Modified Child Dental Anxiety Scale Research Articles

Psychometric and cytomorphometric analysis of dental phobia in pediatric patients: Association between anxiety and cellular structure

ABSTRACT Background: Children frequently experience negative feelings, such as dental fear or anxiety, as a result of the stress of receiving dental care. Extremely anxious individuals resist therapy or completely avoid it, which exacerbates oral and other health issues. Aim: The goal of this study was to examine the cytomorphometric responses toward dental interventions and their potential interplay with psychometric indices of anxiety levels and previous dental experience, specifically anesthesia, and how they varied before and after the treatment in children. Materials and Methods: On informed consent, buccal mucosal samples were obtained from 20 children (33% males and females 67%) in the pediatric dentistry clinic before treatment and immediately posttreatment. Dental anxiety was assessed through specific questionnaires (Modified Child Dental Anxiety Scale faces version) completed by the children. Results: On the cellular level: Cellular diameter (CD), nuclear diameter (ND), nuclear area (NA), and cellular area (CA) were assessed (Magnus Pro software and hematoxylin and eosin staining) while scores from the questionnaire established anxiety levels. Compared to pretreatment, mean CD, CA, and NA were decreased following treatment, while ND was higher at the recall. Dental anxiety questionnaire scores were also significantly correlated with each other which turned out to be positive. Conclusion: As a result, in response to environmental inputs, mitochondrial cells dynamically alter in terms of morphology and functionality. Chronic structural and functional variation in mitochondria can result in functional adjustments which were correlated by cytomorphometric and psychological investigation.

Development and validation of the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM).

The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9-16. The CEDAM was translated into Persian following the guidelines of the IQOLA project. A ‎sample of children completed the measure in a clinical setting, with a subgroup completing it ‎again to assess test-retest reliability. Concurrent criterion validity was evaluated by having all ‎participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the ‎CEDAM. Construct validity was examined using exploratory and confirmatory factor ‎analyses.‎ RESULTS: The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM ‎exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test-retest‎reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and ‎positive correlation between CEDAM and MCDAS scores (ρ = 0.72, p < .01). Exploratory ‎factor analysis identified two factors, and confirmatory factor analysis confirmed that the ‎instrument aligned well with the factor structure obtained from the exploratory analysis.‎ CONCLUSION: This study provides evidence supporting the validity and reliability of the Iranian version of ‎CEDAM as a valuable tool for evaluating dental anxiety in Persian-speaking children between ‎the ages of 9 and 16.‎.

Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A Split-Mouth Randomized Crossover Clinical Trial.

This crossover clinical trial was conducted with eligible 6-8-year-old children requiring bilateral mandibular molar pulpotomy. At the first treatment visit, pulpotomy was performed for 15 children using VR glasses distraction while the other 15 children received a pulpotomy without any VR glasses; this trend was reversed at the second session and pulpotomy was performed for the contralateral tooth. Pulse rate (PR) and Modified Child Dental Anxiety Scale (MCDAS) measured the anxiety levels. Wong-Baker Faces Pain Scale (WBFP) assessed the pain perception before and after the intervention. Data were analyzed by Statistical Package for the Social Sciences version 25 using the Mann-Whitney and χ2 tests. The mean PR was not significantly different between the two groups. However, the test group showed significantly lower scores of MCDAS (P value = 0.02) and WBFP (P value = 0.001) compared with the control group. The present results suggest that VR headsets can decrease the level of pain and anxiety of patients during primary mandibular pulpotomy. This trial is registered with IRCT20200315046782N1.

Evaluation of Child Preference for Dentist Attire and Usage of a Camouflage Syringe in Reduction of Anxiety.

This study aimed to evaluate the effect of child-friendly dentist attire and camouflage syringes on reducing dental anxiety in children. A cross-sectional study was conducted with 120 pediatric patients aged 6 to 12 years. Participants were assigned to one of three groups: group A (child-friendly dentist attire), group B (camouflage syringe), or group C (control group). Child preference for dentist attire was assessed using a visual analog scale, while dental anxiety was measured using the Modified Child Dental Anxiety Scale and the Facial Image Scale. The results showed a significant decrease in dental anxiety scores in both group 2 and group 3 compared to group 1 (P < 0.001). Children in group A exhibited a higher preference for child-friendly dentist attire [mean score: 8.7, standard deviation (SD): 1.2] compared to group 1 (mean score: 3.2, SD: 1.5) (P < 0.001). Similarly, children in group 2 showed a higher preference for a camouflage syringe (mean score: 8.5, SD: 1.3) compared to group 1 (mean score: 3.4, SD: 1.6) (P < 0.001). Child-friendly dentist attire and camouflage syringes were found to be effective in reducing dental anxiety among pediatric patients. These interventions were well received by children and their parents, highlighting the importance of considering child preferences in dental settings.

Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial

BackgroundDental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. ObjectiveThe objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. MethodsThis is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS).The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery. ResultsThe dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05). LimitationsWe did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up. ConclusionsCompared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.

The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study.

The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N2O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC). A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N2O IHS) and TII (after N2O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N2O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N2O IHS. There were significant differences in the dental anxiety level in child patients after administration of N2O IHS, and it also showed an increased rate of acceptance of dental treatment. This study showed that N2O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects. Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N2O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior. Kunta S, Arora RV, Jain R, et al. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):302-307.

The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children

BackgroundGlobally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care.MethodsThis 4-year randomised controlled trial will involve 600 children (aged 9–16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model.DiscussionTreating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group.Trial registrationThis clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).

The Effect of Filmed Modeling by Cartoon Character on Anxiety of Children during Pit and Fissure Sealant Application under Rubber Dam Isolation: A Randomized Controlled Trial

Abstract Aim: The aim of this study was to assess the impact of filmed modeling by cartoon character on the anxiety of children during pit and fissure sealant application under rubber dam isolation. Methodology: The study consisted of a total of 36 children who were randomly allotted to interventional and control groups by flip-coin method. A prerecorded audio-visual film of a cartoon character getting the treatment done was shown to children included in the interventional group. The anxiety level was checked before and after the application of pit and fissure sealant using the Modified Child Dental Anxiety Scale. Results: Pearson’s Chi-square tests and Wilcoxon sign-ranked test were applied for statistical analysis (P &lt; 0.5), wherein statistically significant changes in anxiety level were observed among children following the filmed modeling. Conclusion: Film modeling is an efficient technique to manage 7–9-year-old children’s anxiety as well as to instill positive behavior during dental treatment.

Effect of the new needle-free injection system on pain perception and dental anxiety during anesthesia: randomized controlled split-mouth study.

Pain management is one of the most important factors affecting the success of pediatric dentistry. Therefore, new needle- and pain-free local anesthesia techniques have been developed in parallel with technological advancements. The purpose of this study is to compare the pain perception and dental anxiety levels associated with a needle-free injection system (Comfort-in™) and the classic needle method during treatment-required infiltration anesthesia in children. This randomized controlled crossover split-mouth clinical study included 94 children who required dental treatment with local anesthesia using a dental needle or needle-free injection system for the bilateral primary molars. The Wong-Baker Scale (WBS) was used to measure pain perception at different times, and the Modified Child Dental Anxiety Scale (MCDAS) was used to measure the anxiety level of the child. A statistical software package was used to process the data. Statistical significance was set at P < 0.05. There was no significant difference between the needle-free injection system and dental needle method during the induction stage for filling and pulpotomy (P > 0.05). "Pain on postoperative 1st day" was similar in both types of anesthesia (P = 0.750). The needle-free injection system was as effective as the dental needle method. The Comfort-in™ system was an acceptable alternative for patients during the postoperative period. Understanding how pain management may be provided during local anesthesia administration and a child's fear and anxiety regarding the dentist may lead to better dental compliance.

Multifaceted distraction technique: an innovative tailored approach in dental settings for anxiety reduction in children: A preliminary report

Aim: This study aimed to evaluate the useability of a new multifaceted distraction technique and its effects on dental anxiety reduction in children. Methods: This in vivo experimental study included 54 anxious children with an Modified Child Dental Anxiety Scale- Face Version score&gt;19. Multifaceted distraction was used to relax and distract the children during dental treatment. Ease of use, attractiveness, functionality, and changes in anxiety scores before and after treatment were assessed in the paediatric patients. The scores obtained were tabulated and statistically analysed using the Wilcoxon signed-rank and paired t-tests. Results: The multifaceted distraction technique was attractive, easy to use, and reduced procedural anxiety in 98.15% children aged 3–10 years. Conclusions: Within the limitations of this study, the multifaceted distraction technique was an effective behaviour management technique for reducing procedural anxiety in young children. Keywords: Behaviour Management; Child Behaviour; Dental Anxiety; Paediatric Dentistry; Stress Relaxation

Evaluation of dental anxiety in children with Down's syndrome using dog-assisted therapy: A pilot study.

Dental anxiety and fear are the major treatment challenges faced by pediatric dentists. Oral hygiene in children with Down's syndrome is highly compromised in comparison to their healthy counterparts. Animal-assisted therapy, through dogs, has been beneficial in alleviating dental fear and anxiety in healthy pediatric population. The aim of the study was to assess the impact of dog-assisted therapy (DAT) on children with Down's syndrome undergoing dental examination and fluoride varnish application in dental operatory. Twenty children with Down's syndrome between 5 and 12 years of age were selected. Group A (intervention group): DAT was carried out in the dental operatory. Group B (control group): Dental treatment was performed in the absence of a therapy dog in the dental operatory. Anxiety levels were evaluated by recording the pulse rate and revised modified faces version of the Modified Child Dental Anxiety Scale (MCDAS[f]). The intergroup comparison of pulse rate was done using an unpaired t-test, whereas the variation in intragroup pulse rate was analyzed using the Analysis of Variance test. The anxiety scores were subjected to a paired t-test for intragroup comparison with P < 0.05 considered to be statistically significant. Reduction in dental anxiety was observed in the intervention group (P < 0.001). DAT can be used as an effective behavior management technique for children with Down's syndrome undergoing dental examination and simple dental procedures in the dental operatory.

Association of Dental Anxiety with Color Preferences in Pediatric Dental Patients

Objective: People’s color preferences have been a subject of research and curiosity for many years. Among the methods aimed at minimizing such fears in children is the careful selection of colors in the environment in order to prevent individuals from developing negative feelings. The present study evaluates the association between colors and anxiety in a pediatric dental patient population aged 7–14 through a quantitative test. Material and Methods: The State-Trait Anxiety Inventory for Children (STAIC), the faces version of Modified Child Dental Anxiety Scale (MCDAS-f) and the quick version of the Lüscher Color Test (LCT), respectively, were administered to 65 patients and 48 age and sex matched controls while in the waiting room before treatment. Results: The MCDAS-f and STAIC state scale scores were significantly and moderately correlated with the LCT scores, while there was no statistically significant correlation between the STAIC trait and the LCT scores. The mean LCT score was 6.06±2.85 in the patient group and 3.22±2.21 in controls (p&lt;0.001). Conclusions: The results of this study support that the colors preferred by children during dental examination and treatment are in fact those that reflect their moods rather than those that should be used in dental surgery environments and medical attire, contrary to previous studies investigating the association between color preferences and anxiety in pediatric dentistry.

Assessing the Different Levels of Virtual Reality That Influence Anxiety, Behavior, and Oral Health Status in Preschool Children: Randomized Controlled Clinical Trial

BackgroundCompared with a traditional behavior management strategy and oral health training, virtual reality (VR) integrated with multisensory feedback possesses potential advantages in dentistry.ObjectiveThis study aimed to assess the impact of different levels of VR on anxiety, behavior, and oral health status.MethodsThis study was carried out in the Department of Pediatric Dentistry at the Tabriz University of Medical Sciences from December 2020 to June 2021. We randomly assigned 60 healthy children aged 4 years to 6 years to 4 groups, each consisting of 15 children. The study consisted of 2 consecutive sessions. During the first visit, the plaque index was calculated, and oral health education was carried out in all groups using Immersive VR (group I), Semi-immersive VR (group II), Nonimmersive VR (group III), and tell-show-do (TSD; group IV). In the second session, an amalgam restoration was performed in all groups. Participants’ anxiety and behavior were recorded using the face version of the Modified Child Dental Anxiety Scale (MCDAS[f]) and Frankl scale. The plaque index was recorded in 2 follow-up sessions.ResultsThe greatest prevalence of positive behavior (P=.004) and the lowest anxiety (P<.001) were recorded in group I, followed by group II, group III, and group IV. The plaque index scores showed a reduced trend between the first session and follow-up sessions (P<.001), but the values did not differ significantly between the 4 groups during the 3 sessions (P=.28, P=.54, P=.18).ConclusionsThe most positive behavior was observed in the Immersive VR group, followed by the Semi-immersive VR, Nonimmersive VR, and TSD groups. Moreover, oral health education using VR resources can improve oral health status in children.Trial RegistrationIranian Registry of Clinical Trials 20210103049926N1; https://www.irct.ir/trial/53475

Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial

PurposeThe aim of the study was to compare the effect of a stress ball, an active distraction technique with audio-visual eyeglasses, a passive distraction technique during local anaesthesia administration, on dental anxiety (primary outcome), behaviour and pain levels of children (secondary outcomes).MethodsIn this randomised controlled parallel arm trial involving 123 children aged 8–12 years, who required dental treatment under inferior alveolar nerve block, children were randomly allocated into the following three groups: Group 1: Stress ball, Group 2: Audio-visual eyeglasses, Group 3: Control group (basic behaviour guidance without distraction). Dental anxiety was measured using modified child dental anxiety scale and pulse rate, behaviour was rated using Venham’s scale and pain was measured by both self-reporting and observational scales.ResultsNo significant difference between the groups was observed for dental anxiety, but a significant decrease was seen in dental anxiety scores within all groups. No significant differences were seen between the groups for behaviour ratings and pain scores.ConclusionUse of active stress ball distraction or passive audio-visual eyeglasses during local anaesthesia administration decreased dental anxiety but did not result in a significant improvement in the dental anxiety, behaviour and pain levels when compared to basic behaviour guidance without distraction.Clinical trial registrationThe clinical trial was registered at Clinical Trials Registry–India (CTRI Reg no: CTRI/2019/04/018768, Dated 24 April 2019).

The long-term effect of dental treatment under general anaesthesia or physical restraints on children's dental anxiety and behaviour.

Dental anxiety (DA) is a common problem worldwide because it renders dental treatment in children challenging. This study aimed to evaluate the long-term effect of dental treatment under general anaesthesia (GA) or physical restraints (PR) on children's DA and behaviour. A total of 103 children were recruited and divided into four groups: the GA group, PR group, cooperative (CO) group, and no experience (NE) group. The face version of the Modified Child Dental Anxiety Scale and modified Venham's Clinical Anxiety and Cooperative Behaviour Rating Scale were used to evaluate the level of DA and behaviour. Dental treatment under GA is associated with a higher risk for DA when compared with that under PR in the long term. Increased DA may lead to uncooperative dental behaviour, although the agreement is only moderate.

Translation and Cultural Adaptation of the Modified Child Dental Anxiety Scale – Faces (MCDASf) into Brazilian Portuguese

Objective: To translate and culturally adapt the Modified Child Dental Anxiety Scale - Faces (MCDASf) into Brazilian Portuguese. Material and Methods: The MCDASf consists of eight questions about anxiety toward dental procedures that are answered on a five-point Likert scale ranging from “not worried” (1 point) to “very worried” (5 points). The answers correspond to a scale of face drawings ranging from extremely negative to extremely positive. The process consisted of initial translation, back-translation, expert committee review, and pretesting. Results: The first revised version was applied to 32 children aged 5 to 12 years, 16 from the city of Governador Valadares, Brazil (southeastern region) and 16 from the city of Pelotas, Brazil (southern region). In the first pretest, Item 5 was misunderstood by 6.25% of children in the southern region; Item 6 by 6.25% in both regions; Items 7 and 8 by 87.5% and 100% of those from the southeastern region, respectively, and by 12.5% and 25% of those from the southern region, respectively. Items 7 and 8 were modified by the expert committee, and the second revised version was applied to 32 children, 16 from each region. The only misunderstood items were 4 and 5, both by a 7-year-old boy in Governador Valadares. Conclusion: The Brazilian Portuguese version of the MCDASf was well understood by the sample of children.

Turkish version of the faces version of the Modified Child Dental Anxiety Scale (MCDASf): translation, reliability, and validity.

To cross-culturally adapt of MCDASf into Turkish and to evaluate reliability and validity of the Turkish version of MCDASf using explorative factor analysis (EFA), confirmatory factor analysis (CFA), and receiver operating characteristic (ROC) analysis to form a less time consuming and easy to understand tool for measuring dental anxiety. A total of 300 children (174 females, 126 males) aged 6-12 years who were recruited at the Department of Paediatric Dentistry in RTEU at the first visit participated in the present study. For the internal consistency reliability, Cronbach's alpha was calculated. Intraclass correlation coefficients (ICCs) were calculated for test-retest reliability (n=67). Construct validity was determined by comparing with the Venham Picture Test (VPT). The factor structure was examined using EFA. CFA was used for dimensionality. The cut-off points of the Turkish version of MCDASf were plotted using a ROC curve. The Turkish version of MCDASf showed high internal consistency (0.703) and an excellent ICC value (0.827). Good correlations were found between the global scores of MCDASf and VPT (r=0.632). Three factors were identified from EFA and verified with CFA. Discriminant validity was supported by high scores of females and younger children (p<0.05). The cut-off point was assigned as >24.50. The area under the ROC curve (AUC) was 0.921 (95% CI: 0.873-0.969). The Turkish version of the MCDASf is a reliable and valid scale that satisfied psychometric properties. The Turkish version of MCDASf is a usable tool for the measurement of dental anxiety among Turkish speaking children.

Comparative Evaluation of Pain Related Behavior During Administration of Local Anesthesia Using the Conventional Syringe and the Computerized Controlled Local Anesthetic Device in Children Exhibiting Different Levels of Anxiety: In vivo Study

Background: Pain experienced during dental procedures evolves into negative attitude towards dentistry, which is projected as anxiety and fear of the child. Administration of local anesthesia (L.A) although an intervention to render painless procedures, in itself causes pain by its conveyance. Wand® (Milestone Scientific, Livingston, NJ, USA) is a system introduced to decrease soreness in the course of anesthetic conveyance. Owing to the sparse information comparing conventional systems with those of Wand, the present study evaluated pain related behavior in children exhibiting pre-assessed variant levels of anxiety midst administration of local anesthesia.&#x0D; Aim: To correlate pain related behavior amidst delivery of local anesthesia using conventional syringe and the Wand® STA system in children exhibiting variant anxiety levels.&#x0D; Methodology: The In vivo study embodied 32 children aged between 6 to 8 years. The volunteered participants were pre-categorized into low and high anxiety using the Modified Child Dental Anxiety Scale. They were further divided using the SNOSE technique – receiving L.A the conventional syringe (group A) and those receiving L.A using the C.C.L.A.D (group B). Pain reactions and perceptions to the two delivery methods were calculated using subjective scales and objective physiological parameters.&#x0D; Results: Comparing pain perception in pre-assessed anxiety categories affirmed a remarkable difference with the use of C.C.L.A.D and appeared to bestow effortless, pain-free delivery over the traditional cartridge delivery.&#x0D; Conclusion: C.C.L.A.D builds a refined acclivity for dispersal of the solution, ergo an utilitarian tool in pediatric dentistry.

Effect of pre-operative administration of ibuprofen in children undergoing extraction for reducing post-operative pain: a double-blind randomised controlled clinical trial.

Introduction Administration of non-steroidal anti-inflammatory drugs (NSAIDs) before tooth extraction may reduce post-surgical pain, but there is a lack of research.Aims To compare pain and anxiety in paediatric tooth extraction patients receiving a pre-operative NSAID vs placebo.Design Randomised, double-blind, placebo-controlled clinical trial.Setting Princess Nourah bint Abdulrahman University's dental clinic in Riyadh, Saudi Arabia.Materials and methods Eligible paediatric tooth extraction patients were randomised to group A, which received NSAID pre-operatively, or group B, which received the placebo.Interventions A research coordinator measured participants before extraction, and then 3 hours and 24 hours post-extraction.Main outcome methods The Wong-Baker FACES scale and the Modified Child Dental Anxiety Scale (faces).Results There were 56 participants (28 in each group). Pain and anxiety scores were not statistically significantly different between the two groups before or 24 hours post-extraction. However, group A had significantly lower pain (-1.3151, p = 0.0063) and anxiety scores (-0.6071, p = 0.0081) compared to group B three hours post-extraction.Discussion Pre-operative administration of NSAIDs in paediatric dental patients was associated with significantly lower post-extraction pain and anxiety.Conclusions Clinicians should consider making NSAID administration before paediatric tooth extraction part of their clinical protocol.

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

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