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Mehta S, Naik SS, Kodical SR, Joshi A, Shetty A, Balasubramanian N. Enhancing special care dentistry with waiting room based multisensory-adapted dental environment: A randomized controlled-trial. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38233968 DOI: 10.1111/scd.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
AIM To assess the effectiveness of waiting room based multisensory adapted dental environment (SADE) as a novel, non-invasive behavior management technique in alleviating anxiety levels in children with Down syndrome. MATERIALS AND METHODS This study was conducted in the Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Nerul, Navi Mumbai. A total of 40 children between 8 and 13 years of age diagnosed with Down syndrome were included in our study. Prior to the first dental evaluation, they were divided equally into two groups using simple randomization via lottery system. Group A (Intervention group): Patients were subjected to a sensory adapted environment (SADE) in the waiting room for 10 min prior to dental evaluation. Group B (Control group): Patients were subjected to a regular dental environment (RDE) in the waiting room for 10 min prior to dental evaluation. Outcome parameters evaluated at baseline and post dental evaluation were anxiety and behavior, using a pulse oximeter and the Modified Venham's Scale respectively. Data were subjected to statistical analysis using SPSS version 21.0 (SPSS Inc. Chicago, IL). The 'p' value < .05 was taken as significant at 95% confidence interval. RESULTS Mann-Whitney U test was used to carry out the inter group analysis which showed a significant increase in the heart rate (26.00, p = .00) in Group B and a significant decrease in the Modified Venham Scale score (90.00, p = .001) in Group A. The Wilcoxon Signed ranks test was used to carry out the intra group analysis for which a significant difference between the two time intervals for heart rate (-3.69, p = .00) and Modified Venham Scale score (-1.46, p = .03) was obtained in Group A whereas a significant difference was obtained only in the heart rate (-3.04, p = .002) in Group B. CONCLUSION Multisensory-adapted dental environment (SADE) in the waiting room effectively improves behavior, reduces anxiety and sensory discomfort among children with Down syndrome.
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Affiliation(s)
- Shivani Mehta
- Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Shilpa S Naik
- Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Sanjana R Kodical
- Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Amil Joshi
- Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Ashveeta Shetty
- Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Nikitha Balasubramanian
- Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
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Risner-Bauman A, Henschel M, Robbins MR. An educational model for special patient care in dentistry. SPECIAL CARE IN DENTISTRY 2023; 43:772-775. [PMID: 37544886 DOI: 10.1111/scd.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
Dental school graduates often have a basic knowledge in the management of patients with specialized healthcare needs. As of August 2019, CODA amended their accreditation standard 2-25: dental school graduates must be competent in the assessment and management of treatment of patients with specialized healthcare needs and disabilities. While the majority of these patients require modified dental care, many dental schools lack the facilities to provide both the proper care and education. This paper identifies improvements to dental education brought on by the innovations at Penn Dental Medicines' Personalized Care Suite for Persons with Disabilities (PCARE). Patient centered care is the emphasis of the PCARE curriculum. Although the clinic has special rooms and equipment to assist in accommodating the special needs of the patients, the program focuses on teaching dental students how to provide comfortable, safe, and effective care in a typical office setting. Detailed patient assessment, non-pharmacological management techniques, and treatment plans designed to meet the needs and abilities of the patients and caregivers are taught through lecture and direct patient care. Teaching assessment and management of this population is of great importance. Including treatment in Standard 2-25 creates another challenge to dental education. Penn Dental's facility allows multidisciplinary care in a cohesive and timely manner. The experience in PCARE offers unique opportunities to educate dental professionals in developing a patient centered approach in the treatment and maintenance of oral health in those patients who require accommodation.
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Affiliation(s)
- Alicia Risner-Bauman
- Care Center for Persons with Disabilities, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
- Clinical Oral Medicine and Clinical Restorative Dentistry, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Marc Henschel
- AEGD Program, Division Community Health, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
- Clinical Community Oral Health, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Miriam R Robbins
- Care Center for Persons with Disabilities, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
- Clinical Oral Medicine and Clinical Restorative Dentistry, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
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Reynolds K, Chimoriya R, Chandio N, Tracey D, Pradhan A, Fahey P, Stormon N, Arora A. Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses. BMC Oral Health 2023; 23:769. [PMID: 37858057 PMCID: PMC10585952 DOI: 10.1186/s12903-023-03445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety. METHODS This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by full text retrieval. Quality of the included studies was assessed using Cochrane Risk of Bias (ROB)-2 for crossover trials and data extracted by two reviewers. The details of the interventions and effectiveness were compared and discussed narratively, and comparable outcomes were included to meta-analyses using R software. RESULTS A total of 622 articles were identified and five articles met eligibility for inclusion. Three studies used multi-sensory adaptations and one used single sensory adaptation of music. Narrative synthesis showed some evidence of SADE reducing magnitude and duration, although, questionable for reducing the number of maladaptive behaviours. Two studies demonstrated conflicting evidence of the effect of SADE on cooperation. Three studies demonstrated significant positive impact of SADE on psychophysiological outcomes. Despite an overall tendency to favour SADE, no statistically significant difference of maladaptive behaviours was found between SADE and regular dental environment (RDE) (Standardised mean change (SMC) = 0.51; 95% Confidence Interval (CI) -0.20 to 1.22; p = 0.161). SADE was superior to RDE (SMC -0.66; 95% CI -1.01 to -0.30; p = < 0.001) in reducing psychophysiological responses of dental anxiety. CONCLUSION Current evidence suggests that adapting visual, tactile, and auditory aspects of the dental environment in a single or multi-sensory approach demonstrates small positive effects on psychophysiological responses and maladaptive behaviours of dental anxiety for people with IDD. TRIAL REGISTRATION The title of this review was registered with PROSPERO (CRD42022322083).
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Affiliation(s)
- Kaitlyn Reynolds
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
| | - Ritesh Chimoriya
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW, 2144, Australia
| | - Navira Chandio
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Danielle Tracey
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Centre for Educational Research, Western Sydney University, Kingswood, NSW, 2747, Australia
| | - Archana Pradhan
- Sydney Dental School, The University of Sydney, Surry Hills, NSW, 2010, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Nicole Stormon
- School of Dentistry, The University of Queensland, Herston, QLD, 4006, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia.
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
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