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

Exploring Conscious Sedation in Pediatric Oral Surgery: A Non-Randomized Clinical Trial on Safety and Efficacy

BACKGROUND

Conscious sedation is a well-established technique used in pediatric dentistry that reduces perioperative stress and pain while maintaining verbal contact with the patient. It is particularly beneficial for anxious, very young, or disabled children, improving cooperation and ensuring airway safety. The objective of this study is to assess the safety and efficacy of conscious sedation in pediatric oral surgery by analyzing vital parameters before and after treatment.

METHODS

A total of 57 pediatric patients [29 females; 28 males], aged 5-14 years [mean: 9.4], were treated at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan between September 2022 and June 2024. The patients were divided into two groups: nitrous oxide sedation [Group A] and benzodiazepine sedation [Group B]. Informant consent, medical and dental history, vital signs, and anxiety levels were recorded. A statistical analysis was performed using the Wilcoxon test. Due to the non-randomized design of this study, potential selection bias and limitations in internal validity must be acknowledged.

RESULTS

The post-sedation diastolic pressure was significantly higher [p = 0.02] in Group b, while other vital parameters remained stable. Anxiety significantly decreased in both groups [p < 0.01], with a greater reduction in Group A.

CONCLUSIONS

Conscious sedation is a safe and effective approach, maintaining stable vital parameters. The increase in diastolic pressure in Group B may be explained by preexisting anxiety and benzodiazepine pharmacodynamics. However, the absence of randomization may have influenced group allocation and outcome interpretation. Given the small sample size and the wide age range of the participants, further studies with larger and more homogeneous populations are necessary to refine and validate pediatric sedation protocols.

A Comparative Study of the CARD™ System and Tell-show-do Technique in the Behavior Management of 6-10-year-old Children

Background

Dental fear and anxiety are common issues affecting pediatric dental care, leading to challenges in treatment delivery and patient compliance. Nonpharmacological techniques such as the tell-show-do (TSD) method and CARD™ system have emerged as effective strategies for managing child dental anxiety.

Aim

This study aims to compare the effectiveness of the CARD™ system and TSD technique in managing the behavior of 6-10-year-old children during dental procedures.

Methods

Forty children requiring invasive dental treatments were randomly assigned to either the TSD technique (group 1, n = 20) or CARD™ system (group 2, n = 20) groups. Physiological parameters (oxygen saturation and pulse rate) and behavioral responses (evaluated using the Facial Image Scale) were assessed before and after procedures. Data were analyzed using t-tests and Mann-Whitney U tests as appropriate.

Results

No statistically significant differences were found between the techniques regarding physiological parameters or behavioral responses. Both groups exhibited comparable oxygen saturation levels (CARD™: 98.00 ± 1.02; TSD: 98.00 ± 1.12) and pulse rates (CARD™: 87.45 ± 7.28 bpm; TSD: 90.30 ± 10.26 bpm) before procedures, with minimal changes observed postprocedure. Similarly, there were no significant differences in emotional responses assessed by the Facial Image Scale before (CARD™: 1.90 ± 0.85; TSD: 1.80 ± 0.76) or after procedures (CARD™: 2.80 ± 1.60; TSD: 2.95 ± 1.50).

Conclusion

This study suggests that the CARD™ system and TSD technique are equally effective in managing child dental anxiety. Both methods offer viable options for reducing anxiety and enhancing cooperation during dental procedures.

How to cite this article

Babu A, Eagappan SAR, Srinivasan D, et al. A Comparative Study of the CARD™ System and Tell-show-do Technique in the Behavior Management of 6-10-year-old Children. Int J Clin Pediatr Dent 2025;18(1):53-57.

Oral health with focus on dental fear and dental caries in Swedish preschool child populations attending public dental health care: Trends over 30 years

OBJECTIVES

To study changes in oral health with focus on reported dental fear prevalence and interrelationships between dental fear and prevalence of dental caries and performed restorative dental treatment in preschool child populations attending regular public dental health care between 1983 and 2013.

METHODS

Every 10 years, random samples of about 100 children aged 3 and 5 years, respectively, took part in cross-sectional studies based on oral examination and a questionnaire. One question, put to the child and answered by the parent, mirrored dental fear: "What do you feel at the prospect of an appointment with a dentist?". Agreement to at least one of three alternatives, ill at ease, frightened and sick, indicated dental fear. Frightened and/or sick mirrored severe dental fear. 79%-94% of the samples answered the question and constituted the study group. Prevalence of caries and number of filled tooth surfaces were recorded. Dental parameters were presented in mean values.

RESULTS

During the 30 years, dental fear prevalence was fairly constant. 21% of 3-year-olds and 15% of 5-year-olds reported dental fear in 2013. Positive relationships between dental fear prevalence and caries prevalence and number of filled tooth surfaces were found. Dental caries was reduced during the study time, but to a lesser degree in children with dental fear compared to children without dental fear.

CONCLUSIONS

Although children were offered public dental health care, the prevalence of dental fear remained high. Children with dental fear are caries risk individuals.

A comparative evaluation of the effects of white noise, brown noise, and pink noise on dental anxiety of pediatric patients undergoing dental extraction treatment: A randomized control study

BACKGROUND

Audio-analgesia is one of the unexplored aspects of behavior management in pediatric dentistry, and recently, there have been many new inclusions in shades of noise that were previously just limited to white noise, like brown noise and pink noise.

AIM

The aim of the study was to evaluate and compare the effectiveness of white noise, brown noise, and pink noise on dental anxiety in pediatric patients undergoing primary tooth extraction.

STUDY SETTINGS AND DESIGN

Multiarm, triple-blinded, parallel-group randomized controlled trial.

MATERIALS AND METHOD

Forty children belonging to the age group of 8-12 years having their first dental visit with primary teeth indicated for extraction were included in our study. We evenly divided the 40 children into four groups: Group A (white noise), Group B (pink noise), Group C (brown noise), and Group D (cartoon music), which served as the control. We assessed the patient's anxiety using Venham's Picture Test and a pulse oximeter, as well as their pain using the Visual Analog Scale (VAS) both preoperatively and postoperatively. We also noted changes in the patient's pulse after administering local anesthesia.

RESULTS

All groups have shown significant differences in dental anxiety and pain, preoperatively and postoperatively, but pink noise was found to be effective even in maintaining pulse rate intraoperatively.

CONCLUSION

In pediatric dentistry, audio distraction is an innovative, noninvasive, and effective behavior management technique that can effectively manage dental anxiety in children.

REGISTRATION

The Clinical Trials Registry of India (CTRI) has prospectively registered the study under the CTRI number CTRI/2024/01/061679.

Evaluation of General Anesthesia and Sedation and Follow-Up Compliance in Pediatric Dental Procedures: A Comprehensive Analysis of Long-Term Outcomes and Gender Differences

This retrospective study evaluated the effectiveness of different types of general anesthesia (GA) and sedation in pediatric dental procedures, focusing on treatment outcomes and follow-up compliance with an emphasis on gender differences. Clinical records of 1582 pediatric patients, aged 0-18 years, were analyzed to examine the distribution, duration and impact of anesthesia types on dental procedure complexity. The study population was divided into three age groups: 0-6, 7-12 and 13-18 years. We assessed follow-up attendance rates by gender and anesthesia type, calculated the decayed, missing and filled (DMF) index and evaluated the need for further treatment and reasons for retreatment. Our findings indicated that general anesthesia with inhalational agents and muscle relaxants was the most frequently used method (1260 instances), followed by nitrous oxide sedation (163 instances) and sevoflurane GA with a laryngeal mask airway (158 instances). Inhalational GA with muscle relaxants had the longest average duration (2.78 h) and the highest DMF index (7.43), reflecting its use in more severe dental conditions. Gender analysis revealed a slight male predominance in using inhalational GA with muscle relaxants (55.87% male vs. 44.13% female). Female patients demonstrated higher follow-up compliance across all periods. Overall, our results highlight the importance of tailored anesthesia and sedation plans, as well as follow-up protocols, in pediatric dentistry. This study provides valuable insights for practitioners in selecting appropriate anesthesia and sedation types and developing strategies to improve follow-up compliance and treatment success.

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.

Assessment of Preappointment Parental Counseling on Dental Fear and Anxiety in Children in Pedodontic Dental Operatory: A Randomized Controlled Trial

Background

Dental fear and anxiety are important issues in the practice of pediatric dentistry because they interfere with both the provision and receipt of dental care in children and adolescents. Behavior guidance is a dynamic part of child management. It starts from the preappointment level, where a negative attitude of the mother will be trained to become positive for improved child behavior in the pediatric dental clinic. The use of anticipatory guidance (AG) as parental counseling, where the information on what the parents should follow before their child's dental appointment was provided to the mothers.

Aim

To assess the effect of preappointment parental counseling on dental fear and anxiety in children.

Materials and methods

The study was a randomized, parallel-group, active-controlled trial, wherein the dyad of mother and child was randomly divided into two groups: (1) the test group and (2) the control group. At baseline, fear and anxiety assessment was done using fear and anxiety assessment scales and physiological parameters in both groups. Dental fear and anxiety were assessed using the children fear survey schedule dental subscale, Venham pictorial test in children and state-trait anxiety subscale in mothers. Parental counseling instructions were given verbally, in written format and by videos only in the test group on the same day of the initial appointment. The same subjects in both groups were checked for fear and anxiety scales and physiological parameters after 6 months from the first appointment. The effectiveness of parental counseling on dental fear and anxiety was correlated at the end of the study.

Statistical analysis

The mean dental fear and anxiety scores between the test and control groups at baseline and at 6 months were compared using the Chi-squared test. Chi-squared test was used to compare the dental fear and anxiety in children and mothers in the study and control groups. Spearman's rank correlation test was used to assess the relationship between Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Venham Picture Test (VPT), state-trait anxiety inventory (STAI) scores, and clinical parameters in the study and control group of both populations.

Results

The results showed that there was a significant improvement in the dental fear and anxiety levels in the dyads of mother and child postcounseling. The control group scores did not show any significant change.

Conclusion

Preappointment parental counseling clarified and guided parents about the child's fear and anxiety and was effective in alleviating the dental fear and anxiety among parents and children attending pediatric dental clinics.

How to cite this article

R R, Sathyaprasad S, S N, et al. Assessment of Preappointment Parental Counseling on Dental Fear and Anxiety in Children in Pedodontic Dental Operatory: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(3):346-351.

Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety

BACKGROUND

Dental procedures profoundly affect a child's dental fear and anxiety, rendering dental treatment difficult. Inhalation sedation with a mixture of nitrous oxide and oxygen (NO2/02) breathed through a nosepiece is a form of light conscious sedation widely used in apprehensive children to help them relax and accept dental treatment. This, however, can have both shortand long-term effects on child dental fear and anxiety. This study aimed to assess the short-term immediate effect of inhalation sedation on child dental fear and anxiety scores.

METHODS

This analytical cross-sectional study was conducted at the Department of Paediatric Dentistry at Rehman College of Dentistry, Peshawar, Pakistan, over a period of 1.9 years (January 2019- October 2020). A total of 171 children aged 6-11 years were selected with moderate to severe dental anxiety using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS), requiring pulp therapy in at least one of their deciduous molars. Baseline anxiety scores were calculated using Venham Clinical Anxiety Score (VCAS) and Venham Picture test (VPT) with a dental check-up and fluoride application. VCAS and VPT scores were then assessed at the end of their scheduled second dental visit involving dental anaesthesia and inhalation sedation. VCAS and VPT scores at the end of treatment were compared with the baseline scores.

RESULTS

Out of 171 children, 86 were male and 85 were female, with a mean age of 7.77. Females showed a higher range of VCAS and VPT scores (p ≤0.001) compared to males. The VCAS and VPT scores declined just at the end of the second dental visit following dental anaesthesia with inhalation sedation (mean difference = 1.96 and 3.39, respectively), which was statistically significant (p ≤0.001).

CONCLUSION

Inhalation sedation has a significant role in reducing child dental fear and anxiety in the short term.

Procedural sedation in pediatric dentistry: a narrative review

Procedural sedation and analgesia are now considered standard care for managing pain and anxiety in pediatric dental patients undergoing diagnostic and therapeutic procedures outside of the operating room. Anxiolysis, which combines both pharmacologic and non-pharmacologic approaches, plays a significant role in procedural sedation. Non-pharmacologic interventions such as Behavior Management Technology can help reduce preprocedural agitation, ease the transition to sedation, reduce the required amount of medication for effective sedation, and decrease the occurrence of adverse events. As the introduction of novel sedative regimen and methods in pediatric dentistry, the potential role of mainstay sedatives administered by new routes, for new indications, and with new delivery techniques, should be considered. The purpose of this paper is to examine and discuss the current state of sedation techniques in pediatric dentistry.

Intraoral clinical examinations of pediatric patients with anticipatory anxiety and situational fear facilitated by therapy dog assistance: A pilot RCT

OBJECTIVE

To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients.

METHODS

The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance.

RESULTS

Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population.

CONCLUSION

Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care.

Children's Perceptions of Dental Experiences and Ways to Improve Them

This qualitative study explored children's perceptions of their dental experiences and their acceptability of the CARD™ (Comfort, Ask, Relax, Distract) system, adapted for the dental setting as a means to mitigate dental fear and anxiety (DFA). A purposive sample of 12 participants (7 males) aged 8-12 years receiving dental care at the Paediatric Dental Clinic, University of Toronto, was recruited. Virtual one-on-one interviews were augmented with visual aids. Participants were oriented to and asked about their perceptions of various dental procedures. Data were deductively analyzed, according to the Person-Centered Care framework (PCC). Four themes were identified: establishing a therapeutic relationship, shared power and responsibility, getting to know the person and empowering the person. Children emphasized the importance of clinic staff attributes and communication skills. They expressed a desire to engage more actively in their own care and highlighted the positive influence of pre-operative education and preparation. Participants found the CARD™ system to facilitate opportunities for self-advocacy in their dental care.

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.

EVALUATION OF THE PATIENTS' SATISFACTION WITH PRIVATE DENTAL CLINICS SERVICES: A QUESTIONNAIRE-BASED STUDY

OBJECTIVE

The aim: To evaluate patient satisfaction with dental care services at Iraqi private dental units.

PATIENTS AND METHODS

Materials and methods: Online questionnaires were sent to 1600 Iraqi people. The questionnaires were composed of four sections: the first section was involved with gathering the demographic information of the participants, and the remaining three sections consisted of twenty-one questions to evaluate the responders' satisfaction with regard to the dentist, treatment, and the dental clinic.

RESULTS

Results: The final total of responses was 427 after using the inclusion and exclusion criteria. The distribution of the participants according to the obtained demographic data was as follows: (male 45.4% and female 54.6%), (above 40y 41.7% and less or equal to 40y 58.3%), (employed 52.9% and not employed 47.1%), (postgraduate 29.3%, college graduate 55.7%, and undergraduate 15%), and (enough and exceeding income 4.9%, enough income 51.8%, and less than enough income 43.3%). Only the educational level and the income level appeared to have an effect on the degree of patient satisfaction. Most of the participants complained about the high treatment fees and the long wait in the clinic before receiving treatment.

CONCLUSION

Conclusions: The current study is the first conducted in Iraq to assess dental patient satisfaction. The satisfaction levels differed among the participants, which indicates the need to benefit from the evaluation of patients to improve the quality of treatment service in dental clinics. Future research should be conducted to precisely identify the factors that lead to increased satisfaction of dental patients with their treatment experiences.

The variables associated with dental anxiety and their management in primary care dental clinics in Bahrain: a cross-sectional study

Background

20–80% of adults presenting to a dental clinic experience anxiety. Negative past dental experiences and environmental factors such as the waiting area of a dental clinic or sound of a drill are commonly considered triggering factors for anxiety. Anxiety management strategies are considered a part of routine dental procedure, due to increased prevalence and compromised patient care. Hence the aim of the present study is to identify the prevalence and variables associated with dental anxiety and their management in patients visiting the primary care dental clinics in Bahrain.

Method

Four hundred and eighty participants were included. A 3-part questionnaire deciphered the demographic characteristics of the participants, the dental procedure undertaken, the level of anxiety, and the management strategy used by the dentist. The pre and post-treatment MDAS scores were recorded. Paired t test, ANOVA and Wilcoxon signed rank test was used to test the level of significance between the variables and the mean MDAS scores. The p ≤ 0.05 was considered statistically significant.

Results

The prevalence of dental anxiety was 23.7% with moderate anxiety, and 11.4% with high anxiety. Females presented with a higher mean MDAS both pre and post-treatment compared with males. A statistically significant difference between the pre and post-treatment MDAS scores were observed in educated patients less than 50 years of age. Those with unpleasant previous dental experience showed statistically significant difference. Analyses of anxiety management techniques showed that single techniques worked better than combination techniques. Rest and breaks combined with any other technique of choice showed significant reduction in the MDAS scores post treatment.

Conclusion

To conclude, all patients attending the dental clinic present with some level of anxiety that necessitates the dentist to use anxiety management strategies. Non-pharmacological methods that are non-invasive must be the first choice. Rests and breaks, with any technique of choice provides the best possible anxiety management. It is possible to achieve the desired anxiety reduction in single visit to complete the planned dental intervention, other than in patients who are dental phobic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02173-7.

Generalized Anxiety Disorder and Its Relationship with Dental Anxiety among Pregnant Women in Dammam, Saudi Arabia

Objective

To assess the relationship between generalized anxiety disorder (GAD), dental anxiety (DA), and other factors among pregnant women.

Methods

The Generalized Anxiety Disorder (GAD-7) scale and the Modified Dental Anxiety Scale (MDAS) were used to evaluate GAD and DA, respectively. Hard copies of self-administered questionnaires were distributed among 780 pregnant women attending hospitals/health centers in Dammam, Saudi Arabia.

Results

About 31.7% of the participants demonstrated minimal anxiety, 37.9% mild anxiety, 19.7% moderate anxiety, and 10.6% severe anxiety. The mean GAD score of the sample was 7.53 ± 5.16 which differed significantly among women in the first (7.74 ± 5.47), second (6.82 ± 4.64), and third trimesters (8.13 ± 5.37) (P=0.029). Pregnant women who performed routine dental visits demonstrated lower GAD (6.98 ± 5.23) than those who visited dentists for consultation, pain, or treatment (7.58 ± 5.07). The mean GAD score was significantly higher among participants with dental pain or discomfort during the last 12 months (8.12 ± 5.05) than among those without pain or discomfort (7.02 ± 5.2) (P 0.003). Similarly, the participants with DA showed a significantly higher mean GAD score (7.69 ± 5.17) than those without DA (5.93 ± 4.71) (P 0.006). Multivariate linear regression showed that GAD significantly correlated with DA (B = 0.225, P < 0.001).

Conclusion

In the present study, GAD was common among pregnant women which significantly correlated with DA. Pregnant women with DA and dental pain demonstrated high GAD. Preventive and therapeutic measures should be taken to reduce GAD and DA during pregnancy.

The accuracy of teledentistry in caries detection in children – A diagnostic study

Introduction

: The increasing burden of dental caries and the lack of effective dental caries screening protocols in non-dental settings, such as schools, demand an innovative and cost-effective approach. Teledentistry is the field of dentistry that combines telecommunication with health records and digital imaging to improve access to dental care and help in epidemiological surveys. This study aimed to assess the accuracy of non-dentist teledentistry in caries detection compared with the clinical dental examination of a sample of 5–10-year-old schoolchildren.

Methods

A calibrated dentist examined schoolchildren aged 5–10 years old. The dentist and two teachers took intraoral photographs for each child, using a smartphone. The photographs were concealed; therefore, the dentist assessed the three sets of photographs blindly two weeks after the clinical examination. Accuracy was measured to compare the teledentistry examination with the clinical dental examination.

Results

The mean DMFT of primary teeth was 3.38, 3.42, and 3.17 upon clinical examination, dental-teledentistry examination (findings of photographs taken by a dentist), and non-dental teledentistry (findings of photographs taken by teachers), respectively. The mean DMFT of permanent teeth was 0.75, 0.69, and 0.65 upon clinical examination, dental-teledentistry examination, and non-dental teledentistry examination, respectively. In primary teeth, dental teledentistry and non-dental teledentistry examinations showed 95 and 98.3 sensitivity and 94.3 and 91.4 specificity, respectively. In permanent teeth, dental teledentistry and non-dental teledentistry examinations showed 80.8 and 88.5 sensitivity and 94.1 and 96.1 specificity, respectively.

Conclusions

Teledentistry has acceptable accuracy for caries detection in schoolchildren compared to a clinical dental examination.

Psychometric evaluation of the Lebanese Arabic version of the Dental Fear Survey: a cross-sectional study

BACKGROUND

Dental fear is a prevalent problem that can lead to poor dental health. The Kleinknecht's Dental Fear Survey (DFS) is one of the used scales to assess dental fear. The present study aims to evaluate the psychometric properties of the Lebanese Arabic version of the DFS (DFS-A) and to determine the optimal cut-off to identify dental fear as well as the correlates of dental fear in a group of Lebanese adults dental patients.

METHODS

A cross-sectional study was conducted among a group of 442 dental patients (18-65 years) recruited at 29 dental clinics from March to June 2019. Patients completed a questionnaire including questions about demographic characteristics, previous bad dental experience, trauma's experience period, the sensation of nausea during dental treatment, the DFS-A scale, the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A), and a general question about dental fear.

RESULTS

DFS-A revealed evidence of adequate psychometric properties. DFS-A scale demonstrated high internal consistency (cronbach's alpha = 0.93). Test-retest reliability assessment demonstrated strong reproducibility of the DFS-A scale score (ICC = 0.92 with 95% CI (0.83-0.96), p value < 0.0001 (N = 30). Confirmatory factor analysis revealed a three-factor structure of the DFS-A reflecting fear associated with specific dental stimuli and procedures, patterns of dental avoidance and anticipatory anxiety, and physiologic arousal during dental treatment. A significant correlation was found between DFS-A and the MDAS-A indicating a good convergent validity. The optimal cut-off point to identify patients with and without dental fear is 41. Considering this cut-off score, the prevalence of dental fear in our sample was reported at 33.8%. Multivariable analysis showed that having previous scary and painful dental experiences, a sensation of nausea during treatment, and having dental anxiety were identified as predictors of dental fear.

CONCLUSION

The adapted Arabic version of the DFS (DFS-A) is a valid tool to evaluate dental fear among Lebanese adult patients.

Sense of coherence and dental fear/dental anxiety: A systematic review and meta-analysis

AIM

The aim of this systematic review and meta-analysis was to evaluate the association between sense of coherence (SOC) and dental fear/dental anxiety.

METHODS

Computerized searches were performed in six databases. Gray literature and manual searches were also conducted. Study selection, risk of bias assessment, and meta-analyses were performed. The results of meta-analyses were reported in odds ratio (OR), mean difference (MD), and confidence interval (CI).

RESULTS

After removing duplicates, 131 references were retrieved and the full texts of 12 were evaluated. Nine references met the eligibility criteria and were included. The results of meta-analyses demonstrated that individuals with a weaker SOC had a score in the dental anxiety/dental fear scale 6.04 times higher than individuals with a stronger SOC (OR = 6.04, CI = 2.62-13.91). Individuals with no dental anxiety/dental fear had a mean score of the SOC scale higher than individuals with dental anxiety/dental fear (MD = 5.39, CI = 2.21-8.56). Sensitivity analysis demonstrated that the result of a higher mean score of the SOC scale among individuals with no dental anxiety/dental fear remained (MD = 7.38, CI = 3.79-10.98). Risk of bias ranged from low to high. The certainty of evidence was very low.

CONCLUSION

Individuals with stronger SOC have lower levels of dental fear/dental anxiety.

Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance

Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.

Is dental anxiety associated with the behavior of sedated children?

The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

The Prevalence of Dental Anxiety Associated with Pain among Chinese Adult Patients in Guangzhou

Background

Anxious people appear to exaggerate the severity of aversive experiences such as anxiety and pain. Anxiety towards dental procedures is a common difficulty that may be experienced by dental patients all over the world. The goal of the study is to find out the prevalence of dental anxiety and its associated factors in Chinese adult patients.

Methods

A cross-sectional study was conducted on 183 dental adult patients whose age ranged from 18 to 70 years. Demographic details, first and most recent dental visits with experience, the MDAS, and the Visual Analogue Scale for Anxiety (VAS-A) were obtained. Data were analyzed by frequency analysis, chi-square test, and Spearman correlation test.

Results

Most of the respondents were female (68.9%) and 30-45 years age group. The mean total score for dental anxiety on the MDAS was 13.63 (3.1). 80.3% of participants suffered from moderate or high dental anxiety. Age must show a strong association with dental anxiety among the participants (p=0.011). The first dental visit experience, the frequency of the dental visit, most recent dental experience, length of time since the most recent dental visit, and postponement of the dental visit are strongly associated with the MDAS score (p=0.001).

Conclusions

The MDAS score exhibits that Chinese adult patients have significant dental anxiety and phobia. Identifying patients with dental anxiety as soon as possible is essential to providing better dental care.

Assessment of dental anxiety and dental phobia among adults in Lebanon

Background

Dental anxiety continues to be a widespread problem affecting adult populations. The primary aim of our study was to evaluate the psychometric properties of the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A) and to identify the optimal cut-off for assessing dental anxiety and dental phobia among adults in Lebanon. In addition, we sought to assess dental anxiety and phobia as well as their correlates among Lebanese adult patients.

Methods

A cross-sectional study was carried out on a sample of 451 dental adult patients aged between 18 and 65 years old. Information about demographic characteristics, previous bad dental experience, trauma’s experience period, perception of a periodontal problem, sensation of nausea during dental treatment, the MDAS-A scale, and the Visual Analogue Scale for anxiety (VAS-A) were collected.

Results

MDAS-A exhibited evidence of adequate psychometric properties. The optimal cut-off was 12 for dental anxiety and 14 for dental phobia. Out of the total sample, 31.5% suffered from dental anxiety while 22.4% had a dental phobia. Multivariable analysis showed that the odds of dental anxiety and phobia were higher among females compared to males. Also, patients suffering from periodontal problem perceptions, bad dental experiences during childhood and adolescence, and the sensation of nausea during dental treatment were at a higher risk of developing dental anxiety and phobia compared to their counterparts. However, a higher level of education was found to be a protective factor against dental phobia among Lebanese adult patients.

Conclusion

The MDAS-A scale is a suitable tool for the routine assessment of dental anxiety and phobia among Lebanese adult patients. Identifying patients with dental anxiety at the earliest opportunity is of utmost importance for delivering successful dental care.

Oral health status and oral health-related quality of life in children with attention-deficit hyperactivity disorder and oppositional defiant disorder

AIMS

Oral diseases can affect various aspects of life in patients with attention deficit hyperactivity disorder/oppositional defiant disorder (ADHD/ODD). This study aimed to assess the oral health status and oral health-related quality of life (OHRQOL) in ADHD/ODD children.

METHODS

Forty ADHD/ODD and 80 control children aged 3-7 years old were included in the study. Gingival index (GI), dmft score, and the pediatric oral health-related quality of life (POQL) questionnaire were used to determine the oral health status and OHRQOL, respectively.

RESULTS

The mean dmft and GI were significantly higher in the ADHD/ODD group than the control group (P = .002 and P = .001). In the ADHD/ODD children, the total score of OHRQOL and the mean scores of the emotional, physical, role, and social domains were lower than that in the control group (P = .0004, P = .027, P = .002, P = .014, and P = .043, respectively). Poisson's regression showed that there was a significant relationship between OHRQOL and dmft scores (P-value < .001). However, the association between GI and OHRQOL scores was not significant.

CONCLUSION

Higher dmft and GI scores were found in children with ADHD/ODD than the control children. A lower POQL score was detected in ADHD/ODD patients, which translates to a better level of OHRQOL.

The Effect of Transcutaneous Electric Nerve Stimulation (TENS) on Anxiety and Fear in Children Aged 9-14 Years

Introduction

Dental fear or dental phobia is caused by previous unpleasant dental experiences and pain. It can result in delaying or avoiding dental visits. Most often it leads to individuals avoiding visiting the dentist until physical pain completely impairs the quality of life.

Objectives

Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current. The main aim of this study was to examine whether the TENS device affects the reduction of anxiety and fear during dental procedures.

Material and Methods

The study was conducted on a sample of 125 respondents, aged 9-14 years. Statistical significance of differences between pre- and post-treatment results on all applied measuring instruments was verified by the t-test for dependent samples. The calculation was performed for all respondents and individually for the three observed groups. The Children`s Fear Survey Schedule – Dental Subscale test was used to assess anxiety and fear.

Results

The results on the CFSS-DS scale in all subjects did not differ statistically significantly before and after treatment (p > 0.05). The results on the CFSS-DS scale in subjects who received TENS were statistically significantly different before and after treatment (p < 0.01). The results on the CFSS-DS scale in subjects who received local anesthesia were statistically significantly different before and after treatment (p < 0.05).

Conclusion

The TENS device had an anxiolytic effect after the first visit.

Influence factors of dental anxiety in patients with impacted third molar extractions and its correlation with postoperative pain: a prospective study

Background

To explore the prevalence of dental anxiety (DA) in patients with third molar extractions and its influence factors and the correlation between DA levels and postoperative pain.

Material and Methods

A prospective and descriptive clinical study was performed. All patients who underwent the impacted third molar extraction from October 2017 to February 2019 were enrolled. DA levels were assessed by virtue of the modified dental anxiety scale (MDAS) and pain was assessed with a visual analog scale (VAS).

Results

A total of 150 patients were investigated and 136 valid questionnaires were retrieved, with an effective rate of 90.7%. The independent sample t-test and ANOVA results showed that the anxiety level of patients with the third molar extractions was statistically different in gender, teeth extraction experience and self-assessment oral health status. Multiple linear regression analysis with DA as a dependent variable showed that gender and teeth extraction experience were independent factors influencing DA in patients with third molar extractions. Pearson's test showed that there was a significant correlation between DA level in patients and the postoperative pain on the first day (r=0.542, p=0.000).

Conclusions

For patients (females, poor oral hygiene and no teeth extraction experience), surgeon should pay more attention to DA of such patients and take measures to reduce the anxiety when removing the third molars. Furthermore, surgeon can recommend oral administration ibuprofen sustained release capsules after surgery.

Key words:Dental anxiety, modified dental anxiety scale, visual analogue scale, postoperative pain.

An Introduction to Assessing Dental Fear and Anxiety in Children

Fear and anxiety constitute an important theme in dentistry, especially with children. Anxiety and the fear of pain during dental treatment can lead to avoidance behaviour, which contributes to perpetuating fear and anxiety of dental care. Understanding and assessing dental fear and anxiety in children is important for delivering successful dental care with high satisfaction in this age group. Among the vast assessment method options available today, self-report assessment, parental proxy assessment, observation-based assessment, and physiological assessment are the four major types for dental fear and anxiety in children. Each method has its own merits and limitations. The selection of a method should be based on the objectives, validity, and setting of the assessment. The aim of this paper is to review and discuss the assessment methods for dental fear and anxiety in children.

Children's Pain Perception and Behavioral Feedback during Local Anesthetic Injection with Four Injection Site Preparation Methods

Introduction:An effective pain control significantly contributes to an optimal dental treatment in pediatric dentistry. This study was conducted to compare children's pain perception and behavioral feedback during local anesthetic injection accompanied with counter-irritation, refrigerant, ice precooling or topical benzocaine. Methods:This study was conducted on 99 children who needed dental treatment in bilateral maxillary primary molars by local anesthesia. Subjects were randomly assigned to three groups, in which the injection site was prepared using counter-irritation in group I, ice precooling in group II, and refrigerant spray precooling in group III. In all three groups, 20% benzocaine gel was used in the injection site of opposite quadrant as a control. The perceived pain and behavioral feedback of children during injection were evaluated using the visual analogue scale (VAS) and sound, eye, and motor (SEM) indexes. Sign and Kruskal-Wallis tests were used to analyze data at a significance level of P < 0.05. Results:The perceived pain was significantly lower when using benzocaine compared to the other three methods (P < 0.05). Behavioral feedback of children when using benzocaine was not significantly different from the counter-irritation method (P=1.00). However, behavioral feedback with counter-irritation was significantly better than precooling (P < 0.05). Counter-irritation was significantly more effective than precooling methods in reduction of pain perception and improvement of behavioral feedback (P < 0.05). Conclusions:The perceived pain was significantly lower when the benzocaine method was used. Behavioral feedback was significantly better with benzocaine and counter-irritation methods compared to precooling procedures.

Fear and anxiety managing methods during dental treatments: a systematic review of recent data

INTRODUCTION

The management of anxiety and fear of patients experiencing medical treatment is always a major issue. Dentistry is a branch of medicine that is daily in managing these problems, especially in the case of pediatric patients. Odontophobia can be managed in different ways, and the purpose of this study is to eventually review which methods are currently accepted and which are the most effective.

EVIDENCE ACQUISITION

The literature analysis was conducted on a number of articles, suitably skimmed, after a first research, obtained from the most common scientific databases. The number of works included in the review is 28.

EVIDENCE SYNTHESIS

From the RCTs evaluated we could highlight that there are different methods in the literature, equally effective and certainly conditioned by the systemic condition of the patient. Another chapter instead turns out to be that linked to the management of the syndromic patient.

CONCLUSIONS

It is clear that there are different methods and equally different ways to manage our patients in the event of non-cooperation in the case of dental care. In addition to proper management by the clinician, in the literature methods linked to audiovisual distractions, hypnosis or pharmacological methods that produce conscious sedation are effectively reported.

Children's Perceptions of Dentist's Attire and Environment: A Systematic Review and Meta-analysis

Aim

To assess the children's perceptions of the dentist's attire and environment. The protocol is available in the PROSPERO database.

Search strategies

Systematic searches in the databases were performed in Cochrane, Latin American and Caribbean Health Sciences, PubMed, PsycINFO, Scopus, and Web of Science from their inception to December 12, 2019, Google Scholar, Open Grey, and ProQuest Dissertations.

Selection criteria

Criteria consisted of descriptive studies regarding the above matter while two authors assessed the information. The risk of bias was also performed.

Results

Databases showed 1,544 papers and a two-phase assessment selected 21 studies in narrative and 9 in the quantitative synthesis. A meta-analysis demonstrated no difference between white coat and child-friendly attire (OR = 0.63; 95% CI 0.16-2.49; n = 3,706) and a decorated vs plain dental clinic was the preference of the children's majority (OR = 8.75; 95% CI 1.21-63.37; n = 150).

Conclusion

It can be concluded that there is no difference in the children's perception, white coat vs child-friendly attire; however, children prefer a decorated dental clinic.

How to cite this article

Oliveira LB, Massignan C, De Carvalho RM, et al. Children's Perceptions of Dentist's Attire and Environment: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2020;13(6):700-716.

Satisfaction with Orthodontic Care Provided in a University Orthodontic Clinic

Objective:

To evaluate patients’ satisfaction with their orthodontic care at the Department of Orthodontics of University of Athens.

Materials and Methods:

The study sample comprised of 100 individuals whose orthodontic treatment had been completed during the period May to October 2010. A questionnaire was designed and piloted before the telephone interviews were carried out. Questions concerned socio-demographic characteristics, reason for seeking care at the Dental School, level of satisfaction with treatment outcome, fees paid for treatment, and various aspects of organisation of care provision, assessed on 1-very dissatisfied to 5-very satisfied Likert type items.

Results:

Satisfaction score was particularly high as far as treatment outcome (53% were “very satisfied” and 31% were “satisfied”), dentist’s response to an emergency (81% were “very satisfied”), and personnel’s behavior at initial examination (81% were “very satisfied”) were concerned. Factors appearing to require improvement were the waiting time from initial examination to the beginning of treatment, the waiting room and the duration of treatment. Overall satisfaction was found to be significantly associated with total duration of treatment, fees paid by patients, treatment outcome, the behaviour of personnel who conducted first clinical examination, and dentist’s response to an emergency. Overall satisfaction was confirmed as the vast majority of patients (97%) would recommend the Orthodontic Clinic.

Conclusion:

While the Orthodontics Clinic enjoys overall highly satisfied patients, there is scope for improvement of organizational aspects of care provision like the waiting time between the initial examination and the beginning of treatment, the waiting room and the duration of treatment.

Comparison of the effect of pharmacotherapy and neuro-feedback therapy on oral health of children with attention deficit hyperactivity disorder

Background

Attention deficit hyperactivity disorder (ADHD) is a chronic and progressive mental disorder related to the childhood period. This study aims to compare the oral health of two groups of ADHD children: those under pharmacotherapy and those under neuro-feedback therapy.

Material and Methods

72 ADHD children (aged 6-12) were divided into two 36 member groups: The pharmacotherapy group and the neuro-feedback therapy group. Unstimulated salivary flow (USF), DMFT, and plaque index were assessed in these children. Statistical analysis was carried out on the data with the independent t-test, which was performed using SPSS 16. The significance level of the study was p<0.05.

Results

In this study, the USF of ADHD children who used Ritalin was found to be significantly less than that of the neuro-feedback group (1.25 ± 1.21 vs. 1.91 ± 1.16 ml/min; p=0.002). Also, the plaque index (5.9 ± 3.1 vs. 3.94 ± 1.9; p=0.018) and DMFT scores (39% ± 9% vs. 31% ± 9%; p=0.018) were significantly higher for the pharmacotherapy group.

Conclusions

Neuro-feedback therapy is preferable to Ritalin treatment for ADHD children in terms of their oral health status. Key words:Attention deficit hyperactivity disorder, drug therapy, neurofeedback, oral health.

The relationship between children's media habits and their anxiety and behaviour during dental treatment

OBJECTIVE

The existing evidence suggests that media habits may have moderating role on children's psychological adjustment in the dental setting. The aim of this study was to investigate the relationship between children's media habits and their anxiety and behaviour management problems (BMP) during dental treatment.

MATERIALS AND METHODS

A total of 289 children aged 3-6 years old were included. Dental anxiety (DA) and BMP were assessed using Clinical Anxiety Rating Scale and Frankl's Rating Scale during the dental treatment. The parents reported their own DA, educational level and economic status; and the children's and also their own daily hours of using media. The data were analysed with the Mann-Whitney U, Kruskal-Wallis, Chi-square or Fisher exact tests, Spearman's correlation coefficient and logistic regression.

RESULTS

The children with DA had significantly higher amount of watching TV, playing e-games and surfing the Internet, and total amount of using electronic media than those without DA. The amount of watching TV and the total amount of using electronic media were significantly higher in the children with BMP than those without BMP. DA and BMP were significantly correlated with the children's hours of watching TV and total media time.

CONCLUSIONS

There was a significant relationship between the amount of electronic media usage and DA and BMP in 3- to 6-year-old children.

Does the length of dental procedure influence children's behavior during and after treatment? A systematic review and critical appraisal

The aim of this systematic review was to investigate the effect of treatment duration on children’s behavior and/or anxiety in the dental setting. To this end, a systematic search was conducted in Pubmed/Medline and Scopus from 1970 to march 2017 for English language articles that assessed the relationship between dental treatment duration or length, and fear/anxiety or behavior in children aged <12 with no confounding medical and/or psychological history and neuro-psychiatric disabilities. Four studies investigating the effect of treatment duration on children’s behavior during and/or after treatment were included. None of the reviewed studies investigated the effect of treatment duration on children’s dental anxiety or fear. There was a general tendency towards deterioration of children’s behavior with an increase in treatment duration. In conclusion, our results undermine the validity of current suggestions about the appropriate treatment duration. Further clinical trials are needed to establish appropriate treatment duration for more effective behavioral management of pediatric patients during dental proce-dures.