Childhood dental fear in children aged 7-11 years old by using the Children's Fear Survey Schedule-Dental Subscale

Stakeholder Attitudes, Experiences and Perceptions of the New South Wales Primary School Mobile Dental Program

OBJECTIVES

Tooth decay is a leading cause of total disease burden among Australian children. In 2019, the state government of New South Wales, Australia implemented the Primary School Mobile Dental Program (PSMDP) across five local health districts. Understanding stakeholder satisfaction of the PSMDP is an important measure of quality, to determine appropriateness as relevant to the needs of populations. The aim of the study was to explore parent/caregiver and provider attitudes, experiences, and perceptions of the PSMDP.

METHODS

This study reports on the qualitative component of a mixed methods study examining parent/caregiver and provider (oral health staff) experiences of the program. Two of the five local health districts were selected for study sampling. Parents/caregivers were recruited using flyers administered via schools and oral health teams. Interviews were conducted between 2022 and 2023. The interviews lasted 20-60 min, were recorded, and transcribed verbatim. A critical realist lens was applied, and thematic analysis was conducted. Data saturation was achieved, and bias was reduced through member checking, researcher reflexivity, and team triangulation of the data.

RESULTS

In total, 79 individuals (58 parents/caregivers and 21 providers) were interviewed. Analysis revealed six key themes: (1) oral healthcare access, (2) informed consent, (3) parental attendance, (4) rewarding experiences, (5) operational barriers, and (6) communication clarity. The PSMDP promoted oral healthcare access while some parents/caregivers reported informed consent challenges. Providers cited rewarding experiences but face operational barriers including time constraints. Stakeholders diverged on parental attendance at school dental appointments, and most importantly, parents/caregivers requested follow-up communication clarity and coordination, particularly in feedback letters.

CONCLUSIONS

Qualitative findings identified generally positive attitudes and experiences with the PSMDP, and implications have been identified that would support the scale-up and sustainability of the PSMDP across the state. Study insights could be useful for similar programs, such as extending the attendance time per child, giving greater consideration to parental involvement, and improving communication and follow-up coordination.

Observational Study on Progressive Muscle Relaxation and Breathing Control for Reducing Dental Anxiety in Children

Background and Objectives: Dental anxiety is a common barrier to pediatric oral care. Non-pharmacological relaxation techniques like Jacobson's Progressive Muscle Relaxation (JPMR) and Breathing Control (BC) may help reduce psychological and physiological stress. This study assessed the utility of JPMR and BC in reducing dental anxiety and physiological arousal in children and adolescents. Materials and Methods: In this observational study, 189 participants aged 8-17 undergoing non-invasive dental procedures were assigned to JPMR (n = 63), BC (n = 63), or control (n = 63) groups. Dental anxiety was measured with the Romanian-validated IDAF-4C+, and physiological stress was measured via blood pressure and heart rate. Pre and post-intervention data were analyzed using paired t-tests, ANOVA, and cluster analysis. Results: JPMR led to the highest reductions in IDAF-4C+ scores (Δ = -1.23, p < 0.001, d = 1.12) and systolic blood pressure (Δ = -9.4 mmHg, p < 0.01). BC showed moderate anxiety reduction (Δ = -0.64, p < 0.05, d = 0.61) with minor physiological changes. The control group showed no significant change. Cluster analysis revealed three response patterns: (1) high anxiety-strong responders (n = 58), mainly benefiting from JPMR; (2) moderate anxiety-partial responders (n = 74); and (3) low anxiety-non-responders (n = 57). Younger age and female gender were linked to better JPMR response. Conclusions: JPMR is an effective and practical method for reducing dental anxiety and physiological stress in pediatric dental care.

Influence of the Hall Technique on Patient Cooperation: A Retrospective Analysis

Child's cooperation and behaviour in paediatric dentistry are largely determined by the nature of the treatment. Minimally invasive, faster, and more comfortable treatments can lead to greater cooperation and improved behaviour. Objectives: To assess the impact of the Hall technique (HT) on children's behaviour over time across three consecutive treatment sessions through a retrospective analysis. Methods: The analysis included children aged 3 to 10 years treated with the HT, with both a pre- and post-Hall technique appointment within a 6-month period. The level of cooperation at each visit was assessed using the Frankl behaviour rating scale (FBRS). The FBRS scores from the three visits: T1 (first treatment session), T2 (Hall technique session), and T3 (follow-up session) were analysed to predict the endpoint (T3-T1) using the Wilcoxon signed-rank test. In addition, an ordinal logistic regression model was used to assess the relationship between variables and behavioural change. Results: Of the 90 children included in this study (mean age 5.9 ± 1.56 years; 50 boys, 55.6%), the proportion of patients exhibiting extremely positive/positive behaviour increased steadily over the sessions, from 56.7% at T1 to 76.7% at T2 to 91.1% at T3. The initial behaviour at T1 was the only significant predictor (p < 0.0001) of the improvement in behaviour (T3-T1) in the ordinal logistic regression model, which also included variables such as age, sex of the patient, and the treating dentist. Conclusions: The Hall technique had a significant positive effect on improving children's behaviour over the course of treatment.

Do Parental and Children’s Dental Anxiety Affect Childhood Dental Caries?

Background: Dental anxiety is an unpleasant reaction to fear or stress related to the dental environment and can be observed in both parents and children as dental patients. Despite several studies challenging the significance of parental anxiety in influencing a child's response to dental treatment, conflicting results have emerged regarding the impact of both parental and children's anxiety on the development of dental caries. Objectives: This study aimed to explore the association between parental and children's dental anxiety and the occurrence of dental caries in children. Methods: A cross-sectional study involving 7 - 12-year-old students and their parents in schools of Rasht, Iran, utilized the Modified Dental Anxiety Scale (MDAS) for parents and the Modified Child Dental Anxiety Scale (MCDAS) questionnaire for children. Participants were chosen through a multistage sampling process. A trained dentist assessed children's dental caries using the DMFT/dmft (decayed, missing, and filled teeth) Index. The data were analyzed using the chi-square test and linear regression. Results: The study included 275 parents and an equal number of children, with a mean child age of 9.32 ± 1.85 years. The findings indicated a significant relationship between maternal dental anxiety and DMFT + dmft scores in boys (P = 0.049). The study revealed that the number of teeth with caries experience (P = 0.023), child's sex (P = 0.007), history of dental clinic visits (P = 0.045), and maternal dental anxiety (P = 0.043) significantly influenced the child's dental anxiety. Conclusions: Children with anxious parents showed lower DMFT/dmft values, suggesting increased attention to their dental health. The study highlights the impact of parental dental anxiety on children's oral well-being and emphasizes the need for comprehensive strategies to address dental anxiety in both parents and children.

Computer-Controlled Local Anaesthesia Delivery efficacy - a literature review

Minimising pain with effective local anaesthesia is an essential step towards improving the level of dentally anxious patients' comfort during dental treatment. It can be provided by many different techniques. One of them is using the Computer-Controlled Local Anaesthesia Delivery systems (CCLADs). This study was conducted to compare the efficacy of computerised anaesthesia with the conventional technique in terms of perceived pain. A database literature search was performed on PubMed, Cochrane Library and Google Scholar, covering up the period between 2015 and 2023. Only the studies comparing computerised anaesthesia technique with the use of conventional carpule were included. An overview of 20 relevant studies (n = 1347 subjects) was provided including pediatric patients, as well as the adults. The evaluated parameters were: pain, child's behaviour, heart rate, blood pressure, level of satisfaction, anxiety, further anaesthesia method preference, need for additional anaesthetic, as well as the duration of anaesthesia, measured by different scales, devices and questionnaires. The present literature review led the authors to the conclusion, that the use of CCLADs is significantly less painful than the traditional anaesthesia and it is a promising technique for helping patients deal with pain perception. However, it is advisable to conduct further research on the use of CCLAD.

Evaluation of children's oral diagnosis and treatment using imaging examination using AI based Internet of Things

BACKGROUND

Although cone beam computed tomography (CBCT) plays an important role in the diagnosis and treatment of oral diseases, its image segmentation method needs to be further improved, and there are still objections about the clinical application effect of general anesthesia (GA) on children's dental fear (CDF).

OBJECTIVE

This study aimed to investigate the application value of CBCT based on intelligent computer segmentation model in oral diagnosis and treatment of children in the context of biomedical signals, and to analyze the alleviating effect of GA on CDF.

METHODS

Based on the regional level set (CV) algorithm, the local binary fitting (LBF) model was introduced to optimize it, and the tooth CBCT image segmentation model CV-LBF was established to compare the segmentation accuracy (SA), maximum symmetric surface distance (MSSD), average symmetric surface distance (ASSD), over segmentation rate (OR), and under segmentation rate (UR) between these model and other algorithms. 82 children with CDF were divided into general anesthesia group (GAG) (n= 38) and controls (n= 44) according to the voluntary principle of their families. Children in GAG were treated with GA and controls with protective fixed intervention. Children's fear survey schedule-dental subscale (CFSS-DS) and Venham scores were counted before intervention in the two groups. CFSS-DS scores were recorded at 2 hours after intervention and after recovery in children in GAG. CFSS-DS and Venham scores were performed in all children 1 week after surgery.

RESULTS

The results showed that the S⁢A value of CV-LBF algorithm was higher than that of region growing algorithm (P< 0.05). OR, UR, MSSD, and ASSD values of CV-LBF algorithm were evidently lower than those of other algorithms (P< 0.05). CFSS-DS scores were lower in GAG than in controls 2 hours after intervention and at return visits after 1 week of intervention (P< 0.001), and Venham scores were lower in GAG than in controls after intervention (P< 0.001). After intervention, the proportion of children with Venham grade 0, 1, 2, and 3 was obviously higher in GAG than in controls (P< 0.001), while the proportion of children with Venham grade 4 and 5 was clearly higher in controls than in GAG (P< 0.001).

CONCLUSION

The results revealed that the computer intelligent segmentation model CV-LBF has potential application value in CBCT image segmentation of children's teeth, and GA can effectively alleviate anxiety of children with CDF and can be used as biomedical signals.

A Cross-Sectional Study to Analyze the Correlation Between Alexithymia and Dental Neglect in Persons Pursuing Dental Care

Background Alexithymia is a personality trait involving difficulties in emotional regulation (difficulties in identifying feelings, difficulties in describing feelings, and externally oriented thinking). It has a negative impact on health as it evokes poor personal hygiene, poor nutrition, and unhealthy behaviors in affected subjects. Identifying alexithymia in the dental setup is vital as it can compromise the patient-dentist relationship, especially in subjects neglecting oral hygiene. Aims The present study aimed to establish an association between alexithymia and dental neglect among adult subjects seeking dental care by using Dental Neglect Scale (DNS), and alexithymia was assessed on the 20-item Toronto Alexithymia Scale (TAS-20). Methods The present cross-sectional survey study included adult subjects of age 20 years or more. For all included participants, a structured questionnaire was given to assess dental neglect on demographic profile, six items of the DNS, and alexithymia was assessed on the 20-item TAS-20. The collected data were analyzed using a Chi-square test keeping significance at the p-value of <0.05. Results In 534 adult subjects, females had high scores for both TAS-20 and DNS along with their related factors. With higher education and increasing age, a significant increase in the mean TAS-20 scores and mean DNS scores was seen in the study participants (high mean DNS scores in females (19.55±3.98) compared to male subjects 19.36±4.34). TAS-20 scores were higher in females (59.31±10.78), factor 1 (DIF) (19.54±5.54), factor 2 (DDF) (15.46±4.05), and factor 3 (EOT) (24.34±4.64). Conclusion The present study, considering its limitations, concludes that there is no association between dental neglect and alexithymia in adult subjects seeking dental care. However, higher DNS and TAS-20 scores are seen in females showing them have difficult descriptions and identification of feelings in dental set-up increasing dental neglect among them.

Effect of Photobiomodulation on the Depth of Local Anesthesia during Endodontic Treatment of Teeth with Symptomatic Irreversible Pulpitis

AIM

To determine whether photobiomodulation (PBM) therapy could increase the depth of analgesia during endodontic therapy of teeth affected with symptomatic irreversible pulpitis.

MATERIALS AND METHODS

Forty-nine patients with symptomatic irreversible pulpitis were randomized into two groups. In the laser group, before administering anesthesia, the lower molars' crowns were continuously treated with a diode laser (980 nm) for 20 s with a low-level laser tip in the buccal aspect close to the gingival margin. While the teeth of the second group who was blinded to the type of treatment received placebo treatment wherein the laser device was switched off. The visual analogue scale (VAS) was used to assess pain in both groups before the endodontic procedure, during dentin cutting, and at dropping pulp, wherein, the success was defined as no or mild pain. The Chi-square and independent sample t-tests were used to assess the data.

RESULTS

During dentin cutting and pulp dropping, the group receiving the laser therapy presented with less mean pain score than the placebo group which was statistically significant. Additionally, it was observed that the need for supplementary injection was less frequent in the laser-treated group than in the placebo group (p = 0.01).

CONCLUSION

The irradiation by diode laser (980 nm) prior to administration of local anesthesia appears to be useful in minimizing discomfort and additional injection during root canal therapy (RCT).

CLINICAL SIGNIFICANCE

Pain management is essential for providing the best possible treatment to patients before, during, and after endodontic therapy. Adequate pain control during treatment also aids in reducing postoperative discomfort. This implies the need for additional methods to reduce discomfort during endodontic treatment; hence, adjuncts are crucial to achieving this goal. Photobiomodulation may be used as an adjuvant to reduce discomfort and supplementary injections during RCT.

Comparative study of two different computer-controlled local anesthesia injection systems in children: a randomized clinical trial

PURPOSE

To compare pain perception associated with two computer-controlled local anesthesia devices, the WAND™ STA (Milestone Scientific Inc., Livingston, NJ, USA) and the Calaject (Rønvig dental MFG, Daugaard, Denmark) in young children.

METHODS

A split-mouth randomized clinical trial comprising 30 patients, aged 6-12 years, received randomly, in two separate sessions, a local anesthesia injection in the maxillary using either the wand STA or the Calaject. Pain perception was evaluated using the patient's heart rate, an 11-point numerical scale (NRS), and the Sound, Eye, and Motor (SEM) body movements. Statistical difference was set at p = 0.05. Repeated measures analysis of variance were conducted to compare the mean pulse for Calaject and STA at different times. It was followed by univariate analysis and Bonferroni multiple comparisons tests. Wilcoxon tests were performed to compare NRS, SEM, and injection duration between Calaject and STA.

RESULTS

There was no significant statistical difference between Calaject and STA in pulse rate before injection (p = 0.720), during injection (p = 0.767), and after injection (p = 0.757). The mean NRS score was significantly greater with STA in comparison with Calaject (p = 0.017). The mean SEM score was also significantly greater with STA in comparison with Calaject (p = 0.002). However, the mean duration was significantly longer with Calaject (p = 0.001).

CONCLUSIONS

Calaject was more effective than STA in reducing pain perception associated with periapical injection in young children.

Study of dental phobia, psychological resilience, and related factors in children aged 8-9 years in Weifang city

OBJECTIVES

To investigate the influencing factors of children's dental fear (CDF) and the relationship of CDF with resilience in children aged 8-9 years in Weifang city to provide evidence for the early prevention and intervention of CDF.

METHODS

Random cluster sampling method was applied. A total of 1 995 children aged 8-9 years from 10 primary schools in four districts of Weifang city were selected from June to October 2021 as the survey objects. General information questionnaire, the children's fear survey schedule-dental sub-scale, and adolescent resilience scale were used in the investigation.

RESULTS

The CDF detection rate was 31.78% (634 cases) in children aged 8-9 years in Weifang city, including 28.41% (296 cases) in boys and 35.47% (338 cases) in girls. Multivariate logistic analysis showed that female gender [odds ratio (OR)=1.329, 95% confidence interval (CI)=1.062-1.665], dental caries (OR=1.961, 95%CI=1.330-2.891), dental pain (OR=2.133, 95%CI=1.700-2.676), and dental treatment experience (OR=3.621, 95%CI=2.888-4.540) are risk factors for CDF. Parents with tertiary education or higher (OR=2.123, 95%CI=1.546-2.916; OR=3.304, 95%CI=2.368-4.612), high scores in the positive cognition factor of the psychological resilience-personal strength dimension (OR=1.520, 95%CI=1.141-2.025), high scores in the interpersonal assistance factor of the psychological resilience-support strength dimension (OR=3.819, 95%CI=2.743-5.318), and high scores in the family support factor (OR=5.634, 95%CI=4.047-7.844) were protective factors for CDF occurrence (P<0.05).

CONCLUSIONS

Children with high psychological resilience scores have low CDF incidence, and good parenting practices are beneficial in reducing CDF incidence.