The effect of psychological management on dental anxiety in children

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia

Aim

The present study aimed to assess and compare the efficacy of acupressure, hypnosis and audiovisual aids in reducing anxiety in children during the administration of local anesthesia (LA).

Methodology

Two hundred apparently healthy children were selected randomly between 6 and 10 years of age and were divided into 4 groups with 50 children in each group. Group I: children were subjected to hypnosis, group II: acupressure, group III: AV aids i.e., VPT, and group IV: children were the control group where no anxiety-reducing techniques were used during administration of LA. The anxiety scores were recorded at three different time intervals by recording the pulse rate (PR), respiratory rate (RR) and anxiety rate (AR) and subjected to statistical analysis.

Results

The results showed that, all the three distraction techniques showed a significant reduction in PR, RR and AR at all time intervals, when compared to the control group. A significant reduction in PR, RR and AR was seen in the hypnosis group when compared to acupressure and only PR in comparison to AV aids. There was no significant difference between group II and III in reducing anxiety.

Conclusion

The present study indicates that all the three distraction techniques were effective in reducing anxiety in children. Hypnosis was most promising, followed by audiovisual aids and acupressure.

Clinical significance

The techniques can be utilized in a day-to-day practice to manage patients with anxiety.

How to cite this article

Erappa U, Konde S, Agarwal M, et al. Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S186-S192.

Non‐pharmacological interventions for managing dental anxiety in children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

This review aims to assess the effectiveness of non‐pharmacological interventions for reducing dental anxiety in children.

Dental anxiety: An understudied problem in youth

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

Factors predicting Behavior Management Problems during Initial Dental Examination in Children Aged 2 to 8 Years

AIM

The aim of the present study was to identify the various background variables and its influence on behavior management problems (BMP) in children.

MATERIALS AND METHODS

The study included 165 children aged 2 to 8 years. During the initial dental visit, an experienced operator obtained each child's background variables from accompanying guardians using a standardized questionnaire. Children's dental behavior was rated by Frankel behavior rating scale. The behavior was then analyzed in relation to the answers of the questionnaire, and a logistic regression model was used to determine the power of the variables, separately or combined, to predict BMP.

RESULTS

The logistic regression analysis considering differences in background variables between children with negative or positive behavior. Four variables turned out to be as predictors: Age, the guardian's expectation of the child's behavior at the dental examination, the child's anxiety when meeting unfamiliar people, and the presence and absence of toothache.

CONCLUSION

The present study concluded that by means of simple questionnaire BMP in children may be expected if one of these attributes is found.

CLINICAL SIGNIFICANCE

Information on the origin of dental fear and uncooperative behavior in a child patient prior to treatment process may help the pediatric dentist plan appropriate behavior management and treatment strategy.

HOW TO CITE THIS ARTICLE

Sharma A, Kumar D, Anand A, Mittal V, Singh A, Aggarwal N. Factors predicting Behavior Management Problems during Initial Dental Examination in Children Aged 2 to 8 Years. Int J Clin Pediatr Dent 2017;10(1):5-9.

Understanding children's dental anxiety and psychological approaches to its reduction

BACKGROUND

Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence. Childhood dental anxiety is not only distressing for the child and their family but is also associated with poor oral health outcomes and an increased reliance on costly specialist dental services.

AIM

This article will consider the prevalence, development, and implications of children's dental anxiety. It will also discuss the opportunities for and challenges of psychological approaches such as cognitive behavioural therapy aimed at the reduction of dental anxiety in children.

Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists

BACKGROUND. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. AIM. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. DESIGN. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. RESULTS. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. CONCLUSIONS. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety.