Behaviour Management of the Contemporary Child in Paediatric Dentistry: An Overview of the Research

Ropivacaine effect on hemostasis and pain level in patients undergoing orthognathic surgery: a triple-blinded, randomized, clinical trial

OBJECTIVE

This triple-blind, controlled clinical trial aimed to assess the effects of ropivacaine and lidocaine on hemodynamic factors, blood loss, opioid consumption, and postoperative pain in patients undergoing orthognathic surgery.

METHODS

Thirty-two patients with Class III malocclusion scheduled for orthognathic surgery were included. The participants were randomly assigned to receive 0.5% ropivacaine or 2% lidocaine with 1:80,000 epinephrine for local anesthesia (n = 16). Hemodynamic parameters were recorded at various time intervals, which included heart rate (HR), systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation (SpO2), intraoperative bleeding, opioid consumption, and postoperative pain intensity.

RESULTS

The participants' mean age was 23.67 ± 4.56 years, and 75% were female. The groups were comparable in most measured outcomes. HR was significantly higher in the ropivacaine group at 30 and 60 min post-injection (P < 0.05). SpO2 percentages were comparable between the groups, except at 15 min post-anesthesia, where the lidocaine group demonstrated a significantly higher SpO2 (P = 0.029). Blood pressure, postoperative opioid consumption, intraoperative bleeding, and postoperative pain levels showed no statistically significant differences between the two groups.

CONCLUSION

Within the limitations of this study, both 0.5% ropivacaine and lidocaine with epinephrine demonstrated comparable effects on hemodynamic stability, intraoperative blood loss, postoperative pain levels, and opioid consumption in patients undergoing orthognathic surgery. These findings suggest that ropivacaine may serve as a safe and effective alternative to lidocaine for local anesthesia in orthognathic procedures.

Hypnosis and nitrous oxide impact on the school aged patients' anxiety and cooperation candidate for tooth extraction: A randomized clinical trial

Background

This randomized clinical trial (RCT) investigated whether hypnosis would lead to favorable outcomes in reducing anxiety, enhancing cooperation, and improving physiological responses in school-aged children undergoing tooth extraction compared to nitrous oxide/oxygen (N2O/O2) and conventional behavior guidance (CBG).

Methods

Sixty-six school-aged children (mean age: 7.87 ± 1.18 years) who needed one posterior primary tooth extraction were included. Children with low-to-moderate anxiety were randomly divided into three groups (n = 22 each): hypnosis, N2O/O2, and CBG. Anxiety levels during and after anesthetic injection and tooth extraction were assessed using the Venham Clinical Anxiety Scale (VCAS) and the Venham Picture Test (VPT). Changes in heart rate (HR) and oxygen saturation (SpO2) were monitored. Children's cooperation levels were measured using the Venham Clinical Cooperation Scale (VCCS).

Results

The VPT scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.001). The VCAS scores in the N2O/O2 group were lower than those in the CBG group (p < 0.05) and were comparable to those in the hypnosis group. The VCCS scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.05). HR changes in the N2O/O2 group were significantly lower than in the hypnosis and CBG groups (p < 0.05). No significant difference in pain was observed between the groups the day after the intervention.

Conclusion

N2O/O2 inhalation and hypnosis are effective in reducing self-reported and observed anxiety and improving cooperation levels in pediatric patients during dental extraction. Moreover, the frequency of reported pain was lower in the hypnosis group compared to the other groups.

Efficiency of a Sensory-Adapted Dental Environment Versus Regular Dental Environment in Neurotypically Healthy Children: A Parallel-Arm Interventional Study

Introduction The basic principle of a sensory adaptive dental environment is that an individual's sensory experiences have a significant impact on their emotional and psychological well-being. Taste, smell, touch, hearing, and sight are the five basic senses that affect our perception and responses to the environment. The study aimed to assess the effectiveness of a Sensory-Adaptive Dental Environment (SADE) compared with a Regular Dental Environment (RDE) in reducing anxiety, improving behavior, and providing a smooth experience for children undergoing dental treatment. Materials and methods  This parallel-arm pilot study was conducted at the outpatient Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Chennai, from January 2024 to March 2024. A total of 148 children who met the inclusion criteria were divided into two groups: Group I (intervention group) received SADE or MSE (Multi-Sensory Environment) intervention, while Group 2 (control group) underwent dental treatments in a Regular Dental Environment (RDE). Patient behavior was assessed using Frankl's behavior rating scale, and anxiety levels were measured using Ayesha's Oddbodd anxiety scale. Additionally, heart rate and oxygen saturation (SpO2) were evaluated using a pulse oximeter. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY), with significance set at a p-value less than 0.05. Results Before the procedure, there were no notable differences in behavior or anxiety levels. However, after the procedure, children undergoing treatment under SADE resulted in markedly improved behavior and notably lower anxiety levels. Also, this correlated with reduced anxiety levels, indicated by lower heart rates and higher oxygen saturation levels. Conclusion The study concluded that there were notable differences in patient experiences between SADE and RDE. After their dental procedures, participants in the SADE group were found to behave better and feel less nervous. Still, in the conventional setting, only improved behavior was noted, with no significant difference in anxiety levels. Overall, our study suggests that dental offices can significantly enhance patient experiences by providing a sensory-friendly setting that helps children feel more at ease, improves patient outcomes, and less nervous during their visits.

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.

Relationship of Blood Group with Level of Cooperation of Pediatric Dental Patients

Acquaintance with the behavior of children in dental office setting is highly important in treatment success. People with different blood groups often have different behaviors. Thus, the blood group may aid in prediction of behavior of pediatric dental patients. This study is aimed at assessing the relationship of the blood group with level of cooperation of pediatric dental patients. This cross-sectional study was conducted on 130 children between 4 and 6 years of age. The blood group of children was recorded according to their identification card or by collecting an intraoral blood sample during pulpotomy and using the respective kit. To assess the level of cooperation of children, their behavior was videotaped during the procedure, and the videos were assessed by two pedodontists. The behavior of children was scored according to the Venham scale. Data were analyzed by SPSS 26 and Chi-square, Fisher's exact test, and Mann–Whitney U test. The blood group was A in 35.7%, B in 5.8%, AB in 3.2%, and O in 53.5%. Children with blood group O had maximum cooperation (52.6) while those with blood group B had minimum cooperation. Pairwise comparisons of the groups regarding the Venham scale revealed significant differences between blood groups A and B (P = 0.0001) and also B and O (P = 0.005). Pairwise comparisons of the groups regarding the level of cooperation also revealed significant differences between blood groups A and B (P = 0.0001) and B and O (P = 0.019). Blood group B may be correlated with certain behavioral traits such as dental fear and anxiety and the resultant poor cooperation.