Music distraction--its efficacy in management of anxious pediatric dental patients

Managing the anxiety of pediatric dental patient has long been the purview of dentists over many years. Various techniques have been used with moderate and variant success rates over the last few years. The main aim of this study was to ascertain if music distraction is an effective means of managing anxiety in pediatric dental patients. Forty children aged between 4 and 8 years were selected for the study. The assessment of anxiety was done using Venham's picture test, Venham's anxiety rating scale, pulse rate, and oxygen saturation during different treatment visits. The values were statistically analyzed and it was concluded that audio distraction did decrease the anxiety level in pediatric dental patients, but not to a very significant level.     

The effect of music distraction on pain, anxiety and behavior in pediatric dental patients

PURPOSE: The purpose of this study was to determine if audio distraction could decrease patient anxiety, pain and disruptive behavior during pediatric dental procedures. METHODS: Forty-five children between the ages of 4 to 6 years had two visits each involving restorative dentistry with local anesthesia in a mandibular quadrant. Visit #1 was a baseline session for all patients. During visit #2, the children were assigned to either an upbeat music group, a relaxing music group or a no music group. Variables measured were: (1) parent-reported anxiety via the Modified Corah Anxiety Scale, (2) self-reported anxiety via the Venham picture scale, (3) heart rate, (4) behavior via the North Carolina Behavior Rating Scale and (5) pain via a visual analogue scale. RESULTS: No significant differences were found among the three groups during experimental visit #2 across any variables. A majority of patients (90%) stated that they enjoyed the music and would like to listen to it during their next visit. CONCLUSIONS: Audio distraction was not an effective means of reducing anxiety, pain or uncooperative behavior during pediatric restorative dental procedures. However, patients did enjoy listening to the music during their visits.     

The clinically related predictors of dental fear in Taiwanese children

Background. Dental fear has been singled out as one of the most troublesome problems facing paediatric dentistry today. Children with dental fear may avoid visiting dentists; therefore, their oral health protection is often compromised. However, the aetiology of dental fear is still not entirely understood. Objective. This study investigated the dental visiting habit, the previous dental experiences, the conditioning pathway, and the clinically related predictors of dental fear in children. Design. The dental history of 247 children (2–10 years old) was obtained when they came to a dental clinic for treatment. The level of dental fear in these children was assessed using the Children's Fear Survey Schedule–Dental Subscale (CFSS-DS). Observers rated the clinically anxious responses and uncooperative behaviour towards dental treatment in these children. Three stepwise regression analyses were performed to determine significant predictors of CFSS-DS score, clinically anxious responses, and uncooperative behaviour of children, respectively. Results. We found that the CFSS-DS score and clinical anxiety have different predictors, but age ≤ 3.99 years old and cooperativeness in the first dental visit were important predictors for both the CFSS-DS score and the clinical anxiety. Furthermore, the other predictors of the CFSS-DS score were maternal dental fear, unbearable pain during the first dental visit, and visiting dentists in a regular dental clinic; the other predictors of clinical anxiety were first-born, regular dentist, and CFSS-DS score. Finally, the only significant predictor for uncooperative behaviour was clinical anxiety. Conclusion. Children's dental fear and their anxious response during dental treatment were dynamic processes that consisted of many different factors. The direct conditioning of subjective experience of pain was more important than the objective pathway of child dental fear, and the indirect conditioning does not seem influential in this study sample.     

Anxiety about dental hygienist treatment

Abstract – Although dental anxiety is a well investigated phenomenon in dental health care, remarkably little is known about anxiety reactions related to treatment carried out by the dental hygienist. In the present study anxiety reactions were measured among 101 patients attending the dental hygienist. General level of anxiety was assessed through the PAQ (Photo Anxiety Questionnaire; S touthard , D e J ongh & H oogstraten , 1991), whereas an additional questionnaire was used to obtain information about specific stimuli and situations that might provoke anxiety in the dental hygienist situation. The results indicated that during dental hygienist treatment only 15% of the patients experienced no feelings of anxiety. Another 15% of the patients reported that a visit to the dental hygienist was more distressing than dental treatment. The level of anxiety appeared to be strongly related to a number of stimuli and situations, with actual pain (78%) and expected pain (67%) major anxiety provoking factors. The relation between pain and anxiety was highly significant, with highly anxious patients having more fear for pain than their low anxious counterparts. Also feelings and sounds of instruments, patient's helplessness and perceived lack of control over what happens were identified as important contributors to anxiety for the dental hygienist treatment. The results of this study suggests that treatment by the dental hygienist is a distressing event for many patients.     

Effects of audiovisual distraction on children’s behaviour during dental treatment: a randomized controlled clinical trial

Aim: Dental anxiety leads to undesirable distresses such as avoidance of dental treatment and increase stress among caregivers that consequently affect the treatment quality. The aim of this study was therefore to evaluate the effectiveness of viewing videotaped cartoons using an eyeglass system (i-theatre?) as an audiovisual (AV) distraction technique on behaviour and anxiety in children receiving dental restorative treatment.

Methods: Fifty-six consecutive children patients who presented for treatment and met inclusion criteria were included and randomly divided into two groups; a control group without distraction (CTR-group) and a distraction-group (AV-group). Three dental treatment visits were provided for each patient. Anxiety and cooperative behaviour were assessed with the Facial Image Scale (FIS) and the Modified Venham’s clinical ratings of anxiety and cooperative behaviour scale (MVARS). The vital signs, blood pressure and pulse were also taken.

Results: The AV-group showed significantly lower MVARS scores than the CTR-group (p?=?0.029), and the scores decreased significantly during treatment in the AV-group (p?=?0.04). Further, the pulse rate was significantly increased in the CTR-group during injection with local anaesthesia (p?=?0.02), but not in the AV-group.

Conclusion: AV distraction seems to be an effective method in reducing fear and anxiety in children during dental treatment. Further, children who used eyeglass goggle display as a distraction tool during dental treatment reported not only less anxiety than control groups but also showed more positive responses after injection with local anaesthesia. Hence, AV-distraction seems to be a useful tool to decrease the distress and dental anxiety during dental treatment.     

Management of the petrified dental patient

Fear and anxiety are common responses to anticipated or actual dental treatment. This may range from slight feelings of unease during routine procedures, such as an injection or cavity preparation, to feelings of extreme anxiety long before treatment is happening. There is general agreement that anxiety constitutes a major problem for the dentist, and a barrier to optimal care for the patient, as one of the most significant consequences is avoidance of dental treatment. Common triggers include local anaesthetic injection and the dental drill. This paper uses the term anxiety to encompass both fear and anxiety and reviews current strategies for managing anxious people in the dental setting, with a focus on non-invasive operative techniques. CLINICAL RELEVANCE: Being able to recognize fear and anxiety in dental patients is an important part of overall patient management. Knowledge of various behaviour management techniques, and the use of less-invasive operative techniques, enable the clinician to treat a large proportion of anxious people and help them to cope with dental treatment in the primary care setting. Those who remain anxious and unable to cope in the dental setting may require pharmacological techniques, such as conscious sedation, to enable them to receive dental treatment. These techniques are not always readily available, require appropriate training, are more time consuming and costly. In extreme cases, general anaesthesia may be a last resort option.     

Factors affecting dental fear in French children aged 5–12 years

International Journal of Paediatric Dentistry 2010; 20: 366–373 Background. While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. Objective. We set out to evaluate factors affecting dental fear in French children. Methods. Dental fear was evaluated using a visual analogue scale (DF‐VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5–11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well‐being related to oral health, dental experience, and oral health education were collected via a structured interview. Results. Dental fear was scored low in 75.7% (DF‐VAS 0–3), moderate in 16.7% (DF‐VAS 4–6), and high in 7.6% (DF‐VAS 7–10). DF‐VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. Conclusions. This study shows that for children aged 5–12 years, prior experience of the dental setting can act as a positive component of dental fear.     

Experience with dental pain and fear of dental pain

Anxious people tend to overestimate the intensity of aversive events such as fear and pain. When an aversive event has been experienced personally, prediction is based on experience and is possibly less subject to bias due to anxiety. Therefore, it was hypothesized that subjects will overestimate fear of specific dental pains relative to subjects who experienced the pain or procedure personally. Samples of highly anxious dental patients (n=48), patients waiting for periodontal treatment (n=56), and psychology freshmen (n=262) completed a measure of dental anxiety and the Fear of Dental Pain (FDP) questionnaire. All FDP items were extended with the question whether the subject ever experienced the pain personally (yes or no). Less fear was reported when the pain had been experienced personally, with the exception of the sample of highly anxious dental patients. The results suggest that fear of dental pain is a highly important covariate in dental pain research.     

Dental fear and anxiety in an older adult population

A random sample of 580 people aged between 50 and 89 yr completed a questionnaire containing two measures of dental fear and anxiety. One of these was Corah's Dental Anxiety Scale (DAS) and the other a scale derived from the Structured Interview for Assessing Dental Fear (SIADF). The mean score on the DAS was 7.8, and 8.4% of subjects were classified as dentally anxious. There were no differences in mean DAS scores by sex but significant differences by age, with younger individuals having higher scores (P less than 0.0001). The edentulous had significantly higher scores than the dentate (P less than 0.001). Scores on the SIADF scale were higher among younger individuals (P less than 0.0001), the edentulous (P less than 0.01) and women (P less than 0.05). Older adults who were dentally anxious were less likely to report a regular source of dental care and a dental visit in the previous year and more likely to report having avoided or delayed dental treatment. Possible explanations of higher dental anxiety scores among younger persons and the edentulous are reviewed.     

How can child life specialists help address dental fear and anxiety in children?: A review

BackgroundPainful pokes, buzzing drills, uncomfortable pressure, foreign tastes, and disturbing noises are all events that a child can experience in a single dental appointment. Each event has the potential to trigger dental fear and anxiety in pediatric patients. Dental fear and anxiety are common for children and can lead to the neglect of dental care into adulthood. Many behavioral interventions currently in practice focus on immediate behavior changes rather than long-term psychosocial well-being of children.ObjectiveThe purpose of this paper was to review the literature of pediatric dental fear and anxiety and provide reasoning for child life specialist intervention in the pediatric dental clinic.ResultsRooted in developmental theory, child life specialists advocate for the psychosocial care of children in various healthcare environments, including dental clinics. Child life specialists work to minimize pediatric fear and anxiety using various strategies, including psychological preparation. Psychological preparation is accomplished by the provision of developmentally appropriate education, therapeutic or medical play, and preparation books.ConclusionsFurther research is needed to establish the effectiveness of child life specialist intervention, such as psychological preparation, in pediatric dentistry at reducing pediatric dental fear and anxiety.     

Effect of information on dental anxiety and behaviour ratings in children.

AIM: To establish the effect of information received about dental care on the anxiety level of the child prior to receiving any form of dental treatment and on their behaviour during dental treatment. METHODS: Eighty-four healthy child patients at their first dental visit, between the ages of 8 and 13 years attending a paediatric dental clinic in Nigeria participated in the study. Information on their dental anxiety level was collected using the Dental Subscale of the Child Fear Survey Schedule. The children were asked to identify their source and type of dental information received. The information given was later categorised into positive or negative for analysis purposes. The children's behaviour during dental treatment was assessed using Venham's clinical ratings of anxiety and cooperative behaviour. The mean dental anxiety scores, as well as the mean Venham behavioural ratings, of those that had received information on dental treatment were compared with those that had never received any information. RESULTS: Previously received information did not appear to have any significant impact on the measures of the dental anxiety level of these children neither was there a statistically significant association between information received and behaviour of the child in the dental chair. CONCLUSION: Past information may play only a minor role in affecting dental anxiety levels and behaviour of the child during dental treatment.     

口腔诊疗中低龄儿童行为表现分类标准的制定与信度检验

目的制定并检验口腔诊疗中低龄儿童行为表现的分类标准。方法参考Venham儿童行为和焦虑六分类法制定出低龄儿童在口腔诊疗中行为表现的分类标准，并由11名儿童口腔医护人员对随机选取的24段临床诊疗录像用该标准进行分类。结果此分类标准依据儿童的情绪状态、诊疗中行为表现、医师完成治疗的情况等三方面来对儿童在口腔诊疗中的行为表现进行分类。该分类标准有较好的研究者间一致性（组内相关系数=0．929）和很高的重测信度（Spearman’s相关系数=0．963）。结论该方法可以作为临床对低龄儿童在口腔诊疗中行为表现进行分类的标准。     

Anxiolysis in dental practice: a report of three cases

While general dentists have used many modalities to reduce fear and anxiety in the dental office, including iatrosedation (calming words), distraction techniques, conditioning techniques, and empathy, there still are patients who need pharmacologic management of fear and anxiety to receive dental care. Anxiolysis, the lightest level of sedation, can be employed by all dentists and is safe and effective when used properly. This article presents three cases to introduce the anxiolysis technique as an in-office sedation procedure that can be used by all general dentists.     

Dental anxiety: differentiation, identification and behavioral management.

Dental anxiety has always been and still is a major impediment to regular dental care for a significant proportion of the general public. In years past, dental professionals could afford, by and large, to ignore this problem. Practices could flourish based on their technical virtuosity, and fearful or anxious patients might be considered a burden rather than a concern. Today, however, the laws of supply and demand are causing dentists to pay increased attention to aspects of the profession that extend beyond the science of clinical technique. A successful practice now depends on interpersonal as well as technical skills, particularly the ability to manage dental anxiety. Despite this, most dentists admit to a surprising lack of confidence when it comes to understanding the nature of anxiety and the modern methods advocated for its everyday management, which generally rely on behavioral modes of intervention. This paper is designed to familiarize practitioners with some of the basic elements of dental fear and anxiety, and their day to day management.     

Strategies for combating dental anxiety

Dental anxiety and subsequent avoidance of dental care and deterioration of oral health pose a significant problem for the dental profession. In an attempt to elucidate preferences of anxious dental patients, we gathered survey data from 121 persons at a small, private liberal arts college in the mid-Atlantic region of the United States. Half of the respondents experienced dental anxiety, and most of these (66 percent) attributed anxiety to fear of anticipated pain. The majority of anxious patients preferred a dentist to be friendly (93 percent), talkative (82 percent), and to have an office with adorned walls (89 percent) and a slightly cool temperature (63 percent). Patients who identified themselves as anxious also indicated that music in the background (89 percent) and magazines and books in the dental office (75 percent) were helpful. Anxious patients were more likely than non-anxious patients to prefer a male dentist (77 percent versus 52 percent). This finding was especially marked among anxious male respondents, 93 percent of whom preferred a male dentist compared to 73 percent of anxious female respondents. These survey data may assist dental professionals in understanding and combating patients' dental anxiety, in order to increase the frequency of dental visits and to prompt a corresponding restoration or maintenance of oral health.     

Reliability and validity of the short version of the Dental Anxiety Inventory

The present study focused on a newly developed questionnaire to assess dental anxiety. The short version of the Dental Anxiety Inventory (S-DAI) contains nine items of the Dental Anxiety Inventory (DAI), which was designed to take into account three situations that may evoke dental anxiety, four time elements in which dental anxiety may be provoked, and three reactions. The aim was to assess the validity and reliability of the S-DAI in a sample of highly anxious dental patients applying for treatment at a dental fear clinic in the Netherlands. Three hundred and twenty-one patientslled out several questionnaires assessing dental anxiety (S-DAI, DAS, and a 10-point Likert-scale) and psychological complaints. Total mean score on the S-DAI for women (mean=40.5, s =5.7) was some-what higher than for men (mean=38.8, s =6.9) ( t (306)=2.35; P =0.019). Cronbach's α for the present sample was 0.88. Correlations with other measures of dental anxiety were 0.73 with the DAS ( P < 0.001) and 0.69 ( P < 0.001) with the 10-point scale. The results indicated that the S-DAI has good reliability and construct validity. It was concluded that the S-DAI is easy to administer in general dental practices and dental fear clinics and has satisfactory psychometric qualities.     

Predicting anxiety during dental treatment using patients'self-reports: less is more

BACKGROUND: Self-reported dental fear measures seldom are used in clinical practice to assess patients' fears. This study examined how well dental fear measures predicted anxious behaviors displayed during dental treatment. METHODS: One hundred eight adult patients (54 percent female) in a periodontology clinic completed several paper-and-pencil demographic, dental fear and general anxiety measures before treatment. Dental practitioners, blinded to their patients' responses, rated their patients' anxiety during treatment on a series of 100-millimeter visual analog scales. RESULTS: Higher Dental Fear Survey scores, younger age, more invasive treatment type and previous avoidance of dental care because of a bad experience all were predictive of greater observed anxiety. Neither self-reported nor observed anxiety was affected by previous experience with a particular practitioner or treatment. CONCLUSIONS: Dentists may assess patients' anxiety quickly and accurately with the Dental Fear Survey or a similar measure, as well as by asking patients about their current dental attendance and previous dental experiences.     

Dental anxiety. Assessment, reduction and increasing patient satisfaction

A conceptual schema relating a number of patient and dentist variables to patient anxiety reduction and satisfaction was presented. Evidence was examined that indicates that patient compliance with preventive and treatment regimens can be influenced in a major fashion through variables that reduce anxiety and increase satisfaction with the dentist. An accounting of several studies that investigated behavioral strategies for reducing patient stress during dental procedures indicated that recorded relaxation instructions and the active distraction provided by playing a video game can be effective anxiety-reducing treatments. Attempts to find other useful behavioral strategies were unsuccessful--only relaxation and distraction were consistently successful in reducing stress in moderately anxious patients. Observations of dentist-patient interaction in the context of the behavioral strategy studies indicated that the doctor-patient relationship was an important dimension associated with patient anxiety reduction and satisfaction. A series of investigations were conducted to elucidate the dentist behaviors that were associated with these variables. We found that the dentist behaviors most closely associated with patient satisfaction were those portraying empathy, friendliness, and a calm, competent image to the patient. The most important behavior associated with anxiety reduction was the dentist's explicit promise to prevent pain. Other dentist behaviors--friendliness, being calm, giving moral support--were seen as providing an appropriate behavioral context in support of the pledge to prevent pain. Finally, we considered the need for the dentist to be aware of patient anxiety in order to effectively deal with it. If nothing else, asking about anxiety gives the patient permission to express concerns that are present. If the patient is not anxious, asking about anxiety will not produce it. Two types of measuring instruments were considered in relation to assessing anxiety. The Dental Anxiety Scale, a brief four-item scale, was judged to be a reliable and valid method for assessing general dental anxiety. In addition, a new interval scale of anxiety response was discussed for those occasions on which it is important to assess the patient's response to treatment.     

Relationship between children's first dental visit and their dental anxiety in the Veneto Region of Italy

The aim of this study was to explore the association between negative experiences during children's first dental visit and any subsequent dental anxiety and related factors in three dental clinics in the Veneto Region of Italy. For this purpose, parents of 378 children filled out a questionnaire. Factors related to child dental anxiety (none-some/fairly much-very much) were explored by means of logistic regression analysis. The independent variables were: problems with tht first dental visit (no/yes), parental dental anxiety (none-some/fairly much-very much), number of previous visits (0-3/4 < or =) site visited (public/private) and age of the child (< 10 years/10 < or = years). Parental anxiety was associated with child's anxiety (OR = 2.3, 95% CI = 1.1-4.9). A problematic first visit was a strong predictor of dental anxiety. However, this effect was modified by the number of subsequent visits. Children with 4 or more visits after the first visit were less likely to be anxious after a problematic first visit (OR = 4.6, 95% CI = 1.5-14.1) than children with 3 visits or less after the first visit (OR = 19.8, 95% CI = 7.2-54.5). Thus, the negative effect of a problematic first visit may fade during subsequent dental visits.     

Effects of audiovisual distraction during dental prophylaxis

BACKGROUND: Fear and anxiety often inhibit patients from seeking dental care. Audiovisual, or A/V, distraction techniques have been shown to reduce patient anxiety and pain during dental procedures. The authors investigated the effects of a virtual image A/V eyeglass system on patients' anxiety and pain. METHODS: Twenty-seven routine dental prophylaxis patients participated and completed the Dental Fear Survey and the Fear of Pain Questionnaire-III before treatment. In random order, the clinician scaled and polished two quadrants in subjects while they watched and listened to a standard video using the A/V eyeglasses and two quadrants while they did not. A posttreatment questionnaire was administered to both the patient and the clinician. RESULTS: Subjects reported less anxiety and discomfort when using the A/V eyeglass system than when they did not. Most subjects preferred to use the A/V equipment rather than receive traditional treatment. The clinician experienced no significant technical interference during the use of the A/V device. The use of the A/V eyeglasses led to decreased treatment time in the first one-half of the procedure. The system appeared to lead to some decreases in the physiological parameters over the course of treatment, with the highest systolic blood pressure occurring after the condition with no use of A/V eyeglasses. CONCLUSIONS: A virtual image A/V system is beneficial in the reduction of fear, pain and procedure time for most dental prophylaxis patients. CLINICAL IMPLICATIONS: Use of screening questionnaires may be helpful for identifying anxious patients. An A/V device may be beneficial to the clinician and the mildly or moderately anxious patient.