[Quality of life and oral health in children]. / Levenskwaliteit en mondgezondheid van kinderen.

In recent years, research on the influence of oral health on quality of life among children has become increasingly popular Half of the children and adolescents will have had moments of diminished oral health and that can lead to functional problems, pain and decreased quality of life. While measuring oral health-related quality of life of children, reports of parents are frequently used as a proxy. Diminished oral health not only has an impact on the child's quality of life, but also on that of his family members. Results from studies on oral health-related quality of life in children may be used as the basis for useful guidance for parents and children on improving oral health and quality of life.

The communication of pain in paediatric dentistry.

AIM: In this paper the communication model of pain is reviewed and the information then applied to understanding the acute pain experience of children in dentistry, with attention directed to improving the process of pain assessment. BACKGROUND: Expression of pain in children is of great importance as it enables them to engage others who may provide care. The experience of pain, however, is inherently private and not directly accessible to others. Therefore, it requires judgment and skill on the part of observers if pain is to be assessed accurately. In addition, there are striking individual differences in how people react to pain, which makes the assessment of pain in others an even greater challenge. Craig and colleagues [2008] have proposed the use of the social communication model of pain that gives priority to understanding the numerous social factors that affect whether children are successful in communicating painful distress. CONCLUSION: When children's pain is underestimated or a child's self-report is not seen as credible, there is a considerable risk of failure to deliver needed dental care.

The Dental Discomfort Questionnaire: the basis of a 'Toothache Traffic Light'.

AIM: Firstly to provide an overview of the combined results of the studies done with the Dental Discomfort Questionnaires (DDQ) and second to present a behaviour checklist, a 'Toothache Traffic Light', based on the DDQ, which could possibly be used to raise awareness for toothache among parents and healthcare providers and to improve communication. METHODS: A total of 652 DDQ were analysed to compare the prevalence of toothache related behaviours between children without caries, children with caries but without toothache, and children with caries and toothache. The children had a mean age of 44.6 months (SD+/-10.9). STATISTICS: Chi-square tests were conducted to compare the items of the DDQ between the three groups and predictors of toothache were determined using a binary logistic regression analysis. RESULTS: All items of the DDQ were displayed more often by the children with caries and toothache than by children with only caries or without both caries or toothache. The behaviours: "Reaching for the cheek while eating", "Pushing away something nice to eat", "Problems brushing upper or lower teeth" and "Problems chewing" were found to be the most indicative for the presence of toothache. Finally, 7 toothache related behaviours were combined in the checklist. Using the results of this survey the 'Toothache Traffic Light' was developed as a possible tool for determining toothache in very young children. CONCLUSIONS: All behaviours together could form a checklist that can possibly teach parents, guardians and teachers which behaviours to look for when they suspect a child to have toothache.

[Fear of dental treatment among children. Influence of experience and psychological functioning]. / Angst voor een tandheelkundige behandeling bij kinderen. Invloed van ervaring en psychisch functioneren.

This research considers whether fear of dental treatment among children is linked with a prior (negative) experience with local anaesthesia or with psychological functioning. Furthermore, the study investigated whether these factors play a role in anxious behaviour before and during a local anaesthetic injection. In this study 128 children between the ages of 4 and 11 took part. With the help of video recordings, the anxious behaviour before and during the local anaesthetic injection was scored using the Venham-scale. During the treatment one of the child's parents or guardians was asked if the child had previously been given a local anaesthetic injection (experience). The fear of dental treatment and the child's psychological functioning were measured using the parents' version of the 'Dental Subscale' of the 'Children's Fear Survey Schedule' and the 'Strengths and Difficulties Questionnaire' respectively. Results showed a correlation between on one hand fear of dental treatment and on the other hand anxious behaviour before and during a local anaesthetic injection and psychological functioning. Furthermore, results indicated that children with fear of dental treatment exhibited more fearful behaviour before and during an injection with local anaesthetic. Only in the case of children whose psychological functioning was reduced there was a significant relationship between experience with local anaesthesia and fearful behaviour prior to the injection of a local anaesthetic.

Dental anxiety and psychological functioning in children: its relationship with behaviour during treatment.

AIM: In this study the relationship between the levels of dental anxiety, psychological functioning and earlier experience with dental injections are examined and the possible influence of these factors on children's behaviour before and during a local anaesthesia injection. METHODS: A total of 128 children (4-11 years) were included. The level of dental anxiety and the psychological functioning were measured using the 'Children's Fear Survey Schedule' (CFSS-DS) and the 'Strengths and Difficulties Questionnaire' (SDQ). Based on video recordings the anxiety behaviour was scored on the Venham-scale. RESULTS: There was a positive correlation between levels of dental anxiety, psychological functioning and anxiety behaviour before and during the dental injection. In particular children with emotional problems or peer problems tended to show more anxiety behaviour before the injection and children with emotional or hyperactivity problems tend to show more anxiety behaviour during the injection. Furthermore, the younger children (below 6 years of age), with previous dental experience in the past 6 months, tended to display more anxiety behaviour both before and during the injection than children without or with experience from longer ago. CONCLUSION: The level of dental anxiety and psychological functioning and recent previous dental experience are important factors in determining which child is likely to display more anxiety and uncooperative behaviour during treatment and therefore potentially need more attention to be able to cope well with dental treatment.

Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe.

OBJECTIVE: To compare the pain and distress response of children receiving a local anesthesia injection using a computerised device (Wand) or a traditional syringe over two consecutive treatment sessions and to study whether the response to the two injection techniques was different for high or low dentally anxious children. DESIGN: Randomised controlled trial. SETTING: Secondary dental care practice specialised in treating children. SUBJECTS AND METHODS: Children were selected and randomly allocated to the Wand or traditional injection condition. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-ds). Based on video recordings of the injections, for each 15 seconds, the occurrence of five pain related behaviours was registered and a score was given on the Venham distress scale. Children rated their pain after each injection. INTERVENTION: Over two consecutive treatment sessions one group received two local anaesthesia injections with the traditional syringe and the other group received two injections with the Wand. OUTCOME MEASURES: The mean number of pain related behaviours, the mean distress scores and the self-reported pain scores were compared. Based on the CFSS-ds subjects were split into highly and low dentally anxious children. RESULTS: One hundred and forty-seven subjects participated in the study: aged 4-11 years, 71 girls. Based on the behaviour displayed during the local anaesthesia injection and the self-reported pain after the injection, no difference could be found between an injection with the traditional syringe or the Wand over the first or second treatment session. However, on the first treatment session, highly anxious children reported more pain (p = 0.001), displayed more pain related behaviour (p = 0.002) and more distress (p <0.001) than low anxious children in reaction to the local anaesthesia injection. CONCLUSION: No clear difference in the response of referred children could be found between an injection with the Wand or the traditional syringe. Level of dental anxiety was found to be an important factor in the response of children to a local anaesthesia injection.

Dental Discomfort Questionnaire for young children following full mouth rehabilitation under general anaesthesia: a follow-up report.

AIM: The aim of the present study was firstly to assess the persistence of pain related behaviours of the Dental Discomfort Questionnaire (DDQ) and secondly to complete a follow-up study to assess the effect of dental treatment on pain related behaviours in preschool children. METHODS: The 9-question DDQ instrument was used to assess dental pain related behaviours in a group of preverbal children. The test-retest analysis questionnaire was filled out twice by 44 parents on behalf of their referred child. For the follow-up study the questionnaire was filled out by 71 parents before and after all dental disease was completed. RESULTS: A strong correlation for the test-retest was found over a 2 month period before treatment. When the behaviour items were compared independently before and after treatment it appeared that after treatment all but one behaviour (i.e. bite with molar instead of teeth) was displayed less often. Overall, after treatment all children had a lower mean DDQ score. CONCLUSIONS: Dental treatment of children leads to reduced toothache related behaviours and subsequently to a better quality of life. The DDQ is a sensitive instrument to measure dental discomfort before and after restorative treatment if and when the follow-up period is short. The DDQ can possibly support healthcare providers, teachers and parents in their assessment of toothache in young children.

[Children's distress during application of local anaesthesia. Computerized tool versus traditional syringe]. / Ongemak van kinderen tijdens het geven van lokale anesthesie. Vergelijking van een geautomatiseerd systeem en de traditionele methode.

This study compared the level of distress in children during the application of local anaesthesia by a computerized tool (Wand) and by a traditional syringe. The influence of children's mild or extreme anxiety regarding the dental procedure was also determined. 125 children between the ages of 4 and 11 years old participated in this study. Their discomfort was recorded on videotape and marked on the Venham scale and the Observational Scale of Behavioral Distress at 15 second intervals. Parents rated their child's level of anxiety on the Dental Subscale of the Children's Fear Survey Schedule. The results indicate that mildly anxious children suffered less distress and showed less muscle tension, verbal protest and body movement during the first 2 intervals when the computerized tool was used. However, the maximum distress score at the moment of injection was similar in both methods. There was no difference found in the level of distress in the highly anxious children.

Child coping strategies, dental anxiety and dental treatment: the influence of age, gender and childhood caries prevalence.

AIM: This was to investigate what coping strategies are used by children, the efficacy of these strategies and the influences of age, gender, dental anxiety, pain experience and childhood caries prevalence (place of residence) upon the efficacy of the coping strategies used by Dutch (NL) children in The Netherlands and Northern Ireland (NI). METHODS: Convenience samples of Dutch and NI children were taken and asked to fill out a coping questionnaire (Dental Cope Questionnaire) and an anxiety schedule (CFSS-DS). Data were entered onto a SPSS database and subjected to frequency distributions, Chi-square analysis, t-tests and analysis of variance. RESULTS: The children used a wide variety of coping strategies in dealing with pain in dentistry. The most frequently used and those reported to have the greatest efficacy by the children in this investigation were cognitively based strategies. Different strategies were used in relation to place of residence, age and level of dental anxiety. The variance in the number of strategies used was significantly explained by the experienced pain during dental treatment. The efficacy of the coping strategies used was significantly explained by level of dental anxiety. CONCLUSIONS: Dental coping strategies used by children seem to vary with age, dental anxiety and pain experience. This information can help dental practitioners to adjust his or her treatment to the child's emotional needs.

Dental Discomfort Questionnaire: predicting toothache in preverbal children.

AIM: In the present study the value of the Dental Discomfort Questionnaire in predicting toothache in young children is analysed. METHODS: The Dental Discomfort Questionnaire (DDQ-8; Cronbach's alpha 0.75) was completed by parents on behalf of their children (N=99; mean age 47 months). Half of the children were referred to a special dental care centre and the other half were controls from a day care centre. RESULTS: The behaviours from the DDQ-8 appeared to be more often present in those children with decayed teeth and toothache than in those without decayed teeth or toothache. A score of 3 or higher on the DDQ-8 seemed the best cut-off point to predict toothache in children. The receiver operating characteristic curve (ROC) showed that the DDQ-8 has predictive value for toothache. STATISTICS: The validity of the DDQ-8 was expressed as sensitivity, specificity and positive predictive value and negative predictive value. The DDQ's ability to discriminate between patients with and without toothache was estimated by the area under the ROC area of the questionnaire. CONCLUSIONS: The DDQ-8 could be helpful for parents, non-dental healthcare workers and researchers in predicting the existence of toothache in preverbal children.

[The opinion on care of patients with cancer undergoing palliative treatment in day care]. / De opinie over de zorgverlening van patiënten met kanker die op de dagbehandeling een palliatieve behandeling ondergaan.

OBJECTIVE: To study the care utilisation and unmet care needs of patients receiving palliative treatment at the day care clinic of the Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital. DESIGN: Descriptive. METHODS: During the periods 1 April-31 July 2000 and 1 April-31 May 2001 adult cancer patients were interviewed regarding their complaints and symptoms as a result of the disease and the treatment and regarding the problems that they had with the provision of care. RESULTS: There were 155 patients who agreed to participate: 56 men and 99 women, with an average age of 57.5 years. On average, they had 3.2 'severe' complaints. According to the patients, 65% of these 'severe' complaints were known by the specialists, 38% by the general practitioners, 24% by the day care nurses and 83% by the next of kin. Again according to the patients, 17% of the reported severe complaints received insufficient attention. About 25% of patients felt that they had received insufficient information about their disease, treatment, side effects and/or complications. CONCLUSION: The day care centre did not seem to be optimally equipped to meet the needs of patients receiving chemotherapy on an outpatient basis. According to the patients, the specialists were relatively the best informed of all the care providers about their complaints and problems.

The cost-effectiveness of a back school program in industry. A longitudinal controlled field study.

To define the cost-effectiveness of a back school program in industry, a controlled longitudinal field study was carried out in a Dutch bus company. The experimental group received a program consisting of information on back care, physical fitness, nutrition, stress, and relaxation. Objective data on absenteeism were collected and compared during a 6-year period for the control and experimental groups. Results showed that a tailor-made back school program reduced absenteeism by at least 5 days per year per employee, therefore being cost-effective to industry. A reduction was not observed in incidence, but in mean length of absenteeism. This effect turned out to be persistent during a 2-year period following the program.

Patterns of muscular activity during movement in patients with chronic low-back pain.

Bilateral paraspinal electromyogram (EMG) at levels L1-L2 and L4-L5, and abdominal EMG of a group of 20 low-back pain patients were compared to those of a group of 20 pain-free controls during flexion, extension, lateral bending to right and left, and rotation to right and left. The results showed no significant left-right differences in paraspinal EMG levels between low-back pain patients and pain-free controls during any of the movements. However, patterns of paraspinal and abdominal EMG were found to be different for low-back pain patients compared to pain-free controls during flexion only.