Anticipatory anxiety in children visiting the dentist: lack of effect of preparatory information

Interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety: a Chinese cross-sectional study

BACKGROUND

Children's dental anxiety is common in dental clinics. This study aimed to determine the interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety and its affecting factors.

METHODS

In this cross-sectional study performed in a dental clinic, primary school students and their mothers were assessed for enrollment eligibility. The Modified Dental Anxiety Scale plus Facial Image Scale (MDAS-FIS) was employed to test both the children's self-reported and their mothers' proxy-reported dental anxiety independently. The interrater agreement was analyzed using percentage agreement and the linear weighted kappa (k) coefficient. Factors affecting children's dental anxiety were analyzed using univariate and multivariate logistic regression models.

RESULTS

One hundred children and their mothers were enrolled. The median ages of the children and mothers were 8.5 and 40.0 years old, respectively, and 38.0% (38/100) of the children were female. The scores of children's self-reported dental anxiety were significantly higher than their mothers' proxy-reported dental anxiety (MDAS-Questions 1-5, all p < 0.05); moreover, there was no agreement between the two groups in terms of all anxiety hierarchies (kappa coefficient = 0.028, p = 0.593). In the univariate model, a total of seven factors (age, gender, maternal anxiety, number of dental visits, mother's presence or absence, oral health status, and having siblings or not) were involved for analysis, and age [every 1-year increase, odds ratio (OR) = 0.661, 95% confidence interval (CI) = 0.514-0.850, p = 0.001], several dental visits (every 1 visit increase, OR = 0.409, 95% CI = 0.190-0.880, p = 0.022), and mother presence (OR = 0.286, 95% CI = 0.114-0.714, p = 0.007) were affecting factors. In the multivariate model, only age (every 1 year increase) and maternal presence were associated with 0.697-fold (95% CI = 0.535-0.908, p = 0.007) and 0.362-fold (95% CI = 0.135-0.967, p = 0.043) decreases in the risk of children's dental anxiety during dental visits and treatment, respectively.

CONCLUSION

There was no significant agreement between elementary school students' self-reported dental anxiety and mothers' proxy ratings of children's dental anxiety, which suggests that self-reported dental anxiety by children should be encouraged and adopted, and the mother's presence during dental visits is strongly recommended.

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.

The Use of a Dental Storybook as a Dental Anxiety Reduction Medium among Pediatric Patients: A Randomized Controlled Clinical Trial

This randomized clinical trial aimed to evaluate the effectiveness of a specially designed dental storybook in reducing dental anxiety among children. Eighty-eight children (6−8 years old) were randomly divided into two groups: the intervention group (received the storybook) and the control group (did not receive the storybook). Three dental visits (screening, examination and cleaning, and treatment) were provided for each child. Anxiety was assessed following each visit using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Venham clinical anxiety scale (VCAS). The behavior was assessed using the Frankl’s Behavior Rating Scale (FBRS). The intervention group showed significantly lower anxiety and more cooperative behavior during treatment than the control group (p < 0.0001). The intervention group showed a significant decrease in anxiety scores and more cooperative behavior across time according to the CFSS-DS (p = 0.001) and Frankl behavior scale OR = 3.22, 95% CI 1.18−8.76. Multivariate models found that using the storybook was a significant independent factor in reducing anxiety and improving behavior after controlling for sex, previous visits, family income, and mother’s education. In conclusion, the dental storybook can decrease children’s dental anxiety and improve their behavior during dental treatment.

Impact of a Dental Storybook on Parents' Knowledge of Children's Oral Health: A Randomized Controlled Trial

PURPOSE

To evaluate the effectiveness of a dental storybook on parents' knowledge about oral health of their children and to assess their perception of its effect in reducing dental anxiety levels among their children, as well as improving their oral health knowledge.

PATIENTS AND METHODS

This was a two-arm parallel, single-blind, randomized controlled trial (RCT) which was performed at the pediatric dental clinics in the Dental University Hospital, King Saud University, Riyadh, Saudi Arabia. Parents of 88 children (6-8 years old) were included in the present study. Parents and their children were randomly divided into two groups as follows: the intervention group (received the storybook and verbal oral hygiene instructions) and the control group (only received verbal oral hygiene instructions; same information included in the book). Three dental visits, including screening, examination/cleaning and treatment, were provided for each child. In the screening visit, baseline parental oral health knowledge was evaluated for all parents. Afterward, parental oral health knowledge was re-evaluated in the examination visit. In the treatment visit, a parental perception questionnaire was administered to parents following treatment to evaluate their satisfaction regarding the use of the storybook in reducing anxiety levels among their children.

RESULTS

There was a significant improvement in the total knowledge score at the follow-up visit in the intervention group compared to the control group (P<0.0001). Overall, the majority of parents perceived the storybook as a useful source of information, and they found it to be effective in reducing dental anxiety levels among their children.

CONCLUSION

The dental storybook is an effective educational tool that can help parents become more knowledgeable about their children's oral health. Moreover, parents perceived the storybook as an effective tool for enhancing their oral health knowledge and lowering their children's dental anxiety.

The information needs of children having clinical procedures in hospital: Will it hurt? Will I feel scared? What can I do to stay calm?

BACKGROUND

Children often have unmet information needs when attending hospital, and this can cause them anxiety and uncertainty. If children are prepared and informed about what will happen during a procedure, they tend to have a better experience. Finding out what children want to know before they attend hospital for procedures could provide significant benefits for children, their families, and healthcare professionals. This study set out to investigate children's perspectives of what information is important and valuable to know before attending hospital for a planned procedure.

METHODS

A "write and tell" activity sheet underpinned a semistructured qualitative interview with children attending hospital for a planned procedure. The interview focussed on the information children thought was important to know before a procedure. Data were analysed using content analysis techniques.

RESULTS

One hundred six children aged between 8 and 12 years old participated in the interviews. The children identified 616 pieces of information they thought would be of value to children attending hospital for procedures. These were inductively coded into three types of information: procedural, sensory, and self-regulation. Children want to know detailed procedural and sensory information to actively construct a script of a procedure and then build on this with information about specific strategies to help them cope with and self-regulate the situation.

CONCLUSION

This study has identified three types of information children recognize as important in preprocedural preparation. Children construct an understanding of a planned procedure through actively scaffolding procedural, sensory, and self-regulation information.

Cognitive behaviour therapy for anxious paediatric dental patients: a systematic review

BACKGROUND

There is a paucity of evidence about cognitive behaviour therapy in the management of dentally anxious children.

AIM

To systematically review evidence of the effectiveness of cognitive behaviour therapy for children with dental anxiety or dental phobia.

DESIGN

Clinical trial registries, grey literature, and electronic databases, including The Cochrane Library, EMBASE, PubMed, Scopus, Web of Science, LILACS/BBO, and PsycINFO, were searched (April 2018). The reference lists of relevant studies were hand-searched. Randomised controlled trials that evaluated the effects of cognitive behaviour therapy on dental anxiety or on acceptance of dental treatment in dental patients up to 18 years were included. Two trained and calibrated reviewers performed the study selection and risk of bias assessment. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Six studies with a total of 269 patients, aged 41 months to 18 years, were included. Cognitive behaviour therapy decreased level of anxiety compared to control groups and improved cooperation/behaviour, although the quality of the evidence was low.

CONCLUSIONS

Cognitive behaviour therapy produces better anxiety reduction than diverse behavioural management techniques but the evidence was of low quality and further studies in children are needed.

Barriers and Drawbacks of the Assessment of Dental Fear, Dental Anxiety and Dental Phobia in Children: A Critical Literature Review

OBJECTIVE

Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry.

STUDY DESIGN

A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children.

RESULTS

104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia.

CONCLUSION

The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.

Dental anxiety: An understudied problem in youth

Dental anxiety and dental phobia typically emerge during childhood; the associated avoidance of dental care can result in oral health problems and is associated with lower quality of life. In this review, we discuss the definition of dental phobia and dental anxiety and issues related to their differentiation. We then review the literature on dental anxiety and dental phobia, including its prevalence, assessment, and sequalae. Moreover, we provide a synthesis of findings on the etiology and maintenance of dental phobia and propose a comprehensive cognitive behavioral model to guide further study. We also present a systematic qualitative and a quantitative review of the treatment literature, concluding that although we have made strides in learning how to prevent dental anxiety in youth, the methods effective in preventing anxiety may not be equally effective in treating youth with dental phobia. We propose a multidisciplinary approach, including those with expertise in pediatric anxiety as well as pediatric dentistry, is likely required to move forward.

Nonpharmacologic Intervention on the Prevention of Pain and Anxiety During Pediatric Dental Care: A Systematic Review

BACKGROUND

Nonpharmacologic interventions may be used to reduce fear and anxiety during dental treatment.

OBJECTIVES

To systematically review trials on the effect of nonpharmacologic interventions in behavior, anxiety, and pain perception in children undergoing dental treatment.

DATA SOURCES

Medline, Scopus, Web of Science and CINAHL, Google Scholar, and studies' reference lists.

PARTICIPANTS AND INTERVENTIONS

Studies performed with children and adolescents that evaluated the effect of interventions on children's behavior, anxiety, and pain perception during dental treatment were included.

STUDY APPRAISAL METHODS

Independent quality assessment of the studies was carried out following the classification categories present on the Cochrane Handbook for Development of Systematic Reviews of Intervention.

RESULTS

Twenty-two articles, reporting 21 studies, were selected. Most studies tested distraction techniques. Eight studies presented bias and results were not considered. The remaining 13 studies had control groups with inactive controls, and 4 also included a variation of the intervention. Of the 4 studies assessing behavior, 3 found difference between intervention and control. Anxiety was evaluated by 10 studies: 4 found differences between intervention and control and 2 found differences between interventions. Five studies investigated pain perception: 3 found difference comparing active versus inactive interventions. In 1 of the 3, variations in the intervention decreased pain perception.

CONCLUSIONS

More research is needed to know whether the techniques are effective for improving behavior and reducing children's pain and distress during dental treatment. However, the majority of the techniques improved child's behavior, anxiety, and pain perception.

Effect of Exposure to Positive Images of Dentistry on Dental Anxiety among 7 to 12 Years Old Children

Aim: To evaluate the effect of exposure to positive images of dentistry on dental anxiety among 7 to 12 years old children.

Materials and methods: Controlled trial. Assessment of anxiety and analysis of data were conducted blind to experimental condition. Assessment of anxiety was carried out in the waiting room prior intervention, postintervention into the operatory during the treatment and again after the completion of treatment. Anticipatory anxiety was recorded by Venham's picture test (VPT).

Participants: Sixty children of 7 to 12 years age group.

Intervention: Participants were randomly assigned to one of two conditions. In both conditions the participant was asked to look at photographs for 2 minutes in the waiting area prior to their appointment. The intervention consisted of viewing positive images of dentistry and dental treatment (study group), the (control group) consisted of neutral images. The assessment of anticipatory dental anxiety was made blind to experimental condition and statistical analysis was conducted blind to group membership. Anticipatory anxiety assessed by the VP T.

Results: A total of 60 subjects participated in the study and were equally and randomly allotted to study group (positive image) and control group (neutral image). The mean anxiety score found at waiting area before intervention, after intervention (OPD) and postoperative was statistically significant in study group. Post hoc comparison of anxiety score in study group showed high statistical significance.

Conclusion: Positive dental images have an effect on reducing anxiety as compared to neutral images when measured by the VPT.

How to cite this article: Gangwal RR, Badjatia SR, Dave BH. Effect of Exposure to Positive Images of Dentistry on Dental

Anxiety among 7 to 12 Years Old Children. Int J Clin Pediatr Dent 2014;7(3):176 -179.

Dental anxiety in 6-7-year-old children treated in accordance with conventional restorative treatment, ART and ultra-conservative treatment protocols

OBJECTIVE

To test the hypothesis that dental anxiety levels of children treated in accordance with the conventional restorative treatment (CRT) are higher than in children treated with the atraumatic restorative treatment (ART) or ultra-conservative treatment (UCT) protocols.

MATERIALS AND METHODS

In total, 302 children aged 6-7-years old, with at least two dentine carious lesions, constituted the sample. A parallel group study design was used with ART and UCT as test groups and CRT as the control. The treatment was divided into two sessions. In the first session, one carious tooth (class II in a primary molar) was randomly selected and treated according to one of the treatments. All other treatments were performed in the second session. Before the first (FIS Tx-1) and before the second session (FIS Tx-2) the level of dental anxiety was assessed using the Facial Image Scale (FIS). The GLM test and Spearman's Rank Correlation Coefficient were used to analyse the data.

RESULTS

No treatment group effect was observed on the FIS Tx-2 score (p = 0.64). A FIS Tx-1 score (p < 0.0001) effect on the FIS Tx-2 score was observed. The correlation coefficient between FIS Tx-1 and FIS Tx-2 scores was r = 0.30 (p < 0.0001).

CONCLUSION

At the beginning of the second session there was no difference in dental anxiety levels of the children treated in the first session according to the three treatment protocols. A high dental anxiety score before the first session was a predictor of a high dental anxiety score at the second treatment session.