Are Behavior Rating Scales Able to Identify Behavioral Changes in Preschool Children Undergoing a Dental Intervention? A Systematic Review

Jéssica Aparecida Da Silva,Saul Martins Paiva,Laura Guimarães Primo,Andréa Fonseca-Gonçalves,Daniele Masterson Tavares Pereira,Lucianne Cople Maia

doi:10.1590/pboci.2020.097

Abstract

Objective: To evaluate the scientific evidence concerning the behavior rating scales efficiency to identify behavioral changes in preschool children undergoing dental treatment, through a systematic review. Material and Methods: MEDLINE/PubMed, Scopus, Cochrane Library, Web of Science, BVS databases and grey literature were searched. Also, a hand search of the included studies reference lists was conducted. Studies that evaluated healthy preschoolers’ behavior before and after invasive dental treatments to observe behavioral changes were included. Two independent reviewers selected studies, extracted data and analyzed the risk of bias with a tool for before-and-after studies. The certainty of the evidence was evaluated with the GRADE approach . Results: Three studies were included. The Frankl Scale and North Carolina Behavior Scale were used in these studies. Both scales were able to identify behavioral changes in preschool children undergoing a dental intervention, although two of these included studies were considered fair with a high risk of bias, and one considered good with a low risk of bias . Conclusion: Although Frankl and North Carolina behavior scales were able to identify changes in the children`s behavior during dental treatment, these findings are not supported by strong evidence. Thus, further well-designed studies are needed to confirm this evidence.

Highlights

Dental treatment is a circumstance with great fear, anxiety and uncooperative behavior generating potential, mainly in pediatric dentistry patients [1]
These results demonstrate that the scale used was able to identify behavioral changes in the studied population (p=0.003), since in the second behavior evaluation when an invasive procedure was conducted, just a few children were considered definitely positive
This study conducted by Kamel et al [18] found a statistically significant difference (p=0.003) in children's behavior during the dental treatment, suggesting that the Frankl scale is efficient to identify behavioral changes in preschool children undergoing dental treatment

Summary

Introduction

Dental treatment is a circumstance with great fear, anxiety and uncooperative behavior generating potential, mainly in pediatric dentistry patients [1]. Rating scales play a special role in pediatric dentistry, as they may provide an aid to classify behavior and cooperation of patients. They can be used in children at an early stage, making it possible to prevent further development of behavioral problems [2]. The most consistently employed measure of behavior in dental setting involves analysis of the child's behavior through the use of rating scales, especially in young children. The Frankl Scale [11] is probably the most frequently used This tool has high reliability, is considered the gold standard in the literature and is widely used both in the clinical and in the research areas [2,8,9]

Methods

Findings

Discussion

Conclusion