Baker FACES Pain Rating Scale Research Articles

Investigating the effect of virtual reality glasses during inhaler therapy use in children: A randomized clinical trial

Abstract Objectives Virtual reality (VR) glasses have been used in the medical field, as they are perceived to be suitable for distracting children. In this study, we aimed to compare patients who received inhaler treatment with VR glasses with those who received treatment without the aid of any device in terms of treatment compliance. Materials and Methods A prospective, randomized controlled study was conducted on pediatric patients aged 2 to 5 years requiring inhaler treatment (salbutamol), with the informed consent of their families. Participating patients who received standard care were divided into three groups via randomization: roller coaster VR group, wild dolphin VR group, and no additional device group. The patients were observed during their 15-minute inhaler treatment, and the groups were compared in terms of crying times, pre- and post-treatment physician and family questionnaire data (Face, Legs, Activity, Cry, Consolabity Scale [FLACC], Modified Yale Anxiety Scale [MYPAS], Modifiye Parents’ Pain Measure [MPMM], Wong–Baker Faces Pain Rating Scale [WBS]), and respiratory rate (RR), peripheral oxygen saturation, and heart rate value changes to determine any differences between them. Results Post-treatment questionnaire scores, RR, crying duration, and efficacy of treatment exhibited significant differences in Groups 1 and 2 compared to the control group. A significant difference was found in the post-treatment RR between groups 1 and 2, but no difference was observed in the other parameters. Conclusions Utilizing VR glasses during inhaler therapy has the potential to minimize adverse effects, such as pain, and enhance the overall comfort of the treatment environment for patients.

Do Parents Dental Neglect and Anxiety Affect Their Children s Dental Neglect and Anxiety

Aim: Dental neglect is an obstacle to obtaining the necessary dental care in protecting and maintaining basic oral health. Dental anxiety can cause difficulties in behavior management, maintenance of dental treatments, and poor oral hygiene. In this study, it was aimed to examine the relationship between dental neglect and anxiety levels of both parents and their children. Material and Methods: 220 people including 110 parents and 110 children were included in the study. The Dental Neglect Scale (DNS), Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS) were used for parents. In addition, the Dental Neglect Scale (DNS), the Faces version of the Modified Child Dental Anxiety Scale (MCDASf), and the Wong Baker Faces Pain Rating Scale (WBFS) were applied to children. The statistical analysis was performed using Spearman Correlation test and Mann Whitney-U test. Results: In the study, a positive correlation was found between parent’s and children's neglect scores (r=0.261; p=0.006). Likewise, a positive correlation was observed between the DMFT and anxiety scores of the children (r=0.237; p= 0.013). In addition, it was observed that there was a statistical correlation between the level of pain felt at the last dental treatment and anxiety in children (r=0.316; p=0.001). Conclusion: It was observed that the dental neglect of the children of parents who neglected their own oral health increased. It is thought that informing parents about the importance of oral health and the consequences of dental neglect will have positive effects on their children's oral health.

Comparative Evaluation of the Efficiency of Polymer Bur, Cera Bur, and Tungsten Carbide Bur in Dentin Caries Excavation of Mandibular Primary Molars: An In vivo Study

ABSTRACT Conservative caries removal has become an integral part of minimally invasive dentistry (MID). Polymer and Cera burs are two feasible MID methods. The aim of the study was to compare the efficiency of Polymer, Cera, and Tungsten carbide bur in dentin caries excavation of mandibular primary molars. 45 children in the age group of 6-8 years with dentin caries, not involving pulp in the second mandibular primary molars, were selected for the study. The three burs compared were polymer bur, Cera bur, and Tungsten Carbide bur. The excavation of carious lesion was performed with each burs using a slow-speed handpiece with 500-1000rpm. Caries removal efficiency was evaluated using the Visual-Tactile method and confirmed Dye detection method. The time taken to complete the caries removal was measured using a stopwatch. The patient’s pain perception was assessed using the Wong–Baker Faces Pain Rating Scale. The intergroup comparisons based on time, dye, and Wong-Baker Faces Pain Rating Scale (WBFPRS) were arrived at using Mann–Whitney and Fisher Exact tests at P < 0.0001. A statistical significance between the three groups on the time taken for caries removal at P < 0.0001. No statistical significance was observed between the three groups for caries removal efficiency and pain perception using the dye and WBFPRS scores at P > 0.001. Cera burs had shown high caries removal efficiency, which had taken less time in the excavation, with reduced pain perception followed by Tungsten Carbide bur and the polymer bur in mandibular primary molars.

The use of DryShield versus rubber dam isolation systems among pediatric patients with different airway patency: A randomized clinical trial

ObjectivesThis randomized clinical trial aimed to evaluate the impact of DryShield isolation (DSI) and rubber dam isolation (RDI) system usage on vital signs, behavior, pain and discomfort, and chairside time required among children with different airway patencies based on the Modified Mallampati Classification (MMC). Material and methodsHealthy, cooperative children who required fissure sealant in at least two contralateral, fully erupted, permanent first molars were included. Airway patency was determined by two trained and calibrated dentists using the MMC. The participants were categorized based on their MMC scores into patent airways (classes I and II) and non-patent airways (classes III and IV). The dental procedure was videotaped during treatment, and vital signs, including arterial oxygen saturation, heart rate, and blood pressure, were recorded every 3 min. The participants’ subjective pain and discomfort were evaluated using a previously validated Arabic interview questionnaire and a validated Arabic version of the Wong–Baker Faces Pain Rating Scale. The participants’ behavior and behavioral pain were evaluated utilizing the Frankl Behavior Scale and the face, legs, activity, cry, and consolability scales, respectively. ResultsThere were no significant differences in any of the vital signs between DSI and RDI. DSI use yielded a significant reduction in chairside time (P < 0.001) and was more bothersome (P < 0.001) than RDI use among all participants, regardless of airway patency. DSI was associated with significantly better behavior during the dental procedure (P = 0.002) and less behavioral pain (P < 0.001) among all participants, regardless of airway patency. ConclusionIrrespective of airway patency, DSI outperformed RDI in terms of behavior, pain, and procedure duration; however, DSI was characterized by noise, pressure on soft tissues, and an increased tendency to induce gag reflexes.

The effect of two different methods on reducing the pain and fear during phlebotomy to children: A randomized controlled trial

IntroductionReducing pain and fear during painful medical procedures in children is important since mismanagement of pain causes the child and parent to feel anxious, which can have negative long-term consequences. This study aimed to evaluate the effects of two different distraction methods in reducing pain and fear during the phlebotomy procedure in children. MethodThe study, which has a randomized controlled experimental design was conducted between July and October 2020 with 111 children aged 6–12 years who underwent phlebotomy in the emergency department of a public hospital and their parents. The children were randomly assigned to soap bubble blowing (n:37), ball squeezing (n:37) and control (n:37) groups. During the phlebotomy, soap bubble blowing, and ball squeezing methods were used as active distraction methods. Data were collected using the Wong Baker Faces Pain Rating Scale, and the Children’s Fear Scale. ResultsThe pain scores of the soap bubble blowing group and the ball squeezing group during the phlebotomy procedure were found to be lower than the control group (p < 0.001). In addition, the soap bubble blowing group had lower fear scores than the ball squeezing and control groups (p < 0.001). ConclusionThe active distraction methods used in the study reduced pain and fear during the phlebotomy procedure. In addition, the method of soap bubble blowing was found to be a more effective method in reducing fear. Distraction methods should be used as a nursing intervention to reduce pain and fear during the phlebotomy procedure in children.

The effect of dry heat and dry cold application on pain, anxiety and fear levels before blood sample collection in school age children (7–12 years): A randomized controlled study

BackgroundBlood sampling, which is frequently performed on children admitted to hospital, causes them pain, anxiety and fear. ObjectivesThe study was carried out to determine the effects of dry heat and dry cold application before blood sampling on pain, anxiety and fear levels in school age children. MethodsThe study was conducted between June and January 2021 with a parallel-group randomized controlled experimental design. It was carried out with 117 children who applied to the Pediatric Blood Collection Polyclinic of a training and research hospital. The children were assigned to dry heat application, dry cold application and control group by simple randomization. Data were collected using the Child-Family Introductory Information Form, Wong Baker Faces Pain Rating Scale (WBFPS), Child Fear Anxiety Scale (CFAS) and Medical Procedure Fear Scale (MPFS). In the data analysis, descriptive statistics, the Kruskal-Wallis H test, the Dunn test, Yates correction and the Pearson Chi-Square test were used. A level of p < 0.05 was considered statistically significant. ResultsIt was found that children who were treated with dry heat and dry cold before blood sampling experienced less pain. The anxiety of the children in the dry heat treatment group was lower than the control group. According to the children's MPFS Operational Fear sub-dimension median scores, procedural fear was found to be lower in the dry heat application group. Practice implicationsPediatric nurses can safely use dry heat and dry cold application in the management of invasive procedure-related pain, and dry heat application in the management of anxiety. Trial registrationThis trial is registered with the US National Institutes of Health (ClinicalTrials.gov) under the number NCT05974319.

The effect of a hand puppet-based therapeutic play for preschool children on the fear and pain associated with blood collection procedure

PurposeThe aim of this study was to determine the effects of a therapeutic play involving a hand puppet on the fear and pain associated with blood collection procedure in preschool children. Design and methodsThe research was conducted as a randomised controlled experiment. The sample included children aged 3–6 years who attended the blood collection unit between July and October 2022 and met the study's inclusion criteria. The research was completed with a total of 120 children, divided evenly into one of two groups. The nursing intervention of the research was a therapeutic play applied with a hand puppet. Data were collected through face-to-face interviews using a Questionnaire Form, the Child Fear Scale and the Wong–Baker Faces Pain Rating Scale. Ethical principles were followed in the research. ResultsDifferences between mean fear and pain level scores between the groups were statistically significant (p < 0.05). ConclusionsThe therapeutic play applied with a hand puppet reduced the level of fear and pain associated with the blood collection process. Practice implicationsHealth professionals working in units related to paediatrics can use hand puppets, which are easy to use, inexpensive and practical, to reduce the fear and pain associated with blood collection from pre-school children.

Ultrasound-Guided Thoracolumbar Interfascial Plane Block with and Without Dexamethasone: A Comparative Study in Patients Undergoing Lumbar Spine Surgeries

ABSTRACT Background: Thoracolumbar interfascial plane (TLIP) block is a novel regional anesthetic technique that can provide effective postoperative analgesia in patients undergoing lumbar spine surgeries. This block targets the dorsal rami of thoracolumbar nerves as they pass through the paraspinal muscles. Multilevel spine surgeries are often prolonged, requiring extended duration of postoperative analgesia. Objective: To compare the duration and quality of postoperative analgesia of TLIP block when given with and without dexamethasone as an additive to bupivacaine. Methodology: This was a prospective, double-blinded randomized study done on 20 patients undergoing two- or three-level lumbar spine surgeries. Ten patients in group C received 20 ml of 0.25% bupivacaine alone, whereas 10 patients in Group D received 8 mg dexamethasone along with 20 ml of bupivacaine for TLIP block before skin incision. Time for first analgesic request and pain scores using Wong–Baker Faces Pain Rating Scale were measured postoperatively. Results: The mean duration of sensory block was longer in group D when compared to group C (502.00 ± 95.13 vs. 383.5 ± 54.53 min with a P value of 0.001). The amount of rescue analgesic requirement was also higher in group C compared to group D. Conclusion: Dexamethasone, as an additive to bupivacaine, prolongs the duration and improves the quality of TLIP block for lumbar spine surgeries.

ASSOCIATION OF CHRONIC LOW BACK PAIN AND DEPRESSION AT A TERTIARY CARE SETTING OF PAKISTAN

Objective: To assess the association of Depression with Chronic Low back pain. Methodology: In this cross-sectional investigation, 169 participants with a mean age of 54.1 years were studied at the PN Shifa medical outpatient department in Karachi, Pakistan. The research was conducted over a three-month period, from June to August 2020, using a non-probability convenience sampling approach. The severity of low back pain (LBP) was measured using the Numeric Rating Scale (NRS) and the Wong Baker Faces Pain Rating Scale. To evaluate levels of depression, the Patient Health Questionnaire (PHQ-9) scale was employed. The Chi-square test and one-way ANOVA test were used to establish statistical significance. Results: Patients with moderate to severe chronic low back pain (CLBP) demonstrated higher pain levels on both the Wong Baker Faces Pain Rating Scale and NRS, with a p-value of 0.000. Based on the PHQ-9 scores, severe depression correlated with more intense pain, with a p-value of 0.000, and greater pain severity in the current and previous week (as assessed by the NRS and Wong Baker Faces Pain Rating Scale). A higher percentage of males (34%) experienced mild CLBP compared to females (22%). However, 26% of females were found to suffer from severe CLBP, as opposed to 12% of males, with a p-value of 0.014. Conclusion: Patients with chronic low back pain often experience depression and report high levels of pain.

Assessment of postoperative pain in children with computer assisted facial expression analysis

PurposeThe present study was conducted to evaluate the use of computer-aided facial expression analysis to assess postoperative pain in children. Design and methodsThis was a methodological observational study. The study population consisted of patients in the age group of 7–18 years who underwent surgery in the pediatric surgery clinic of a university hospital. The study sample consisted of 83 children who agreed to participate and met the sample selection criteria. Data were collected by the researcher using the Wong Baker Faces pain rating scale and Visual Analog Scale. Data were collected from the child, mother, nurse, and one external observer. Facial action units associated with pain were used for machine estimation. OpenFace was used to analyze the child's facial action units and Python was used for machine learning algorithms. The intraclass correlation coefficient was used for statistical analysis of the data. ResultsThe pain score predicted by the machine and the pain score assessments of the child, mother, nurse, and observer were compared. The pain assessment closest to the self-reported pain score by the child was in the order of machine prediction, mother, and nurse. ConclusionsThe machine learning method used in pain assessment in children performed well in estimating pain severity.It can code facial expressions of children's pain and reliably measure pain-related facial action units from video recordings. Application to practiceThe machine learning method for facial expression analysis assessed in this study can potentially be used as a scalable, standard, and valid pain assessment method for nurses in clinical practice.

Evaluation of pain response in children to the SoftClamp™ as an alternative to the metal rubber dam clamp: A randomized clinical trial.

The use of a rubber dam is more important than ever in today's COVID-19 era to limit cross infections. In children, the placement of the metal clamp to retain the rubber dam is perceived to be painful and often requiring a local anesthetic injection. This dissuades many clinicians from placing the rubber dam. Hence, this study evaluated the pain response of children to a SoftClamp™ compared to the conventional metal clamp. This was a randomized controlled, equal allocation ratio, split-mouth clinical trial. Forty-two children aged between 8 and 12 years, having two permanent mandibular molars in need of sealants, were divided into Groups A and B (metal clamp and SoftClamp™, respectively). The pain response was recorded using both an objective and a subjective scale i.e., the Faces Legs Activity Cry Consolability (FLACC) scale and the Wong Baker Faces Pain Rating Scale (WBFPRS). The level of significance was set at 5% (P < 0.05). The pain response recorded from the WBFPRS and the FLACC scale for the metal and the SoftClamp™ were analyzed using the Wilcoxon signed rank test. The difference in pain response between genders and between two age groups (below and above 10 years of age) was analyzed using the Mann-Whitney U-test. The children reported mild discomfort to clamp placement in both the scales. The P values for the FLACC and WBFPRS scores comparing the pain response to the metal and SoftClamp™ were 0.311 and 0.149, respectively. There was no significant difference in the pain response of children to both the clamps. Good rubber dam application practices in children through the use of behavior guidance and a proper topical anesthesia technique may play a far more important role regardless of the clamp used. But the SoftClamp™, with its more child friendly appearance could be a viable alternative to the metal clamp in children.

Opioid sparing analgesia: Continuous intraoperative infusion of dexmedetomidine versus lidocaine for intracranial surgeries in children: A double-blind randomized clinical trial

ABSTRACT Background The usage of opioid sparing analgesia in different surgeries leads to varied results. The aim of this study is to compare between the effects of continuous intraoperative infusion of dexmedetomidine versus lidocaine as opioid sparing analgesia in children undergoing intracranial surgeries. Methods It is a double-blind randomized clinical study in which, 64 children were randomly allocated into 2 equal groups; 32 children for each group. The first one was dexmedetomidine group which received continuous intraoperative dexmedetomidine iv infusion [1ug/kg dexmedetomidine over 15 minutes as a loading dose and 0.5ug/kg/h for maintenance]. The second one was lidocaine group which received continuous intraoperative lidocaine iv infusion [1.5mg/kg lidocaine over 15 minutes as a loading dose and 1.5mg/kg/h for maintenance]. The continuous intraoperative iv infusion of each tested drug was stopped 10 minutes before the end the surgical procedure. Results Intraoperative total fentanyl consumption was significantly reduced in dexmdetomidine compared to lidocaine group ([19.33±11.15 vs 43.10±21.15] ug, 95% CI, -45.8 to -1.7). Children in dexmedetomidine group were significantly more sedated compared to lidocaine group. The time to reach Wong–Baker Faces Pain Rating Scale (WBFPS) scores 4 or more was around 4 hours in dexmedetomidine and around 1hour in lidocaine group. The time to first call of naluphine with dexmedetomidine was significantly prolonged compared to lidocaine ([235.03±5.02 vs 55.87±6.28] min, 95% CI, 176.3-182) with significantly reduced total postoperative naluphine consumption in dexmedetomidine compared to lidocaine ([4.22±1.46 vs 7.96±2.8] mg, 95% CI,-4.9 to -2.6) . The duration of PACU stay was significantly prolonged in lidocaine compared to dexmedetomidine ([99.75±14.36 vs 114.28±10.56] min, 95% CI,-20.8 to -8.2). Conclusion Continuous Intraoperative intravenous infusion of dexmedetomidine was superior to lidocaine in opioid sparing analgesia during intracranial surgeries in children.

A randomized controlled trial on virtual reality distraction during venous cannulation in young children.

Background and ObjectivesPain management in children is often inadequate, and the single most common painful procedure in children who are hospitalized is needle procedures. Virtual reality (VR) has been shown to decrease anxiety and pain in children undergoing painful procedures primarily in children from the age of 7 years. Our aim for this study is to investigate patient satisfaction and pain reduction by using a three‐dimensional VR interactive game as a distraction in 4–7 years old children during venous cannulation.MethodsIn this randomized clinical trial, we enrolled 106 children aged 4–7 years who were scheduled for venous cannulation. Patients assigned to the control group were adherent to standard of care, including topical numbing cream, positioning, and distraction in this group by games of choice on a tablet/smartphone. In the study group, children were adherent to standard of care and were distracted by an interactive VR game. Primary outcomes were patient satisfaction and the procedural pain assessed by using Wong–Baker Faces Pain Rating Scale; secondary outcomes were the procedural time and any adverse events.ResultsWe found an overall high level of patient satisfaction with our regime of topical numbing cream, positioning, and distraction. The primary outcome of pain during the procedure was median 20 mm (IQR 0–40) and 20 mm (IQR 0–55) (Wong–Baker 0–100 mm) in the VR group and the control group, respectively (difference: 0 mm, 95%CI: 0–20, p = .19). No significant difference was found in procedural times. The number of adverse effects was low, with no significant difference between the two groups.ConclusionsVR distraction is an acceptable form of distraction for children 4–7 years old when combined with topical numbing cream and positioning during preoperative venous cannulation. No difference was found between VR‐ and smartphone/tablet distraction.

The Effect of Pre-Emptive Analgesia on the Postoperative Pain in Pediatric Otolaryngology: A Randomized, Controlled Trial.

The aim of this randomized, controlled trial was to determine whether children undergoing otolaryngological procedures (adenoidectomy, adenotonsillotomy, or tonsillectomy) benefit from pre-emptive analgesia in the postoperative period. Methods: Fifty-five children were assessed for eligibility for the research. Four children refused to participate during the first stage of the study, leaving fifty-one (n = 51) to be randomly assigned either to receive pre-emptive analgesic acetaminophen (15 mg/kg; n = 26) or a placebo (n = 25) in addition to midazolam (0.5 mg/kg) as premedication. All children were anesthetized with sevoflurane, propofol (2–4 mg/kg), and fentanyl (2 mcg/kg). Postoperative pain was assessed using the Visual Analogue Scale (VAS), the Wong–Baker Faces Pain Rating Scale, and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. The postoperative pain was measured 1, 2, 4, and 6 h after the surgery. Results: The clinical trial reported a statistically significant correlation between administering pre-emptive analgesia (acetaminophen) and reducing pain in children after otolaryngological procedures compared to placebo. The ratio of boys to girls and age were similar among the groups (p > 0.05), so the groups of children were not divided by gender or age. Conclusions: Standard pre-emptive analgesia reduced the severity of pain in the postoperative period after otolaryngological procedures in children. Acetaminophen given before surgery reduces postoperative pain in children undergoing otolaryngological procedures.

TOTAL INTRAVENOUS ANAESTHESIA (TIVA) WITH DEXMEDETOMIDINE VERSUS NALBUPHINE IN COMBINATION WITH PROPOFOL IN UPPER LIMB ORTHOPAEDIC CLOSED MANIPULATION PROCEDURE- A COMPARATIVE STUDY IN A TERSIARY HEALTH CARE CENTRE IN TRIPURA

Background: Manipulation under anaesthesia is a closed short non-surgical procedure but it demands a cool and calm patient with immobility and relaxation of body parts, to be manipulated. Thus, the role of anaesthesia is vital for success of the procedure. At the same time, it is a challenge for the anaesthesiologist because immobility requires to be maintained and as these procedures are treated as minor, muscle relaxants and intubation are avoided. Adequate analgesia, rapid and complete recovery and controlled sedation is essential to avoid hospital stay.&#x0D; Materials and Methods: It was an observational analytical study with longitudinal design. This study was conducted at AGMC &amp; GBP hospital, Tripura and the duration was one and half year. Patient of sex, normal BMI and age between 20-60 years are served as study population. 60 cases are divided into two groups and coded as group D &amp; N. Intra-procedural hemodynamic (MAP, HR, RR, SPO2), operation time, post procedural (up to 2 hour) pain by Wang – Baker faces pain rating scale and post procedural sedation by Ramsey sedation scale are observed and measured and analysed in this study.&#x0D; Results: Intra-operative MAP and HR were significantly higher in nalbuphine group than Dexmedetomidine group (p&lt;0.05). No significant difference was there in RR and SPO2 (intra-operative). Recovery of orientation was significantly lesser in dexmedetomidine group. Post procedural perception of pain was significantly lower in dexmedetomidine group (P&lt;0.005). Post procedural sedation was lower in Dexmedetomidine group which was statistically significant (P&lt;0.005).&#x0D; Conclusion: Dexmedetomidine is superior to nalbuphine in respect of recovery of orientation, pain control after procedure and control of sedation after procedure. Dexmedetomidine is superior to nalbuphine as it provides adequate analgesic and sedation without increasing MAP and HR in the above said procedure.&#x0D; Keywords: Dexmedetomidine, Nalbuphine, MAP- Mean arterial pressure, HR- Heart Rate, RR- Respiratory Rate

Ozone Therapy for Early Childhood Caries (ECC) Treatment: An In Vivo Prospective Study

The present study aimed to evaluate the effectiveness of ozone therapy in (1) increasing the compactness of decayed dentin (main aim), (2) reducing dentin hypersensitivity, (3) decreasing the salivary bacterial count, and (4) improving the quality of life in ECC-affected children during a 3-month follow-up. A total of 20 subjects uncooperative with conventional restorative treatment were treated with a 60 s ozone application/week (OzoneDTA®) for 4 weeks. Patients were evaluated at T0 = baseline; T1 = after ozone cycle and T2, T3, T4 = 1, 2, 3-month follow-up, respectively. Dentin compactness was evaluated according to the Affected Dentine Scale (ADS) proposed by the authors; dentin hypersensitivity was recorded with the Wong–Baker Faces Pain Rating Scale (WBFPRS); salivary bacteria were measured with the Saliva Check Mutans Test and quality of life with the Early Childhood Oral Health Impact Scale (ECOHIS). ADS values and salivary bacteria count results were analyzed using non-parametric tests. Statistically significant differences were detected for both parameters between T0 and T1 (p &lt; 0.01). At T1, dentin hypersensitivity was resolved and quality of life improved. Ozone therapy is a simple and painless approach, which might be useful for controlling caries’ progression in uncooperative children until appropriate cooperation is achieved.

Intracanal cryotherapy with two different temperature ranges in reducing postendodontic pain: A double-blind randomized clinical trial

Introduction: The use of intracanal cryotherapy in the reduction of postendodontic pain (PEP) has been investigated in several recent scientific publications. This study aims to compare the effect of intracanal cryotherapy at three different temperature ranges (room temperature, 2°C–4°C and 13°C–15°C) on PEP.Materials and Methods: A parallel, double-blind randomized clinical trial was conducted at SEGi University, Malaysia. This trial included 51 participants who were diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis in single-rooted teeth. The root canal therapy was completed in single visit for all the patients. Prior to the obturation step, they were randomly allocated into three groups of 17 participants each (Group 1: room temperature [control], Group 2: 2°C–4°C, and Group 3: 13°C–15°C). The intracanal cryotherapy was performed over a period of 5 min. The PEP scores were measured using Wong Baker Faces Pain Rating Scale and recorded at different time intervals (6, 24, 48, and 72 h), and the data were statistically analyzed.Results: Kruskal–Wallis test showed statistically significant difference in mean pain ranks between at least two out of three groups studied at 24 and 48 h (P ≤ 0.05). At 24 and 48 h, the pairwise post hoc Dunn test with Bonferroni adjustments showed statistically significant difference in pain scores within the Groups 1 versus 3 (room temperature vs. 13°C–15°C) and Groups 1 versus 2 (room temperature vs. 2°C–4°C) (P ≤ 0.05), while within the Groups 2 versus 3 (2°C–4°C vs. 13°C–15°C), there was no statistically significant difference.Conclusion: Intracanal cryotherapy with 13°C–15°C saline is as effective as 2°C–4°C saline in reducing PEP and can be easily incorporated as one of the steps of root canal therapy.

Application of virtual reality on non-drug behavioral management of short-term dental procedure in children

BackgroundDue to the inherent characteristics of immersion, imagination, and interactivity in virtual reality (VR), it might be suitable for non-drug behavior management of children in dental clinics. The purpose of this trial was to measure the role of VR distraction on behavior management in short-term dental procedures in children.MethodsA randomized clinical trial design was carried out on 120 children aged between 4 and 8 years to identify the comparative efficacy of VR and tell-show-do (TSD) to improve behavioral management during dental procedures. The primary outcomes were evaluated anxiety, pain, and compliance scores in perioperative children. The levels of operative anxiety and pain were assessed using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Wong Baker FACES Pain Rating Scale (WBFS), respectively. The Frankl Behavior Rating Scale (FBRS) was tested before and during dental procedures. The length of the dental procedure was compared between both groups after treatment.ResultsThe average anxiety and behavioral scores of the VR group significantly reduced compared with the control. The decreased anxiety score for the VR group and control group were 8 (7, 11) and 5 (5, 7), p < 0.05. The compliance scores of the control group during treatment were 3 (2, 3), and the same in the VR intervention were 3 (3, 4), p = 0.02. A significant reduction in pain was observed when using VR distraction (p < 0.05). Comparing the length of the dental procedure, the VR group (19.0 2 ± 5.32 min) had a shorter treatment time than the control group (27.80 ± 10.40 min).ConclusionThe use of VR significantly reduced the anxiety and pain of children and the length of the dental procedure and improved the compliance of children that underwent short-term dental procedures without an adverse reaction.Trial registrationChinese Clinical Trial Registry, ChiCTR2000029802. Registered on February 14, 2020

Virtual Reality Interventions for Needle-Related Procedural Pain, Fear and Anxiety-A Systematic Review and Meta-Analysis.

Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in blood pressure and heart rate as well as satisfaction were evaluated as outcomes during needle-related procedures in VR compared with standard care conditions. A meta-analysis was performed, taking into account online databases. Two authors independently conducted literature searches in December 2020. The last search was conducted in March 2021 from a total of 106 records, 7 met our inclusion criteria. One study was excluded from the meta-analysis due to insufficient data. VR was applied as a distractor during venous access. Statistically significant benefits of using VR were shown in children’s pain scores, where VR significantly decreased symptoms (n = 3204 patients, MD = −2.85; 95% CI −3.57, −2.14, for the Wong–Baker Faces Pain Rating Scale and n = 2240 patients, MD = −0.19; 95% CI −0.58, 0.20, for the Faces Pain Scale—Revised). The analysis of fear, anxiety and satisfaction scores revealed no significant differences between the conditions, as the studies were too heterogeneous to be pooled. Distraction using virtual reality may be an effective intervention for reducing pain in children undergoing needle-related medical procedures. However, further research in the implementation of VR as a distractor for children and adolescents is required, due to the limited research into this field.

Perceived Pain during Rapid Maxillary Expansion (RME): Trends, Anatomical Distinctions, and Age and Gender Correlations.

Objectives To investigate pain trends and characteristics of different facial districts in patients undergoing rapid maxillary expansion (RME) and its possible correlations with age and gender. Materials and Methods 85 subjects (45 males and 40 females) undergoing RME were selected and analyzed during first two weeks of treatment. Patients rated daily two types of pain perception: the general perceived pain (GPP), i.e., the pain overall perceived in the face, and the local perceived pain (LPP), i.e., the pain perceived locally in the following anatomical areas: anterior palate (APA), posterior palate (PPA), nasal (NA), joint (JA), and zygomatic (ZA). Patients were provided the Numeric Rating Scale (NRS) and Wong–Baker Faces Pain Rating Scale (FPS) to correctly assess their GPP and LPP. Pearson correlation coefficient and analysis of variance (ANOVA) were, respectively, used to define the linear relationship between all the variables considered and to verify whether the response variables (gender and age) were significantly different (α < 0.05). Results Sample's mean age was 10.11 years. Average pain values of GPP and LPP progressively rise from day 1 to days 2-3 (pain peak) and tended to decrease until day 14, with a linear decrease for GPP and a not linear decrease for LPP. PPA and APA resulted the most painful areas, followed, respectively, by JA, ZA, and NA. Statistically significant differences resulted in average pain values according to patients' age and gender, both in GPP and LPP. Conclusion RME causes perception of pain in several maxillofacial areas. Pain reported during RME resulted positively correlated with age and gender of patients.