The Use of a Respiratory Biofeedback Device to Reduce Dental Anxiety in Children: A Randomized Controlled Clinical Trial

Abstract

Introduction: Dental anxiety occurs when the patient presents to the dentist with the anticipation of dental treatment. Many children react to dental stressful situations through uncooperative behaviors. Objectives: Investigate the effect of a respiratory biofeedback device (RESPeRATETM) in reduction of preoperative anxiety in children undergoing dental procedures under local anesthesia. Materials and methods: A randomized controlled clinical trial comprising 110 healthy children, of age range 7-12 years, were selected. Their scores were 19 or more according to the Faces version of Modified Child Dental Anxiety Scale. Participants were randomly allocated into two groups: Study and Control group. For both groups, heart rate was recorded prior to local anesthesia administration and a salivary sample was collected to measure the salivary amylase. The study group was submitted to a session of respiratory biofeedback “RESPeRATETM”. The control group was managed by a routine behavioral management technique “Tell, Show and Do”. Infiltration or block local anesthesia injections were administered, after which heart rate measurement and salivary sample was repeated. T and paired T tests were used for statistical analysis. Results: Heart rate decreased significantly in the study group (P=0.001), and increased significantly in the control group (P=0.002). There were non-significant changes among both groups regarding salivary amylase. A weak correlation was found between heart rate and salivary amylase. Conclusions: “RESPeRATETM” group showed a decrease in dental anxiety, as evidenced by decreased heart rate. “RESPeRATETM” can be used effectively before dental procedures for anxious children. Salivary alpha amylase was a poor stress biomarker.