Music distraction--its efficacy in management of anxious pediatric dental patients

Are technological contributions in behavior guidance techniques superior to conventional methods?: Effects on dental anxiety and pain perception

BACKGROUND

To evaluate the effects of three different behavior guidance methods on children's dental anxiety levels and pain perception.

METHODS

This study included 63 children aged 6-8 years who required pulpotomy and were divided into three groups: tell-show-do (TSD; Group 1), TSD with video modeling (Group 2), and TSD with mobile phone application (Group 3). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and hemoglobin oxygen saturation (SPO2) of the participants were recorded before the procedure, after local anesthesia, after pulpotomy, and after the end of the procedure. Faces Version of the Modified Child Dental Anxiety (MCDASf), Wong-Baker Faces Pain Rating Scale (WBFPRS), and Face, Legs, Activity, Cry, Consolability (FLACC) pain scales were applied. Chi-squared test, one-way ANOVA, Kruskal-Wallis test, Friedman's test, and repeated measurement analysis statistical tests were used.

RESULTS

No significant difference was found between the steps in terms of BP, HR, and SPO2 within the groups (p > 0.05). When comparing the groups, there were significant differences in SBP (p = 0.040) and DBP (p = 0.027) measured at the beginning and end of the procedure, and between MCDASf (p = 0.041) and WBFPRS (p = 0.013) scores. These values ​​were lower in Group 3.

CONCLUSION

Dental anxiety and pain perception scores were lowest when using TSD with mobile phone application (Group 3). In line with developing technology, the use of mobile phone applications in pediatric dentistry can contribute to more harmonious treatment management in children.

TRIAL REGISTRATION

The trial protocol was retrospectively registered ID NCT06912789 ( https://clinicaltrials.gov/ ); 2025-03-26.

Effect of music intervention on dental anxiety and fear: A bibliometric analysis of RCTs from 2004 to 2024

BACKGROUND

Dental treatments, especially invasive procedures, often induce anxiety and fear, impacting future treatment adherence. Music intervention, a non-pharmacological approach, has shown promise in reducing anxiety and enhancing well-being, but further research is needed to explore its application in dental settings and the influence of factors like music type, duration, and volume.

OBJECTIVE

To assess the effects of music interventions on dental anxiety and fear, analyze research trends, and identify knowledge gaps through a bibliometric analysis of randomized controlled trials.

METHODS

Data from eligible studies were extracted through a comprehensive search. Descriptive bibliometrics, citation analysis, and keyword analysis were performed to assess research outputs, distribution, hotspots, and trends. Different human development indices (HDI) were used to analyze variations in publication year, sex distribution, and interventions across countries.

RESULTS

This study included 46 randomized controlled trials (RCTs) from 2004 to 2024, with a mean annual growth rate of 5.95 %. India, Japan, and Turkey led the research output and citations. Approximately 4112 participants, with 45.68 % males were enrolled. Most RCTs focused on adults (65.22 %) and used passive music interventions (73.91 %). The most common treatment was dental extraction (39.13 %), with classical music being the predominant intervention (60.87 %). The control group were often blank (80.43 %). Various indicators of anxiety and fear have been reported. Significant differences were found in the sex distribution among the different HDI ranks (p < 0.001).

CONCLUSIONS

This study outlined the research profile of music interventions for reducing anxiety and fear during dental treatments, with India, Japan, and Turkey leading in terms of output. The most frequently studied intervention is classical music, which is typically used preoperatively. Notable sex distribution differences were observed across HDI groups. Future research trends should include more extensive trials, personalized interventions, standardized guidelines, and enhanced collaboration to optimize patient engagement and emotional regulation.

The effect of audio distraction in reducing signs of stress and anxiety during pediatric dental treatment: a systematic review and meta-analysis

AIM

To perform a systematic review to investigate if the use of audio distraction reduces signs of stress and anxiety in paediatric patients undergoing dental treatment.

MATERIALS AND METHODS

Search was made in electronic databases (MEDLINE, Scopus, Embase, Web of Science, Scielo, BVS, Springer Link, Science Direct, Cochrane Library, and grey literature) until March 11th, 2024. The eligibility criteria were: paediatric patients under dental treatment; use of audio as a distraction method; comparison between groups with and without use of audio distraction; Clinical trials. The outcomes measured were alterations in the anxiety, fear and/or stress levels. Evaluation of the risk of bias and assessment of the certainty of the evidence (GRADE) were performed. Meta-analysis was conducted for four outcomes, considering 95% confidence interval (CI), random effects and heterogeneity from Tau².

RESULTS

From 5,495 results, 25 studies composed the narrative sample and 12 composed the meta-analysis. High risk of bias was generally observed. Three results from the meta-analysis showed high heterogeneity and some outcomes presented a statistical association: systolic blood pressure reduction (p = 0.52; CI= -6.05 [-7.50 to -4.60]), pulse rate (p < 0.00001; CI= -4.95 [-9.95 to -3.52]), Venham's test scores (p < 0.00001; CI= -1.24 [-1.79 to -0.68]), and oxygen saturation (p < 0.00001; CI = 0.14 [-0.04 to 0.33]). The outcomes presented "very low" and "low" certainty of evidence.

CONCLUSION

Although a low certainty of evidence was observed, our study suggests that audio may be an effective alternative for reducing stress and anxiety and pain perception during non-invasive treatments. Future well-designed studies are necessary.

CLINICAL RELEVANCE

Audio distraction presents a potential role as an efficient method to reduce stress in children undergoing dental treatment. More RCTs are necessary to improve the evidence level, considering the main variables related to audio distraction.

Binaural auditory beats vs music of choice as audio distraction behaviour guidance technique among children: A randomized controlled trial

Background

Binaural beat is created by presenting two different pure-tone sine waves with less than a 30Hz difference dichotically. In dental settings, children listening to familiar music during treatments gain control over the anxiety caused by tools like the airotor or syringe, creating a comforting, familiar environment.

Aim

To evaluate and compare anxiety level during restorative treatment using No Music, Music of choice and Binaural Auditory Beats as Audio distraction behaviour guidance technique in children aged 6-12 years.

Methods

In-vivo, double-blind, three-arm, parallel-group randomized study was conducted in the department of pediatric and preventive dentistry where 75 participants were allocated into 3 groups. The teeth with Class I cavity in primary and permanent molars were prepared and restored. Anxiety was measured pre- and post-intervention using Pulse oximeter and Venham's picture test.

Results

Children who were treated with Binaural beats and Music of choice showed reduction in anxiety levels as indicated by lower anxiety scores in Venham picture test and pulse rate values as compared to the control group.

Conclusion

Binaural auditory beats and Music of choice can be used effectively as a non-invasive treatment modality to reduce anxiety in apprehensive pediatric patients.

Thaumaturgical Distraction as a Modality for Reducing Dental Anxiety in Children: A Systematic Review

Background

Dental fear and anxiety have become a major obstacle for children to accept dental treatment. Dental anxiety ranks fifth among common fears.

Aim

The aim of this current systematic review is to assess the effect of thaumaturgical distraction in reducing anxiety in children undergoing dental procedures.

Materials and methods

This current systematic review was registered in Prospero (CRD42023411750) following PRISMA guidelines. Electronic searches were performed in the databases: PubMed, Scopus, Web of Science, and Google Scholar. The search was conducted from inception to March 1, 2024. A broader search strategy was used to prevent missing articles. The search was performed using broad terminology: ((thaumaturgy) OR (magic)) AND (dental). ResearchGate was also consulted, and cross-references were reviewed on this topic to extract all available literature. Only randomized controlled trials are included for data synthesis. Narrative and systematic literature reviews are excluded. Evaluation of the risk of bias is planned using the ROB2 criteria of the Cochrane Collaboration.

Results

A total of 798 titles were screened by title and abstract rigorously by three independent evaluators. After duplicate exclusion and removal of irrelevant titles, 11 articles were included for full-text analysis, of which 6 qualified for final data synthesis.

Conclusion

Within the limits of the available studies, significantly lower anxiety is exhibited in the children treated under the thaumaturgical distraction group as opposed to the control group.

How to cite this article

Lekhwani P, Tirupathi S, Afnan L. Thaumaturgical Distraction as a Modality for Reducing Dental Anxiety in Children: A Systematic Review. Int J Clin Pediatr Dent 2024;17(11):1296-1301.

The Effect of Music Distraction on Dental Anxiety During Invasive Dental Procedures in Children and Adults: A Meta-Analysis

Background: Dental anxiety and odontophobia are common issues, leading to challenges with oral hygiene and dental health. Music distraction offers an effective and side effect-free solution to alleviate pain and increase the acceptability of dental treatments. Our meta-analysis aimed to assess the efficacy of music distraction in reducing patient anxiety during invasive dental procedures in children and adults. Methods: The PubMed, Web of Science, and Embase databases were searched for clinically controlled trials, using the keywords "music" and "dental anxiety". The main outcome measured was the anxiety score. A meta-analysis was conducted using a random-effects model to estimate the standardized mean differences (SMDs). The subgroup analyses were conducted based on age groups, music preferences, and music styles. The research protocol has been registered with PROSPERO (Registration ID: CRD42022357961). Results: A total of 24 controlled clinical trials involving 1830 participants met the inclusion criteria for the meta-analysis. Music distraction significantly reduced dental anxiety during invasive procedures under local anesthesia (SMD, -0.50; 95% CI, -0.80 to -0.21; p = 0.0009; I2 = 83%). Our subgroup analysis revealed that music distraction was more effective in adults (SMD, -0.51; p = 0.0007) than in children (SMD, -0.47; p = 0.13) in reducing dental anxiety. Regarding music selection, music chosen by the participant (SMD, -1.01; p = 0.008) demonstrated more anxiolytic effects than by the author (SMD, -0.24; p = 0.02). Regarding music styles, classical music (SMD, -0.69; p = 0.009) was associated with better anxiolytic effects in adults. Conclusions: Our meta-analysis supports the use of music to alleviate dental anxiety during invasive procedures. Listening to classical or customized music can serve as an effective adjunct to outpatient surgical care in dental clinics.

Recent Developments in the Non-Pharmacological Management of Children's Behavior Based on Distraction Techniques: A Concise Review

Oral diseases and conditions affect children's oral health and negatively influence their overall health. Early detection and intervention are important in mitigating these negative consequences. However, dental fear and anxiety (DFA) regarding dental procedures often hinder children from seeking necessary dental care. Non-pharmacological behavior management strategies, such as distraction techniques, are commonly adopted to manage children's behaviors. Distraction techniques have been developed rapidly in recent years and are widely accepted by both health professionals and parents due to their noninvasive and low-cost nature. This concise review aims to summarize current distraction techniques applied during dental treatments, especially for children. The most commonly reported techniques for children are audio distraction, audio-visual distraction, tactile distraction, olfactory distraction, and gustatory distraction. Audio distraction techniques involving music and storytelling help children relax. Audio-visual distraction techniques help to divert children's attention from the dental treatment. Tactile stimuli can reduce the transmission of pain signals. Olfactory stimuli can help children feel comfortable and relaxed. Gustatory distraction involving sweet substances can create a positive environment. These distraction techniques effectively reduce DFA in children and improve their satisfaction with dental procedures. As technology continues to develop, further research is needed to provide more robust, evidence-based guidance for dentists using distraction techniques.

Comparative Evaluation of Videos with and without Binaural Beat Audio on Anxiety in Pediatric Patients during Dental Procedures: A Preliminary Study

Background

Various behavioral and emotional reactions to dental care are seen in pediatric patients. As a result, pediatric dentists are deeply concerned with effective behavior coaching. The use of audiovisual stimuli at a certain frequency, which causes the brain impulses to adjust to the new frequency, is one such technique. For relaxation, verbal and working memory, multiple cognitive activities, and pain relief, audio beats have proven to be successful. The goal of this pilot study is to compare the impact of auditory beats on children who are worried during dental operations in terms of anxiety reduction.

Materials and methods

A total of 10 children aged between 6 and 9 years were shown cartoon videos with and without binaural beat audio of α wavelength alternately at two consecutive visits. The patients were preconditioned for 30 minutes before the treatment procedures using noise-cancellation headphones with an iPad as the audiovisual aid. The use of the audiovisual aid was then continued throughout the procedure. The pulse rate (PR) and oxygen saturation (SpO2) were noted preoperatively and after the procedure was completed.

Results

Using paired and unpaired t-tests, the resulting mean values before and after the procedure were compared. Compared to the control group's mean PR reduction of 3.6, the binaural beat audiovisual group saw a substantial PR reduction of 8.5 (mean). As for the SpO2 level, the experimental group's mean value increased significantly (6.8) compared to the control group's value (2.9).

Conclusion

Audiovisual aids with binaural beat audio are a noninvasive therapeutic method that targets the brain centers to influence the psychological and physiological processes of the body. It is an effective anxiolytic modality that should be considered in pediatric dentistry.

Clinical significance

The present article centers on the assessment of anxiety levels among pediatric patients. The study aims to provide insights into the mechanisms of anxiety in this specific population, with the ultimate goal of improving the quality of care and treatment options available.

How to cite this article

Rathi N, Srivastava R, Thosar N, et al. Comparative Evaluation of Videos with and without Binaural Beat Audio on Anxiety in Pediatric Patients during Dental Procedures: A Preliminary Study. Int J Clin Pediatr Dent 2024;17(9):971-975.

Effectiveness of brainwave entrainment on pre-operative fear and anxiety in pediatric dental patients: a randomized controlled trial

PURPOSE

The study aims to evaluate the effectiveness of brainwave entrainment on pre-operative fear and anxiety in pediatric dental patients.

METHODS

The study protocol received approval from the Institutional Ethical Committee under reference number 3010/IEC/2021. Pediatric patients (252) aged from 7 to 12 years, who reported to the dental department were randomized pre-operatively and presented either with brainwave entrainment (experimental), delivered using a "David delight plus device" or a standard behavior management protocol (control). Baseline and post-assessment of anxiety and fear levels were done using the Visual Facial Anxiety Scale and Frankl's behavior rating scale with Wright's modification. Vitals such as blood pressure and pulse rate were also measured.

RESULTS

The study sample (n = 252) comprised 118 females and 134 males. The non-significant differences for values of (VFAS1, FRS1, HR1, and BP1) indicated similar baseline characteristics. In the brainwave entrainment group, the p values of the Mann-Whitney U test and Wilcoxon Signed Ranks test (p < 0.01) between the two-timepoints indicated a statistical difference for the values of (VFAS1, FBRS1, HR1, BP1) and (VFAS2, FBRS2, HR2, BP2).

CONCLUSIONS

Brainwave entrainment effectively reduces pre-operative fear and anxiety in pediatric dental patients. Therefore, they can be a non-pharmacological and non-invasive behavior management aid.

TRIAL REGISTRATION

Clinical Trial Registry of India database CTRI/2023/03/051066.

Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis

BACKGROUND

Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12.

METHOD

A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses.

RESULT

A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children.

CONCLUSIONS

The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.

Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study

Aim and objective

To assess and compare children's anxiety level and pain perception during cavity preparation using an erbium-doped yttrium aluminum garnet (Er:YAG) laser vs traditional rotational treatment.

Materials and methods

A randomized, controlled, split-mouth clinical trial was carried out in 35 healthy children with 70 carious primary molars. Teeth were divided equally into two groups according to the method of treatment. A bur was used to prepare the cavity in one quadrant, while an Er:YAG laser was used to prepare the cavity in the other quadrant. Anxiety was assessed using Venham's dental anxiety scale and a fingertip pulse oximeter. The pain was assessed using the Wong-Baker Face Pain Rating Scale, and the number of local anesthesia (LA) needed during both procedures was also considered.

Results

The mean age was 9.4 ± 1.29. Males accounted for 51.4% of the participants. There were no statistically significant variations in pulse rate at the baseline between Er:YAG laser and the conventional treatments. The mean pulse rate was higher during the conventional intervention than during the laser intervention; this difference was statistically significant vs the baseline pulse rate. The mean pulse rate with the conventional method was significantly higher during and after cavity formation than with the laser method. The Er:YAG laser and the conventional groups showed statistically significant differences in the Venham's and Wong-Baker scores. The scores of both scales were much higher in the conventional group. The number of participants who requested LA during the conventional technique was significantly higher than during the laser procedure.

Conclusion

Using Er:YAG lasers to remove caries produces minimal pain and anxiety and reduces the requirement for LA.

Clinical significance

During cavity preparation, the Er:YAG laser helps children stay calm.

How to cite this article

Abdrabuh RE, El Meligy OAES, Felemban OM, et al. Evaluation of the Erbium-doped Yttrium Aluminum Garnet Laser and the Conventional Method on Pain Perception and Anxiety Level in Children during Caries Removal: A Randomized Split-mouth Study. Int J Clin Pediatr Dent 2023;16(S-1):S39-S44.

Effectiveness of thaumaturgic distraction in alleviation of anxiety in 4-6-year-old children during inferior alveolar nerve block administration: a randomized controlled trial

Background

Dental anxiety is a matter of serious concern to pediatric dentists as it may impede the efficient delivery of dental care. If not adequately resolved, a persistent negative response pattern may emerge. Thaumaturgy, commonly known as magic trick, has become popular recently. It is a tool that distracts and relaxes the child by using magic trick while the dentist performs necessary treatment. Hence, the aim of this study was to evaluate the effectiveness of Thaumaturgic aid in alleviation of anxiety in 4-6 - year-old children during administration of local anesthesia using the inferior alveolar nerve block (IANB) technique.

Methods

Thirty children aged between 4-6 years with dental anxiety requiring IANB were included in this study. Patients were divided equally into two groups: Group I, thaumaturgic aid group and Group II, conventional non-pharmacological group using randomization. Anxiety was measured before and after using the intervention with Raghavendra Madhuri Sujata-Pictorial scale (RMS-PS), Venham's anxiety rating scale, and pulse rate. All the data were tabulated and compared using statistical analysis.

Results

Children in thaumaturgy group (Group- I) exhibited significantly lower anxiety during IANB in comparison with children in the conventional group (Group- II) and the difference was statistically significant.

Conclusion

Magic tricks are effective in reducing anxiety among young children during IANB; Moreover, it expands the arsenal of behavior guidance techniques for treatment of children with anxiety and plays an important role in shaping the behavior of a child in pediatric dentistry.

Which audio distraction technique is more effective for reduction the pain and anxiety of pediatric dental patients; "music" or "kids-story"? A randomized split-mouth crossover clinical trial

OBJECTIVE

Control of pain, fear, and anxiety of children during dental procedures is a major challenge in pediatrics. This study aimed to compare the effect of audio distraction by music and audio-story on pain and anxiety of children during dental treatment.

METHODS

This randomized crossover clinical trial evaluated 60 systemically healthy children between 4 and 8 years, who were candidates for pulpotomy and steel crown of bilateral primary maxillary first or second molars. The patients were randomly divided into two groups of music-story (M first), and story-music (S first) according to the sequence of receipt of the distraction techniques with a split-mouth design. The level of pain and anxiety of patients was measured using physiological scales such as pulse rate (PR), sound-eye-motor (SEM) and faces pain rating (FPR). The pkcross package in Stata software version 14 was used to assess the treatment effect, period effect, sequence effect and carryover effect.

RESULTS

In each group, 28 cases were included in the analysis. The difference in PR was not significant at the onset and termination of each treatment session between two distraction techniques and also, the mean FPR (P = 0.55) and SEM (P > 0.99) scores were not significantly different between the two groups.

CONCLUSIONS

The "audio-story" and "music" distraction techniques were not significantly different for pediatrics relieving during LA administration. Thus, considering the equal efficacy of the two techniques, dental clinicians can use any of the two to distract children.

REGISTRATION INFORMATION

The study registered in the Iranian Registry of Clinical Trials (IRCT20190702044077N1).

Comparative evaluation of the effect of audio and virtual reality distraction on the dental anxiety of healthy and mild intellectually disabled children

Context

Dental environment is one of the most anxiety-provoking stimuli for children, which makes patient management a constant challenge in both typically growing and intellectually disabled children. Distraction is a nonpharmacological technique to manage anxiety in children during dental treatment.

Aim

This study compares the effect of audio and virtual reality (VR) distraction on the dental anxiety of healthy and mild intellectually disabled children.

Methods

Forty children aged 6-14 years were divided into two groups (Group I: children with mild intellectual disability and Group II: healthy children). Groups I and II were further subdivided into two subgroups of 10 children each, based on the distraction technique given to them during the first appointment. After 1 month, we carried out a cross-over of the subgroups. Anxiety levels were measured using physiological and observational parameters at three-time intervals.

Statistical Analysis

Performed using paired t-test for the intergroup comparison and Wilcoxon Signed Rank test for the intra-group comparison.

Results

A decrease in the pulse rate, improvement in oxygen saturation levels, and lower Venham's anxiety rating scores were observed on introducing audio and VR distraction in all the subgroups. The inter-group comparison revealed that audio and VR were more effective in healthy children than children with mild intellectual disabilities.

Conclusions

Audio and VR distraction techniques can be employed successfully to reduce anxiety in children with mild intellectual disability and healthy children undergoing dental restorative treatment.

The Effect of Sound in the Dental Office: Practices and Recommendations for Quality Assurance-A Narrative Review

Sound is inextricably linked to the human senses and is therefore directly related to the general health of the individual. The aim of the present study is to collect data on the effect of two dimensions of sound, music, and noise from an emotional and functional point of view in the dental office and to perform a thorough review of the relevant literature. We collected articles from the databases PubMed and Google Scholar through keywords that were related to noise and music in healthcare. Important information was also extracted from articles on the web and official websites. Screening of the relevant literature was performed according to accuracy and reliability of the methodology tested. A total of 261 articles were associated to sound and music in healthcare. Ninety-six of them were the most well documented and were thus included in our article. Most of the articles associate noise with negative emotions and a negative impact on performance, while music is associated with positive emotions ranging from emotional state to therapeutic approaches. Few results were found regarding ways to reduce noise in a health facility. If there is a difficulty to find effective methods of reducing the daily noise-inducing sounds in the dental office, we must focus on ways to incorporate music into it as a means of relaxation and therapy.

Basic behavioral management techniques in paediatric dentistry: A systematic review and meta-analysis

OBJECTIVE

To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in paediatric patients.

DATA SOURCES

Electronic and hand searches were conducted to locate Randomized Controlled Trials (RCTs) reporting on objective and subjective evaluation of anxiety and behavior of children up to 12 years of age. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool (RoB 2.0 Tool), were performed independently and in duplicate for all included studies. Mean differences and standard deviations were used to summarize the data from each study and meta-analyses were conducted with studies of limited heterogeneity.

STUDY SELECTION

A total of 708 papers were identified and screened, 122 retrieved for full text appraisal and 62 finally included. Results suggested that all basic BMTs have acceptable effectiveness on paediatric patients' anxiety, fear and behavior during dental treatment. Meta-analysis showed a statistically significant difference in favor of distraction for subjective anxiety using facial scale (Mean diff.: 2.78; 95% CI: -3.08, -0.53; p=0.005) and Modified Child Dental Anxiety Scale (Mean diff.: 12.76; 95% CI: -6.09, -4.47; p=0.001) and a non-significant difference for heart rate (Mean diff.: 1.70; 95% CI: -6.54, 0.46; p=0.09). Music significantly reduced heart rate when compared to a control comparator, underlining the superiority of the BMT (Mean diff.: 2.71; 95% CI: -3.70, -0.59; p=0.007).

CONCLUSIONS

Limited evidence about efficacy of one technique over another raises important issues on the topic for future research regarding the management of the child patient in the dental setting of the 21^st century.

CLINICAL SIGNIFICANCE

Behavioral management comprises a challenge for clinicians, who need to be familiar with a range of techniques to meet patients' needs at individual level and be flexible in their implementation. Appropriate technique should incorporate patients' personality and parents' active involvement, within the contents of the changes in modern societies.

Does the Efficacy of Behavior Management Techniques Differ Between Children From Single-Child and Multi-Child Families?: A Quasi-Experimental Study

Aim

Behavior management techniques (BMTs) efficiently deliver dental treatment to children with dental anxiety. The objective of this quasi-experimental study was to examine whether the efficacy of BMTs applied for the improvement of compliance in pediatric patients differs between children 3–10-year-olds from single-child and multi-child families.

Materials and Methods

In this quasi-experimental, 197 caregiver-child couples were divided into two groups: single-child group (116 couples) and multi-child group (81 couples). Children's pre- and post-treatment anxiety levels were measured by facial mood scale (FMS) and Frankl Behavior Rating Scale (FBRS), respectively.

Caregivers' dental anxiety was measured by the Chinese version of the Modified Dental Anxiety Scale (MDAS), which was included in the self-designed questionnaire. Data were analyzed by using the Mann-Whitney U-test, chi-square tests, and binary multivariate regression analysis.

Results

There was no statistically significant difference in the demographic characteristics of the children between the two groups. BMTs were found to be capable of reducing children's dental anxiety (CDA): the compliance rate was 45.69–88.79% in the single-child group and 44.44–85.79% in the multi-child group pre- and post-BMTs, but there was no significant difference in the change of compliance between the two groups (p > 0.05). In the subgroup analysis, parenting style (odds ratio [OR] = 0.054, p < 0.05) and father's education (OR = 8.19, p < 0.05) affected the varies of children's compliance in the single-child group. In contrast, in the multi-child group, gender (OR = 8.004, p < 0.05) and mother's occupation (OR = 0.017, p < 0.05) were associated with these changes in compliance.

Conclusions

In this study, BMTs were proved to be beneficial in improving compliance in 3- to 10-year-olds children in dental treatment. Though there was no significant difference in the change of compliance between children from single-child and multi-child families, different associated factors may affect the two groups. Therefore, the related family factors should be taken into account when professionals manage each child's behavior in dental practice.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

Evaluation effect of color in dental office and dentist's uniform while using two different distraction techniques on injection anxiety of 6-9 years' old children referring to Hamedan Dental School: Randomized clinical trial

Background:

The management of children's anxiety in dental offices is still a challenge for the treatment team. The most important factors which affect children's dental anxiety are the clinician-related factors and the physical factors of the dental operatory. Color is an environmental factor whose relationship with the perceptive and emotional factors of children has been reported. On the other hand, distraction is essential factors in a treatment environment that can be used to manage children's anxiety.

Materials and Methods:

In this randomized clinical trial study, from 132 6 to 9 years of age children, 52.3% were male, and 47.7% were female, with a mean age of 7.45 ± 1.1 years. The children's anxiety levels were determined using the Venham Picture Test and pulse oximetry before and after the administration of local anesthesia. The children were randomly assigned to two groups (n = 66): Group 1, music, and Group 2, animated cartoons. The data were analyzed with SPSS 25, using descriptive statistics and the statistical tests consisting of one-way analysis of variance (ANOVA), t-test, and repeated-measures ANOVA, followed by Tukey honestly significant difference tests. Statistical significance was set at P < 0.05.

Results:

The anxiety levels were the lowest in the blue and pink environments and the highest in the black and red. Anxiety levels between different colors in terms of physiologic markers and the questionnaire in each distraction technique at different intervals was significantly different.

Conclusion:

The use of blue, pink, green, and yellow for dentists' attire, and the interior design of the dental operatory decreased the child patients' anxiety.

Effectiveness of Aromatherapy and Music Distraction in Managing Pediatric Dental Anxiety: A Comparative Study

Background

Managing a child's anxiety is most critical for the success of treatment in the pediatric dental setup. Present trend advocates the use of non-aversive behavior management techniques.

Aim and objective

To compare and evaluate the efficacy of aromatherapy using orange essential oil with that of music distraction in the management of anxious pediatric dental patients.

Design

One hundred and fifty children of the age 6–8 years were divided into three groups of 50 each and performed restorative treatment under aromatherapy, with music distraction, without aromatherapy, or music distraction, respectively. Venham's picture test and facial image scale (FIS), pulse rate, respiratory rate, and oxygen saturation were recorded before and after the procedure.

Results

Compared with controls, both the aromatherapy group and music distraction group showed significant posttreatment change in anxiety levels with respect to Venham's picture test and FIS, along with the reduction in pulse rate and respiratory rate. When compared between music distraction and aromatherapy, it did not yield statistical significance, though music distraction showed better results compared to aromatherapy.

Conclusion

Both music distraction and aromatherapy using orange essential oil are effective in anxiety management of which music distraction presents a comparatively better result. Either these non-invasive techniques alone or a combination of both may be employed in the dental setup of pediatric dentists for molding cooperative patients.

How to cite this article

James J, Retnakumari N, Vadakkepurayil K, et al. Effectiveness of Aromatherapy and Music Distraction in Managing Pediatric Dental Anxiety: A Comparative Study. Int J Clin Pediatr Dent 2021;14(2):249–253.

Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability

Aim and objective

To analyze the impact of Indian instrumental music on children with intellectual disability (mild) exhibiting dental anxiety during dental procedures using electrical skin resistance measured by a biofeedback machine.

Materials and methods

A total of 20 children of 6-14 years having an intellectual disability (mild) were randomly divided into two groups comprising of 10 each. The study was carried out in a cross-over design, with and without music distraction in two appointments spaced out at a gap of 1 month. The children were subjected to a dental examination, oral prophylaxis, and auditory operative stimuli in both appointments. The electrical skin resistance during each procedure was measured using a galvanic skin response (GSR) biofeedback machine and the values were statistically analyzed using paired and unpaired t-tests.

Results

A statistically significant increase in electrical resistance was observed during music distraction, which indicated an anxiety reduction when music distraction was employed.

Conclusion

The increased electrical skin resistance due to low anxiety proves the positive impact of music distraction in intellectually disabled children.

Clinical significance

Music can be employed as a distraction technique to reduce anxiety in intellectually disabled children.

How to cite this article

Gowdham G, Shetty AA, Hegde A, et al. Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability. Int J Clin Pediatr Dent 2021;14(1):170-174.

Comparative Evaluation of the Efficacy of Virtual Reality Distraction, Audio Distraction and Tell-show-do Techniques in Reducing the Anxiety Level of Pediatric Dental Patients: An In Vivo Study

Objectives and methods

Children, in the age-group of 6 to 8 years, with moderate level of anxiety, (measured with M-DAS), requiring inferior alveolar nerve block (IANB) for mandibular tooth extraction were selected. Informed consent was obtained from parents. Selected children were allocated randomly into 3 groups virtual reality (VR) distraction group, audio distraction group and Tell-show-do (TSD) group. Pre- and post- distraction anxiety level of children was measured subjectively with facial image scale and objectively with pulse rate and oxygen saturation (measured with pulse oxymeter).

Results

There was a statistically significant decrease in pulse rate after distraction (with a p < 0.01) in all the three groups. Postdistraction pulse rate was lowest in the VR distraction group when compared to other groups. While comparing postdistraction pulse rate values in the three groups, the difference in pulse rate between TSD and VR distraction group was significant. But while comparing the pulse rate between audio distraction and TSD group (p = 0.06), and audio distraction and VR distraction group (p = 0.24) was not statistically significant. Oxygen saturation increased in all the three groups which was statistically significant (p < 0.01). There was a statistically significant difference in the postdistraction oxygen (O2) saturation levels between TSD and audio distraction groups (p < 0.05) with more O2 saturation in audio distraction group. But while comparing the audio distraction with VR group and TSD with VR group, the difference was not significant. Facial image scale (FIS) scores decreased in all the three groups (p < 0.01).

Conclusion

The overall results revealed by all the parameters indicate that children were most relaxed in VR group, followed by audio group and were least relaxed in TSD group during dental visits. Hence VR distraction can be considered as a useful technique for behavior management of pediatric patients during a conventional dental treatment.

How to cite this article

SG G, George S, S A, et al. Comparative Evaluation of the Efficacy of Virtual Reality Distraction, Audio Distraction and Tell-show-do Techniques in Reducing the Anxiety Level of Pediatric Dental Patients: An In Vivo Study. Int J Clin Pediatr Dent 2021;14(S-2):S173-S178.

Assessment of dental anxiety in children between 5 and 10 years of age in the presence of a therapy dog: a randomized controlled clinical study

PURPOSE

Children are often afraid to visit a dentist. Dental anxiety is a worldwide issue and a barrier to successful treatment outcome. Pet therapy, especially through dogs, has been demonstrated to be beneficial in reducing anxiety. In today's generation, where dopamine is prevalent, attention is hijacked, and children are tethered to screens-this research on animal-assisted therapy outlines the impact on children undergoing simple dental procedures, and to evaluate its use in long-term behavior management, and child and parental acceptance of this technique.

METHODS

One hundred and two children between five and 10 years of age and requiring simple dental procedures were selected randomly and divided into two groups. In Group A, dental treatment was carried out in the presence of a therapy dog, and in Group B (the control group), dental treatment was carried out in a regular dental setup. Anxiety levels were evaluated by pulse rate and anxiety rating scale. Prior to exiting the room, the parents were asked to rate the child's interaction with therapy dogs.

RESULTS

According to an independent t test, reduction in anxiety was highly significant (p < 0.001).

CONCLUSION

Animal-assisted therapy is an effective behavior management strategy.

Effects of music therapy as an adjunct to chest physiotherapy in children with cystic fibrosis: A randomized controlled trial

Airway clearance therapy (ACT) is considered an important approach to improve airway clearance in children with cystic fibrosis (CF). Daily ACT administration requires substantial commitments of time and energy that complicate ACT and reduce its benefits. It is crucial to establish ACT as a positive routine. Music therapy (MT) is an aspect of integrative strategies to ameliorate the psycho-emotional consequences of chronic diseases, and a MT intervention could help children with CF between the ages of 2 and 17 develop a positive response. The aim of this randomized controlled trial was to evaluate the effects of specifically composed and recorded instrumental music as an adjunct to ACT. We compared the use of specifically composed music (Treated Group, TG), music that the patient liked (Placebo Group, PG), and no music (Control Group, CG) during the usual ACT routine in children with CF aged from 2 to 17. The primary outcomes, i.e., enjoyment and perception of time, were evaluated via validated questionnaires. The secondary outcome, i.e., efficiency, was evaluated in terms of avoided healthcare resources. Enjoyment increased after the use of the specifically composed music (children +0.9 units/parents +1.7 units; p<0.05) compared to enjoyment with no music (0 units) and familiar music (+0.5 units). Perception of time was 11.1 min (±3.9) less than the actual time in the TG (p<0.05), 3.9 min (±4.2) more than the actual time in the PG and unchanged in the CG. The potential cost saving related to respiratory exacerbations was €6,704.87, while the cost increased to €33,524.35 in the CG and to €13,409.74 in the PG. In conclusion, the specifically composed, played and compiled instrumental recorded music is an effective adjunct to ACT to establish a positive response and is an efficient option in terms of avoided costs.

Trial registered as ISRCTN11161411. ISRCTN registry (www.isrctn.com).

Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment

BACKGROUND

Delivery of pain-free dentistry is crucial for reducing fear and anxiety, completion of treatment, and increasing acceptance of future dental treatment in children. Local anaesthetic (LA) facilitates this pain-free approach but it remains challenging. A number of interventions to help children cope with delivery of LA have been described, with no consensus on the best method to increase its acceptance.

OBJECTIVES

To evaluate the effects of methods for acceptance of LA in children and adolescents during dental treatment.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register (to 24 May 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019 Issue 4) in the Cochrane Library (searched 24 May 2019); MEDLINE Ovid (1946 to 24 of May 2019); Embase Ovid (1980 to 24 May 2019); and Web of Science (1900 to 24 May 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were also searched to 24 May 2019. There were no restrictions on language or date of publications.

SELECTION CRITERIA

Parallel randomised controlled trials (RCTs) of interventions used to increase acceptance of dental LA in children and adolescents under the age of 18 years.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. We performed data extraction and assessment of risk of bias independently and in duplicate. We contacted authors for missing information. We assessed the certainty of the body of evidence using GRADE.

MAIN RESULTS

We included 26 trials with 2435 randomised participants aged between 2 and 16 years. Studies were carried out between 2002 and 2019 in dental clinics in the UK, USA, the Netherlands, Iran, India, France, Egypt, Saudi Arabia, Syria, Mexico, and Korea. Studies included equipment interventions (using several LA delivery devices for injection or audiovisual aids used immediately prior to or during LA delivery or both) and dentist interventions (psychological behaviour interventions delivered in advance of LA (video modelling), or immediately prior to or during delivery of LA or both (hypnosis, counter-stimulation). We judged one study to be at low risk and the rest at high risk of bias. Clinical heterogeneity of the included studies rendered it impossible to pool data into meta-analyses. None of the studies reported on our primary outcome of acceptance of LA. No studies reported on the following secondary outcomes: completion of dental treatment, successful LA/painless treatment, patient satisfaction, parent satisfaction, and adverse events. Audiovisual distraction compared to conventional treatment: the evidence was uncertain for the outcome pain-related behaviour during delivery of LA with a reduction in negative behaviour when 3D video glasses where used in the audiovisual distraction group (risk ratio (RR) 0.13, 95% confidence interval (CI) 0.03 to 0.50; 1 trial, 60 participants; very low-certainty evidence). The wand versus conventional treatment: the evidence was uncertain regarding the effect of the wand on pain-related behaviour during delivery of LA. Four studies reported a benefit in using the wand while the remaining studies results suggested no difference between the two methods of delivering LA (six trials, 704 participants; very low-certainty evidence). Counter-stimulation/distraction versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with children experiencing less pain when counter-stimulation was used (RR 0.12, 95% CI 0.04 to 0.34; 1 trial, 134 participants; very low-certainty evidence). Hypnosis versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with participants in the hypnosis group experiencing less pain (mean difference (MD) -1.79, 95% CI -3.01 to -0.57; 1 trial, 29 participants; very low-certainty evidence). Other comparisons considered included pre-cooling of the injection site, the wand versus Sleeper One, the use of a camouflage syringe, use of an electrical counter-stimulation device, and video modelling acclimatisation, and had a single study each. The findings from these other comparisons were insufficient to draw any affirmative conclusions about their effectiveness, and were considered to be very low-certainty evidence.

AUTHORS' CONCLUSIONS

We did not find sufficient evidence to draw firm conclusions as to the best interventions to increase acceptance of LA in children due to variation in methodology and nature/timing of outcome measures. We recommend further parallel RCTs, reported in line with the CONSORT Statement. Care should be taken when choosing outcome measures.

Comparison of the effectiveness of Bach flower therapy and music therapy on dental anxiety in pediatric patients: A randomized controlled study

BACKGROUND

Dental anxiety is a primary cause of missed dental appointments, delayed treatment, and untreated dental caries in children. Alternative techniques such as music therapy (MT) and Bach flower therapy (BFT) have potential to reduce anxiety. Lack of randomized controlled studies evaluating effectiveness of these methods in reducing dental anxiety led us to this study.

AIM

To compare the effectiveness of BFT and MT on reduction of dental anxiety in pediatric patients.

MATERIALS AND METHODS

A total of 120 children (aged 4-6 years) were selected and randomly allocated to three groups: BFT, MT, and control. All children received oral prophylaxis and fluoride treatment. Dental anxiety was evaluated using North Carolina Behavior Rating Scale, Facial Image Scale (FIS), and physiological parameters.

RESULTS

Significantly better behavior was seen in children from the BFT group as compared to the control group (P = 0.014). FIS scores measured postoperatively did not show significant differences among the groups. Children from the BFT and MT groups showed a significant decrease in the pulse rates intraoperatively from the preoperative period. Intraoperative systolic blood pressure in children from the MT group was significantly lower than both the BFT and the control groups. Diastolic blood pressure significantly increased in the control group intraoperatively, whereas other groups showed a decrease.

CONCLUSION

The results of this study demonstrate significant effects of both single dose of BFT and exposure to MT, on reduction of dental anxiety in children aged between 4 and 6 years.

Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials

OBJECTIVE

To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment.

METHODS

Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively.

RESULTS

Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies.

CONCLUSION

There is a very low certainty of evidence that DT can be effective in managing children's/adolescents' dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well-executed RCTs are needed.

The reassuring role of music associated with the personality traits of children during dental care: a randomized clinical trial

AIM

The objective of this study was to analyze the reassuring role of music associated with the personality traits of children during dental care.

METHOD

The study involved a randomized crossover clinical trial with 34 children, aged from 4 to 6 years, who exhibited two carious lesions on the occlusal surfaces of the molars. The children were divided into two groups: (G1) first tooth restoration intervention session with music, second session without music; and (G2) first tooth restoration intervention session without music, second session with music. The first consultation was to perform a clinical examination, and the second and third to perform modified Atraumatic Restorative Treatment (mART). Symphony No. 40 by Mozart was played via headphones. Pulse rate (PR) was measured using a pulse oximeter. The Brazilian version of the Eysenck Personality Questionnaire-Junior (EPQ-J) was used to measure the children's personality. For statistical analysis, descriptive, Chi-square, and Wilcoxon tests were carried out.

RESULTS

The G1 group exhibited a lower PR at the time of the intervention during the second consultation compared to the third consultation (p = 0.012). The G2 group exhibited a lower PR at the time of the intervention during the third consultation compared to the first consultation (p = 0.002). The majority of the children with a low level of extraversion presented with higher PR (p = 0.005).

CONCLUSION

Music could reduce the PR among children during dental intervention. Children with low extraversion showed a tendency towards a higher PR without music during dental care.

Effectiveness of Distraction Techniques in Managing Pediatric Dental Patients

Aim

Children having dental anxiety usually hesitate to seek dental care which can result in poor oral health and may lead to expensive and complex dental treatment in the future. The aim of the present study is to compare and evaluate the effectiveness of various distraction techniques in managing pediatric dental patients.

Materials and methods

Eighty healthy children selected for the study were randomly divided into 4 groups with 20 children in each group. Group I was termed as the control group; in group II, the audio distraction technique was used. Group III received audio–video distraction (AVD) by means of a chair-mounted audio–video device and group IV received AVD by means of a ceiling-mounted television. Each child had four dental visits. Child's anxiety in each visit was assessed using four parameters: RMS pictorial scale (RMS-PS), Venham picture test (VPT), pulse rate, and oxygen saturation.

Results

Ceiling-mounted AVD was found to be the most effective in reducing the anxiety followed by chair-mounted AVD. Audio distraction was found to be the least effective but was better than the control group.

Conclusion

The AVD technique is simple, passive, and noninvasive means of behavior management and can be used alternatively in managing anxious pediatric dental patients.

How to cite this article

Khandelwal M, Shetty RM, et al. Effectiveness of Distraction Techniques in Managing Pediatric Dental Patients. Int J Clin Pediatr Dent 2019;12(1):18–24.

A review of the effect of music on dental anxiety in children

AIM

To review the current literature on the effectiveness of using music as an intervention to reduce dental anxiety in children.

METHODS

At the University of Leeds, the School of Music and the School of Dentistry collaborated to conduct an online search strategy. The Cochrane Library and Medline databases were used to find the current available evidence.

RESULTS

Systematic reviews and clinical trial studies as well as cohort studies containing pertinent information on the effect of music on anxiety in the clinical setting were reviewed. The literature showed that music can have a biological and psychological impact on emotion and consequently has been used effectively as an aid to moderate anxiety in the clinical setting. With regard to paediatric dentistry, majority of studies were found to support the use of music in reducing dental anxiety in children, however several additional studies showed that music did not significantly reduce the children's dental anxiety. The studies employed a number of methods to measure dental anxiety including the Venham's Picture Test, the Venham's clinical anxiety rating scale and pulse oximetry. They also used a range of music types; some studies allowed for patient self-selection of music whereas others dictated the music the children listened to.

CONCLUSIONS

There is an increasing body of evidence to support the use of music to moderate anxiety within the clinical setting in both medicine and dentistry. However, the current evidence for the effectiveness of using music to reduce dental anxiety in children is inconclusive and of limited quality.

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

OBJECTIVE

Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry.

STUDY DESIGN

A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children.

RESULTS

104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia.

CONCLUSION

The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.

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.

Nonpharmacologic Intervention on the Prevention of Pain and Anxiety During Pediatric Dental Care: A Systematic Review

BACKGROUND

Nonpharmacologic interventions may be used to reduce fear and anxiety during dental treatment.

OBJECTIVES

To systematically review trials on the effect of nonpharmacologic interventions in behavior, anxiety, and pain perception in children undergoing dental treatment.

DATA SOURCES

Medline, Scopus, Web of Science and CINAHL, Google Scholar, and studies' reference lists.

PARTICIPANTS AND INTERVENTIONS

Studies performed with children and adolescents that evaluated the effect of interventions on children's behavior, anxiety, and pain perception during dental treatment were included.

STUDY APPRAISAL METHODS

Independent quality assessment of the studies was carried out following the classification categories present on the Cochrane Handbook for Development of Systematic Reviews of Intervention.

RESULTS

Twenty-two articles, reporting 21 studies, were selected. Most studies tested distraction techniques. Eight studies presented bias and results were not considered. The remaining 13 studies had control groups with inactive controls, and 4 also included a variation of the intervention. Of the 4 studies assessing behavior, 3 found difference between intervention and control. Anxiety was evaluated by 10 studies: 4 found differences between intervention and control and 2 found differences between interventions. Five studies investigated pain perception: 3 found difference comparing active versus inactive interventions. In 1 of the 3, variations in the intervention decreased pain perception.

CONCLUSIONS

More research is needed to know whether the techniques are effective for improving behavior and reducing children's pain and distress during dental treatment. However, the majority of the techniques improved child's behavior, anxiety, and pain perception.

Effects of audiovisual distraction on children's behaviour during dental treatment: a randomized controlled clinical trial

Aim: Dental anxiety leads to undesirable distresses such as avoidance of dental treatment and increase stress among caregivers that consequently affect the treatment quality. The aim of this study was therefore to evaluate the effectiveness of viewing videotaped cartoons using an eyeglass system (i-theatre™) as an audiovisual (AV) distraction technique on behaviour and anxiety in children receiving dental restorative treatment.

Methods: Fifty-six consecutive children patients who presented for treatment and met inclusion criteria were included and randomly divided into two groups; a control group without distraction (CTR-group) and a distraction-group (AV-group). Three dental treatment visits were provided for each patient. Anxiety and cooperative behaviour were assessed with the Facial Image Scale (FIS) and the Modified Venham’s clinical ratings of anxiety and cooperative behaviour scale (MVARS). The vital signs, blood pressure and pulse were also taken.

Results: The AV-group showed significantly lower MVARS scores than the CTR-group (p = 0.029), and the scores decreased significantly during treatment in the AV-group (p = 0.04). Further, the pulse rate was significantly increased in the CTR-group during injection with local anaesthesia (p = 0.02), but not in the AV-group.

Conclusion: AV distraction seems to be an effective method in reducing fear and anxiety in children during dental treatment. Further, children who used eyeglass goggle display as a distraction tool during dental treatment reported not only less anxiety than control groups but also showed more positive responses after injection with local anaesthesia. Hence, AV-distraction seems to be a useful tool to decrease the distress and dental anxiety during dental treatment.

Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients

BACKGROUND

Dental anxiety is a widespread phenomenon and a concern for paediatric dentistry. The inability of children to deal with threatening dental stimuli often manifests as behaviour management problems. Nowadays, the use of non-aversive behaviour management techniques is more advocated, which are more acceptable to parents, patients and practitioners. Therefore, this present study was conducted to find out which audio aid was the most effective in the managing anxious children.

AIMS AND OBJECTIVES

The aim of the present study was to compare the efficacy of audio-distraction aids in reducing the anxiety of paediatric patients while undergoing various stressful and invasive dental procedures. The objectives were to ascertain whether audio distraction is an effective means of anxiety management and which type of audio aid is the most effective.

MATERIALS AND METHODS

A total number of 150 children, aged between 6 to 12 years, randomly selected amongst the patients who came for their first dental check-up, were placed in five groups of 30 each. These groups were the control group, the instrumental music group, the musical nursery rhymes group, the movie songs group and the audio stories group. The control group was treated under normal set-up & audio group listened to various audio presentations during treatment. Each child had four visits. In each visit, after the procedures was completed, the anxiety levels of the children were measured by the Venham's Picture Test (VPT), Venham's Clinical Rating Scale (VCRS) and pulse rate measurement with the help of pulse oximeter.

RESULTS

A significant difference was seen between all the groups for the mean pulse rate, with an increase in subsequent visit. However, no significant difference was seen in the VPT & VCRS scores between all the groups. Audio aids in general reduced anxiety in comparison to the control group, and the most significant reduction in anxiety level was observed in the audio stories group.

CONCLUSION

The conclusion derived from the present study was that audio distraction was effective in reducing anxiety and audio-stories were the most effective.

Effect of audiovisual distraction with 3D video glasses on dental anxiety of children experiencing administration of local analgesia: a randomised clinical trial

AIM

To determine the effect of three-dimensional (3D) audiovisual (AV) distraction in reducing dental anxiety of children.

STUDY DESIGN

A randomised clinical trial with a parallel design carried out on 90 children (49 boys and 41 girls) aged between 7 and 10 years (mean age of 8.4 years) to ascertain the comparative efficacy of audio (music) and AV (3D video glasses) distraction in reducing the dental anxiety of children during local analgesia (LA) administration.

METHODS

Ninety children were randomly divided into three groups; control (basic behaviour guidance techniques without distraction), audio (basic techniques plus music) and AV (basic techniques plus 3D AV) distraction groups. All the children experienced LA administration with/without distraction and the anxiety was assessed using a combination of measures: MCDAS(f) (self-report), pulse rate (physiological), behaviour (using Wright's modification of Frankl behaviour rating scale and Houpt scale) and preferences of children.

RESULTS

All 90 children completed the study. A highly significant reduction in the anxiety of audiovisual group as reported by the MCDAS(f) values (p<0.001) and Houpt scale (p=0.003); whereas pulse rate showed statistically significant increase (p<0.001) in all the three groups irrespective of distraction. The child preferences also affirmed the usage of 3D video glasses.

CONCLUSIONS

LA administration with music or 3D video glasses distraction had an added advantage in a majority of children with 3D video glasses being superior to music. High levels of satisfaction from children who experienced treatment with 3D video glasses were also observed.

Stress Reduction through Audio Distraction in Anxious Pediatric Dental Patients: An Adjunctive Clinical Study

AIM

The purpose of the present study was to evaluate the eff-cacy of 'audio distraction' in anxious pediatric dental patients.

MATERIALS AND METHODS

Sixty children were randomly selected and equally divided into two groups of thirty each. The first group was control group (group A) and the second group was music group (group B). The dental procedure employed was extraction for both the groups. The children included in music group were allowed to hear audio presentation throughout the treatment procedure. Anxiety was measured by using Venham's picture test, pulse rate, blood pressure and oxygen saturation.

RESULTS

'Audio distraction' was found efficacious in alleviating anxiety of pediatric dental patients.

CONCLUSION

'Audio distraction' did decrease the anxiety in pediatric patients to a significant extent. How to cite this article: Singh D, Samadi F, Jaiswal JN, Tripathi AM. Stress Reduction through Audio Distraction in Anxious Pediatric Dental Patients: An Adjunctive Clinical Study. Int J Clin Pediatr Dent 2014;7(3):149-152.

Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media

BACKGROUND

Dental care is a significant unmet health care need for children with autism spectrum disorders (ASD). Many children with ASD do not receive dental care because of fear associated with dental procedures; oftentimes they require general anesthesia for regular dental procedures, placing them at risk of associated complications. Many children with ASD have a strong preference for visual stimuli, particularly electronic screen media. The use of visual teaching materials is a fundamental principle in designing educational programs for children with ASD.

PURPOSE

To determine if an innovative strategy using 2 types of electronic screen media was feasible and beneficial in reducing fear and uncooperative behaviors in children with ASD undergoing dental visits.

METHODS

We conducted a randomized controlled trial at Boston Children's Hospital dental clinic. Eighty (80) children aged 7 to 17 years with a known diagnosis of ASD and history of dental fear were enrolled in the study. Each child completed 2 preventive dental visits that were scheduled 6 months apart (visit 1 and visit 2). After visit 1, subjects were randomly assigned to 1 of 4 groups: (1) group A, control (usual care); (2) group B, treatment (video peer modeling that involved watching a DVD recording of a typically developing child undergoing a dental visit); (3) group C, treatment (video goggles that involved watching a favorite movie during the dental visit using sunglass-style video eyewear); and (4) group D, treatment (video peer modeling plus video goggles). Subjects who refused or were unable to wear the goggles watched the movie using a handheld portable DVD player. During both visits, the subject's level of anxiety and behavior were measured using the Venham Anxiety and Behavior Scales. Analyses of variance and Fisher's exact tests compared baseline characteristics across groups. Using intention to treat approach, repeated measures analyses were employed to test whether the outcomes differed significantly: (1) between visits 1 and 2 within each group and (2) between each intervention group and the control group over time (an interaction).

RESULTS

Between visits 1 and 2, mean anxiety and behavior scores decreased significantly by 0.8 points (P = .03) for subjects within groups C and D. Significant changes were not observed within groups A and B. Mean anxiety and behavior scores did not differ significantly between groups over time, although group A versus C pairwise comparisons showed a trend toward significance (P = .06).

CONCLUSION

These findings suggest that certain electronic screen media technologies may be useful tools for reducing fear and uncooperative behaviors among children with ASD undergoing dental visits. Further studies are needed to assess the efficacy of these strategies using larger sample sizes. Findings from future studies could be relevant for nondental providers who care for children with ASD in other medical settings.

Can We Tune Our Pediatric Patients?

For the pedodontic team, a child’s dental anxiety poses major management problems. Previously, wide variety of aversive techniques have been used with varying success rates to manage anxious child patients. The present trend advocates the use of nonaversive techniques like distraction in the management of anxious pediatric patients. So the aim of this study is to compare the effect of audio distraction with the normal set up operatory. Thirty patients of age between 4 and 8 years were included in the study. Each patient had gone through four dental visits. Anxiety was measured using Venham’s picture test. The values obtained were tabulated and statistical analysis and concluded that audio distraction did decrease the level of anxiety in anxious pediatric dental patients to a significant level during the restorative procedure visit (3rd) and invasive procedure visit (4th).

Effectiveness of music interventions on dental anxiety in paediatric and adult patients: a systematic review

BACKGROUND

Dental anxiety has been identified as a significant and common problem in both children and adults and is considered an obstacle for dental care providers in the delivery of quality oral care. Patients with dental anxiety tend to avoid professional dental care which poses a problem for dentists and patients alike.There are various treatment options for reducing dental anxiety. Music has been used in different medical fields to meet physiological, psychological, and spiritual needs of patients. Music interventions can either be passive (music listening) or active music (therapy).There was a significant gap in the literature on the effectiveness of music therapy and music listening in reducing dental anxiety in patients undergoing various dental treatments/procedures. This systematic review specifically examined the effectiveness of music interventions in reducing dental anxiety in both paediatric and adult patients.

OBJECTIVE

The objective of this systematic review was to critically appraise, synthesise and present the best available evidence related to the effectiveness of music interventions on dental anxiety in paediatric and adult patients.

DATA SOURCES

A comprehensive search was undertaken on major electronic databases from their inception to October 2010. The search was restricted to English language and other languages where a translation was available from colleagues (for e.g. Chinese, Japanese, and Italian).

REVIEW METHODS

Randomised controlled trials, quasi-randomised controlled trials and quasi-experimental studies were included in the review. Critical appraisal and data extraction were undertaken using the Joanna Briggs Institute critical appraisal instrument and the standard data extraction form for evidence of effectiveness.

RESULTS

Seven studies with a combined total of 598 patients were included. Two out of the seven studies were RCTs, four quasi-randomised and one quasi-experimental study. There were 513 adult patients as participants from five studies and 85 paediatric patients from two studies. The results were classified into two categories.Two studies had paediatric patients as population group. One study found that music listening did not result in any reduction of anxiety during dental procedures on young patients; therefore the authors concluded that music alone is ineffective as a distraction during dental procedures. However, another study found that music reduced anxiety to some extent, although it was not significant.Five studies included in this review had adult patients as population group. Two studies concluded that relaxation when compared to music is an effective method of reducing patient's anxiety. One study concluded that music listening significantly lowered levels of anxiety and stress of females during dental procedures. Authors of the study concluded that there was a strong physiological (increased secretory immunoglobulins level) response to music by females. Two other studies provided conclusive evidence on effectiveness of music in reducing dental anxiety in this population group.

CONCLUSIONS

This systematic review concluded that there was enough evidence to suggest that adult patients may benefit from a procedural music-listening program. There was inconclusive evidence on the effectiveness of music in reducing dental anxiety in children.

IMPLICATIONS FOR PRACTICE

It is recommended that pre-recorded music be offered through headphones during the dental procedure to adult patients to reduce their dental anxiety. The evidence on the effectiveness of music in reducing dental anxiety in children is inconclusive.

IMPLICATIONS FOR RESEARCH

More research needs to be performed before it is possible to show, with a higher degree of certainty, that music listening does have a significant effect on the reduction of dental anxiety. Future studies, most likely randomised controlled trials should evaluate music therapy as an intervention for managing dental anxiety.

Can Indian classical instrumental music reduce pain felt during venepuncture?

OBJECTIVE

Local anesthetic agent is not usually used to reduce pain experienced by children undergoing venepuncture. This study was undertaken to determine comparative efficacy of local anesthetic cream, Indian classical instrumental music and placebo, in reducing pain due to venepuncture in children.

METHODS

Children aged 5-12 yr requiring venepuncture were enrolled in a prospective randomized clinical trial conducted at a tertiary care center. They were randomly assigned to 3 groups: local anesthetic (LA), music or placebo (control) group. Eutactic mixture of local anesthetic agents (EMLA) and Indian classical instrumental music (raaga-Todi) were used in the first 2 groups, respectively. Pain was assessed independently by parent, patient, investigator and an independent observer at the time of insertion of the cannula (0 min) and at 1- and 5 min after the insertion using a Visual Analog Scale (VAS). Kruskal- Wallis and Mann-Whitney U tests were used to assess the difference amongst the VAS scores.

RESULTS

Fifty subjects were enrolled in each group. Significantly higher VAS scores were noted in control (placebo) group by all the categories of observers (parent, patient, investigator, independent observer) at all time points. The VAS scores obtained in LA group were lowest at all time points. However, the difference between VAS scores in LA group were significantly lower than those in music group only at some time-points and with some categories of observers (parent: 1 min; investigator: 0-, 1-, 5 min and independent observer: 5 min).

CONCLUSION

Pain experienced during venepuncture can be significantly reduced by using EMLA or Indian classical instrumental music. The difference between VAS scores with LA and music is not always significant. Hence, the choice between EMLA and music could be dictated by logistical factors.