Non-pharmacological Behaviour Research Articles

A software-based observational coding approach for evaluating paediatric dental pain, anxiety, and fear.

Dental practitioners desire non-pharmacological methods to alleviate anxiety, fear, and pain in children receiving dental care; high-quality evidence, however, is required to evaluate methods' efficacy. This study aimed to develop and validate an observation-based coding approach (paediatric dental pain, anxiety, and fear coding approach [PAFCA]) to evaluate non-pharmacological behavior management techniques for anxiety, fear, and pain. Objective (video-based) and subjective (self-reported) anxiety, fear, and pain data were collected from a pilot clinical trial evaluating animal-assisted therapy (AAT) in paediatric dentistry, in which 37 children aged 7-14 were assigned to AAT or control before dental treatment (restorations or extractions). A coding approach utilizing a codebook, a gold standard calibration video, and a user training guide was developed. Trained examiners coded the gold standard video for inter-rater agreement, and masked, calibrated examiners analyzed videos using the Noldus Observer XT software. A novel, software-based coding approach was developed, with moderately high inter-rater agreement. Using PAFCA, we found children reporting higher levels of pain, fear, and anxiety exhibited treatment-interfering behaviors, including crying/moaning, attempts to dislodge instruments, and more upper and lower body movements. PAFCA shows promise as a reliable tool for assessing anxiety, pain, and fear in behavioral research for paediatric dentistry.

Comparative Study of Different Behavioral Management Techniques in Treating Anxious Pediatric Dental Patients

ABSTRACT Background: Pediatric dental anxiety poses a significant challenge in the delivery of dental care, often resulting in compromised treatment outcomes and negative experiences for both patients and dental professionals. Materials and Methods: A randomized controlled trial (RCT) was conducted involving 120 pediatric dental patients aged 4 to 10 years old, presenting with varying degrees of dental anxiety. Patients were randomly assigned to three groups: Group A received tell-show-do (TSD) technique, Group B received audiovisual distraction (AVD), and Group C received non-pharmacological behavior guidance (NPBG). Anxiety levels were assessed using a standardized anxiety scale before and after the dental procedure. Patient cooperation during treatment, as well as dentist and parent satisfaction, was also evaluated. Results: The study revealed significant reductions in anxiety levels across all groups post-treatment. However, Group B (AVD) demonstrated the most substantial reduction in anxiety scores, with a mean decrease of 60% from baseline. Group A (TSD) and Group C (NPBG) showed comparable reductions in anxiety levels, with mean decreases of 45% and 50%, respectively. Patient cooperation during treatment was highest in Group B, followed by Groups C and A. Dentist and parent satisfaction scores were significantly higher in Group B compared to the other groups. Conclusion: AVD emerged as the most effective behavioral management technique for treating anxious pediatric dental patients, resulting in significant reductions in anxiety levels and higher levels of patient cooperation during treatment compared to TSD and NPBG techniques.

Dental treatment outcomes in Thai children treated for severe early-childhood caries under general anaesthesia and non-pharmacological behaviour management: a retrospective study

PurposeThe aim of this study was to compare dental-treatment outcomes, oral-hygiene improvement, and patient co-operation during follow-up visits between children treated under general anaesthesia (GA) and non-pharmacological behaviour management (NP).MethodsThis retrospective study reviewed the dental chart records of healthy patients less than 71-month-old with severe early childhood caries (S-ECC) from 2008 to 2020 with at least a 6-month follow-up. The demographical data, dental-treatment outcomes, oral-hygiene status, and patient behaviour at the follow-up visits were analysed by the Mann–Whitney U test, Pearson’s Chi-square, Fisher’s exact test, Friedman test, and Wilcoxon test with a significance level of 0.05.ResultsThis study included 210 GA cases and 210 age-matched control NP cases. The GA group had a significantly higher caries experience, lower patient co-operation, poorer oral hygiene, and higher number of complex dental treatment than the NP group at baseline (p < 0.001). The number of children who had incomplete dental treatment under non-pharmacological behaviour management was higher than the GA group. After treatment, the number of new carious teeth in the NP group was significantly higher than in the GA group only at the 6-month follow-up. However, there was no significant difference in treatment failure, oral-hygiene improvement, and patient behaviour between groups.ConclusionAlthough patients in the GA group had higher dental and behaviour problems than the NP group, the overall dental-treatment outcomes, including oral hygiene and behaviour improvement, were not significantly different between groups Therefore, regular follow-up and preventive treatment in the maintenance phase are essential for children with severe early-childhood caries.

Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia.

Administration of local anesthesia via injection is the main reason for inducing anxiety in children and if not intervened it aggravates the anxiety in subsequent appointments. There are many approaches, including pharmacological and non-pharmacological methods that can be used to reduce children’s perception of pain and anxiety. A frequently used non-pharmacological behaviour management method to reduce anxiety and procedure pain is distraction. The rationale of distraction is to shift the attention to avert the brain from receiving unwanted stimulus which induce anxiousness. Many approaches including music, television, portable video games, virtual reality (VR) helmet, and virtual reality audio-visual eyewear, have been implemented so far. Kaleidoscope and virtual reality goggles may help as distraction techniques in reducing the levels of anxiety caused during administration of local anesthesia. By the aid of which the operator may be able to make the dental experience child friendly and ultimately provide quality dental care to anxious children. Non pharmacological measures of reducing pain are cost effective and best means that can be used while performing dental procedures. This is a research protocol for a study aimed to evaluate and compare the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children.

Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia.

Administration of local anesthesia via injection is the main reason for inducing anxiety in children and if not intervened it aggravates the anxiety in subsequent appointments. There are many approaches, including pharmacological and non-pharmacological methods that can be used to reduce children’s perception of pain and anxiety. A frequently used non-pharmacological behaviour management method to reduce anxiety and procedure pain is distraction. The rationale of distraction is to shift the attention to avert the brain from receiving unwanted stimulus which induce anxiousness. Many approaches including music, television, portable video games, virtual reality (VR) helmet, and virtual reality audio-visual eyewear, have been implemented so far. Kaleidoscope and virtual reality goggles may help as distraction techniques in reducing the levels of anxiety caused during administration of local anesthesia. By the aid of which the operator may be able to make the dental experience child friendly and ultimately provide quality dental care to anxious children. Non pharmacological measures of reducing pain are cost effective and best means that can be used while performing dental procedures. This is a research protocol for a study aimed to evaluate and compare the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children.

The results of pulpectomy in primary molars in children with negative behaviour

Relevance. A pulpectomy is a procedure predominantly performed for pulpitis treatment in single-rooted primary teeth. Data on the pulpectomy in primary molars are limited. Pulpectomy in children with negative behaviour is particularly difficult. The study aimed to determine the survival rate of primary molars after treatment of chronic pulpitis by pulpectomy in children with negative behaviour depending on the behaviour management method.Material and methods. A prospective clinical study in parallel groups involved 120 children aged 3-6 years who demonstrated negative behaviour (according to the Frankl scale) during a dental examination. Chronic fibrous pulpitis was treated by vital pulpectomy in 180 primary molars. In group 1 (60 children, 90 teeth), children underwent non-pharmacological behaviour management; in group 2, children were treated under conscious sedation (pharmacological correction of behaviour). Follow-ups after 6, 12, 18 and 24 months determined the tooth survival rate after pulpectomy.Results. The 24-month tooth survival rate after pulpectomy was 76.7% in group 1 (95% CI 67.9-85.4%), 81.1% – in group 2 (95% CI 73.0-89.2%), p &gt; 0.05.Conclusion. More than 75% of primary molars survived for 24 months after vital pulpectomy in children with negative behaviour. The results of pulpectomy with pharmacological behaviour correction were better than after non-pharmacological behaviour management; however, the detected differences were not statistically significant.

The application of behaviour modification techniques among paediatric patients in a dental set-up- A pilot study

This study was performed to evaluate the different non-pharmacological behaviour modification techniques preferred by the parents, to know whether single or multiple behaviour modification techniques are required to regulate the behaviour of the child and to assess the effectiveness of non-pharmacological behaviour modification techniques in the operating procedure. 30 children aged between 4-7 years who required pulp therapy treatment to be done under local anaesthesia were enrolled for the study with parental consent. A video containing different behaviour management techniques was shown to the parents who had accompanied the child to the operatory. A questionnaire was given to the parents for their feedback, the response to each question was coded and the values of each code were analyzed statistically. The parents’ preferred technique was applied to their children before the planned treatment. Nonpharmacological behaviour modification techniques were effective in 90% of the children and it was found to be highly significant (p ≤ 0.05). It was seen that 66.67% of the children required more than one nonpharmacological behaviour modification technique to make them behave positively. The most preferred technique by the parents in this study was Positive Reinforcement (30%).This study brings forth that nonpharmacological behaviour management techniques can be successfully used to regulate most of the children in a paediatric clinic setup.

The use of pediatric behavior management techniques among Syrian dentists - A cross-sectional study

Objectives: The aim of this study was to evaluate and compare the attitude toward several behavior management techniques among Syrian pediatric dentists (PDs), general dental practitioners (GDPs), and other dental specialists (ODSs). Dental fear and anxiety are highly prevalent among schoolchildren and pre-school children. Behavior management techniques can be either pharmacological or non-pharmacological. Distraction is a non-pharmacological behavior management technique, which is safe, economical, and effective. Materials and Methods: A self-designed questionnaire was distributed through social networks. Syrian GDPs, PDs, and ODSs participated in the online questionnaire. The questionnaire consisted of four sections and required responses regarding participants’ demographic characteristics, work setting, the use of several behavior management techniques, and attitude toward tablet distraction use. Pearson’s Chi-square test was performed at 5% for statistical analysis using SPSS version 23.0. Result: A total of 642 participants responded. Most of the participants reported using tell-show-do (63.08%) and positive reinforcement (65.58%) techniques. Less than half of the participants (45.79%) used virtual reality (VR) eyeglasses for distraction. PDs used cartoons and storytelling techniques significantly more than GDPs and ODSs, with P = 0.023 and P &lt; 0.001, respectively. However, most of the participants never used touch screen video games (74.45%) or joystick video games (92.21%) for distraction. Half of the questionnaire participants (52.34%) were unsure about using a tablet device for distraction. Conclusion: This study concluded that tell-show-do, positive reinforcement techniques, and VR eyeglasses were used the most. However, the vast majority of the participants never used video games for distraction. A good proportion of the study participants were hesitant about using a tablet device as a means of distraction.

Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients.

To evaluate the effectiveness of the audiovisual distraction (AVD) technique and filmed modeling (FM) on anxiety and fear in pediatric dental patients. This experimental in vivo study was conducted on 80 subjects of age-groups 5-8 years coming to the Department of Pediatric and Preventive Dentistry for their first dental visit. Study subjects were subjected to noninvasive restorative treatment under AVD in group I, FM in group II, and a combination of AVD and FM in groups III and IV (control 0). To assess the level of pre and postoperative anxiety and fear, various biological parameters like pulse rate, oxygen saturation, body temperature, respiratory rate, and salivary cortisol estimation along with facial image scale (FIS), and fear assessment picture scale (FAPS) were used. Group III (a combination of AVD and FM) came out to be better than other experimental groups and control groups in reducing dental anxiety and fear in pediatric dental patients. A combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique. A child's disruptive behavior due to dental anxiety causes difficulty in delivering effective dental treatment. Thus, a child's behavior management is of paramount importance in the pediatric dental setup. Nonpharmacological behavior management techniques, that is, a combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique to reduce dental anxiety and fear in pediatric dental patients. Jamil F, Khan SY, Jindal MK. Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients. Int J Clin Pediatr Dent 2023;16(4):598-602.

Experiences of dentists and caregivers of patients with special care needs-A qualitative study.

Patients with special care needs (developmental disabilities) have unique and complex needs regarding their oral health and care. This qualitative study aimed to identify the experiences, preferences and challenges of dentists and caregivers regarding behavior guidance techniques for dental care in persons with special care needs. Relying on qualitative description as articulated by Sandelowski, we conducted telephone interviews with a purposeful sample of five special care dentists and seven caregivers. We analyzed the data using thematic analysis. Four themes were highlighted: (1) Neither pharmacological or non-pharmacological behavior guidance techniques was universally suitable, (2) A patient-centered approach was critical, (3) The dental environment triggered patients' behaviors and anxiety levels, (4) There was more demand for, than supply of, qualified dentists to treat patients with special care needs. Persons with special care needs are heterogeneous and respond to various behavioral techniques required to deliver their treatment. Behavior guidance planning should be negotiated carefully with patients and caregivers and then individualized based on patients' capabilities and needs for treatment. The necessity to manage complex behaviors has contributed to the limitation of access to dental care for persons with special care needs. Dentistry as a profession has the obligation to uphold the social contract and meet its responsibility to the dental care needs of this population.

Non-pharmacological Behavior Management Techniques in Pediatric Dentistry: A Bibliometric Analysis.

As an emerging trend, non-pharmacological behavior management has gained immense research interest. By utilizing a bibliometric approach, this investigation aims to review the state of the non-pharmacological behavior management techniques research in pediatric dentistry. A Scopus search was done onnon-pharmacological behavior management in pediatric dentistry, including literature from 1900 to 2022, using "Cited Reference Search" on 4/2/2022. After being screened, the articles were ranked according to the number of citations they had, and the publication year, authorship, contributinginstitutions, countries, article topic, study design, H index, and keywords were extracted. Out ofthe 1431 articles found during the literature search, the top 50 cited articles were used foranalysis. The citation counts of the 50 selected articles varied from 163 to one, and their highestpublications were in the years 2017 and 2019 (n = 7). Most studies were published in the United Kingdom (n = 10). The studies done in Australia and USA have the highest mean citationwith the most significant contributions from the Department of Dental Medicine, Children's Hospital, RegionalMedical Center, USA.The systematic review was the most frequent study design (n = 19).Among 110 unique keywords, dental anxiety (n = 11) was the most frequently used. Thisbibliometric analysis offers valuable details on the top 50publications cited between2006 and 2022. Although these methods have been employed for many years, only recently havethey been the subject of significantscientific publications. It is hoped that this study will enableaspiring and seasoned researchers to envision and create potential future scenarios forinterdisciplinary research collaborations on the use of non-pharmacological behavior management techniques in pediatric dentistry.

Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia.

Administration of local anesthesia via injection is the main reason for inducing anxiety in children and if not intervened it aggravates the anxiety in subsequent appointments. There are many approaches, including pharmacological and non-pharmacological methods that can be used to reduce children's perception of pain and anxiety. A frequently used non-pharmacological behaviour management method to reduce anxiety and procedure pain is distraction. The rationale of distraction is to shift the attention to avert the brain from receiving unwanted stimulus which induce anxiousness. Many approaches including music, television, portable video games, virtual reality (VR) helmet, and virtual reality audio-visual eyewear, have been implemented so far. Kaleidoscope and virtual reality goggles may help as distraction techniques in reducing the levels of anxiety caused during administration of local anesthesia. By the aid of which the operator may be able to make the dental experience child friendly and ultimately provide quality dental care to anxious children. Non pharmacological measures of reducing pain are cost effective and best means that can be used while performing dental procedures. This is a research protocol for a study aimed to evaluate and compare the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children.

Evaluation of children’s perception of non-pharmacological behaviour management techniques - An innovative study

Background: Behaviour management is considered a keystone entity in paediatric dentistry. Good behavioural management techniques are essential for managing children. To ensure the acceptance of dental care, appropriate behaviour management technique should be applied. Aim: To evaluate children’s perception of various non-pharmacological behaviour management techniques used by pediatric dentists. Materials and methods: 68 patients, 9 to 12 years of age were individually shown videos of 8 different non-pharmacological behaviour management techniques: Tell show do, positive reinforcement, distraction, non-verbal communication, parental presence/ absence, protective stabilization, voice control and magic trick. After watching these videos, children were asked to evaluate their perception on a Likert scale. Results: Positive reinforcement was the most accepted followed by distraction and magic trick. The least accepted were protective stabilization and voice control. Conclusion: It is important to understand the child’s point of view and their opinion should always be considered as they are the ones receiving the dental treatment.

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.

An Online Acceptance and Mindfulness Intervention for Chronic Pain in Veterans: Development and Protocol for a Pilot Feasibility Randomized Controlled Trial.

In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning. The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20). This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system. This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023. The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning. ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132. DERR1-10.2196/45887.

Effect of Parental Dental Anxiety Level on Acceptance of Non-Pharmacological Behavior Management Strategies used in Pediatric Dentistry

Objective: To determine the effect of parental dental anxiety level on acceptance of non–pharmacological behavior management strategies used in pediatric dentistry Methodology: This cross-sectional study was conducted at the Pediatric department of FUCDH Pakistan over five months. It was carried out through a pre-validated questionnaire. Behavior management techniques with audiovisual aids were explained to the participants. Patients reporting for routine dental check-ups, on follow up of ongoing dental treatment were included in the study whereas patients with dental trauma, unwilling to be a part of this research, undergoing general anesthesia and medically compromised patients were excluded from the study. Patients are grouped based on age to determine parental behavior in different age groups. Results: 302 parents participated in this study including 130 (43.0%) fathers and 172 (57.0%) mothers. The mean age of children was 7.81±1.92 years, with an age range of 4 – 12 years. The majority of the parents, 297 (98.3%) agreed with behavioral management techniques with 293 (97.0%) parents agreed that the dentist should show videos of behavior management techniques for their understanding. 254 (84.1%) parents agreed to consent for use of sedation and anesthesia. Refusal to sedation technique was significantly more common among parents of children of younger age group as compared to children of older age group (p&lt;0.001). Conclusion: Modest anxiety levels were recorded in parents accompanying pediatric dental patients irrespective of age group thus expressing eagerness for non – pharmacological behavior management strategies with prior explanation and demonstration. However, reluctance to sedation and anesthesia modalities were deciphered by parents particularly evident in parents of younger age group patients.

Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia.

Administration of local anesthesia via injection is the main reason for inducing anxiety in children and if not intervened it aggravates the anxiety in subsequent appointments. There are many approaches, including pharmacological and non-pharmacological methods that can be used to reduce children's perception of pain and anxiety. A frequently used non-pharmacological behaviour management method to reduce anxiety and procedure pain is distraction. The rationale of distraction is to shift the attention to avert the brain from receiving unwanted stimulus which induce anxiousness. Many approaches including music, television, portable video games, virtual reality (VR) helmet, and virtual reality audio-visual eyewear, have been implemented so far. Kaleidoscope and virtual reality goggles may help as distraction techniques in reducing the levels of anxiety caused during administration of local anesthesia. By the aid of which the operator may be able to make the dental experience child friendly and ultimately provide quality dental care to anxious children. Non pharmacological measures of reducing pain are cost effective and best means that can be used while performing dental procedures. This is a research protocol for a study aimed to evaluate and compare the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children.

Assessment of parental acceptance towards different non-pharmacological behaviour management techniques in pediatric dental care-a cross-sectional study.

It is imperative to manage children with empathy and concern for their well-being in order to carry out any dental procedure smoothly. Owing to the inherent fear of dental operatory, behaviour management of children is an important aspect of pediatric dental care. Many techniques are available to help manage the behaviour of children. It is, however important to educate parents about these techniques and to get their cooperation for these techniques to be used on their children.This study aimed to familiarize the parents with non-pharmacological behavior management techniques and to determine the parental acceptance of such techniques in children seeking dental treatment in specialty care dental units. A total of 303 parents were evaluated through online questionnaires in this research. They were shown videos of randomly selected non-pharmacologic behaviour management techniques including tell-show-do, positive reinforcement, modelling and voice control. Parents were asked to watch the videos and give their response on seven-items inquiring about their acceptance levels regarding the respective techniques. The responses were recorded on a Likert scales ranging from strongly disagree to strongly agree. According to parental acceptance score (PAS), positive reinforcement was the most accepted technique whereas voice control was the least acceptable technique. Majority of the parents were more receptive towards those techniques that involved a healthy and friendly communication between a dentist and the pediatric patient such as, positive reinforcement, tell show do and modelling. Most significantly the people having low socio-economic status (SES) in Pakistan were more acceptable of voice control than people with high SES.

Safety of deep intravenous propofol sedation in the dental treatment of children in the outpatient department

Background/purposeIntravenous sedation with propofol in the dental treatment offers an alternative to inhalation sedation or general anesthesia. The aim of this study was to evaluate the safety and identify risk factors for intraoperative complications. Materials and methodsUncooperative children who could not complete dental treatment under non-pharmacological behavior management or mild-to-moderate sedation in the outpatient pediatric department were selected. Details and time of dental treatment; intraoperative vital signs data, including blood pressure, heart rate, respiratory rate, pulse oxygen saturation (SpO2), end-tidal carbon dioxide, and electrocardiogram; and incidence of intraoperative and postoperative complications were recorded. ResultsOverall, 344 children were selected, with 342 completing dental treatment. The dental treatment time was 20–155 (median, 85; interquartile range, 70–100) min. The number of treated teeth was at least 1 and at most 13 (median, 6; interquartile range, 5–8). Among 342 children, 35 (10.2%) had their treatment interrupted temporarily due to choking cough. No serious complications occurred; the incidence rate of minor complications was 47/342 (13.7%). Tachycardia was observed in 5/342 (1.5%) cases, oxygen desaturation (SpO2 < 95%) in 18, and hypoxemia (SpO2 ≤ 90%) in 25. The treatment duration was significant longer in cases with than without complications (P < 0.05), and children coughing during treatment were more likely to have complications (P < 0.05). Postoperative restlessness occurred in six children, but there was no vomiting, aspiration, or respiratory obstruction. ConclusionDecreased oxygen saturation is the most common complications. Cough during treatment and longer treatment duration were risk factors for complications.

Effectiveness of Different Distraction Techniques in The Management of Anxiety in Differently Abled Pediatric Dental Patients - A Randomized Comparative Clinical Study

Anxiety and fear have become the most significant problem for normal children and differently-abled children at the dental operatory. Various techniques in distraction such as audio, and visual are employed for the behavior management of children. The study aimed to evaluate the effectiveness of four different techniques in anxiety management in differently abled dental pediatric patients. The study included 120 children, randomly assorted into four groups i.e consisting of 30 children in each. Each of these groups was subjected to different distraction techniques, like audio distraction, audio-visual distraction, video distraction and tell-show-do techniques. The parameters assessed were systolic and diastolic blood pressure (SBP and DBP), pulse rate (PR) and oxygen saturation (SPO2) levels. Variables were compared before, during and after the dental procedure using Kruskal-Wallis test. Post-hoc analysis and Bonferroni tests were used to determine the statistical significance in inter-group comparison. SBP was insignificant statistically intra-group at before-after time points. However, SBP during-after treatment showed statistical significance in intergroup (p=0.02). SBP in audio-visual distraction was statistically significant when compared with video distraction group. There was no statistically significant difference observed in the DBP and PR for intra and intergroup, however, SPO2 levels at alltime points in intergroup were statistically significant (p&lt;0.001). Audio-visual distraction proved to be effective as a part of the behavior management technique followed by audio distraction. These non-pharmacological behavior management techniques provided a peaceful dental environment for differently abled children, who have anxiety and fear.