgesia for overcoming airotor-related anxiety in children: a randomized controlled trial

BACKGROUND

Most children experience distress while visiting a dentist, above which the sound of the airotor and suction machine results in fear and difficulty in performing further procedures.

METHODS

This was a randomized controlled parallel-group study of 40 children aged 6-13 years who required cavity preparation via the airotor. The children were randomly allocated to either Group 1 (Piano music app; active distraction combined with audio analgesia) or Group 2 (basic behavioural guidance alone). Self-reported dental anxiety was measured via a modified child dental anxiety scale, and behavior was assessed via Venham's and FLACC (Faces Legs Activity Cry and Consolability) scales. The data obtained were subjected to appropriate statistical analysis.

RESULTS

Self-reported dental anxiety was significantly lower in group 1 (p < 0.005). No significant difference between the groups was observed for the Venham and FLACC scores.

CONCLUSION

Compared with basic behavioural guidance alone, the use of active distraction with audio analgesia in the form of the piano music app significantly decreased the degree of dental anxiety caused by the use of the airotor. This also resulted in clinically better cooperation by the child during cavity preparation.

TRIAL REGISTRATION

Registered in the Clinical Trials Registry India (CTRI/2024/07/070160) dated 08/07/2024.

Efficacy of administering a sugar-free flavor before dental injections on pain perception in children: A split-mouth randomized crossover clinical trial

BACKGROUND

Sweet taste administration before dental injections helps to control associated pain in children.

AIM

To evaluate the efficacy of using a sugar-free flavor on pain perception during dental injections.

DESIGN

Children (n = 84) aged 4-9 (mean 6.71 ± 1.55) years who required buccal infiltration bilaterally participated in this split-mouth randomized crossover study. On the test side (flavor visit), infiltration injections were applied after receiving a sugar-free flavor. On the control side (no flavor visit), sterile water was administered. Demographic characteristics, body mass index (BMI), and sweet taste preference (STP) were recorded. Pain perception during injection was measured using heart rate (HR), sound, eyes, and motor (SEM) scale, and Wong-Baker Faces pain scale (WBFPS).

RESULTS

Most children had healthy weight (72.6%) and equal STP (32.1%). In the test side, mean HR during injection, HR differences before and during injection, and SEM scores were significantly lower (p < .001, for all). There was no significant difference in the WBFPS between both visits. Flavor had a significant effect on pain reduction (p = .001 for HR, p = .000 for SEM), whereas age, gender, BMI, STP, and treatment side did not. Treatment sequence had a significant effect on total SEM scores (p = .021); children who received the flavor during their first visit had lower SEM scores.

CONCLUSION

Using a sugar-free flavor before dental injections helps in reducing associated pain in children.

Non-pharmacological interventions for reducing dental anxiety in pediatric dentistry: a network meta-analysis

BACKGROUND

Child dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators.

METHODS

A thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration's bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610.

RESULTS

The study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate.

CONCLUSION

In this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future.

Recent Developments in the Non-Pharmacological Management of Children's Behavior Based on Distraction Techniques: A Concise Review

Oral diseases and conditions affect children's oral health and negatively influence their overall health. Early detection and intervention are important in mitigating these negative consequences. However, dental fear and anxiety (DFA) regarding dental procedures often hinder children from seeking necessary dental care. Non-pharmacological behavior management strategies, such as distraction techniques, are commonly adopted to manage children's behaviors. Distraction techniques have been developed rapidly in recent years and are widely accepted by both health professionals and parents due to their noninvasive and low-cost nature. This concise review aims to summarize current distraction techniques applied during dental treatments, especially for children. The most commonly reported techniques for children are audio distraction, audio-visual distraction, tactile distraction, olfactory distraction, and gustatory distraction. Audio distraction techniques involving music and storytelling help children relax. Audio-visual distraction techniques help to divert children's attention from the dental treatment. Tactile stimuli can reduce the transmission of pain signals. Olfactory stimuli can help children feel comfortable and relaxed. Gustatory distraction involving sweet substances can create a positive environment. These distraction techniques effectively reduce DFA in children and improve their satisfaction with dental procedures. As technology continues to develop, further research is needed to provide more robust, evidence-based guidance for dentists using distraction techniques.

Efficacy of kaleidoscope, virtual reality, and video games to alleviate dental anxiety during local anesthesia in children: a randomized clinical trial

Background

Distraction is a technique used to divert a patient's attention from unpleasant procedures. This study aimed to evaluate the effectiveness of kaleidoscopy, virtual reality, and video games in reducing anxiety and pain during invasive dental procedures in children.

Methods

Sixty-six children aged 6 to 9 years were randomly assigned to three groups during local anesthesia administration: Group 1 (kaleidoscope), Group 2 (virtual reality), and Group 3 (mobile video games). The anxiety of the children was evaluated using physiological measures (heart rate) at three different time points: before, during, and after the procedure. The Raghavendra, Madhuri, and Sujata pictorial scale was used as a subjective measure before and after the procedure. Subjective measures of pain were assessed using the Wong-Baker Faces Pain Scale. The data were statistically analyzed using the Kruskal-Wallis and Wilcoxon signed-rank tests.

Results

In the intergroup comparison, there were no statistically significant differences in the physiological measures of anxiety scores between the three groups before, during, and after distraction. Raghavendra, Madhuri, and Sujata pictorial scale scores were assessed before and after distraction, but no statistically significant differences were observed. Among the three groups, the children in Group 2 showed a significant reduction in pain scores.

Conclusion

Compared with kaleidoscopes and video games, virtual reality is a promising distraction technique for reducing dental fear, anxiety, and pain during local anesthesia administration in children.

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.

Active versus passive distraction for reducing procedural pain and anxiety in children: a meta-analysis and systematic review

BACKGROUND

Procedural pain is very important in clinical children care. We aimed to evaluate the effects of active versus passive distraction for reducing procedural pain and anxiety in children.

METHODS

Two researchers searched the Web of Science, PubMed, EMBASE, Cochrane, SinoMed, Wanfang, China National Knowledge Infrastructure, Weipu databases for the randomized controlled trials(RCTs) on the active versus passive distraction affecting procedural pain and anxiety in children until May 18, 2023. The literature screening and data extraction were carried out by two researchers independently. Review Manager 5.3 software was used for data analysis.

RESULTS

13 RCTs were finally included. 553 children received active distraction intervention and 551 children received passive distraction intervention. There were no significant differences in the children self-reported procedural pain betweent active and passive distraction. The parent-reported procedural pain, medical staff-reported procedural pain, children-reported procedural anxiety, parent-reported procedural anxiety, medical staff-reported procedural anxiety in the active distraction were significant less than that of active distraction. Egger regression analysis showed that there was no publication bias in the results.

CONCLUSIONS

Existing evidence suggests that active distraction may be more effective in reducing operational pain and anxiety in children than passive distraction. More studies on the effects of active distraction versus passive distraction in children with larger sample size are needed in the future.

The effects of playing digital games on children's pain, fear, and anxiety levels during suturing: A randomized controlled study

OBJECTIVE

The aim was to determine the effects of digital game play on children's pain, fear, and anxiety levels during suturing.

METHODS

Data were obtained from 84 children between the ages of 8 and 17 years at the pediatric emergency department between January 16 and March 19, 2020, using the Socio-Demographic and Clinical Characteristics Form, the Wong-Baker Faces Pain Rating Scale (WBFPS), the Visual Analogue Scale (VAS), the Fear of Medical Procedures Scale (FMPS), and the State-Trait Anxiety Inventory for Children (STAI-CH). A four-block randomization system was used. The study group (n = 42) played digital games during the suturing procedure, unlike the control group (n = 42). Ethical permissions were obtained from the ethical committee, hospital, and families.

RESULTS

Before the suturing procedure, there was no statistically significant difference between the groups' mean scores. The intervention group was found to have statistically significantly lower WBFPS and VAS pain scores than the control group during the suturing procedure, and after the procedure, statistically significantly lower WBFPS, VAS, FMPS, and STAI-CH mean scores than the control group.

CONCLUSIONS

The digital game-playing approach applied before and during the suture procedure was found to be effective in reducing children's pain, fear, and anxiety levels.

Assessment of Different Distraction Behavioral Methods in Pediatric Dental Clinic: A Systematic Review

Dental anxiety is one of the main problems dentists may face during the treatment of pediatric dental patients; therefore, clinicians tend to perform different behavior management techniques to reduce dental anxiety in children. This review aimed to systematically compare and evaluate the published literature regarding the effects of distraction techniques on anxiety, pain perception, and patient experience during dental practice. A detailed electronic search was conducted on 3 databases including PubMed, Google Scholar, and Cochrane Library. The databases were searched for articles published in the English language between 2015 and 2022. Among 102 studies, 27 studies fulfilled the criteria of eligibility and were included in this study to be analyzed. Numerous approaches have been proposed for the reduction of dental anxiety, out of which the use of audio-visual aids and instruments, active distraction such as tablets, smartphones, and virtual reality glasses showed governance in decreasing the children's anxiety followed by cognitive and behavioral methods.

Effect of the Case for Carpule as a Visual Passive Distraction Tool on Dental Fear and Anxiety: A Pilot Study

The present cross-over study aimed to evaluate the effect of a visual passive distraction tool, a case for carpule, in the management of fear and anxiety during invasive dental treatment. Children between the ages of 4 and 8 years that need at least two treatments with inferior alveolar nerve block were selected. All the included children received two treatments at different moments: in one treatment, local anesthesia was performed with a visual passive distraction tool, the crocodile case, for carpule (experimental); in the other treatment, local anesthesia was performed without the device (control). An evaluation of the anxiety levels was performed by measuring the heart rate and salivary cortisol levels. Wilcoxon's nonparametric test was used for a data analysis (p < 0.05). The mean heart rate with the visual passive distraction device fell from 81.8 to 78.1, while the control rose from 91.4 to 100 (p < 0.05). The mean salivary cortisol levels with the visual passive distraction device fell from 2.0 to 1.6, while in the control, they rose from 2.1 to 2.4 (p < 0.05). In conclusion, the crocodile case for carpule as a visual passive distraction device contributed positively to the management of fear and anxiety during inferior alveolar nerve block in children.

Effectiveness of stress ball and relaxation exercises on polymerase chain reaction (RRT-PCR) test-induced fear and pain in adolescents in Türkiye

PURPOSE

This study aimed to determine the effectiveness of stress balls and relaxation exercises in relieving PCR test-induced fear and pain in adolescents.

DESIGN AND METHODS

A randomized controlled experimental study with a parallel-group design was conducted. The sample size was determined by G*Power analysis, and 32 adolescents were included in each group accordingly. The data were collected using the Adolescent and Parent Information Form, The Children's Fear Scale, and The Wong-Baker Faces Pain Scale. Descriptive statistics, t-test, paired t-test, ANOVA, and Tukey's forward analysis were used to analyze the data.

RESULTS

The mean age was 14.93 ± 2.07 years for the adolescents, 43.58 ± 4.50 years for the mothers, and 48.25 ± 4.92 years for the fathers. Adolescents were stratified according to age, gender, and fear of invasive procedures, and homogeneity was ensured in their distribution to the groups. The pre-procedural level of fear was moderate in each group with no significant difference (p > 0.05). However, a significant difference was found between the groups in terms of both post-procedure levels of fear and pain. The pre-procedural fear of the adolescents in the control group (3.91 ± 0.29) did not change much after the procedure (3.91 ± 0.30), while there was a decrease in the other groups. The least post-procedure fear (0.09 ± 0.29) and pain (0.44 ± 0.67) were found to be in the relaxation exercise group.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Relaxation exercise is the most effective method to reduce fear and pain during the PCR procedure. It is recommended to use it during the PCR procedure for being easily accessible, applicable, and cost-effective. Clinical Trials ID: NCT05250544.

Assessing an active distracting technique during primary mandibular molar pulpotomy (randomized controlled trial)

OBJECTIVES

This study aims to evaluate the effectiveness of two different distraction techniques (Audio Video Distraction/Video Game Distraction) in the management of anxious pediatric patients during dental treatment.

MATERIALS AND METHODS

One hundred and five children were randomly divided into three groups; Group A: active distraction using video games on a tablet device and wireless joystick (VG). Group B: passive distraction using video on tablet, and wireless headphones (AV). Group C (Control group): basic behavior guidance technique Tell Show Do was used (C). The children were selected from the department of pediatric dentistry at the Faculty of Dentistry, Damascus University, who required pulpotomy in primary mandibular molars. All children were assessed by: Simplified Wong-Baker FACES for pain scale (self-report), and "HOUPT" Behavior Rating Scale for Overall Behavior (non-self-report), at the end of treatment.

RESULTS

One hundred and five children completed the study (57 boys and 48 girls) aged between 6 and 10 years (mean age of 7.4 years). The active distraction (VG) group was superior to the passive distraction (AV) group and the control group (C) on the pain scale with statistically significant differences as appeared in Simplified Wong-Baker Scale (p = .000), The active distraction (VG) group was superior to the control group (C) in overall behavior as appeared in HOUPT scale (p = .041), but it was no statistically significant differences between (VG) group and (AV) group in overall behavior (p = .605). With the use of Bluetooth technology and wireless devices, the workspace was comfortable for the dentist and did not interfere with the movement of his hands.

CONCLUSION

Positive distraction with video games by wireless joystick displayed on the portable tablet on the dental chair was the best technique for reducing dental anxiety and reported pain in school children (6-10 years) and was better than negative distraction by video cartoons on the tablet device.

The Effect of Visualization Techniques on Students of Occupational Therapy during the First Visit to the Dissection Room

Background: Part of the basic teaching of human anatomy are prosection sessions with a human corpse, which may generate stress or anxiety among students. The objective of this work was to study how, through the visualization technique (a coping technique), these levels could be reduced before starting prosection classes. Methods: A cross-sectional pilot study was conducted involving first-year students who had never participated in screening sessions. Prior to the visit, occupational therapy students underwent a viewing session (visualization technique). On the day of the visit, before and after the screening session, an anonymous questionnaire was distributed to find out about aspects of the students’ experiences, such as their feelings and perceptions. The State−Trait Anxiety Inventory was used to assess anxiety. Results: The baseline levels of anxiety measured remained stable (from 18.5 to 18.2 points), with no differences being found (p > 0.05). The levels of emotional anxiety measured fell from 15.2 to 12.6 points (p < 0.05). Before starting the class, there were six students (17.1%) with anxiety criteria, and this figure was doubled at the end of the session (33.3%) (p < 0.05). Conclusions: Sessions in a dissection room can cause stressful experiences and change the emotional balances of some students. The results obtained and published here showed no significant differences after the visualization technique. We found that the students believed that the prosection sessions were very useful for teaching anatomy.