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

Respiratory infectious disease transmission of dental healthcare workers

Respiratory pathogens significantly impact public health, with transmission primarily occurring during close contact. Dental healthcare workers (HCWs) are particularly at high risk due to long-term mouth opening of patients, and frequent close proximity between HCWs and patients. This study systematically analyzed close contact patterns in 200 dental procedures in mainland China's specialized dental settings, developing a mechanistic model to quantify exposure doses and infection risks for HCWs treating patients with respiratory infections. Findings revealed that the infection risks among dentists are 5.0-fold that among assistants, underscoring the need for enhanced protective measures. Infection risks for assistants were significantly impacted by patient age, especially in cases involving patients under 14 years, while disease type influenced risks for both dentists and assistants, with higher risks in prosthodontics and orthodontics. The assessments of protective measures for HCWs showed that combining N95 respirators with face shields provided over 95 % protection, while N95 respirators alone conferred over 89 % protection, suitable for high-risk settings. Face shields with surgical masks offered over 75 % protection, providing a cost-effective alternative in resource-limited environments. These results emphasize the importance of tailoring protective strategies to specific risk factors, offering valuable guidance for infection control practices in specialist-based dental healthcare systems. ENVIRONMENTAL IMPLICATION: This study addresses the environmental challenge of respiratory pathogen transmission in specialist-based dental healthcare systems. Through mechanistic modeling based on real close-contact behaviors from 200 dental procedures, dentists face 5.0-fold higher infection risks than assistants, with prosthodontics and orthodontics presenting high risks. The findings emphasize the necessity of targeted protective measures, recommending N95 respirators with face shields for optimal protection and surgical masks with face shields as cost-effective alternatives. By tailoring infection control strategies to specific risks, this study offers practical insights to enhance occupational safety and mitigate pathogen transmission in specialist-based dental environments.

Effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients attending dental clinics - a systematic review and meta-analysis

OBJECTIVE

The study aims to compare the effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients visiting dental clinics.

METHODS

A search was conducted in PubMed, Cochrane databases, Scopus, and Google scholar through August 2024. All the randomized control trials, cohort studies, case control, cross-sectional studies that evaluated the effectiveness of behavioural therapy with inhalational/conscious sedation among children and adults to reduce dental anxiety were included. Outcome assessed was change in the dental anxiety scores as measured by the validated tools. PRISMA guidelines were followed for the meta-analysis. Meta-analysis was conducted using Cochrane Review Manager (Revman) version 5.3. Random effects model was used to compare the two groups in reducing dental anxiety. Quality of the studies included was evaluated using the Risk of Bias Assessment tool and Newcastle-Ottawa tool. Heterogeneity was assessed using I2 values. Certainty of evidence was assessed using GRADE pro software. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024581013.

RESULTS

A total of 940 participants were included in the analysis. Behavioural therapy was significantly more effective than inhalational sedation in reducing dental anxiety among patients prior to the dental treatment (SMD: -0.87; 95% CI: -1.29 to -0.45; P < 0.0001; I2:78%). Additionally, behavioural therapy demonstrated more effectiveness than inhalational sedation in reducing the dental anxiety among children (SMD: -0.64; 95% CI: -1.16 to -0.11, P = 0.02%; I2:88%). Certainty of evidence was high among the randomized controlled trials and moderate among the observational studies.

CONCLUSION

The findings of this review and meta-analysis suggests that behavioural therapy is more effective than inhalational sedation in reducing dental anxiety specifically among children.

Effectiveness of Non-Pharmacological Interventions in Reducing Dental Anxiety Among Children with Special Needs: A Scoping Review with Conceptual Map

BACKGROUND

Children with special needs often need tailored approaches to oral healthcare to address their unique needs effectively. It is essential to analyze the effectiveness of non-pharmacological management in reducing dental anxiety among special needs children during dental treatment.

METHODS

Five electronic databases, PubMed, Scopus, Web of Science, Embase, and Google Scholar, were searched from 2007 to August 2024 for randomized control trials and observational studies comparing the effectiveness of non-pharmacological techniques in reducing dental anxiety during invasive and noninvasive dental treatment. The primary outcomes of the studied intervention were reduced dental anxiety and improved behavior during dental treatment. The conceptual map was created to understand the need for assessment and behavior management for special needs children (SN).

RESULTS

Nineteen articles qualified for the final analysis from 250 screened articles. Included studies evaluated the effect of strategies applied clinically, such as audio-visual distraction, sensory-adapted environment, and virtual reality. The included studies measured the trivial to large effect of measured interventions and supported non-pharmacological interventions in clinical settings.

CONCLUSIONS

Most basic non-pharmacological interventions showed a trivial to large reduction in dental anxiety among SN patients. The conceptual map developed in this study supports the need for non-pharmacological interventions as they are cost-effective and create a positive environment in dental clinics. However, more studies need to focus on non-pharmacological behavior interventions in SN children to support the findings of this scoping review.

Comparison of the Efficacy of Aromatherapy and Bubble Breath Play Therapy in Reducing Dental Anxiety in Children: A Randomized Clinical Trial

Aim and background

Managing dental anxiety in children is a challenging aspect of pediatric dentistry, often addressed using various pharmacologic and nonpharmacologic methods. Nonpharmacologic methods are preferred due to their noninvasiveness and minimal adverse effects. This study compares the efficacy of aromatherapy and bubble breath play therapy (BBPT) in reducing dental anxiety in pediatric patients.

Materials and methods

In this randomized clinical trial, 64 healthy children aged 6-10 years with moderate-to-severe dental anxiety and attending their first dental visit were included. Participants were randomly assigned to either the aromatherapy group, where lavender essential oil was diffused, or the BBPT group, where children engaged in bubble blowing for 5 minutes. Anxiety levels were assessed using the Chhota Bheem-Chutki Scale (CBCS), pulse rate (PR), and oxygen saturation (SpO2) levels at baseline, postintervention, and posttreatment.

Results

Both interventions significantly reduced anxiety levels; BBPT showed a greater reduction (p < 0.001) than aromatherapy. PR significantly decreased post-BBPT (p < 0.05) but not with aromatherapy. SpO2 levels improved significantly in the BBPT group (p < 0.05). Intergroup comparisons indicated BBPT had superior outcomes in reducing anxiety and PR and improving SpO2 levels compared to aromatherapy.

Conclusion

Both aromatherapy and BBPT effectively reduce dental anxiety in children, with BBPT offering additional benefits due to its interactive nature. Future research should explore long-term effectiveness and personalized approaches to optimize anxiety management strategies in pediatric dental settings.

Clinical significance

The relatively novel nonpharmacological behavior management techniques of aromatherapy and BBPT can be incorporated into the routine clinical practice of pediatric dentists to effectively reduce the anxiety of the patients. This would improve their cooperation during the treatment procedures, reduce the chairside time, and also improve the treatment outcome and subsequently, the overall quality of health care.

How to cite this article

Bartakke RR, Bhattad MS, Bargaje P, et al. Comparison of the Efficacy of Aromatherapy and Bubble Breath Play Therapy in Reducing Dental Anxiety in Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2025;18(1):29-33.

What influences the close contact between health care workers and patients? An observational study in a hospital dental outpatient department

BACKGROUND

Dental outpatient departments, characterized by close proximity and unmasked patients, present a considerable risk of respiratory infections for health care workers (HCWs). However, the lack of comprehensive data on close contact (<1.5m) between HCWs and patients poses a significant obstacle to the development of targeted control strategies.

METHODS

An observation study was conducted at a hospital in Shenzhen, China, utilizing depth cameras with machine learning to capture close-contact behaviors of patients with HCWs. Additionally, questionnaires were administered to collect patient demographics.

RESULTS

The study included 200 patients, 10 dental practitioners, and 10 nurses. Patients had significantly higher close-contact rates with dental practitioners (97.5%) compared with nurses (72.8%, P < .001). The reason for the visit significantly influenced patient-practitioner (P = .018) and patient-nurse (P = .007) close-contact time, with the highest values observed in prosthodontics and orthodontics patients. Furthermore, patient age also significantly impacted the close-contact rate with nurses (P = .024), with the highest rate observed in patients below 14 years old at 85% [interquartile range: 70-93].

CONCLUSIONS

Dental outpatient departments exhibit high HCW-patient close-contact rates, influenced by visit purpose and patient age. Enhanced infection control measures are warranted, particularly for prosthodontics and orthodontics patients or those below 14 years old.

Lack of assent to dental examination in children with intellectual disabilities: Dentists' practices in Europe and ethical issues

AIM

(1) To determine the repartition of criteria which can be considered as marks of lack of assent by the child with intellectual disabilities from the dentist's point of view and whether that influences the decision to examine the patient or not. (2) To explain the decision of practitioners and determine the ethical implications of these practices.

METHODS

An anonymous and structured questionnaire was distributed online using the scenario of a 9-year-old child with moderate cognitive impairment with eight different oppositional behaviours. The practitioners were asked about their perception of the patient's lack of assent and about their decision to perform the dental examination or not.

RESULTS

The proportion of them who performed a dental examination despite the patient's refusal represented between 13% and 28.8% of the population of respondents.

CONCLUSION

There was an ambivalence among the practitioners who carried out a dental consultation when children were uncooperative. They adopted a teleological point of view. It calls for us to reflect on the ethical principles of autonomy and beneficence.

Outpatient dental procedures carried out by Pediatric Dentists within Brazil's public healthcare system

Brazil's public healthcare system (SUS) offers specialized oral health services to Brazilians, but the productivity of specialists, such as Pediatric Dentists, has not been characterized. Therefore, the objective of this study was to characterize the outpatient dental procedures (ODPs) carried out by Pediatric Dentists within the SUS. An epidemiological study with an ecological, longitudinal, retrospective, and quantitative approach was conducted. The ODPs carried out by Pediatric Dentists within the SUS were characterized based on type of procedure, complexity level, and circumstance (urgent or elective). Data were analyzed using a descriptive and analytical approach, considering a significance level of 5%, as well as the impact of the COVID-19 pandemic (the 2020-2022 years were not included in secondary analyses). In the last 15 years, 29,234,972 ODPs were carried out by Pediatric Dentists within the SUS. Clinical procedures were the majority (55.4%), significantly more frequent than all other types of procedures (all p <0.05). Among these, restorative and periodontal procedures were the most common (30.7% and 21.0%, respectively). From 2008 to 2019, excluding COVID-19 pandemic years, the trend over the last 15 years was constant for all types of procedures (all p >0.05). In addition, low complexity ODPs were the majority (90.1%), significantly more frequent than medium (9.7%) and high complexity procedures (0.1%) (both p <0.05). At last, most ODPs were not characterized by circumstance in the outpatient production reports (96.9%). Therefore, it was possible to conclude that Pediatric Dentists carried out diverse ODPs within the SUS over the past 15 years, although there was a dominant pattern of type and complexity.

Labels and descriptions of dental behaviour support techniques: A scoping review of clinical practice guidelines

INTRODUCTION

There is no agreed taxonomy of the techniques used to support patients to receive professional oral healthcare. This lack of specification leads to imprecision in describing, understanding, teaching and implementing behaviour support techniques in dentistry (DBS).

METHODS

This review aims to identify the labels and associated descriptors used by practitioners to describe DBS techniques, as a first step in developing a shared terminology for DBS techniques. Following registration of a protocol, a scoping review limited to Clinical Practice Guidelines only was undertaken to identify the labels and descriptors used to refer to DBS techniques.

RESULTS

From 5317 screened records, 30 were included, generating a list of 51 distinct DBS techniques. General anaesthesia was the most commonly reported DBS (n = 21). This review also explores what term is given to DBS techniques as a group (Behaviour management was most commonly used (n = 8)) and how these techniques were categorized (mainly distinguishing between pharmacological and non-pharmacological).

CONCLUSIONS

This is the first attempt to generate a list of techniques that can be selected for patients and marks an initial step in future efforts at agreeing and categorizing these techniques into an accepted taxonomy, with all the benefits this brings to research, education, practice and patients.

Chairside oral prophylaxis for people with profound intellectual or multiple disabilities-a retrospective feasibility study

OBJECTIVES

People with severe intellectual or multiple disabilities (PIMD) have been receiving dental care in a specialized unit offering special care dentistry. For most of these adult patients, the initial consultation is complaint driven. In addition, the limited ability to cooperate due to their disabilities often means that dental treatment for these patients is usually carried out under general anesthesia (GA). Chairside treatment attempts are the exception rather than the rule. This retrospective study evaluated whether consistent practice of behavioral management principles and techniques embedded in a specific dental environment enables successful dental treatment of PIMD.

MATERIALS AND METHODS

The feasibility of chairside dental prophylaxis in PIMD (n=36) was analyzed: specific behavioral management techniques were applied, and professional tooth cleaning (PTC) was performed in the dental chair. Clinical data obtained from medical records and a questionnaire were analyzed.

RESULTS

All patients had severe intellectual or multiple disabilities and had previously undergone at least one dental treatment under GA. Of these patients, 55.6% never had their teeth professionally cleaned before. Applying different behavioral techniques, all patients were compliant with receiving PTC in the dental chair.

CONCLUSIONS

An individualized and disability-specific treatment strategy using various noninvasive and nonpharmacological behavioral guidance techniques resulted in a higher compliance rate in PIMD, which allowed chairside PTC and reduced the need for treatment under GA.

CLINICAL RELEVANCE

Consistent implementation of various behavioral guidance techniques and communication strategies in a supportive environment enabled all patients to receive chairside PTC and be involved in a lifelong recall program.

The Future of Pediatric Dentistry Is Now

For decades, pediatric dentistry was considered the Cinderella of all dental disciplines [...].