A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety

Using virtual reality to manage pain and anxiety during dental treatments in patients with stroke: A case series

Dental anxiety is common post-stroke, with many patients unable to receive standard anesthetics. Virtual reality has been increasingly used to manage pain and anxiety in dentistry, though its use in individuals with stroke is largely unexplored. A case series of two patients with a history of stroke and dental anxiety was conducted at a specialized dental clinic. Patients watched 360°-virtual reality videos in a dental chair using a head-mounted display. Outcomes (patient: dental anxiety and pain, reactions to virtual reality; dental team: system usability, impact on workflow) were assessed using a standard observation tool, questionnaires, and interviews. Both patients wore virtual reality throughout the procedure and reported that the device was comfortable, provided a distraction, and had potential to reduce anxiety/pain. The dentist reported a positive impact on patient anxiety and time to complete procedures, and intends to continue using virtual reality with other stroke patients and clinical populations.

Virtual Reality Distraction: A Novel Behaviour Management Technique

Virtual reality distraction (VRD) is developing technologies for behavior management that can assist a child in adjusting to the dental setting and provide high-quality dental care. The purpose of this literature is to shed light on VRD and its application to the treatment of pediatric dental patients.

Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A Split-Mouth Randomized Crossover Clinical Trial

Materials and Methods

This crossover clinical trial was conducted with eligible 6-8-year-old children requiring bilateral mandibular molar pulpotomy. At the first treatment visit, pulpotomy was performed for 15 children using VR glasses distraction while the other 15 children received a pulpotomy without any VR glasses; this trend was reversed at the second session and pulpotomy was performed for the contralateral tooth. Pulse rate (PR) and Modified Child Dental Anxiety Scale (MCDAS) measured the anxiety levels. Wong-Baker Faces Pain Scale (WBFP) assessed the pain perception before and after the intervention. Data were analyzed by Statistical Package for the Social Sciences version 25 using the Mann-Whitney and χ2 tests.

Results

The mean PR was not significantly different between the two groups. However, the test group showed significantly lower scores of MCDAS (P value = 0.02) and WBFP (P value = 0.001) compared with the control group.

Conclusion

The present results suggest that VR headsets can decrease the level of pain and anxiety of patients during primary mandibular pulpotomy. This trial is registered with IRCT20200315046782N1.

Virtual reality in managing dental pain and anxiety: a comprehensive review

Objectives

This study aimed to identify, analyze, and summarize the clinical efficacy of virtual reality (VR) distraction therapy for oral treatment in different hospital settings in contrast to medical interventions that induce anxiety and pain. Furthermore, this review aimed to determine the implications for research and clinical practice of VR distraction therapy.

Data

This review investigated the clinical efficacy of VR in the oral treatment of procedural pain or anxiety. Quality assessment of the included studies was conducted. A narrative synthesis of the collected data was performed.

Sources

Literature studies from six electronic databases were searched for a comprehensive review, namely, the Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials (Central), MEDLINE (PubMed), EMBASE, Scopus, and Web of Science.

Study selection

One thousand five hundred twenty-two patients aged between 0 and 60 years who used VR during dental treatment were included in this review. Among these studies, 8 and 14 studies comprised adult and pediatric patients.

Conclusion

Overall, the reviewed studies underscore the efficacy of VR to mitigate pain and anxiety in the context of dental treatment. VR is an innovative pain and anxiety management approach that facilitates dental treatment patients to immerse themselves in a virtual world while using distractions to reduce pain and anxiety.

Clinical significance

VR is an effective and novel non-pharmacological method of behavioral management that contributes to improving medication safety for dental patients. VR as a distractive approach can reduce the fear associated with medical interventions and prevent severe pain sensitivity, anxiety, and medical avoidance among adults and children.

Effects of a Virtual Reality Game on Children's Anxiety During Dental Procedures (VR-TOOTH): Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Dental fear and anxiety (DFA) is a condition that affects approximately one-quarter of children and adolescents. It is a significant cause for pediatric patients to avoid dental care later in adulthood. Lack of patient cooperation due to DFA can create an environment of stress, often obligating dentists to end appointments prematurely and consider alternative pharmacological treatment options. Virtual reality (VR) use during dental care, providing an immersive experience through sensory stimuli, is potentially an additional nonpharmacologic tool to better manage DFA in children with special health care needs (SHCN) undergoing dental procedures.

OBJECTIVE

This pilot study aims to assess the feasibility and acceptability of VR immersion as a tool to reduce DFA in pediatric special needs patients undergoing dental procedures. The study also aims to gain insight on parent and health care provider perspectives on the use of VR during dental appointments.

METHODS

This pilot randomized controlled trial study will follow a parallel design including 2 groups: a control group (clinic's standard care using a wall TV) and an experimental group (using a VR game). We will randomize 20 participants to either group. Recruitment will be carried out at the dental clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary-quaternary care center that mostly serves pediatric patients with SHCN. The primary outcome will be patient recruitment rates and completion rates of planned procedures. DFA in children will be assessed using both an observation-based proxy assessment with the Venham Anxiety and Behavior Rating Scale and physiological assessments using parameters such as change in heart rate and levels of salivary alpha-amylase as a stress biomarker before and 10 minutes after the procedure. Sociodemographic characteristics, measures of the levels of parent and health care professional satisfaction, occurrence of side effects, and any deviation from normal procedure length will also be collected. Descriptive statistics, nonparametric tests, and effect sizes will be used for demographic and clinical variables and to present parent and health care professional satisfaction levels as well as procedural time.

RESULTS

This study will be conducted from May 2023 to May 2024, with results expected to be available in December 2024.

CONCLUSIONS

The pilot study will provide insight on the feasibility and acceptability of VR use in clinical dentistry to reduce DFA for pediatric patients with SHCN. This study will guide future research on VR use in pediatric dentistry and can serve as a framework for a larger randomized clinical trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05898100; https://classic.clinicaltrials.gov/ct2/show/NCT05898100.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49956.

Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature

BACKGROUND

It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments.

METHODS

The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations.

RESULTS

Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered.

CONCLUSIONS

this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.

Effects of preoperative education using virtual reality on preoperative anxiety and information desire: a randomized clinical trial

This study aimed to investigate the effect of preoperative education using virtual reality (VR) on preoperative anxiety and information desire. The participants were randomly assigned to the VR group and control group. The VR group received preoperative education using VR content describing preoperative and postoperative processes and their management, and the control group received preoperative education with traditional verbal education. Preoperative anxiety and information desire were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Additionally, patient satisfaction was investigated. Preoperative anxiety (APAIS-A) and information desire (APAIS-I) scores were statistically significantly different between the VR group and the control group (p < 0.001). Patient satisfaction was not statistically significant (p = 0.147). Preoperative education using VR effectively reduced preoperative anxiety and information desire.Trial registration CRIS, KCT0007489. Registered 30 June 2022. http://cris.nih.go.kr/cris/ .

The Use of Patient-Oriented Mobile Phone Apps in Oral Health: Scoping Review

BACKGROUND

Oral health is a significant part of general health. Poor oral health can influence an individual's appearance, self-esteem, eating, and speaking. The use of mobile phone apps has been growing in the field of medicine, including dentistry. However, to date, there is no evidence related to the availability of mobile apps focusing on various branches of dentistry.

OBJECTIVE

The aim of this study was to review the scientific literature on the use of patient-oriented mobile phone apps in oral health and summarize the key findings.

METHODS

A scoping review of published scientific literature on the use of patient-oriented mobile phone apps in oral health was conducted in accordance with the Joanna Briggs Institute. A search was performed in PubMed and Scopus for studies published between January 2000 and June 2021 that were written in English. All study types except for those reporting developmental protocols were included in this review. In total, 2 reviewers independently screened the studies using the eligibility criteria. The study protocol was registered in the Open Science Framework registries in June 2021.

RESULTS

The initial search yielded a total of 977 studies, 45 (4.6%) of which met the inclusion criteria. All the studies (45/45, 100%) were published after 2009. Most studies (31/45, 69%) concerned oral health promotion using mobile phone apps, followed by behavior management (5/45, 11%). More than half (23/45, 51%) of the included studies were conducted in Asian countries. Overall, 31% (14/45) of the studies focused on adolescents. A total of 51% (23/45) of the studies were randomized controlled trials (RCTs). Approximately 39% (9/23) of the included RCT studies reported a substantial reduction in dental plaque, and 26% (6/23) of the studies reported significant improvement in gingival health. Regarding dental anxiety management, 13% (3/23) of the RCT studies reported a significant decrease in mean heart rate and lower Facial Image Scale scores.

CONCLUSIONS

According to the literature, the use of mobile apps in oral health is increasing among patients, mainly children and adolescents. Many studies that have used mobile apps have focused on promoting oral health. However, other areas such as diagnostic and remote consultations (teledentistry) have until recently been neglected despite their great potential.

A Literature Review of the Future of Oral Medicine and Radiology, Oral Pathology, and Oral Surgery in the Hands of Technology

In the realm of dentistry, a myriad of technological advancements, including teledentistry, virtual reality (VR), artificial intelligence (AI), and three-dimensional printing, have been extensively embraced and rigorously evaluated, consistently demonstrating their remarkable effectiveness. These innovations have ushered in a transformative era in dentistry, impacting every facet of the field. They encompass activities ranging from the diagnosis and exploration of oral health conditions to the formulation of treatment plans, execution of surgical procedures, fabrication of prosthetics, and even assistance in patient distraction, prognosis, and disease prevention. Despite the significant strides already taken, the relentless pursuit of new horizons fueled by human curiosity remains unabated. The future landscape of dentistry holds the promise of sweeping changes, notably characterized by enhanced accessibility to dental care and reduced treatment durations. In this comprehensive review article, we delve into the pivotal roles played by AI, VR, augmented reality, mixed reality, and extended reality within the realm of dentistry, with a particular emphasis on their applications in oral medicine, oral radiology, oral surgery, and oral pathology. These technologies represent just a fraction of the technological arsenal currently harnessed in the field of dentistry. A thorough comprehension of their advantages and limitations is imperative for informed decision-making in their utilization.

The Future of Dental Care: The Manipulation of Dental Instruments & Preparation Towards Automated Tooth Cleaning

Dentistry is an essential practice to maintain the health of the oral cavity. Recent advances in digitization and technology for oral examinations have improved the speed and ease of disease diagnosis and dental treatment. Dental robotics has emerged as a new field of dentistry and offers numerous benefits to dental professionals and society. This paper proposes an innovative design of a dental robot setup with a preliminary study on a head model for the preparation of automated dental exploration in MATLAB and discusses further considerations for automation.

Clinical evaluation of feasibility and effectiveness using a virtual reality device during local anesthesia and extractions in pediatric patients

PURPOSE

Pediatric dentistry requires more than routine dental knowledge and skills in executing quality dental care. The quality of dental treatment is indirectly proportional to a child's anxiety and fear. The recent distraction technique, the use of virtual reality (VR) devices has intrigued many researcher's minds. Therefore, this study was conducted to assess the clinical feasibility and effectiveness of the VR device in reducing pain and anxiety in pediatric patients during mandibular primary molar extraction.

METHODS

This research trial had 30 healthy children between the ages of 6 and 12 who required mandibular primary molar extraction. The subjects were divided into two groups using a simple randomization method. In the study group (n = 15), extraction was carried out using a VR device, whereas, in the control group (n = 15), extraction was carried out without the use of a VR device. Pre- and post-extraction anxiety levels were measured by Venham's picture test (VPT) and the heart rate. After the procedure, pain and behavior were evaluated by the Wong-Bakers Faces pain rating scale (WBS) and FLACC Scale respectively.

RESULTS

The pre-extraction values of the VPT and heart rate showed no statistically significant difference. This indicates that participants of both groups had a similar level of anxiety at baseline. There was a statistically significant increase (p = 0.028) between pre- and post-heart rates in the control group, with no significant change in the study group.

CONCLUSION

The use of a virtual reality device in children can reduce anxiety during primary molar extractions as evaluated by heart rate. Virtual reality devices might be an adjunct to high-quality dental care and to other behavior management methods. Definitive outcomes can be attained by encouraging studies overcoming the present limitations, and considering salivary biochemical indicators for the assessment of these devices.

Web-Based Interventions Reduced Dental Anxiety among Adults in Lithuania and Norway: A Pilot Study

Dental anxiety (DA) is a prevalent public health issue. However, there is a lack of self-administered DA interventions. The aim of this study was to evaluate the short-term effects of web-based interventions aiming to reduce DA in adults in two European countries. A pretest posttest design was used. Tailor-made websites were developed in Lithuania and Norway. Volunteers who self-reported DA were invited to participate. DA levels measured by the Modified Dental Anxiety Scale (MDAS) were assessed at baseline and after two weeks via online questionnaires. The interventions were completed by 34 participants in Lithuania and 35 participants in Norway. In Lithuania, the median posttest MDAS score (9.5, IQR 5.25) decreased compared to the median pretest MDAS score (14.5, IQR 8; Z value = -4.246, p < 0.001). The same was found in Norway-the median posttest MDAS score (12, IQR 9) was lower compared to the median pretest MDAS score (15, IQR 7; Z value = -3.818, p < 0.001). The present study demonstrated that two tailor-made web-based interventions had the potential to reduce dental anxiety levels when assessed in the short term in Lithuania and Norway. Studies with more controlled designs assessing long-term outcomes are needed to validate the results of this pilot study also in other cultures.

Comparative evaluation of the effect of audio and virtual reality distraction on the dental anxiety of healthy and mild intellectually disabled children

Context

Dental environment is one of the most anxiety-provoking stimuli for children, which makes patient management a constant challenge in both typically growing and intellectually disabled children. Distraction is a nonpharmacological technique to manage anxiety in children during dental treatment.

Aim

This study compares the effect of audio and virtual reality (VR) distraction on the dental anxiety of healthy and mild intellectually disabled children.

Methods

Forty children aged 6-14 years were divided into two groups (Group I: children with mild intellectual disability and Group II: healthy children). Groups I and II were further subdivided into two subgroups of 10 children each, based on the distraction technique given to them during the first appointment. After 1 month, we carried out a cross-over of the subgroups. Anxiety levels were measured using physiological and observational parameters at three-time intervals.

Statistical Analysis

Performed using paired t-test for the intergroup comparison and Wilcoxon Signed Rank test for the intra-group comparison.

Results

A decrease in the pulse rate, improvement in oxygen saturation levels, and lower Venham's anxiety rating scores were observed on introducing audio and VR distraction in all the subgroups. The inter-group comparison revealed that audio and VR were more effective in healthy children than children with mild intellectual disabilities.

Conclusions

Audio and VR distraction techniques can be employed successfully to reduce anxiety in children with mild intellectual disability and healthy children undergoing dental restorative treatment.

Mobile virtual tooth morphology teaching environment for preclinical dental students

OBJECTIVES

Extended reality as an additional digital learning concept comprises virtual reality (VR), augmented reality, and mixed reality. In particular, VR allows an interaction in the virtual world. The aim of this study was to evaluate the students' attitude toward a mobile VR application for teaching tooth morphologies.

METHODS

Eighty-two first year dental students were enrolled. After using the VR learning environment with mobile VR glasses at home for 1 week, the students were asked to fill in a questionnaire with 21 questions regarding intuitive handling, and supplemental learning information in comparison to the use of conventional textbooks. Nine questions provided predefined answer options, another nine had the form of a visual analog scale (VAS, range 0%-highly negative to 100%-highly positive), and three allowed free text answers. The data were checked for normal distribution (Kolmogorov-Smirnov test) and was analyzed descriptively.

RESULTS

Forty-four percent of the students rated their perception of understanding of dental morphologies much better with VR than with conventional learning. The potential of the VR learning environment for further dental topics was assessed with a median VAS score of 75.8%. Its intuitive handling was evaluated with a median VAS score of 67.1%. The haptic, visual, and auditory supplemental learning information was consistently rated positively with VAS scores of 73.9%, 80.0%, and 71.6%, respectively. Overall, a majority of the students (85.5%) recommended the VR learning environment for dental morphology.

CONCLUSIONS

The VR dental learning environment allows dental students an additional learning opportunity of dental morphologies, recommended by more than 85% of students.

Systematic review of the development and effectiveness of digital health information interventions, compared with usual care, in supporting patient preparation for paediatric hospital care, and the impact on their health outcomes

Background and aim

Elective surgery can be overwhelming for children, leading to pre-operative anxiety, which is associated with adverse clinical and behavioural outcomes. Evidence shows that paediatric preparation digital health interventions (DHIs) can contribute to reduced pre-operative anxiety and negative behavioural changes. However, this evidence does not consider their design and development in the context of behavioural science. This systematic review used the Theoretical Domains Framework (TDF) to evaluate the design and development of DHIs used to support children up to 14 years of age and their parents, prepare for hospital procedures, and determine any correlation to health outcomes. It also considered whether any behavioural frameworks and co-production were utilised in their design.

Methods

A search of the MEDLINE, EMBASE, PsycINFO, and HMIC databases was carried out, looking for original, empirical research using digital paediatric preparation technologies to reduce pre-operative anxiety and behavioural changes. Limitations for the period (2000-2022), English language, and age applied.

Results

Seventeen studies were included, sixteen randomised control trials and one before and after evaluation study. The results suggest that paediatric preparation DHIs that score highly against the TDF are (1) associated with improved health outcomes, (2) incorporate the use of co-production and behavioural science in their design, (3) are interactive, and (4) are used at home in advance of the planned procedure.

Conclusion

Paediatric preparation DHIs that are co-produced and designed in the context of behavioural science are associated with reduced pre-operative anxiety and improved health outcomes and may be more cost-effective than other interventions.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022274182.

The Use of Virtual Reality to Reduce Pain and Anxiety in Surgical Procedures of the Oral Cavity: A Scoping Review

PURPOSE

Virtual reality (VR) is considered a nonpharmacological intervention to manage pain and anxiety for different procedures. We aimed to review the literature about the role of VR in reducing pain and anxiety in surgical procedures performed in the oral cavity.

METHODS

A literature review was conducted using Medline and Embase with no restrictions on language or publication date. Our inclusion criteria were articles related to the use of VR to manage perioperative pain and anxiety on procedures in the oral cavity.

RESULTS

Twenty-seven articles met the inclusion criteria. The number of publications increased significantly from 2 studies between 2000-2010 to 25 between 2011 and 2021. Of the 27 included studies, 22 (81.4%) studied patients undergoing dental procedures, and 5 (18.5%) in oral and maxillofacial surgery (OMS). There was heterogeneity in the VR software used in the different studies. Thirteen studies (41.9%) evaluated self or observational assessments of pain and anxiety. Pain alone was evaluated in 9 studies (29%) and anxiety alone in 8 studies (25.8%). Also, 6 studies (19.3%) evaluated physiological parameters such as heart rate and respiratory rate as objective measures of pain and anxiety. In oral surgery studies, VR was effective at reducing acute pain, fear, and anxiety levels.

CONCLUSIONS

There is a paucity of research in OMS compared to dentistry. Given that this specialty involves highly stimulating and anxiety-provoking procedures, OMS could benefit from VR intervention for improved patient care.

Effect of a game-based intervention on preoperative pain and anxiety in children: A systematic review and meta-analysis

BACKGROUND

Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological.

AIMS

To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients.

METHODS

A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication.

RESULTS

26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded.

CONCLUSIONS

Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients.

RELEVANCE TO CLINICAL PRACTICE

In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients' emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.

Increasing empathy for children in dental students using virtual reality

BACKGROUND

Virtual reality (VR) can be used to simulate the viewpoint of a child to allow dental students to experience what a child experiences during a dental visit.

AIM

The aim of this study was to evaluate the effect of VR simulation on the empathy and comfort managing children among dental students.

DESIGN

Sixty dental students experienced a VR scenario created for the study. Empathy levels were examined using the Jefferson Scale of Empathy (JSE). A self-administered questionnaire was used to collect information on self-perceived ability, comfort and impact of the intervention.

RESULTS

There was a significant (p = .004) increase (indicating greater empathy) in JSE scores between pre-intervention (112.35 ± 9.34) and post-intervention (117.64 ± 10.03), which returned to baseline 3 months later (112.72 ± 10.36). Dental students perceived themselves to be more confident at communicating (6.45 ± 1.64 vs. 5.75 ± 1.71, p = .011) and interacting (6.63 ± 1.44 vs. 6.00 ± 1.78, p = .046) with children after the intervention. All (100%) felt that the VR scenarios helped them better empathize with children. Only 30% revisited the scenario after the intervention, and they were significantly more likely (p < .001) to find it helpful for actual clinical sessions.

CONCLUSION

Virtual reality could be used to improve empathy, self-perceived comfort and ability at managing children in dental students. Yet, they should be encouraged to revise using it to maintain this effect.

Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new?

Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.

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.

Experience of using a smartphone WeChat applet for dental anxiety assessment and preoperative evaluation: A nationwide multicenter study

Introduction

Dental anxiety is a multivariate phenomenon that regularly occurs during a dental procedure. Although it may lead to patients' safety concerns and adverse events in routine treatment, it is often ignored. The purpose of this research is to develop a novel WeChat Applet for dental anxiety (WADA) with the following features and aims: (1) to help patients with dental anxiety management; (2) provide patient with a physical status self-evaluation; and(3) provide a platform for online assessment and tele-consultancy by dentists. We aimed to test and verify whether such an applet could play a beneficial role before and after a dental procedure and facilitate management of high-risk patients during the COVID-19 pandemic.

Materials and methods

During the 12-month survey period (August 2020 to July 2021), a total of 180 patients aged 3–74 years from eight different cities (n = 180 at the end of treatment, n = 25 for the System Usability Scale (SUS) and follow-up interview) and 20 medical staff from eight different cities (n =20 for follow-up interview) were evaluated by WADA. At the end of the survey period, the results of the interviews were analyzed thematically.

Results

WADA assessment results from 180 patients and follow-up interview results from 45 participants were analyzed. In this study with a male to female ratio of 2:3, 75% were found to be suffering from dental anxiety, 86% were found with postoperative complications, and 11 cases were found to have contraindications to surgery. The total SUS score for WADA is 72.25 above the mean score, proving that WADA is a relevant and useful tool before and after dental treatment. Based on the results of the interviews, the following themes were identified: patient satisfaction; dentists' effectiveness; multi-center data integration; and increase its frequency of usage.

Conclusions

The WADA was developed for dental procedures and is effective for reducing treatment risks, improving patients' satisfaction and dentists' convenience, especially in terms of facilitating management of high-risk patient during the COVID-19 pandemic.

Pediatric apps: what are they for? A scoping review

In recent years, there has been a surge in the development of mHealth apps. Nevertheless, there are no scoping reviews that analyze the scientific peer-reviewed articles of these tools. This research systematically reviews the scientific literature published on health apps targeting children in peer-reviewed journals. It aims to answer four questions: what is the primary purpose of these apps; for what medical specialties and main topics were they developed; whom do they target; and how they were analyzed. The study followed PRISMA methodology, and the search process used the Web of Science Core Collection. The selected terms for the search were "pediatr*" and "app." The initial search resulted in 303 papers which, after applying filters, excluded 187 papers. In the end, 116 articles were deemed appropriate for addressing our research questions and were thoroughly reviewed. The primary purpose of pediatric health apps is to support clinical decision-making, patient education, and patient self-management. The most frequent topics covered are cancer, obesity, and asthma. Hematological oncology and endocrinology are the most frequent medical specialties addressed. The apps mainly target children, their caregivers, or both groups. Most of the apps were analyzed using observational studies, predominantly conducted in the USA, with an average participant sample size of 842. No analyses of development costs were found. These findings can be helpful for the development of future pediatric health apps. What is Known: • Health care has become increasingly digital due to digital health technologies, which have helped to expand the scope of health care. • Digital health technology can be used to improve the health of children. • The increasing availability of smartphones for children and families may enable the use of apps to deliver, promote, and sustain interventions which could lead to long-term improvements in health. What is New: • The most frequent topics covered were cancer, obesity, and asthma. Hematology-oncology and endocrinology were the most frequent medical specialties addressed. • The principal aims of the pediatric health apps were to facilitate clinical decision support, patient education, and patient self-management. • The apps mainly targeted children, their caregivers, or both groups. • Most of them had been analyzed using observational studies.

Virtual dental teaching and its effect on test success - A cross-over study

OBJECTIVES

The aim of this cross-over investigation was to analyze the effect of virtual teaching using virtual reality (VR) within a dental learning environment by preclinical students with or without dental professional experience on test performance.

METHODS

Preclinical students (N = 82) were randomly divided into two groups for cross-over testing of tooth morphology knowledge: (a) anterior VR-group (group 1) using the VR-glasses as an additional learning tool for the anterior tooth morphologies and (b) posterior VR-group (group 2) using it for the posterior tooth morphologies also in addition to conventional learning. All students used the VR-glasses for 1 week independent of time and location depending on group. The students had to recognize teeth (anterior or posterior within two separate tests after three [anterior test] and 6 weeks [posterior test] of practical course) and note the tooth number and characteristics in written form. Former dental experience (dental technician/assistance) was noted. Test results were analyzed to quantify the effect of virtual teaching on test scores. Data were analyzed with the Kolmogorov-Smirnov and Mann-Whitney U test (p = 0.05).

RESULTS

By differentiating the two student groups (use of VR glasses for anterior/posterior teeth) within the dental experience group, significantly better test results (p = 0.040) were shown for group 1 in the total posterior teeth test score. Furthermore, no other significant differences, but a possible tendency, in the test results and thus no effect of the use of the VR glasses on both VR groups could be analyzed (p ≥ 0.051).

CONCLUSIONS

Using the VR tooth learning environment predominantly did not lead to a significant improvement of test results. Anterior teeth test scores predominantly showed significantly better results than posterior teeth test scores.