Behavior Management Techniques Research Articles

Attitudes of dental students towards paediatric dental behaviour guidance

Aim: To compare the pre-clinical and clinical students` perceptions about the non-pharmacological behaviour management techniques in paediatric dentistry and to investigate the influence of the dental curriculum on the students` knowledge regarding this issue. Methods: A total of 283 students from the IV-and X-semester completed a questionnaire, consisted of 12 statements, describing the nonpharmacological behaviour management techniques for the treatment of paediatric dental patients. The acceptability rate was evaluated with a Likert scale ranging from 1 to 5. Results: The students from all courses demonstrated high acceptance for Reinforcement and Desensitization techniques and low for the Negative reinforcement and Physical restraint. The comparison between the perceptions of the pre-clinical and clinical students demonstrated a statistically significant increase in the acceptance of the physical restraint, along with Nonverbal communication, Modelling and Parental presence/absence (p<0.05). Conclusion: The results provide information about the students’ knowledge and skills in behaviour management techniques together with some insights about how the educational process can modify the students` perceptions and views in dealing with paediatric dental patients.

Dental Management of Pediatric Patients with Bronchial Asthma.

ABSTRACTAsthma is a disease marked by recurrent dyspnea caused by spasmodic bronchoconstriction. Bronchial asthma is a serious global problem that has steadily increased in prevalence during the past two decades. Oral manifestations of pediatric patients suffering from bronchial asthma are an increased upper anterior and total anterior facial height, higher palatal vaults, greater overjets, and a higher prevalence of posterior crossbites. Dental treatment of such patients requires the role of a pedodontist. Behavior management techniques, conscious sedation techniques along with medical management, and comprehensive dental treatment by a pediatric dentist may prove beneficial to such patients.How to cite this articleChhabra K, Sood S, Sharma N, et al. Dental Management of Pediatric Patients with Bronchial Asthma. Int J Clin Pediatr Dent 2021;14(5):715–718.

Knowledge, Attitude, and Awareness about Nitrous Oxide Inhalation Sedation among Dental Practitioners of Gujarat, India

Introduction: Conscious sedation is a safe and effective method of anxiolysis. However, the use of conscious sedation in pediatric dental patients is a controversial topic as it involves the intersection of dentistry and medicine. Among the many questions that could be asked, it is necessary to find out what dental practitioners think about the use of sedatives in their routine pediatric dental practice. Therefore, the above survey was conducted aiming to evaluate the perceptions of dentists on the use of Conscious Sedation in pediatric dental practice in Vadodara city, Gujarat.
 Methods: Questionnaires were sent electronically to Indian Dental Association (IDA) members of Vadodara at the time of the study. The contact details of these dental practitioners were obtained from the IDA members list. Details on personal status, use of, and training in, conscious sedation techniques were sought via the questionnaires to find the knowledge, attitude, and awareness towards the use of Conscious Sedation in pediatric dental practice.
 Results: The questionnaire was sent to IDA members in Vadodara city, Gujarat. 64.37% (150 dentists) responded to the questionnaire. 48% were female practitioners and 52% were male practitioners. 78.5% were in favor of using conscious sedation as a behavior management technique in pediatric dental practice, irrespective of their qualification or years of experience. Maximum knowledge about conscious sedation was obtained through the curriculum.
 Conclusion: It can be concluded that the dentists of Vadodara city, Gujarat state developed a positive attitude towards the use of conscious sedation, however, complained of a lack of training to the subject.

Attitude of dental practitioners and parental acceptance in using Animal-Assisted Therapy (AAT) in behaviour management of pediatric patients

Aim: To evaluate the acceptance of Dentist, Parents and child to therapy pets, child’s choice of pet and to analyse attitude of dentist towards animal-assisted therapy in the paediatric dental et-up as an aid to improve behaviour of the child during the dental treatment. Materials and Methods: A descriptive cross-sectional survey was conducted among 60 children and their parents and 108 dentists. Chi-square test was used to determine the association of independent variables with each of the main outcome of interest. Results: The consent to the presence of pet was given by 56.67% parents (p=0.0359, Significant) Children who chose dog as their preferred pet were 46.67% those who chose cat as their preferred pet were 25% (p=0.049, Significant) Almost 76% Dentist agreed that AAT helps in behaviour management for Pediatric dentist (p=0.0001,S). Conclusion: Animal-Assisted Therapy (AAT) can prove to be a good behaviour management technique and can be a part of the exclusive Pediatric dental clinic. Keywords: Animal-assisted therapy, Pediatric Dentist

Clinical Experience, Knowledge, Attitudes and Practice of Turkish Pediatric Dentists during the COVID-19 Pandemic.

Background and Objectives: “Coronavirus Disease 2019” (COVID-19) is a critical public health problem that has affected all fields, including dentistry. The dental management of children has become even more difficult during the COVID-19 pandemic. The purpose of this study was to evaluate the current knowledge, attitudes and practices of Turkish pediatric dentists who have been providing dental treatments to children during the COVID-19 pandemic. Materials and Methods: After receiving ethical approval, this cross-sectional study was conducted using the Google Forms online survey instrument. An online questionnaire link was sent to all the members of the Turkish Society of Paediatric Dentistry by e-mail and through social media. Statistical analyses were performed using descriptive statistics and Chi-square test; a p-value less than 0.05 was considered statistically significant. Results: A total of 200 pediatric dentists participated in this study and most of them (82%) only performed emergency dental treatments, whereas 18.5% performed both emergency and routine dental practices during the COVID-19 pandemic. The vast majority (72.5%) of pediatric dentists prescribed antibiotics and analgesics to their patients who were not cooperative with non-pharmacological behavior management techniques. The findings of the current study showed that the Turkish pediatric dentists had a good level of knowledge about COVID-19, satisfactorily conducted most of the infection control measures before and after the dental treatments, and attached importance to the use of PPEs; however, infection control measures during the dental treatments could be implemented better. Conclusions: Along with all precautions, the vaccination of healthcare workers and requesting a recent test result from patients showing a lack of COVID-19 disease before dental appointments could be used as effective infection control measures. Additionally, pediatric dentists should continue to follow local and universal guidelines, and education programmes should be frequently implemented in order to keep their COVID-19 management strategies up to date.

Personalized behavior management as a replacement for medications for pain control and mood regulation

A lack of personalized approaches in non-medication pain management has prevented these alternative forms of treatment from achieving the desired efficacy. One hundred and ten female patients with fibromyalgia syndrome (FMS) and 60 healthy women without chronic pain were assessed for severity of chronic or retrospective occasional pain, respectively, along with alexithymia, depression, anxiety, coping strategies, and personality traits. All analyses were conducted following a ‘resource matching’ hypothesis predicting that to be effective, a behavioral coping mechanism diverting or producing cognitive resources should correspond to particular mechanisms regulating pain severity in the patient. Moderated mediation analysis found that extraverts could effectively cope with chronic pain and avoid the use of medications for pain and mood management by lowering depressive symptoms through the use of distraction mechanism as a habitual (‘out-of-touch-with-reality’) behavior. However, introverts could effectively cope with chronic pain and avoid the use of medications by lowering catastrophizing through the use of distraction mechanism as a situational (‘in-touch-with-reality’) behavior. Thus, personalized behavior management techniques applied according to a mechanism of capturing or diverting the main individual ‘resource’ of the pain experience from its ‘feeding’ to supporting another activity may increase efficacy in the reduction of pain severity along with decreasing the need for pain relief and mood-stabilizing medications.

English

BACKGROUND Paediatric dentists are expected to recognize and effectively treat childhood dental diseases which can be cumbersome owing to the child’s inert anxiety and fear. Behaviour management techniques facilitate communication and establish social and behavioural guidelines for the dental environment. On what basis do paediatric dentists decide the appropriate management techniques for a child? This requires an understanding of children’s expected behaviour at different stages of intellectual development. Jean Piaget theorized cognitive development through four stages. According to him, children’s knowledge about reality is acquired by touching and observing, balanced by an interplay between assimilation and accommodation. The objective of the study was to prepare an outline integrating contemporary behaviour management techniques with Piaget’s cognitive development stages for a child to be able to provide them with a positive dental experience. METHODS A thorough literature search was done utilising different search engines (PubMed, Scopus, MedLine and google scholar) using different key words from the MeSH terminologies database. Comparative clinical trials and randomized clinical trials were included in the study and the recommendations were tabulated. RESULTS After performing a literature review, relevant articles were identified from various search engines. Piaget’s theory was reviewed as it views cognitive and intellectual activities as adaptive and helpful for the child in coping, organizing and reorganizing their thoughts and actions. CONCLUSIONS A systematic outline was prepared with the goal to develop a guideline fitting the objectives of this paper. CLINICAL SIGNIFICANCE This outline will enable the paediatric dentist to decide the appropriate behaviour management technique to provide a positive dental experience for a child in accordance with their expected cognitive and intuitive stage of development. KEY WORDS Cognitive Development Theory, Behaviour Management, Jean Piaget, Child Psychology

Investigation of The Effectiveness of Using Virtual Reality as A Distraction Technique in Children During Local Anesthesia Injection For Extraction of Primary Mandibular Molars

ABSTRACT Background: Local anesthesia injection for tooth extraction of primary molars is one among the causes of avoiding dental visits in children. Voice control and hand over mouth exercise are invasive and considered the least accepted techniques, a more accepted technique for children and their parents was needed. Aim:To evaluate the efficacy of virtual reality (VR) distraction on dental anxiety and pain perception to local anesthesia injection in pediatric dental patients during primary teeth extraction. Material and Methods: A prospective, parallel two arms randomized; clinical trial was performed on seventy-two children. Patients were (7-11) years old with unilateral carious non-restorable mandibular primary first molars required local anesthesia (LA) for extraction. Group (A) received treatment wearing virtual reality (VR) device and Group (B) received treatment using tell, show and do behavior management technique. Anxiety levels were measured using heart rate (HR) measuring before and after the injection while pain perception was assessed immediately after the injection using the Face, Legs, Activity, Crying and CONSOL ability scale (FLACC)and Facial Image Scale (FIS). Results: There was a statistically significant difference in heart rate mean values between both groups. Virtual reality (VR) distraction group showed better results in lowering anxiety during dental treatment. Conclusion: Virtual reality (VR) device for reducing anxiety to local anesthetic injection in children undergoing extraction of primary teeth.

EVALUATION OF KNOWLEDGE, ATTITUDE AND PRACTICE OF INHALATION SEDATION IN CHILDREN AMONGST PEDODONTISTS AND GENERAL DENTAL PRACTITIONERS IN MANGALORE, INDIA

Inhalation sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain an airway independently and continuously and respond to stimulation and command. Found to be safe for use in dentistry with positive outcomes, it is used to manage anxiety in pediatric patients during procedures. Aim of our study was to determine the frequency of usage of inhalation sedation as adjunctive management technique in children by Dentists. A Cross sectional study was conducted with pre-structured questionnaire given to Pedodontists and General dental practitioners in various Dental colleges and clinics in and around Mangalore. Total sample size was 72. Data was collected and analyzed using SPSS version 17.0 with the Test of Proportions. 32 out of 72 participants were trained in usage of Inhalation Sedation, out of which 14 used it regularly. Out of the 80.56% dentists not using it, majority said that expensive equipment, increased cost of treatment and potential complications were the main reasons for not using it. 59.72% of participants wanted to gain information, knowledge and undergo training in the usage of Inhalation Sedation.58.33% agreed to use it in their future dental career. 70.83% believed that knowledge and training to use Inhalation Sedation is integral part of dental curriculum for undergraduates. This study showed willingness of the dentists to provide Inhalation Sedation as a behavior management technique to their patients. The lack of training, costly equipment, increased cost of treatment are the main barriers to providing such services to the patients.

Comparative Evaluation of Changes in Physiological and Psychomotor Effects in Pediatric Patients during Extraction under Different Concentrations of Nitrous Oxide-Oxygen Inhalation Sedation.

Introduction:Nonpharmacological behavioral management techniques are routinely used to create an environment that facilitates and builds a rapport between the child and the dentist to carry out procedures with minimal disruption. However, the discomfort associated with oral injections produces varying degrees of stress in all patients. Nitrous oxide (N2O)–oxygen (O2) inhalation sedation is one of the most widely used modalities for the management of fear and anxiety in children.Objective:The objective was to evaluate changes in physiological and psychomotor effects in pediatric patients during extraction under different concentrations of N2O–O2 inhalation sedation.Materials and Methods:A total of 300 healthy patients in the age range of 6–12 years (mean 8.9 years), who needed extraction of primary tooth, were included in the study. Pulse rate, SpO2, blood pressure (BP), and temperature were recorded at baseline, 30% N2O concentration, 50% N2O concentration, and again postoperatively. In addition, anxiety levels and neuromuscular coordination were recorded at the respective intervals.Results:The results revealed a mean decrease in pulse rate and BP from baseline and an increase in temperature and O2 saturation during the sedation procedure. The findings were statistically significant. Significant impairment of coordination and psychomotor ability was seen at each step. Anxiety had significantly reduced after the onset of sedation due to the anxiolytic effect of N2O.Conclusion:N2O–O2 inhalation sedation under different concentrations reduces the anxiety of the patient and produces adequate sedation with vital signs within normal limits along with temporary impairment of psychomotor ability and coordination.

Spanish and Portuguese Parental Acceptance of Behavior Management Techniques in Pediatric Dentistry.

To compare acceptance of behavior management techniques used in pediatric dentistry by Spanish and Portuguese parents. cross-sectional study. A survey of 8 behavior management techniques used in pediatric dentistry was administered to parents whose children were being treated at the Universitat Internacional de Cataluña (Barcelona, Spain) or at the Universidade de Coimbra (Portugal). The techniques evaluated were: tell-show-do (TSD), nitrous oxide sedation, passive restraint using a papoose board, voice control, hand-over-mouth, oral premedication, active restraint and general anaesthesia. The questionnaire also included information on parents' sex, number and sex of children receiving treatment, parents' previous dental experience (positive or negative), children's previous dental experience (positive or negative), and the socioeconomic status of the families. TSD and voice control were rated the most acceptable techniques in both Spain and Portugal, whereas the least accepted techniques in both countries were active and passive restraint. There were no significant differences in the acceptance of each of the techniques, in relation to parents' sex or their previous dental experience, children's sex or age, children's previous dental experience, or families' socioeconomic status. TSD was the most widely accepted behavior-management technique by Spanish and Portuguese parents, even with the passage of time. Both groups of parents had a low opinion of active and passive restraint techniques.

Teaching pediatric behavior management in student dentists with constructive video feedback from faculty.

The range of child behaviors encountered in real-life situations far exceeds that of any classroom-based simulated scenarios. For such reasons, clinical training with real-time clinical supervisor's feedback is optimal for learner-centricity. This study aimed to objectively evaluate the effect of video feedback on the student dentist's ability to manage behaviors in children. Third-year dental student volunteers were randomly allocated to two groups: control and intervention. They were video recorded for three pediatric dental treatment sessions and received standard feedback for all sessions. Additionally, the intervention group received two constructive 1-on-1 feedback sessions after the first and second video sessions. Students' application of behavior management techniques for all recorded treatment sessions was scored with a study-specific objective scale (maximum score: 20; larger score indicating better performance) by two independent and blinded evaluators. A self-administered student questionnaire elicited subjective feedback on the intervention. There was a significant difference (p=0.008) between behavior management scores when comparing all pre-intervention sessions (10.74 ± 3.55) and all post-intervention sessions (13.57 ± 2.96). The intervention significantly improved these techniques: 1. Providing specific feedback - positive reinforcement and descriptive praise (p=0.006) and 2. Distraction - Using imagination with stories and singing (p=0.035). The feedback sessions (4.29 ± 0.54) were perceived to be significantly (p=0.032) more effective than having the students view the videos on their own (3.76 ± 0.87). Video feedback improved the behavior management scores of student dentists. The faculty feedback sessions were found by student dentists to improve confidence and the techniques for managing children.

Síndrome da deleção 2q37.3 – A primeira descrição de achados orais, relato de caso

Introduction: The 2q37.3 deletion syndrome is a disorder caused by the microdeletion of a subband on chromosome 2, whose epidemiology is approximately 150 cases worldwide, and the prevalence of 1: 10000. Its characteristics are developmental delay, facial dysmorphia, musculoskeletal abnormalities, and increased risk of congenital diseases. The purpose is to present, for the first time in the literature, the oral and dental clinical findings associated with the syndrome. Case report: The main physical characteristics of the syndrome were identified during the physical examination: thin upper lip, prominent columella, and epicanthic folds. In the intraoral examination, dental characteristics were reported, which may be associated with the syndrome: accumulation of dental calculus, hypomineralization and hypoplasia, crossbite, open bite, agenesis, taurodontism, and dentigerous cyst. The dental treatment consisted of the application of behavior management techniques, hygiene and diet instruction, prophylaxis, supragingival scraping, topical fluoride application, and extraction of the lower second molar. This is the first report of oral characteristics of the 2q37.3 deletion syndrome, giving importance to the characteristics observed in this patient. Such findings will be useful in the characterization of the syndrome, which is extremely rare, and may contribute to the clinical diagnosis of these patients, in addition to subsidizing the dental treatment of other individuals. Conclusion: We present oral clinical findings such as hypomineralization and hypoplasia, crossed and an open bite, agenesis, taurodontism, and dentigerous cyst present in the patient with the syndrome and we suggest that the involved gene or its deletion may be responsible for such findings.

Paediatric dentistry undergraduate education across dental schools in the Arabian region: a cross-sectional study

PurposeTo assess and compare teaching of paediatric dentistry in the undergraduate curriculum among dental schools in the Arabian region.MethodsA 28-item online cross-sectional questionnaire survey was conducted of undergraduate dental programme directors in the Arab region. The survey included questions related to the programme’s content, method of instruction on specific paediatric dentistry topics as well as the director’s opinion on the level of training obtained by the undergraduate students at the end of the programme.ResultsThe final sample included 31 dental schools representing undergraduate programmes in ten Arabian countries (60.8% response rate). All programmes provided theoretical and practical education on communicative behaviour management techniques and caries prevention. Pulpectomy and formocresol pulpotomy were taught in the form of theoretical and practical education in 87.1% and 80.6% of the programmes, respectively. The method of education on common orthodontic topics was mainly theoretical with the exception of space maintainers. Instructions on managing trauma to permanent dentition was theoretical and practical in most programmes (61.3%).Most respondents rated the level of training of students in behaviour management and caries prevention as good to reasonable, while only 22.6% thought that the level of training was excellent in pulp therapy.ConclusionVariations were observed in paediatric dentistry education among undergraduate dental programmes in the Arabian region in terms of topics, instruction methods, year of introduction of paediatric dentistry education, and number of clinical sessions offered. This study establishes a framework for future paediatric dentistry curriculum development and/or improvement in the Arabian region.

Is Silver Diamine Fluoride Really a Magic Alternative in Pediatric Caries Management?

Aim and objective: To review the success of silver diamine fluoride (SDF) in the management of caries in children. Background: The current concept of caries management is based on a biological approach. When it comes to children with early childhood caries, managing their behavior along with effective and comprehensive caries management is necessary for which an algorithm-based approach is discussed. Silver diamine fluoride acts as a tertiary preventive procedure that reduces the negative consequences of established disease (cavity) and restores, thus improving the child’s quality of life. It is a magic bullet that comprises antibacterial actions of silver and remineralizing effects of highly concentrated fluoride. Review results: Previous systematic reviews have reported the success of SDF in arresting caries in primary teeth and root caries in adults. Caries removal is not a prerequisite;therefore, SDF application is suitable when other modalities of caries management are unavailable or impractical. Apart from staining the arrested lesion black, no significant complication of SDF use among children was reported. Conclusion: Even though the black staining was unappealing, a significant number of parents chose SDF over advanced pharmacological behavior management techniques and it is really the magic alternative in children as it supports the contemporary “biological approach” for caries management. Clinical significance: In such times of the COVID-19 pandemic, SDF allows the interruption of aerosol-generating procedures and serves as interim treatment procedure to arrest dentin caries to prevent development of pulpitis which further requires intervention using aerotor. Most of all, SDF application is child-friendly and provides exceptional success rates when used where indicated. © Jaypee Brothers Medical Publishers. 2021.

English

Over the last few years there has been a growing interest to cater to the requirements of children with special health care needs, especially those with autism spectrum disorder (ASD). ASD is a neurodevelopmental condition characterized by limited communication skills and an obsessive need for structured patterns. Individuals with a genetic predilection to autism can be provoked by the various prenatal, natal, or post-natal environmental factors. Drugs such as thalidomide, valproic acid and consumption of antidepressants during pregnancy as well as high maternal age and viral infections are known to be prenatal triggers for autism. Autism affects 1 in every 110 children with a significant preponderance of boys to girls with a ratio of 4:1. According to Caries Risk Assessment tool (CAT) adapted by the American Academy of Paediatric Dentistry, children with ASD are at a high risk for dental caries due to their preference for carious food, pouching of food due to poor masticatory ability combined with inadequate maintenance of oral hygiene and help required for tooth brushing. These children do not behave positively to sudden changes in their environment thus a dental operatory might be intimidating to them. A thorough understanding of the individual’s needs of these patients along with combining various behaviour management techniques will help make their dental treatment a pleasant one. This articles reviews literature on the aetiology and diagnosis of Autism Spectrum Disorder with a special emphasis on the health status and issues encountered while treating these children. This study is also an update on the various strategies such as using Applied Behaviour management approaches, Picture Exchange Communication System, Video Pedagogy, Social stories as well as pharmacological ways to communicate and also manage a child with ASD in the dental clinic. KEY WORDS Autism, Oral Health Status, Behaviour Management, Dental Management

Can behavioural management improve behaviour and reproduction in captive blue-and-yellow macaws (Ara ararauna)?

Environments that do not provide animals with appropriate stimuli may affect their welfare and reproduction, for example by precluding them from exhibiting their full behavioural repertoire. In this study, we sought to evaluate the effectiveness of behavioural management techniques to stimulate the exhibition of normal behaviours, and to promote breeding improvement of nine captive pairs of blue-and-yellow macaws (Ara ararauna). Birds’ behaviours were recorded in five 4-week stages: baseline (BL), physical enrichment (PE), feeding enrichment (FE), cognitive enrichment (CE), and post-enrichment (PO). Three times a week, five 5-minute behavioural observation sessions took place for every animal by focal sampling, with records made every 30 s. Egg production was also recorded. Behaviours recorded in the experimental stages were compared with BL; egg production during the study period was compared with the productivity of the first six months of 2014–2017 (Repeated-Measures ANOVA/Dunnet or Friedmann/Dunn). The FE stage promoted increased foraging and movement (p < 0.01, p < 0.05, respectively), and a reduction in inactivity (p < 0.01) and in object destruction (p < 0.05). The stages CE and PE also promoted reduction in rest (p < 0.05 for both) and increase in movement (p < 0.01, p < 0.05, respectively). We also recorded a numerical increase in sexual behaviour in PE and a decrease in behaviours indicative of dysfunction (stereotypies), especially in FE. Egg production increased in the experimental period only compared to 2014 (p < 0.05). Decreases in object destruction, in dysfunctional behaviours, and increases in activity and in foraging have long been correlated with improvements in welfare conditions. The strategies applied may have allowed the birds to spend more energy, resulting in more active, less bored animals. As we recorded a slight increase in reproductive behaviours, the lack of a measurable effect of enrichment on egg production may be due to a need of the birds’ physiology to adapt to the new conditions of environment and activity. Our results indicate that the techniques used have the potential to promote improvements in the birds’ behavioural repertoire and, possibly, in the reproduction of the study species, when in captivity. This information is relevant to ex-situ conservation, and can also contribute to in-situ conservation efforts.

Surgical Management of a Giant Compound Odontoma with 52 Denticles and Impacted Canine in the Maxilla of a Non-syndromic Child: A Case Report

Supernumerary tooth (ST) refers to any tooth or odontogenic structure that is formed excess of usual number for any given region of the dental arch. The treatment of ST usually involves surgical removal to avoid further complications to the developing dentition. This report presents a rare case of a giant compound odontoma that was observed in the left maxillary region of a 10-year-old child during routine dental examination. Surgical removal of the compound odontoma was performed in the dental setting under Nitrous oxide sedation. In total, 52 denticles were removed from the left maxillary region. Additionally, exposure, bonding, and orthodontic traction was performed in the contralateral impacted maxillary canine. Both surgical procedures were successful and well tolerated by the patient with adequate behavior management technique.

Assessment Of Pediatric Dentists On Modifications Of Treatment Protocols Since The Pandemic Covid-19

Aim: To assess the modifications in treatment protocols by pediatric dentists since Covid-19. Objective: Focus on the modifications while treating children in the current pandemic situation and to assess whether these alterations are being implemented in a day to day practice. Materials and Methods: The questionnaire was mailed to 200 pediatric dentists out of which 163 responses were obtained. An online survey was conducted in October 2020, using the Google Forms platform to collect the responses. There were a total of 17 questions included in the study. The questions were framed in english and were in the form of multiple choice. The questions that were included in the survey were related to use of protective masks, equipment and difficulties in behaviour management techniques. Results: On comparing all the responses to the questions based on the professional status, it was observed that clinicians modified their treatment protocols more during the pandemic as compared to academicians and those who practiced both. Conclusion: A set of protocols can be followed before, during and after the treatment to maintain a safe environment to practice. It is essential that the pediatric dentists are updated with the latest information concerning the pandemic in order to deliver effective treatment to children. © 2021 Niharika Kotian.

Management of Gagging and Anxiety in Children by Play Way Method

Introduction: The gag reflex (GR) is an innate healthy defense mechanism that helps prevent foreign bodies from entering the trachea. Psychological, anatomic, iatrogenic, local, and systemic factors influence the GR. The pharyngeal reflex that prevents choking involves five triggering zones in the oral cavity: the palatoglossal and palatopharyngeal folds, the post-pharyngeal wall, the uvula, the palate, and the base of the tongue. So, this study is undertaken to determine gag reflux using the Intellectual Colored game distraction technique during the dental impression. Aim: The aim of this study is to determine the effect of distraction using the intellectual colored game (ICG) on the severity of GR and anxiety in children during the dental impression. Methodology: 50 children aged between 5 to 11 years, needing upper alginate impressions will be selected for the study and will be divided into 2 groups of 25 each. Children’s baseline anxiety will be evaluated according to the Buchanan’s Facial Image Scale (FIS) before any impression attempt. In Group 1 the upper alginate impression will be taken without playing ICG and group 2 upper alginate impressions will be taken while playing ICG. Result: Statistical analysis showed that 28% and 76% of children from the control and treatment groups respectively had a higher level of anxiety before the use of the distraction technique. However, 12% and 4% of children had higher anxiety after the use of distraction technique and a statistically significant change in anxiety in the treatment group with existing anxiety level (Z = -3.412, p = 0.001) was observed. Conclusion: Intellectual distraction is a safe, successful & cost-effective method for gag reflux management in pediatric dentistry. The Intellectual coloured game diverted the child’s attention during the stressful alginate impression, henceforth it should be considered to further advance behaviour management techniques.