Clinical evaluation of feasibility and effectiveness using a virtual reality device during local anesthesia and extractions in pediatric patients.

PURPOSE: Pediatric dentistry requires more than routine dental knowledge and skills in executing quality dental care. The quality of dental treatment is indirectly proportional to a child's anxiety and fear. The recent distraction technique, the use of virtual reality (VR) devices has intrigued many researcher's minds. Therefore, this study was conducted to assess the clinical feasibility and effectiveness of the VR device in reducing pain and anxiety in pediatric patients during mandibular primary molar extraction. METHODS: This research trial had 30 healthy children between the ages of 6 and 12 who required mandibular primary molar extraction. The subjects were divided into two groups using a simple randomization method. In the study group (n = 15), extraction was carried out using a VR device, whereas, in the control group (n = 15), extraction was carried out without the use of a VR device. Pre- and post-extraction anxiety levels were measured by Venham's picture test (VPT) and the heart rate. After the procedure, pain and behavior were evaluated by the Wong-Bakers Faces pain rating scale (WBS) and FLACC Scale respectively. RESULTS: The pre-extraction values of the VPT and heart rate showed no statistically significant difference. This indicates that participants of both groups had a similar level of anxiety at baseline. There was a statistically significant increase (p = 0.028) between pre- and post-heart rates in the control group, with no significant change in the study group. CONCLUSION: The use of a virtual reality device in children can reduce anxiety during primary molar extractions as evaluated by heart rate. Virtual reality devices might be an adjunct to high-quality dental care and to other behavior management methods. Definitive outcomes can be attained by encouraging studies overcoming the present limitations, and considering salivary biochemical indicators for the assessment of these devices.

Assessment of parental attitude toward different behavior management techniques used in pediatric dentistry.

BACKGROUND: The goal of any good dental treatment is to provide a quality dental care to the patient. This may not be possible if the patient is unwilling to cooperate or unable to do so due to their age or related factors. In such children, behavior management techniques are very helpful. With changing times, there have been changes in the law and the outlook of parents and society toward dental treatment. This influences the various behavior management methods used by pediatric dentists. OBJECTIVES: This study was conducted to assess the attitudes of parents of children of different pediatric age groups towards: Behavior management techniques used by pediatric dentists The effect of maternal anxiety on the child's behavior in clinic Pharmacological behavior management techniques The effect of parental presence in the operatory on the child's behavior. MATERIALS AND METHODS: Three hundred parents were evaluated and divided into three groups comprising 100 each on the basis of their children's age, Group A: 2-5 years, Group B: 6-9 years, and Group C: 10-13 years, which were further divided into two subgroups, on the basis of the child's gender, with each subgroup having parents of 50 male and 50 female children each. For example, Group A1: 50 parents of 2-5-year-old boys, Group A2: 50 parents of 2-5-year-old girls. RESULTS: ANOVA test showed different hierarchies of acceptance for the techniques in all the groups. In all the three groups, tell show do, positive reinforcement, and live modeling were the most accepted techniques. However, statistically significant difference between the groups was not observed for the three techniques. The least accepted techniques for all the groups were hand over mouth technique and voice control technique. CONCLUSION: Parents were more receptive of those techniques which were visually more acceptable involving a communicative management, such as tell show do, positive reinforcement, and live modeling.

Assessment of the changes in the stress-related salivary cortisol levels to the various dental procedures in children.

BACKGROUND: Fear and pain are the factors producing stress and there is evidence that dental fear acquired in childhood may persist to influence adult behavior. Dental treatment is often considered as anxiety producing and stressful. AIM: To assess the levels of stress displayed by the healthy children undergoing routine dental procedures like oral examination, restoration, and extraction by analyzing salivary levels of cortisol before, during, and after the procedures. MATERIALS AND METHODS: Twenty healthy children aged between 4 and 8 years having their first dental visit and requiring at least one restoration and one extraction were selected. In each patient, three procedures were carried out: (i) Routine dental examination, (ii) restoration, and (iii) extraction. Unstimulated salivary samples were collected 10 min before, during the procedure, and 30 min after each procedure at three different visits for comparison of cortisol production in response to anxiety and stress over time. Total 180 samples were collected to determine salivary cortisol levels using UBI-MAGIWEL TM kit and the readings were noted. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS) software with paired t-test, two independent sample t-tests, and analysis of variance (ANOVA) were used to analyze the findings. RESULTS: A correlation between salivary cortisol and stress in dental procedure was noticed. Cavity preparation is more stressful procedure in children, so alternative methods can be used in anxious children. Stress associated with extraction persists to a postoperative period. No correlation exists in between Corah's anxiety scale and salivary cortisol.