Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study

Needs of non-pharmacological management versus sedation or general anesthesia for dental treatment in older adults with special needs: A systematic review

BACKGROUND

Adults with special needs have dental problems requiring treatment; however, patient management could be extremely difficult under local anesthesia. This review aimed to compare the needs of pharmacological approaches versus non-pharmacological approach for dental treatment to adults with special needs.

METHODS

This systematic review was registered in PROSPERO (CRD42024528488). The systematic search was conducted in databases: PUBMED; EBSCO; SCOPUS, April 10, 2024. Clinical studies published in English from 2000 to June 2024, demonstrating the needs for pharmacological as compared with non-pharmacological approach in older adults over 18 years old were included. The primary outcome was the completion of dental treatment.

RESULTS

Titles and abstracts were screened after the initial search, then forty studies were identified for potential inclusion. After retrieving full-text studies, Information relevant to objectives and outcome measures was recorded by using a data extraction form and analyzed again by three reviewers. Only 2 articles were eligible and included.

CONCLUSIONS

The best patient management approach could not be conclusive. Pharmacological approach remains necessary in many situations. Preparation of health care setting and multidisciplinary team is important to ensure patient safety. Further studies focusing on older adults with special needs are needed.

Parenting Styles and Sedation Efficacy in Pediatric Dental Care; A Study in Uncooperative Children Aged 4 to 6 Years: Structural Equation Modeling Approach

Background

Behavioral problems in children contribute significantly to non-compliance and lack of cooperation with dentists.This study aimed to assess the impact of parenting styles on the success of conscious sedation with midazolam in uncooperative children aged 4 to 6 years.

Methods

This short-term longitudinal study included ninety-six children aged 4-6 years who were classified as uncooperative according to the Frankl Behavior Rating Scale (Frankl I, II), requiring pulp treatment and Stainless-Steel Crown (SSC) restoration. Midazolam was orally administered at 0.25 mg/kg. Parenting Styles and Dimensions Questionnaire (PSDQ), Strengths and Difficulties Questionnaire (SDQ), and Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Treatment began at least thirty minutes post-drug administration. Vital signs were monitored using a pulse oximeter. Sedation effectiveness was assessed with the Houpt scale at local anesthesia injection (T0), cavity preparation (T1), restoration (T2), and treatment conclusion (T3). Statistical analysis used Mann-Whitney U test (P < 0.05).

Results

Most parents (69, 71.9%) had an authoritative parenting style, while 10 (10.4%) were authoritarian, and 17 (17.7%) were permissive. Authoritative parenting is associated significantly with sedation success (P = 0.001) and reduced dental fear (P = 0.008). Conversely, authoritarian (P = 0.031) and permissive (P = 0.001) parenting styles are associated with sedation failure. Authoritarian parenting is associated positively with increased dental fear (P = 0.001). No significant association was found between permissive parenting style and dental fear (P > 0.05). No significant association existed between behavioral problems and parenting styles (P > 0.05). There was no significant association observed between permissive parenting style and dental fear (P = 0.279). Similarly, no significant associations were found between behavioral problems and specific parenting styles: authoritative (P = 0.625), authoritarian (P = 0.050), and permissive (P = 0.522).

Conclusion

Understanding parenting styles aids in predicting conscious sedation success with midazolam and assisting in managing uncooperative children during dental procedures.

Dental treatment outcomes in Thai children treated for severe early-childhood caries under general anaesthesia and non-pharmacological behaviour management: a retrospective study

PURPOSE

The aim of this study was to compare dental-treatment outcomes, oral-hygiene improvement, and patient co-operation during follow-up visits between children treated under general anaesthesia (GA) and non-pharmacological behaviour management (NP).

METHODS

This retrospective study reviewed the dental chart records of healthy patients less than 71-month-old with severe early childhood caries (S-ECC) from 2008 to 2020 with at least a 6-month follow-up. The demographical data, dental-treatment outcomes, oral-hygiene status, and patient behaviour at the follow-up visits were analysed by the Mann-Whitney U test, Pearson's Chi-square, Fisher's exact test, Friedman test, and Wilcoxon test with a significance level of 0.05.

RESULTS

This study included 210 GA cases and 210 age-matched control NP cases. The GA group had a significantly higher caries experience, lower patient co-operation, poorer oral hygiene, and higher number of complex dental treatment than the NP group at baseline (p < 0.001). The number of children who had incomplete dental treatment under non-pharmacological behaviour management was higher than the GA group. After treatment, the number of new carious teeth in the NP group was significantly higher than in the GA group only at the 6-month follow-up. However, there was no significant difference in treatment failure, oral-hygiene improvement, and patient behaviour between groups.

CONCLUSION

Although patients in the GA group had higher dental and behaviour problems than the NP group, the overall dental-treatment outcomes, including oral hygiene and behaviour improvement, were not significantly different between groups Therefore, regular follow-up and preventive treatment in the maintenance phase are essential for children with severe early-childhood caries.

A Comparative Study of Parent and Child Perspectives on Using the Intranasal Mucosal Atomization Device for Behavior Management in Pediatric Dental Sedation

Background Dental anxiety in children often necessitates sedation for effective treatment. Different methods of sedation have proved to be beneficial. However, intranasal sedation provides a needleless, rapid drug delivery method that bypasses hepatic metabolism. Intranasal sedative drugs can be delivered using a mucosal atomization device (MAD). This study aimed to find the opinions, beliefs, and existing knowledge of parents and children regarding intranasal sedation and the method of drug delivery through MAD. Materials and methods The study comprised 50 parents, aged 20 to 50, who came in with a single child, aged five to nine years. In separate rooms, parents and kids were each shown a video about the use of the intranasal sedation technique with MAD as a pharmaceutical help during routine dental procedures. After the video presentation, each participant was required to complete a pretested self-made questionnaire with 21 questions and multiple-choice options. The chi-square test was used in the statistical analysis of the completed questionnaires (P < 0.05). Paired t-test was used for behavior assessment of the children before and after intranasal sedation. Results A significant correlation between parental socioeconomic status and acceptance of intranasal sedation was observed. Parents with higher education levels exhibited a greater level of acceptance (P = 0.000). Parents whose children had prior dental experiences were more likely to view intranasal sedation as a safe option (P = 0.038). Additionally, a significant proportion of previously sedated children expressed willingness to undergo treatment using intranasal sedation. Evaluation of children's behavior before and after treatment revealed a notable improvement, indicating the effectiveness of intranasal sedation (P = 0.000). Conclusion The study thoroughly investigated how parents and children view intranasal sedation via MAD. It revealed a positive perception of safety and trust among parents regarding this method for pediatric dental procedures.

Professional Attitudes and Practice of Pediatric Dentists About the Use of Local Anesthesia for the Treatment of Children Under General Anesthesia

Background

The application of local anesthesia in dental surgeries conducted under general anesthesia poses a challenge in pediatric dentistry. There is a lack of consensus regarding the benefits and drawbacks of using general anesthesia in this field.

Objectives

The purpose of this study was to assess the attitudes and practices of pediatric dentists regarding the use of local anesthesia for dental treatments in children under general anesthesia in Iran.

Methods

This cross-sectional study involved 110 pediatric dentists from across Iran. The dentists' professional attitudes and practices were assessed using a specially designed questionnaire for this study. The questionnaire was distributed through the Line press system, and the data were analyzed following collection.

Results

Regarding professional practices, 34.5% of specialists refrained from using local anesthesia. The most frequent application of local anesthesia was observed in tooth extractions. The preferred local anesthetic agent was 2% lidocaine with 1:100 000 epinephrine. A lower dose than that used in outpatient settings was administered, and most specialists allowed sufficient time for the anesthesia to take effect.

Conclusions

This study revealed that opinions and attitudes towards the use of local anesthesia in the dental treatment of children under general anesthesia vary across different specialties and are significantly influenced by the patient's condition, type of treatment, and practice techniques.

Longitudinal Study on Dental Status, Caries Risk Assessment, and Oral Health-Related Quality of Life in 3-6-Year-Old Children Receiving Nitrous Oxide Inhalational Sedation

Introduction Dental caries prevention in early childhood is crucial, necessitating timely assessments by dental professionals and parents. The oral health of children during their early years can significantly impact both the children themselves and their parents' quality of life. This study seeks to assess the changes in oral health-related quality of life after treatment under nitrous oxide sedation in anxious preschool children, for whom treatment otherwise is quite difficult chairside. Aim The aim of this study is to assess the association between dental caries status, risk assessment, and oral health-related quality of life (OHRQoL) in 3-6-year-old children, before and after undergoing treatment under nitrous oxide inhalation sedation. Materials and methods Eighty children were assessed for caries risk and dental status using the caries risk assessment for treatment (CRAFT) tool. Nitrous oxide sedation was employed for dental treatment, and assessments were conducted pre-treatment and post-treatment. Statistical analyses performed were paired t-tests, correlation analyses, and Chi-Square tests. Results The study revealed a mean age of 4.033 ± 0.96, with a balanced gender distribution (47.5% boys, 52.5% girls). Post-treatment, significant negative correlations were observed between OHRQoL and treatment outcomes, emphasizing improved oral health-related quality of life. Associations were found between OHRQoL, pufa index, and caries risk post-treatment. Conclusion The current research suggests that treatment done under nitrous oxide sedation could improve the OHRQoL in preschool children. Integrating risk assessment and OHRQoL enhances understanding, facilitating targeted prevention and treatment strategies. Addressing untreated dental caries is imperative for optimizing the overall well-being of children in this age group.

Evaluation of the effectiveness of tell-show-do and ask-tell-ask in the management of dental fear and anxiety: a double-blinded randomized control trial

Background

The objective of behavioral guidance is to establish effective communication that aligns with a child's requirements to manage disruptive behavior. This study aimed to evaluate the effectiveness of the Tell-Show-Do and Ask-Tell-Ask techniques in managing dental anxiety in children during their initial appointment.

Methods

The study included 50 children (28 boys and 22 girls) without any prior experience between the ages of 7 and 11 at their first dental visit. The children were randomly categorized into two groups: Group 1, Tell Shows Do, and Group 2, Ask-Tell-Ask. Subsequently, all children underwent noninvasive treatment procedures such as restorations, sealants, and oral prophylaxis. Furthermore, behavioral management techniques were employed based on the allocated group. Finally, anxiety levels for all children were assessed using the Raghavendra, Madhuri, and Sujata Pictorial Scale (RMS-PS) and heart rate at three different intervals (before, during, and after). The obtained data were entered into Microsoft Excel, and statistical analysis was performed using SPSS software. A paired t-test and Mann-Whitney U-test were used to compare the mean and median values of the two groups and determine their effectiveness.

Results

Children in the TSD group exhibited statistically significant heart rates and RMS-PS scores in intra-group comparisons. However, children in the ask-tell-ask group showed a significant reduction only in the RMS-PS scores (P < 0.001) but not in the measures used to assess heart rate (P < 0.001).

Conclusion

Tell-Show-Do was more effective than ask-tell-ask in alleviating dental anxiety in children. The simultaneous application of these two strategies can synergistically alleviate dental anxiety during a child's initial dentist appointment.

The residency levels' effect on pediatric dental rehabilitation operation time

BACKGROUND

Postgraduate pediatric dental residents' competency, to perform dental rehabilitation procedures under General anesthesia (GA), at different levels of training is challenging for operation time control. An adequate operation time (OT) for children decreases morbidity risk and improves hospital time utilization efficiency. The aim of the study is to assess the effect of pediatric dental resident training level on OT for pediatric dental rehabilitation procedures under GA at King Abdulaziz Medical City (KAMC).

METHODS

A cross-sectional study included pediatric dental rehabilitation performed under GA by pediatric dental residents at (KAMC) -Jeddah from October/2015 to September/2022. The primary outcome was OT, and the predictive variable was resident training levels. A linear regression analysis was used to compare OT between procedures performed by junior (years 1-2) or senior (years 3-4) trainees, adjusting for patient and operative factors.

RESULTS

One thousand seven pediatric dental rehabilitation cases were performed under GA by junior (13) and senior (31) residents. The univariant analysis indicated that OT for senior residents was significantly longer (13 min) than for junior residents. However, the linear regression analysis showed that senior residents had a significantly shorter OT when considering the more dental procedures performed per case under GA than junior residents. Senior residents took significantly more radiographs and performed more primary pulp therapies and multi-surface anterior colored restorations under GA than junior residents.

CONCLUSIONS

The OT for pediatric dental rehabilitation procedures under GA is associated with resident training level. The total OT was significantly longer based on procedure number, type, and resident level. The study indicated that senior residents could manage more complex cases in a shorter time. The finding emphasizes the importance of assigning GA cases to residents based on their level and the case's complexity. Additionally, it helps standardize the resident privileges under GA and understand the impact of residency training on hospital efficiency.

Silver diamine fluoride modified atraumatic restorative treatment compared to conventional restorative technique on carious primary molars-A randomized controlled trial

OBJECTIVE

To compare the success of silver diamine fluoride-modified atraumatic restorative technique (SMART) with that of the conventional drill and fill method in restoring carious lesions in primary molars.

METHOD

Children (4-8years old) reporting to a tertiary care hospital setting with asymptomatic cavitated dentinal carious lesions in primary molars were randomly allocated to two groups; SMART and Conventional; and subsequently restored with Glass Ionomer Cement (GIC). Follow-up evaluations were carried out by blinded independent evaluator at 6-months intervals to assess the status of restorations. Primary outcome was the success of restorations at 24 months and the secondary outcome was the child's behaviour and acceptance of the treatment at the time of interventions. Two sample Z-test of proportion, logistic regression analysis and Chi-square test were used to compare the outcomes in two groups.

RESULTS

A total of 226 children (SMART group, 112 and conventional, 114) were included with 280 and 282 GIC restorations placed by the SMART and the conventional method respectively. At 24-months, 459 (81.6 %) primary molars were available for evaluation. Success rates of restorations was 38.4 % and 45.8 % % in SMART and conventional groups respectively (p = 0.105). The rate of acceptability of treatment in the SMART and conventional group was 79 % and 56 % (p<0.001) respectively.

CONCLUSION

There was no significant difference in the success rates of GIC restorations by SMART and conventional technique in carious primary molars at 24 months. SMART was better accepted by children as compared to the conventional restorative technique.

CLINICAL SIGNIFICANCE

SMART can be an alternative option to treat the asymptomatic carious lesions in primary molars and is well accepted by children than the conventional drill and fill technique thus implying that it has a useful role in un-cooperative children.

Effect of forceful suction and air disinfection machines on aerosol removal

BACKGROUNDS

Dental procedures involving drilling and grinding can produce a significant amount of suspended aerosol particles (PM) and bioaerosols. This study aims to analyze the size and concentration of aerosol particles generated during drilling and to investigate the effectiveness of two air exchange systems, namely forceful suction (FS) and air disinfection machines (DM), in removing PM.

METHODS

For this study, 100 extracted permanent teeth were collected and divided into three groups: without suction (n = 50), suction with forceful suction (n = 25), and suction with air disinfection machines (n = 25). The removal rate of suspended aerosol particles was analyzed using particle counters and air data multimeter.

RESULTS

When drilling and grinding were performed without vacuum, 0.75% of the aerosol particles generated were PM2.5-10, 78.25% of total suspended aerosol particles (TSP) were PM2.5, and 98.68% of TSP were PM1. The nanoanalyzer measurements revealed that the aerodynamic diameter of most aerosol particles was below 60 nm, with an average particle diameter of 52.61 nm and an average concentration of 2.6*1011 ultrafine aerosol particles. The air change per hour (ACH) was significantly lower in the air disinfection machines group compared to the forceful suction group. Additionally, the number of aerosol particles and mass concentration was significantly lower in the air disinfection machines group compared to the forceful suction group in terms of PM2.5 levels. However, the forceful suction group also reduced the mass concentration in PM10 level than the air disinfection machines group.

CONCLUSION

In conclusion, the air exchange system can reduce the aerosol particles generated during drilling and grinding. Comparing the two air exchange systems, it was found that the air disinfection machines group reduces the number of aerosol particles and mass concentration in PM2.5 levels, while the forceful suction group reduces the mass concentration in PM10 level.

Pediatric Dental Emergencies during the COVID-19 Pandemic in Romania: A Retrospective Study

Pediatric dental emergencies can occur as a result of untreated dental caries, or can be caused by trauma or periodontal issues. The lockdown imposed during the COVID-19 pandemic reduced the number of centers authorized to deliver dental services in Romania, with only a small number of dentists delivering dental emergency treatments. The aim of this study was to investigate the demographic characteristics of children and adolescent patients who were treated in the dental emergency department of Oradea, Romania and to compare the patients who were treated in the dental emergency department in the pre-lockdown (2019), lockdown (2020) and post-lockdown year (2021). All patients who were treated in the dental emergency department were included in the study except for adults and medical files that did not contain all relevant information. Several variables were investigated (age, gender, living environment, location of affected teeth, type of emergency). In 2019, 257 children and adolescents were treated, in 2020, 198, and in 2021, 136. Most patients were aged 7-12 years in all investigated years (2019-47.9%; 2020-50.5%; 2021-43.4%), and the most affected teeth were located in the lower posterior arch (2019-53.3%; 2020-53%; 2021-48.5%). The most frequent emergencies were pulpitis (2019-40.5%; 2020-43.9%) and acute apical periodontitis (2021-42.6%). It was observed that in 2019, patients aged between 0 and 6 years were more frequently associated with trauma (p < 0.001), and in 2019 and 2020, patients aged between 7 and 12 years were more frequently associated with periodontal emergencies (p < 0.001). In 2020, patients from rural areas were more frequently associated with pulpitis (p = 0.025), and in 2021, patients from rural areas were more frequently associated with pulpitis or acute apical periodontitis, and patients from urban areas were associated more frequently with periodontal emergencies (p = 0.042). Pediatric patients with ages between 7 and 12 years old, who lived in an urban environment were most affected. Teeth located in the lower and upper posterior dental arches were most affected, and pulpitis or acute apical periodontitis were the most common pathologies.

Behavioral and Dental Management of a Pediatric Patient Diagnosed with Autoimmune Encephalitis: A Case Report

Background

This is a case report presenting the behavioral and dental management of a 9-year-old child recently diagnosed with autoimmune encephalitis, seizure disorder, and psychosis and treated with anticonvulsant and antidepressant medications. In this case, seizure semiology was presented as eye blinking during the attack, and the child was usually not conscious. It is absorbed by itself and associated with a post-sleeping attack that lasts for minutes.

Case description

Parents presented to the pediatric dental clinic with a chief complaint of decayed teeth that needs to be restored. The child has mixed dentition and is diagnosed with anterior crossbite and single posterior crossbite. The child was cleared by the pediatric neurologist and psychiatrist and had no contraindications to dental treatment under local anesthesia. The child's treatment was completed on the dental chair without any seizure attacks, and the patient's chief complaint was resolved.

Conclusion

Pediatric dentists should be educated about dental precautions and consider drug interactions when treating children with autoimmune encephalitis. Various types of non-pharmacological behavior guidance techniques and pharmacological methods of behavior management techniques can aid in the behavioral management of children with psychosis.

How to cite this article

Alowi WA, Baghlaf K. Behavioral and Dental Management of a Pediatric Patient Diagnosed with Autoimmune Encephalitis: A Case Report. Int J Clin Pediatr Dent 2023;16(2):416-419.

Oral Care for Children with Special Healthcare Needs in Dentistry: A Literature Review

Oral health is a very important aspect of general health, especially for vulnerable groups such as children with special healthcare needs. It is important to provide appropriate oral care in order to promote quality of life and good health for everyone, especially for children with special healthcare needs. Method: We reviewed the recent literature to collect knowledge regarding the delivery of quality oral care to children with special healthcare needs. We also explored some of the treatment management options that could address the needs of these children when attending dental clinics. Result: Unfortunately, we noted significant inequalities with issues related to oral health among those children. This situation often results in limitations to the activities of daily living for these children. There is therefore a need for much-needed advancements and refinements in oral healthcare to address the needs of children who have special healthcare needs. Conclusions: Providing children with special healthcare needs with high-quality dental care may necessitate active liaisons with healthcare facilitators and will require work across professions to make certain that these children’s oral health is also prioritized. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.

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.

Does the Efficacy of Behavior Management Techniques Differ Between Children From Single-Child and Multi-Child Families?: A Quasi-Experimental Study

Aim

Behavior management techniques (BMTs) efficiently deliver dental treatment to children with dental anxiety. The objective of this quasi-experimental study was to examine whether the efficacy of BMTs applied for the improvement of compliance in pediatric patients differs between children 3–10-year-olds from single-child and multi-child families.

Materials and Methods

In this quasi-experimental, 197 caregiver-child couples were divided into two groups: single-child group (116 couples) and multi-child group (81 couples). Children's pre- and post-treatment anxiety levels were measured by facial mood scale (FMS) and Frankl Behavior Rating Scale (FBRS), respectively.

Caregivers' dental anxiety was measured by the Chinese version of the Modified Dental Anxiety Scale (MDAS), which was included in the self-designed questionnaire. Data were analyzed by using the Mann-Whitney U-test, chi-square tests, and binary multivariate regression analysis.

Results

There was no statistically significant difference in the demographic characteristics of the children between the two groups. BMTs were found to be capable of reducing children's dental anxiety (CDA): the compliance rate was 45.69–88.79% in the single-child group and 44.44–85.79% in the multi-child group pre- and post-BMTs, but there was no significant difference in the change of compliance between the two groups (p > 0.05). In the subgroup analysis, parenting style (odds ratio [OR] = 0.054, p < 0.05) and father's education (OR = 8.19, p < 0.05) affected the varies of children's compliance in the single-child group. In contrast, in the multi-child group, gender (OR = 8.004, p < 0.05) and mother's occupation (OR = 0.017, p < 0.05) were associated with these changes in compliance.

Conclusions

In this study, BMTs were proved to be beneficial in improving compliance in 3- to 10-year-olds children in dental treatment. Though there was no significant difference in the change of compliance between children from single-child and multi-child families, different associated factors may affect the two groups. Therefore, the related family factors should be taken into account when professionals manage each child's behavior in dental practice.

Prevalence and Parental Attitude Toward Nitrous-Oxide and Papoose-Board Use in Two Dental Referral Centers in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Parental preferences and attitudes strongly influence dentists' choices for managing children's behavior in clinics. This study aimed to assess parental attitudes toward two behavior management technique (BMTs)-nitrous oxide (N2O) sedation and/or protective passive stabilization by papoose board (PB)-before and after their children received dental treatment at two referral centers in Jeddah, Saudi Arabia.

METHODS

Participants were parents of healthy children who required dental treatment under N2O and/or PB over an 18-month period. Before and after dental treatment, parents answered a questionnaire on their attitudes toward BMTs used on their children. Parents were divided into three groups: Group 1 (parents of children who received N2O), Group 2 (parents of children who received PB), and Group 3 (parents of children who received both N2O and PB).

RESULTS

Out of the 132 parents who answered the questionnaire, 106 (80.3%) were in Group 1, 10 (7.6%) in Group 2, and 16 (12.1%) in Group 3. More children of parents with low monthly family incomes were in Group 3 than Group 1 compared to other family-incomes.

CONCLUSION

Parental attitudes toward N2O and/or PB improved after their children experienced BMTs. The future use of PB alone with their child's sibling was parents' least preferred BMT (p = 0.001).