Frankl Behavior Research Articles

Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis

ObjectiveThe objective of this review is to determine the global prevalence of dental fear and anxiety (DFA) in early childhood and identify its related factors. MethodsThe systematic review utilized three common English-language databases (PubMed, EMBASE, and Web of Science). Two independent researchers performed a systematic search to include observational studies on young children published from 2000 to 2023. They extracted information on prevalence of DFA, assessment tools used, study sites, respondents, and children's dental visit experiences. ResultsA total of 2,895 studies were identified, and 25 studies met the inclusion criteria for analysis. The pooled prevalence of DFA among 2- to 6- year-old children was estimated to be 30 % (95 % CI=25, 36). Children without dental visit experience (OR=1.37, 95 % CI=1.18, 1.59) and children with caries experiences (OR=1.18, 95 % CI=1.09, 1.27) had higher odds of experiencing DFA compared to those with dental visit experience or caries-free status. The most commonly used assessment tools in the included studies were the Frankl Behaviour Rating Scale (32 %, 8/25), Children's Fear Survey Schedule-Dental Subscale (20 %, 5/25), and Dental Anxiety Question (20 %, 5/25). ConclusionsThis systematic review reveals that approximately one-third of young children globally experience DFA. Children who lack dental visit experience or have caries experiences are at increased risk of DFA. Clinicians can use this information to make informed decisions regarding dental care provision for young children. Clinical SignificanceThis study provides comprehensive information on the global prevalence of dental fear and anxiety and its associated factors in early childhood. The findings can assist clinicians in understanding and addressing DFA in their dental care approach for young children. RegistrationPROSPERO (CRD42023446464)

Evaluating Child Behavior and Preference Toward NumBee and Traditional Syringe (a Randomized Clinical Trial)

BACKGROUND: Local anesthetics are the gold standard for pain control in dentistry. Most patients still view the “needle” as a source of anxiety and disruptive behavior rather than relief. The patient’s cooperation and comfort level will increase with the administration of painless local anesthetic injection using appropriate technique. The purpose of this study was to assess the patient cooperation and behavior after receiving local anesthesia injection and to compare patients’ acceptance and preference of needleless NumBee anesthetic delivery device to conventional dental syringe. MATERIALS AND METHODS: 30 non-fearful 6-8-year-olds who had never been to the dentist were selected for the study using a split-mouth design. They underwent a simple class I restoration on both mandibular permanent first molar teeth in two separated dental visits. The Frankl behavior rating scale was used to assess patient behavior following injection. Patients expressed their preference and acceptance of the used syringes by answering a questionnaire. RESULTS: After injection by either method, 25 patients had Frankl behavior rating score of 4. Patients that had a negative response with the traditional method, showed a score of 2, following NumBee injection (p=0.035). CONCLUSION: Patients accepted both methods, and NumBee may induce less fear, with minimum stinging and unpleasant taste.

Assessment of child personality attributes using Pictorial Personality Traits Questionnaire (PPTQ-C) for prediction of child behavior at the first dental visit and its co-relation with the Frankl behavior rating scale

Aim: To assess child personality attributes using Pictorial Personality Traits Questionnaire Children (PPTQ-C) for prediction of child behavior at the first dental visit and its co-relation with the Frankl behavior rating scale. Methodology: A sample size of 110 children between the ages 6-9 years requiring preventive treatment was included and they were asked to fill out the PPTQ-C before the treatment. The personality trait was evaluated. The Frankl behavior rating of the subjects was noted at the time of the treatment. A correlation was established between the personality trait and Frankl behavior rating scale. The Pearson correlation test was used to obtain a correlation between the Frankl behavior rating scale and the personality traits. Results: A positive correlation was found between the trait of Extraversion and a negative correlation between Neuroticism and the Frankl behavior rating scale. Conclusion: The PPTQ-C can be used to assess child personality attributes for the prediction of child behavior at the first dental visit. However, the findings are preliminary and need to be validated with bigger sample sizes across varied groups.

Effectiveness of a needle-free local anesthetic technique compared to the traditional syringe technique for the restoration of young permanent molars: a single-blind randomized clinical trial.

The sensation of pain can elevate anxiety levels, establishing a cyclical pattern that may result in the avoidance or premature termination of dental procedures. Previous endeavors employing various methods and products have produced varied outcomes. Jet injection systems, employing high pressure and velocity to deliver anesthesia without needles, offer a non-invasive option for local anesthesia administration. To assess and measure pain perception levels in a pediatric population during the restoration of young permanent teeth, comparing a needle-free injection system with the traditional dental needle method. Sixty participants with young permanent first molars requiring indirect pulp capping were enrolled, all under the care of a single operator. A simple randomization method was employed, utilizing sequentially numbered, opaque, sealed envelopes to allocate participants into two intervention groups: Group 1 and Group 2. Group 1 received traditional needle syringe anesthesia, while Group 2 received the needle-less injection system, Injex (INJEX Pharma AG, Germany). Following topical anesthesia application, local anesthesia was administered, and indirect pulp capping was performed. The Face, Legs, Activity, Cry, Consolability Scale (FLACC), Wong-Baker Scale, Time of local anesthesia (LA) Administration, Frankl Behavior Rating Scale (FBRS), and Pulse rate were evaluated and recorded at various intervals. The needle-less injection system required approximately 26.2 seconds for anesthesia administration, significantly less time than the traditional syringe (p < 0.001). FBRS score analysis revealed no significant differences between groups at all intervals. FLACC score analysis during anesthesia administration indicated lower scores in the needle-free injection group (p < 0.001). Evaluation of Wong Baker Scale (WBS) scores showed higher values in the traditional syringe needle group (p < 0.05). Using the Injex system presents a promising alternative for dental anesthesia administration, enhancing patient comfort and alleviating fear associated with traditional injections.

Assessment of Dental Fear and Anxiety in Children Undergoing Nitrous Oxide-Oxygen Inhalation Sedation visiting BPKIHS

Introduction: Dental treatment of children is the most needed service that remains neglected because of a lack of skill to manage dental fear and anxiety (DFA). Both the non-pharmacological and pharmacological behavior management continuum should be followed to treat children. Objective: To assess and compare DFA levels in children before and after dental treatment using nitrous oxide-oxygen inhalation sedation (NOIS), to assess and compare the change in behavior in children undergoing NOIS, and to compare the level of DFA in children undergoing invasive and non-invasive dental treatment. Methods: DFA was measured using the Children's Fear Survey Schedule Dental Subscale (CFSS-DS), Modified Child Dental Anxiety Scale (MCDAS), and Facial Image Scale (FIS) before and after the dental treatment under NOIS. The change in children’s behavior during invasive and noninvasive treatment under NOIS was assessed by Frankl Behavior Rating Scale (FBRS). Results: A significant reduction in DFA was seen within each cohort as measured by 3 scales: CFSS-DS, MCDAS, and FIS (P≤0.001). There was also a positive change in behavior of children during the time of dental treatment under NOIS as measured by FBRS. However, there was no significant difference between invasive and non-invasive treatment groups with regard to DFA. Conclusions: Minimal sedation provided by NOIS significantly reduced DFA in children, and there was a positive change in their behavior during the time of treatment. NOIS was effective in decreasing DFA in both invasive and non-invasive dental treatment.

Interrelationship Between Intelligence Quotient and Space Maintainers Among Children: A Cross-Sectional Comparative Study.

Introduction Intelligence quotient (IQ) is an indicator to measure a child's cognitive ability to learn or understand and to deal with new situations with their logical and analytical skills. Children with better IQ exhibit increased cooperation when undergoing dental treatments, leading to a positive attitude toward dental care. The primary aim of the study was to assess the interrelationship between the IQ of children, space maintainer therapy, and the behavior of children aged 6-10 years. Materials and methods A total of 104 children were divided into two groups: group 1 included children undergoing space maintainer therapy and group 2 included children who did not undergo space maintainer therapy. Their IQ scores were assessed using Raven's Coloured Progressive Matrices and behavior and the Frankl behavior rating scale. The data were analyzed by SPSS Version 23 (IBM Corp., Armonk, NY). Independent t-tests were used to evaluate the differences between IQ and children with space maintainers, and Mann-Whitney U tests were used to assess the differences between behavior and space maintainers. Results The mean age of the participants was approximately 8.28 years. The mean IQ score of the group of children undergoing the space maintainer therapy was 90.69 ± 7.65 and that of the control group was 105.59±10.71. Based on the Frankl behavior rating scale, the mean score in the space maintainer group was 35.44 and that of the control group was 69.56. There was a significant association between IQ, behavior, and the presence of space maintainers. Conclusion The group of children undergoing space maintainer therapy demonstrated comparatively lesser IQ, and the majority of children exhibited negative behavior. Also, children wearing space maintainers had undergone one or multiple extractions, which is traumatic for children and may lead to them likely exhibiting a negative behavior than children in the control group. Hence, it may be concluded that intelligence, behavior, and space maintainers are all significantly associated with each other.

Behavior and anxiety levels in pediatric patient: The behavioral changes and anxiety of pediatric patient in dental clinic.

The aim of this study is to evaluate the behavioral patterns and anxiety levels of pediatric patients in dental clinics, discern their behavioral expectations, and investigate the associations between these factors and the patient's age and gender. In this cross-sectional study, 150 pediatric patients visiting Sharjah Thumbay Dental Hospital for treatment were recruited over a study period of 23 weeks (February 12, 2022 to July 23, 2022). The patient's age ranged from 2 to 14 years. Guardians were informed about the study and their written consent was taken. Children over 14 years old, children whose guardians refused to participate in the study, and medically compromised children. Frankl's behavior rating scale, Categorical rating scale, and Venham anxiety and behavioral rating scales were used to evaluate the pediatric patient's behavior and anxiety at the end of the dental visit, the evaluation was done by the same trained dental student for all the patients. When the Mann-Whitney U test was used for gender, no significant differences were observed in behavior and anxiety between male and female patients across all scales employed in this study. Conversely, when examining various age groups for behavior and anxiety using the Kruskal-Wallis test, significant findings emerged across nearly all scales. In the categorical rating scale, the age group of 11-14 years exhibited the most notable results in subscales of crying (p = .034), cooperativeness (p = .002), and apprehensiveness (p = .003). The pediatric patients who took part in this study exhibited heightened anxiety when attending dental clinics. This study underscores the importance of understanding child behavior and utilizing effective communication with children and their guardians. Dental professionals should consider implementing strategies to manage child behavior during visits. Further research is required to develop sufficient strategies tailored to different pediatric populations, aiming to enhance dental care outcomes for pediatric patients.

Predictors of Parental Acceptance towards Contemporary Behavior Management Techniques Used in Pediatric Dentistry: A Preliminary Study on Turkish Population.

Parents, who make the final decision regarding their child's treatment, play a significant role in their dental care. Parental approval is important for each stage of treatment and may affect the physician's approach to the treatment. Therefore, it is essential for pediatric dentists to comprehend which behavior management techniques (BMTs) are acceptable to parents and to identify the factors that influence their acceptability. Parents who were bringing their children for dental treatment answered a survey on the acceptance of twenty contemporary BMTs. The sociodemographic data of the parents and the age, gender, and Frankl behavior rating scale (Frankl) scores of their children were recorded. Parents were asked to indicate their level of acceptance of each BMT. Binary logistic regression analysis was designed to see the predictors of "accepted" and "declined" answers. According to acceptance frequencies, the most accepted technique was communication and communicative guidance. The most declined technique was parental absence. The child's age, gender, Frankl score, parental educational status, and parent type predict the acceptability of some BMTs. This study revealed that pediatric dentists must consider parent and child factors when selecting BMTs for children. We believe that this study can provide a basis for determining which factors pediatric dentists should consider when selecting individualized BMTs.

Assessment and Correlation between Dactyloscopy and Behavior of Children Undergoing Dental Treatment: A Cross-sectional Study.

To assess and correlate dactyloscopy and behavior of children undergoing dental treatment. A total of 30 children aged 4-8 years who needed at least one restoration without administration of local anesthesia were included. Two examiners recorded the behavior of the child as per Frankl's behavior rating scale and after the treatment, the subjects' fingerprints were taken using an ink pad and white paper. The data were analyzed using Statistical Package for the Social Sciences (SPSS) versions 23 and a Chi-squared test was carried out (p < 0.05). The loop type fingerprint had the highest frequency, while the archtype had the lowest. The child's behavior differed greatly (p < 0.05) based on dermatoglyphic characteristics, with the loop pattern being seen in cooperative children and the whorl pattern in uncooperative children. There is a positive correlation between fingerprint type and children's dental care. Dactyloscopy can be used to determine the behavior of children coming for dental treatment and hence help in their management. Janiani P, Subramanian EMG. Assessment and Correlation between Dactyloscopy and Behavior of Children Undergoing Dental Treatment: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(3):444-447.

Impact of Parenting Style on Child's Behavior and Caries Experience in 3-6-year-old Children: A Cross-sectional Study.

The aim of the study is to evaluate the impact of parenting style on a child's behavior and caries experience in 3-6-year-old children. This cross-sectional study included 1,216 parent-child pairs of 3-6-year-old preschool children. Parenting style was determined using Parenting Style and Dimensions Questionnaire (PSDQ). Child behavior was assessed using Frankl's behavior rating scale, and caries experience was recorded using the decayed, extracted and filled deciduous teeth surfaces index. Out of the 1,216 parents, the authoritative parenting style is seen in 70%, authoritarian in 20%, and permissive parenting style in 9.5%. Children with a permissive type of parenting style have shown more negative behavior. Children of authoritative parents had 4.1 times higher odds of exhibiting definitely positive behavior, which is statistically significant (p = 0.004). Children of positive child behavior had 2.4 times higher odds of avoiding caries which is statistically significant (p = 0.0001). Children of authoritarian parents had 1.45 times higher odds of exhibiting caries than children of permissive parents; however, this difference is not statistically significant. Children of authoritative parents demonstrated low caries experience and desirable behavior in the dental office. On the contrary, children of permissive parents exhibited undesirable dental behavior, and children of authoritarian parents had high caries experience. Twenty-first-century parents are less controlling and are more permissive leading to problematic child behavior in the dental office. Parenting styles have an impact on the effectiveness of behavior management as well as dental treatment. Pediatric dentists should identify different parenting styles and anticipate the child's behavior. This study emphasizes the effect of different parenting styles on a child's behavior and dental caries experience. Shalini K, Uloopi KS, Vinay C, et al. Impact of Parenting Style on Child's Behavior and Caries Experience in 3-6-year-old Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):276-279.

Development and evaluation of an individualised dental habituation programme for children with autism spectrum disorder living in Rogaland, Norway.

To develop and evaluate an individualised habituation programme for children with autism spectrum disorder (ASD) to enhance their cooperation during a routine dental examination. In collaboration with school personnel, we developed and evaluated a research-based habituation programme comprising a toolbox with aids (pictures, videos, appliances, social stories) for preparations and gradual exposure to a 10-step dental examination. The habituation programme was subjected to a small-scale evaluation involving 17 children with ASD living in Rogaland, Norway. Changes in cooperation were registered using Frankl behaviour rating scale. Further, school personnel were interviewed using semi-structured interviews, and the data obtained were analysed through content analysis. Fourteen children (82%) completed the dental examination. Compared to previous accomplishments reported by the caregivers, an increased number of children completed the examination with a mirror and probe and were able to take an X-ray with good compliance following the habituation programme. The registration of cooperation (Frankl score) during each session indicated varying progression rates. Further, changing the dentist did not influence compliance, and most children showed a similar level of cooperation towards the dental examination one year later. Further, school personnel highlighted the need for preparations that could facilitate control and the importance of catering to individual needs. An individualised approach combining preparations and behavioural methods in close collaboration with school personnel can increase cooperation during a dental examination in children with ASD.

The impact of school-based social media and online technology on oral health education for individuals with disability.

To evaluate the impact of school-based online communication methods on the oral health-related behavirs of individuals with disability. A prospective interventional study was conducted on 154 students (age 3-22 years) with various disabilities attending educational centers. A clinical examination was carried out before and after a school-based online educational program. Online in-person sessions were held for the participants, and educational videos were shared with parents and teachers over social media. The clinical examination included the Special Olympics HAS form, (1) Oral Hygiene Index-Simplified (OHI-S) (2) and the Modified Frankl Behavior Index. (3) Dietary and oral hygiene habits were collected via parent-administered questionnaires. Improvements in behavior in a dental setting (p<.001), oral hygiene levels (p<.001) and dietary choices (p<.001) were observed throughout the study. Oral health education online modalities can be used effectively by dental professionals to educate individuals with disabilities and their carers regularly, thus helping improve oral health and rapport with dental professionals.

Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years: A Randomized Clinical Trial.

A comparative evaluation of children's anxiety with the use of nitrous oxide-oxygen (N2O-O2) inhalation sedation during the administration of inferior alveolar nerve block (IANB). A total of 60 children between 3 and 12 years of age, with Frankl's behavior rating of 2-3 requiring IANB for any dental procedure were enrolled in this randomized clinical study. Group I (n = 30) received N2O and oxygen inhalation sedation at a concentration in the range of 25-50%, whereas group II (n = 30) received 100% O2 as a placebo. The physiological parameters like pulse rate, respiration, blood pressure, and O2 saturation were measured at the baseline, intraoperatively [during and after administration of local anesthesia (LA)] and postoperatively after the termination of the gases in both groups. The sedation level was measured intraoperatively (before administration of LA) using the Ramsay Sedation Score (RSS). The discomfort and anxiety were measured at the baseline, intraoperatively, and postoperatively using the Face, Legs, Activity, Cry, Consolability (FLACC) behavior scale. The data were evaluated using the statistical software International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistics 20.0. There was a significant difference in the FLACC scores between the two groups, intraoperatively (p-value-0.002), and postoperatively (p-value-0.049). The mean of the RSS for group I was 2.80 + 1.03, and for group II was 1.80 + 0.81. All the physiological parameters recorded were within the normal range. The use of N2O-O2 inhalation improved the anxiety levels in children while receiving the IANB and showed significant anxiolytic and sedative effects as compared to O2 inhalation. Nitrous oxide-oxygen (N2O-O2) inhalation can be used as a nonpharmacological behavior management adjunct for invasive treatments for children with utmost comfort for the child. Thomas PS, Dave BH, Shah DJ, et al. Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(1):30-36.

Evaluation and Comparison of Effectiveness of Kedo-S Pediatric Rotary Files vs Manual Instrumentation for Root Canal Treatment in Primary Molars.

To evaluate and compare the clinical and radiographic success of Kedo-S pediatric rotary files vs manual K-Files for pulpectomy in primary mandibular molars. A sample of 30 primary mandibular molars with irreversible pulpitis was taken per group. The groups were divided as below mentioned-group I (n = 30) was treated using the Kedo-S file system. Group II (n = 30)-treated using manual stainless steel K-File. The clinical and radiographic success was compared of both techniques. Statistical analysis involved t-test, Chi-squared test, and Cochran's Q test. The overall clinical success at 3, 6, and 9 months in group I were 72.4, 89.7, and 93%, respectively and in group II were 82.1, 92.9, and 92.9%, respectively. The overall radiographic success in group I at 3, 6, and 9 months were 6.9, 17.2, and 69%, respectively and in group II were 0, 7.1, and 35.7%, respectively. According to the Frankl behavior rating scale, 19 children in group I (65.5%) showed negative behavior, and 15 children in group II (53.57%) showed positive behavior. The mean instrumentation time in group I (Kedo-S pediatric rotary file group) and group II (hand K-File group) was 8.03 ± 0.823 and 11.25 ± 0.928, respectively. There was a statistically significant/highly significant difference in intergroup comparison postoperative behavior among the children in the two study groups. There was a statistically significant difference between the two study groups with relation to instrumentation time. The trend that was observed in the clinical and radiographic profile was that group I (Kedo-S rotary files) cases had more success when absolute numbers and figures were compared than group II (hand stainless steel K-File) in which success rates were comparable; however, the difference between the groups were found to be statistically nonsignificant. Rajain T, Tsomu K, Namdev R. Evaluation and Comparison of Effectiveness of Kedo-S Pediatric Rotary Files vs Manual Instrumentation for Root Canal Treatment in Primary Molars. Int J Clin Pediatr Dent 2023;16(1):22-29.

Effect of Deep Breathing Exercise using Smartwatch on Behaviour, Anxiety and Pain in Children during Buccal Infiltration Anaesthesia-A Randomised Clinical Trial

Introduction: Despite the newer innovation and recent technological advances in modern dentistry, fear and anxiety constitute an important theme in dentistry. They are a usual reaction to stressful conditions that help children while staying alert in situations of an impending threat. Aim: To evaluate the effect of deep breathing exercise in reducing dental anxiety, behaviour and pain using smartwatch during maxillary buccal infiltration in children aged 7-11 years. Materials and Methods: A prospective interventional and single-blinded randomised clinical trial conducted in the Department of Paediatric and Preventive Dentistry, NDCH, Nellore, Andhra pradesh, India, from November 2019 to October 2020. A total of 70 children of age between 7-11 years. They were randomly allocated into two groups, 35 in each. Children in group I were trained for deep breathing exercise using smartwatch and group II (control group) was traditional tell show do technique. The reaction of children during maxillary buccal infiltration anaesthesia was recorded in terms of behaviour (Frankl behaviour rating scale), anxiety {Facial Image Scale (FIS) and pulse rate}, and pain perception (Wong-Baker FACES pain rating scale and face, leg, activity, cry and consolability scale). Data was tabulated using Kolmogorov-Smirnov test and Kruskal-Wallis for data distribution. Independent Student’s t-test or Mann-Whitney test (Quantitative variables) and Chisquare test or Mann-Whitney test (Qualitative variables) were used to test statistical significance using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The mean age of children in smartwatch group was 8.9±1.4 years and in control group was 8.9±1.6 years with no statistical significant difference. Statistically significant decrease in pulse rate was observed in smartwatch group (p=0.003), subjective anxiety and pain was lowered in intervention group. Objective pain was decreased significantly in smartwatch group (p=0.007). Conclusion: Children performing deep breathing exercise using smartwatch had efficiency to reduce dental anxiety and pain perceived during maxillary buccal infiltration anaesthesia.

Effect of Virtual Reality and Artificial Intelligence on Anxiety and Behavior Among Individuals with Mental Disabilities in a Dental Setting

Over one million individuals suffer from mental disabilities in Saudi Arabia. These individuals are unable to express their dental treatment needs. This study focuses on assessing the impact of interventions based on virtual reality (VR) and artificial intelligence (AI) on the anxiety levels and behavioral responses of individuals with mental disabilities when undergoing dental treatments. Our findings indicate that VR and AI interventions have great potential in reducing anxiety and behavioral responses of individuals with mental disabilities. The reduction in anxiety levels was determined using a galvanic skin response sensor, whereas the improvement in behavior was evaluated using the Venham and Frankl behavior rating scales. Descriptive statistics were used to calculate the means, standard deviations, and ranges of the scores on various scales. The mean scores of pretreatment and posttreatment were analyzed. Our results from the above-mentioned tests revealed lowered anxiety and positive behavior when VR and AI interventions were used in dental care settings. In conclusion, our research indicates that distraction using VR and AI interventions is an effective method for lowering anxiety and improving behavior among individuals with mental disabilities during dental treatments. Moreover, a positive correlation between anxiety and behavior was observed.

Reliability of three pain assessment tools in children requiring dental treatment: A comparative clinical study.

The appropriate intervention of pain is based on its accurate evaluation, which is a challenge in the pediatric population as they often do not have the language development or cognitive sophistication to describe it correctly. Untreated pain has a negative impact on the psychosocial well-being of children. The study aimed to evaluate and compare the reliability of different pain assessment scales, namely, the Wong Baker Facial Pain Rating scale (WBFPS), Modified Emoji Pain Scale (MEPS), and indigenously developed indigenously made GIF Pain Scale (SPGPS) in children undergoing dental treatment under local anesthesia (LA). The study included 152 children aged 4-6 years with a Frankl behavior rating of score 3 and 4 (positive and definitely positive) requiring dental treatment under LA. After local infiltration, each child with two independent observers was asked to record the response of the current pain on the WBFPS, MEPS, and SPGPS. The reliability of the pain scales was assessed on the basis of similar responses given by all three individuals. The Pearson correlation test was performed to determine the correlation among the scales. A very strong correlation was found between the WBFPS and SPGPS (r = 0.848), while a moderate correlation was found among the WBFPS and MEPS (r = 0.691). A strong correlation was found between the SPGPS and MEPS (r = 0.723). The SPGPS proved to be a more reliable pain assessment tool compared to the WBFPS and MEPS in clinical pediatric dentistry.

Preparing Children for Their First Dental Visit: A Guide for Parents.

The aim of the study was to test an information booklet containing suggestions to parents on how to prepare their child for the first dental visit. Forty-five children and one parent per included child took part in the trial. Children were randomized in two groups; the information booklet was e-mailed to the parents of the study group. At the end of the visit, the dentist and the parent evaluated the child's behavior through the Frankl Behavior Rating Scale (FBRS) and the utility of the booklet through a Likert scale. The children evaluated the pleasantness of the visit and the perceived pain through the Wong-Baker FACES® Pain Rating Scale (WBFPRS). Parents evaluated the information booklet as highly understandable and useful. According to the dentist, informed children were more cooperative (FBRS median score: 4; IQR: 3.5-4) than the control group (median score 3; IQR: 2-4) (p = 0.013; Mann-Whitney U test). Children prepared with the booklet reported less pain (WBFPRS: 0.40 ± 0.82 vs. 1.42 ± 1.99; p = 0.034; t-test;) and tended to evaluate the visit as more enjoyable (WBFPRS: 1.1 ± 2.14 vs. 2.75 ± 3.43; p = 0.064; t-test) than unprepared children. The information booklet increases the child's ability to cooperate during the visit and could represent a useful instrument for the clinical practice.

Use of rubber dam versus cotton roll isolation on composite resin restorations’ survival in primary molars: 2-year results from a non-inferiority clinical trial

BackgroundThis non-inferiority randomised clinical trial aimed to evaluate the survival of direct bulk fill composite resin restorations in primary molars using different methods of moisture control: rubber dam isolation (RDI—local anaesthesia and rubber dam) and cotton roll isolation (CRI—cotton roll and saliva ejector). Secondary outcomes included baseline and 2-year incremental cost, self-reported child’s pain scores and patient behaviour during the restorative procedure.MethodsA total of 174 molars (93 children) with dentine caries lesions were randomly allocated to study groups (RDI or CRI) and restored with bulk fill composite resin by trained operators. Two blinded examiners assessed the restorations for up to 24 months. Wong-baker faces and Frankl's behaviour rating scales were used for accessing the child's pain and behaviour, respectively. The primary outcome (restoration survival) was analysed using the two-sample non-inferiority test for survival data using Cox Regression (non-inferiority/alternative hypothesis HR > 0.85; CI = 90%). Bootstrap Linear regression was used for cost analysis and logistic regression for pain and behaviour analysis (α = 5%).ResultsAfter 2-years, 157 restorations were evaluated (drop-out = 9.7%). The survival rate was RDI = 60.4% and CRI = 54.3%. The non-inferiority hypothesis was accepted by the Cox Regression analysis (HR = 1.33; 90% CI 0.88–1.99; p = 0.036). RDI was 53% more expensive when compared to the CRI group. No differences were found between the groups regarding pain (p = 0.073) and behaviour (p = 0.788).ConclusionCotton roll isolation proved to be non-inferior when compared to rubber dam for composite restorations longevity in primary molars. Furthermore, the latest presented the disadvantage of higher cost and longer procedure time.Clinical Significance The moisture control method does not influence the longevity of composite restorations in primary molars. Cotton roll isolation proved to be non-inferior to rubber dam isolation and is a viable option for restoring primary molars.Clinical trial registration registered NCT03733522 on 07/11/2018. The present trial was nested within another clinical trial, the CARies DEtection in Children (CARDEC-03-NCT03520309).

Is there a link between dermatoglyphics and the Frankl behavior rating scale in the paediatric dental setting: A pilot study

Aim: Dermatoglyphics appears during the 12th and 13th weeks of pregnancy and persists throughout life. Fingerprints are blueprints for one's personality; they can provide information about one's perception, emotions, intellect, and motivation. Dermatoglyphic is a non-invasive and low-cost method of obtaining illness information. The aim of this study was to see if there was a link between distinct fingerprint patterns and Frankl's behavior rating scale in children aged 6 to 12. Methods: A total of 52 participants between the ages of 6 and 12 years old received dental procedures and were scored using Frankl's behavior rating scale. Children were divided into three groups: Group 1: Whorl, Group 2: Loops, and Group 3: Arches. After scanning fingerprints of 10 fingers with a SecuGen Hamster Pro 20 biometric finger scanner, the resulting fingerprint pattern types were compared to Frankl's behavior rating scale. Results: Many non-cooperative participants had loop pattern fingerprints (46.4%), while most cooperative participants had whorl pattern fingerprints (58.3%). Conclusions: Children with a loop pattern fingerprint were more likely to receive a negative assessment. On the other hand, children with whorl patterns were more common among the positive participants. Keywords: Behavior Rating Scale; Dermatoglyphics; Pediatric Dentistry