Which Dental Procedures Lead to Greater Distress During Children's Dental Treatment? A Cohort Study

ABSTRACT Objective: To assess children's self-reported distress during dental procedures and investigate risk factors. Material and Methods: A total of 163 children (3-10 years old) were included from a clinical trial on diagnostic strategies for evaluating restorations in primary teeth. Treatment plans were elaborated based on the clinical examination performed at the baseline of the study. Dentists performed 742 dental procedures, and an external evaluator collected children's self-reported distress through the Wong Backer Facial Scale (WBFS) and dentists' opinions about children's behavior during the treatment. Kruskal-Wallis Test was performed to compare the distress and the dentists' perception of the different dental procedures, and multilevel ordered logistic regression analysis was conducted to the evaluate association between explanatory variables and the outcomes. Results: More complex procedures caused more distress in children (p=0.017), with a 5.5 times higher risk than simple operative treatments. Similarly, dentists reported children's worse behavior (p<0.001). Older children (older than 7 years) reported less distress than younger children (OR 0.52; CI 0.30-0.87; p=0.014). Patients reported greater distress in the first consultations, reducing the chance of higher scores by 16% in the next interventions. Conclusion: Children experience higher levels of distress during their first treatment appointments. More complex operative procedures and the child's age below 7 years were risk factors associated with greater distress during dental treatment.

Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

ABSTRACT Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods: Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.

Dental Fear/Anxiety in Children and Child Emotional and Behavioural Problems

ABSTRACT Objective: To investigate the association between emotional and behavioural problems and dental fear/anxiety (DFA) in children aged four to 12 years treated at a clinic in southern Brazil. Material and Methods: In this cross-sectional study where mother-child dyads were interviewed, emotional and behavioural problems were investigated using the Strengths and Difficulties Questionnaire (SDQ) (considering five subscales). Children's DFA was evaluated through the Venham Picture Test. For each SDQ subscale, Poisson regression model was explored. Prevalence ratios (PR) were estimated, considering a significant level of p ≤ 0.05. Results: Overall, 128 children participated in this study. Most children were female (54.7%) and aged between 7 and 9 years (39.8%). The prevalence of emotional problems was 47.7% and behavioural problems were 46.1%. The prevalence of DFA was 18.8%. Children with emotional problems had a 2.3 higher prevalence of DFA (95%CI 1.06-5.04). In general, behavioural problems were not associated with DFA (95%CI 0.84-3.34) only when conduct problems were considered (2.20; 95%CI 1.02-4.70). Conclusion: Children aged between 4 and 12 years who present emotional and conduct problems tend to show higher DFA.

Associação entre características infantis e estresse de alunos de graduação durante atendimento odontopediátrico / Association between childhood characteristics and stress in undergraduate students during pediatric dental care

Objetivo: O objetivo desse trabalho foi avaliar a associação entre as características das crianças com o estresse apresentado por estudantes de graduação em Odontologia durante o atendimento odontopediátrico. Materiais e métodos: Participaram 48 crianças com idade entre 6 e 10 anos e 37 alunos voluntários do 7º, 8º e 9º semestres de um curso de Odontologia. Foi realizado um questionário sobre aspectos socioeconômicos e também coletados dados sobre comportamento, percepção de dor e ansiedade da criança e do responsável. Ainda, foram coletados dados relacionados aos alunos da graduação: sexo, semestre, nível de estresse, tipo de procedimento realizado. Foram obtidas as frequências absolutas e relativas por meio da análise descritiva dos dados. As comparações nos desfechos de interesse foram feitas utilizando o teste quiquadrado para variáveis dicotômicas e categóricas, teste linear por linear para variável ordinal e teste exato de Fischer para contagens menor do que 5. Foi adotado um nível de significância de 5%. Resultados: Os resultados mostraram que a maioria dos operadores que atenderam crianças não colaboradoras relataram nível de estresse alto (83,33%) (p<0,001). Os operadores que atenderam crianças com nível de ansiedade médio ou alto relataram nível de estresse alto (p= 0,043) e em pacientes com dor, o nível de estresse da maioria dos operadores foi considerado alto (75%) (p=0,001). Conclusão: as características das crianças influenciaram no estresse apresentado pelo aluno operador durante o atendimento odontológico infantil. Crianças ansiosas, não colaboradoras e que estavam sentindo dor durante o atendimento deixaram o operador mais estressado.

Objective: The aim of this study was to evaluate the association between the characteristics of children and the stress presented by undergraduate dentistry students during pediatric dental care. Materials and Methods: Participants were 48 children aged between 6 to 10 years old and 37 volunteer students from the 7th, 8th and 9th semesters of a Dentistry course. A questionnaire on socioeconomic aspects was carried out and data on behavior, perception of pain and anxiety of the child and the guardian were also collected. Also, data related to undergraduate students were collected: sex, semester, stress level, type of procedure performed. Absolute and relative frequencies were obtained through descriptive data analysis. Comparisons in the outcomes of interest were made using the chi-square test for dichotomous and categorical variables, linear by linear test for ordinal variable, and Fisher's exact test for counts less than 5. A significance level of 5% was adopted. Results: The results showed that students who assisted non-cooperative children reported a high level of stress (83.33%) (p<0.001). Students who assisted children with medium or high levels of anxiety reported high levels of stress. (p=0.043) and in patients with pain, the students' stress level was considered high (75%) (p=0.001). Conclusion: The characteristics of the children influenced the stress presented by the student during child dental care. Anxious children, noncooperative and who were in pain during care left the student more stressed.

Factores asociados con la colaboración de los niños peruanos durante el tratamiento odontológico / Factors associated with the collaboration of peruvian children during dental treatment

Resumen Objetivo: Determinar los factores asociados con la colaboración de los niños peruanos durante el tratamiento odontológico. Materiales y método: Estudio observacional, analítico y transversal. Se realizó una entrevista estructurada a los acompañantes y una evaluación de la colaboración en los niños (escala de Frankl). Se investigaron los factores sociodemográficos, odontológicos (experiencia dental previa, visita dental anterior, pieza tratada y procedimiento odontológico) y psicológicos (ansiedad materna e infantil). Se utilizó la prueba de Kruskal-Wallis, chicuadrado y la regresión logística binaria. Resultados: La muestra estuvo conformada por 175 niños y sus acompañantes, estos presentaron baja ansiedad (54.95%) y los niños presentaron colaboración positiva (72.57%). La edad del acompañante y la experiencia dental previa tuvieron un valor de OR= 0.42; 95% IC: 0.103 - 1.717 y OR= 1.941; 95% IC: 0.39 - 9.656 respectivamente (p>0.05). El procedimiento odontológico y la ansiedad del niño tuvieron un valor de OR= 0.201; 95% IC: 0.043 - 0.930 y OR= 5.733; 95% IC: 1.478 - 22.238 respectivamente (p<0.05). Conclusión: Los factores asociados con la colaboración de los niños peruanos durante el tratamiento odontológico son la ansiedad del niño y el procedimiento odontológico.

Abstract Objective: To determine the associated factors with collaboration of Peruvian children during dental treatment. Materials and methods: An observational, analytical and cross-sectional study. A structured interview was carried out with the companions and an evaluation of the collaboration in the children (Frankl scale). Sociodemographic, dental (previous dental experience, previous dental visit, tooth treated and dental procedure) and psychological factors (maternal and infant anxiety) were investigated. The Kruskal-Wallis test, chisquare and binary logistic regression were used. Results: The sample consisted of 175 children and their companions, these presented low anxiety (54.95%) and the children presented positive collaboration (72.57%). The age of the companion and previous dental experience had an OR = 0.42; 95% CI: 0.103 - 1.717 and OR = 1.941; 95% CI: 0.39 - 9.656 respectively (p> 0.05). The dental procedure and the child's anxiety had an OR = 0.201; 95% CI: 0.043 - 0.930 and OR = 5.733; 95% CI: 1,478 - 22,238 respectively (p <0.05). Conclusion: The factors associated with the collaboration of Peruvian children during dental treatment are the child's anxiety and the dental procedure.

Validade da Escala de Imagens Faciais (FIS) para uso com crianças brasileiras na clínica odontopediátrica / Validity of the Facial Image Scale (FIS) for use with Brazilian children in the pediatric dental clinic

O objetivo deste estudo foi avaliar a validade da Escala de Imagens Faciais (Facial Image Scale; FIS) em pacientes odontopediátricos do Rio de Janeiro, Brasil, por meio da: 1) validade de critério concorrente, medida através do Venham Picture Test ­ versão brasileira; 2) validade de construto, medida através da correlação da FIS com as variáveis idade, sexo, ansiedade percebida pelos pais/cuidadores, classificação socioeconômica (renda), primeira visita ao dentista, tipo de tratamento realizado, uso de anestesia local, experiência prévia e atual de dor de dente, índice de cárie dentária e comportamento durante a consulta odontológica; 3) avaliação qualitativa com 30 crianças de forma a conhecer se o instrumento estava capturando o sentimento da criança em relação à ATO. A forma de aplicação da FIS foi adaptada para o contexto brasileiro por um grupo de quatro odontopediatras brasileiras e uma psicóloga britânica (autora da FIS). O trabalho foi aprovado pelo comitê de ética em pesquisa do Hospital Universitário Pedro Ernesto - HUPE/UERJ. Foram incluídas crianças de três a 12 anos de idade e seus responsáveis, que compareceram ao tratamento odontológico em clínicas de odontopediatria da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro, do serviço de Odontologia da Policlínica Piquet Carneiro e do Ambulatório Naval da Penha da Marinha do Brasil. Foram excluídas crianças com deficiências e que não quiseram participar do estudo. Foi realizado um estudo piloto com objetivo de avaliar a compreensão da FIS e testar os procedimentos que seriam empregados no estudo principal, em uma amostra não probabilística de 15 crianças/responsáveis. Os resultados sugeriram que a idade poderia influenciar na mensuração da validade da escala e foi decidido realizar um processo de amostragem por cotas, adaptações das instruções de aplicação da FIS e VPT para uma linguagem mais acessível e decisão de realizar o estudo qualitativo. A amostra selecionada por cotas do estudo de validação compreendeu 150 crianças, divididas em grupos de 31 crianças nas faixas etárias 3-4 anos, 5-6 anos, 7-8 anos, 9-10 anos e 26 crianças na faixa etária de 11-12 anos; 65 (43%) eram do sexo feminino; 20 (13,3%) estavam indo ao dentista pela primeira vez; 47 procedimentos invasivos foram realizados no dia da entrevista (tratamento restaurador, procedimentos sob isolamento absoluto, exodontia e/ou tratamento endodôntico); 55 (36,7%) não tiveram experiência de cárie na dentição decídua (ceod=0) e 111 (74%) na dentição permanente (CPOD=0). O coeficiente de correlação de Spearman (rs) com a Venham Picture Test foi moderado (rs= 0,50; p<0,01) e foram encontradas associações estatisticamente significativas (p <0,05) com sexo feminino, ansiedade percebida pelos cuidadores, uso de isolamento absoluto, dor de dente atual e experiência de cárie. O estudo qualitativo encontrou discrepâncias entre a escolha da FIS e o sentimento da criança em relação à ATO em todas as faixas etárias. Os resultados sugerem que a FIS não parece ser capaz de medir de forma válida a ATO em crianças brasileiras

This study aimed to evaluate the validity of the Facial Image Scale (FIS) in pediatric dental patients in Rio de Janeiro, Brazil, based on: 1) the criterion validity, which was measured with the Venham Picture Test - Brazilian version; 2) the construct validity, using the correlation of FIS with the following variables: age, sex, DA perceived by parents/caregivers, socioeconomic classification (income), first visit the dentist, type of treatment performed, use of local anesthesia, previous and current experience of toothache, dental caries index and behavior during the dental appointment; and 3) a qualitative assessment with 30 children to evaluate if the instrument was capturing the child's feeling regarding DA. The form of application of the FIS was adapted to the Brazilian context by a group of four Brazilian pediatric dentists and a British psychologist (author of the FIS). The work was approved by the research ethics committee of the Pedro Ernesto University Hospital ­ HUPE/UERJ. Children aged 3 to 12 years old and their guardians who attended a dental appointment in the pediatric dentistry clinics of the Faculty of Dentistry of the Rio de Janeiro State University, the dental service of the Policlínica Piquet Carneiro Polyclinic and Penha's Naval Ambulatory of the Brazilian Navy were included. Children with special needs and who did not want to participate in the study were excluded. A pilot study was carried out to assess the understanding of FIS and test the procedures that would be used in the main study, in a non-probabilistic sample of 15 children/guardians. The results suggested that age could influence the measurement of FIS validity and it was decided to carry out a sampling process by quotas, adaptations of the FIS and VPT application instructions for a more accessible language and decision to carry out the qualitative study. The sample selected by quotas of the validation study comprised 150 children, divided into groups of 31 children aged 3-4 years, 5-6 years, 7-8 years, 9-10 years, and 26 children aged 11-12 years; 65 (43%) were female; 20 (13.3%) had their first dental appointment; 47 invasive procedures were performed on the day of the interview (restorative treatment, procedures under rubber dam, extraction and/or endodontic treatment); 55 (36.7%) had no experience of caries in the primary dentition (dmft=0) and 111 (74%) in the permanent dentition (DMFT=0). Spearman's correlation coefficient (rs) with the Venham Picture Test was moderate (rs=0.50; p<0.01); statistically significant associations (p<0.05) was found with female gender, anxiety perceived by caregivers, use of rubber dam, current toothache, and caries experience. The qualitative study found discrepancies between the choice of FIS and the child's feelings towards DA in all age groups. The results suggest that FIS does not seem to be able to measure DA in Brazilian children.

Percepção do paciente infantil frente à aparência dos odontopediatras e inter-relação com ansiedade e histórico odontológico / Perception of the infant patient the appearance of pediatric dentists and their relationship with anxiety and dental history

Identificar fatores que possam estar relacionados à percepção das crianças é essencial para otimizar a comunicação não verbal atribuída à aparência dos odontopediatras. Objetivou-se desenvolver e validar um instrumento para avaliar a percepção dos pacientes infantis frente à aparência dos odontopediatras, para aplicá-lo observando a influência da ansiedade e da experiência odontológica prévia. Além disso, caracterizar o perfil da ansiedade, identificando o efeito exercido por fatores socioeconômicos e histórico odontológico. O estudo incluiu 120 crianças na faixa etária de 7-12 anos. Responsáveis informaram sobre aspectos socioeconômicos, parte do histórico odontológico e experiência odontológicas prévias. As crianças responderam ao Children's Fear Survey Schedule (CFSS-DS) para verificação da ansiedade odontológica e foram examinadas para a avaliação da experiência de cárie (ceo-d/CPO-D). As crianças também avaliaram imagens de odontopediatras de ambos os sexos com diferentes paramentações (A: controle: paramentação toda branca; B: jaleco e touca estampadas, máscara colorida; C: jaleco, touca e máscara estampados; D: jaleco e touca brancos, máscara estampada) e responderam ao questionário desenvolvido, gerando um escore. Foi definido que quanto maior a pontuação, mais positiva a percepção. O instrumento passou por avaliação das propriedades psicométricas: aceitabilidade, validade e confiabilidade. Os dados foram analisados pelos testes do x2 ; Mann-Whitney; Testes de Friedman e Wilcoxon, no software IBM SPSS® , versão 21.0, considerando p<0,05. O questionário apresentou excelente aceitabilidade, validade de construto com correlações moderadas e fortes (Spearman > 0,40), estabilidade temporal satisfatória (Intervalo de Correlação Intraclasse > 0,70) e consistência interna (Coeficiente alfa de Cronbach > 0,70). Os resultados mostraram que a percepção das crianças em relação à aparência dos odontopediatras foi mais positiva com as paramentações C e D (p<0,05, Friedman). As análises intergrupos não identificaram diferenças estatisticamente significantes (p>0,05, Mann-Whitney). Comparadas à paramentação A, as crianças mais jovens apresentaram percepções mais positivas quando usada a paramentação D; meninas, crianças sem ansiedade e experiência prévia pontuaram melhor nas paramentações C e D; em crianças com experiência prévia, não houve diferença quando comparada à A, apenas entre B e C (p<0,05, Wilcoxon). Em relação à ansiedade odontológica, não houve diferença entre meninos e meninas, no entanto, as crianças mais jovens apresentaram escores médios mais altos do CFSS-DS (p=0,036; Mann-Whitney). Foi encontrada maior prevalência de ansiedade em crianças com famílias de baixa renda e que não receberam tratamento endodôntico. Escores médios mais altos do CFSS-DS também foram observados em crianças que não receberam tratamento endodôntico (p<0,05; Mann-Whitney). Assim, conclui-se que o instrumento validado exibiu boas propriedades psicométricas e avaliou que, quando comparadas à paramentação toda branca, outras opções (C e D) melhoraram a percepção em relação à aparência do odontopediatra. Ressalta-se que fatores inerentes ao paciente, como idade, sexo, experiência prévia e ansiedade odontológica não influenciaram os escores de percepção. Já, os aspectos socioeconômicos e do histórico odontológico exerceram efeito sobre o perfil de ansiedade odontológica na amostra estudada. (AU)

Identifying factors that may be related to children's perception is essential to optimize non-verbal communication attributed to the appearance of pediatric dentists. This study aimed to develop and validate an instrument for assessing the perception of child patients regarding the appearance of pediatric dentists, as well as applying it, observing the influence of anxiety and previous dental experience. Moreover, characterize the profile of anxiety, identifying the effect exerted by socioeconomic factors and dental history. The study included 120 children aged 7-12 years. Guardians informed about socioeconomic aspects, part of dental history, and previous dental experience. Children responded to the Children's Fear Survey Schedule (CFSS-DS) for verification of dental anxiety and were examined for the dmft/DMFT index assessment. The children also evaluated images of both sexes pediatric dentists with different attires (A: control: All white attire; B: Printed coat and head cap, colorful face mask; C: Printed coat, head cap, and face mask; D: White coat and head cap, printed face mask) and answered a questionnaire that generated a score. It was defined that the higher it was, the better the perception. The following psychometric properties of the instrument were assessed: acceptability, validity and reliability. The data were analyzed with the x 2 ; Mann-Whitney; Friedman, and Wilcoxon tests, in IBM SPSS® software, version 21.0, considering the level of significance in 5% (p<0.05). The questionnaire showed excellent acceptability, construct validity with moderate and strong correlations (> 0.40), satisfactory temporal stability (ICC, >0.70), and consistency internal (Cronbach's alpha coefficient, >0.70). Considering only the attires, the children's perception was more positive with the use of attires C and D (p<0.05, Friedman test). Intergroup analyses in all variables did not identify a statistically significant difference (p>0.05, MannWhitney test). In intragroup analyses, comparing to attire A: younger children showed higher perception?s scores when used attire D; Girls, children without anxiety and previous experience, attires C and D; in children with previous experience, there was no difference when compared to A, only between B and C (p<0.05, Wilcoxon test). Regarding dental anxiety, there was no difference between boys and girls, however, younger children had higher mean CFSS-DS scores (p= 0.036; Mann-Whitney test). A higher prevalence of anxiety was found in children with low-income families, and who did not receive endodontic treatment (p<0.05, x2 test). Higher mean CFSS-DS scores also observed in children that no received endodontic treatment (p<0.05; Mann-Whitney test). Thus, it is concluded that the validated instrument exhibited good psychometric properties and evaluated that although some attire options (C e D) when compared to all white attire, can improve perception regarding the appearance of pediatric dentists. It is emphasized that factors inherent to the patient, such as age, sex, previous experience, and dental anxiety, did not influence the perception scores. The socioeconomic and dental history aspects had an effect on the profile of dental anxiety in the sample studied.

Adaptação infantil ao tratamento odontológico: relato de caso / Child adaptation to dental treatment: a case report

Na odontopediatria, o ambiente odontológico gera medo e ansiedade, demonstrados de diversas formas pela criança, de modo que há necessidade de promover sua adaptação para que entenda o processo e se sinta parte dele. É importante, ainda, que se identifiquem situações em que o desconforto estético possa gerar constrangimento na convivência diária das crianças. Objetivo: relatar um caso clínico de resolução de comprometimento estético causado por defeito de desenvolvimento do esmalte (DDE) e utilização de técnicas de adaptação de comportamento. Relato de caso: uma paciente do sexo feminino, 3 anos de idade, nascida prematura, apresentava DDE no incisivo central superior esquerdo, que, ao sorrir, cobria com as mãos. O perfil da criança foi avaliado e, a partir das suas características, foram escolhidas as técnicas de dizer-mostrar-fazer, controle de voz, reforço positivo, distração e repetição, usando-as de forma associada para melhores resultados, considerando a necessidade da repetição das visitas ao consultório. Após cinco consultas, foi possível realizar a restauração com resina fotopolimerizável, restabelecendo a estética e o conforto para a criança. Considerações finais: para o atendimento odontológico de crianças, é de fundamental importância conhecer técnicas de manejo infantil e usá-las de acordo com as necessidades individuais, com a finalidade de tornar as crianças participativas no processo, diminuindo a ansiedade, o medo e as reações que podem dificultar ou impedir o atendimento. (AU)

In pediatric dentistry, the clinical environment generates fear and anxiety, which children show in a number of ways, causing the need to promote their adaptation so they understand the process and feel part of it. It is also important to identify situations in which the aesthetic discomfort may lead to embarrassment in the daily lives of the children. Objective: to report a clinical case of resolution of aesthetic impairment caused by the developmental defect of enamel (DDE) and the use of behavioral adaptation techniques. Case report: female patient, three years old, born premature, presented DDE in the upper left central incisor and, when smiling, covered it with her hands. The profile of the child was evaluated and, based on her characteristics, the techniques of tell-show-do, voice control, positive reinforcement, distraction, and repetition were chosen and used in association for better results, considering the need for repeat visits to the dental office. After five consultations, it was possible to perform the restoration with light-curing resin, restoring the aesthetics and comfort of the child. Final considerations: for the dental care of children, it is essential to know child management techniques and use them according to the individual needs, with the purpose of promoting the participation of the children in the process, decreasing their anxiety, fear, and reactions that may hinder or prevent the treatment. (AU)

Family Health Strategy associated with increased dental visitation among preschool children in Brazil.

BACKGROUND: Early-life dental service utilization could improve child dental health. AIM: Identify contextual, socioeconomic, and child characteristics associated with dental visitation by age 3 years. DESIGN: Within a Brazilian birth cohort (N = 435), multivariable regression models were fitted to identify independent predictors of having made a dental visit at age 3 years. Contextual variables considered included health center type (Traditional vs. Family Health Strategy, which perform home visits) and composition of oral health teams at the heath center where mothers accessed prenatal care. RESULTS: Dental visitation was positively associated with Family Health Strategy health centers (36% vs. 23%) and with higher maternal education and family social class. Visitation was lowest among families served by a health center without a dentist, but number of dentists and oral health team composition were not associated with visitation among facilities with ≥1 dentists. Dental visitation was not statistically significantly associated with caries experience but was higher if parents reported worse oral health-related quality of life. The vast majority of dental decay remained untreated. CONCLUSIONS: Dental visits were underutilized, and socioeconomic inequalities were evident. Dental visitation was more common when mothers received prenatal care at Family Health Strategy health centers, suggesting a possible oral health benefit.

Oral Health Literacy as a Predictor of Dental Anxiety in Parents of Children Undergoing Dental Treatment.

PURPOSE: The purpose of this cross-sectional study was to evaluate the association between parents' dental anxiety (DA) and independent variables. METHODS: One hundred sixty-eight dyads of parents and six- to 12-year-old children who were undergoing treatment at a university pediatric dentistry clinic were recruited. Two examiners evaluated parents' DA and oral health literacy (OHL) using the Brazilian version of Corah's dental anxiety scale and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), respectively. Children's DA was reported by parents through the dental anxiety question (DAQ). Demographic data was also collected. A single examiner used the decayed, missing, and filled permanent teeth and primary teeth (DMFT/dmft) indices to assess the children's oral health status. The data analysis involved univariate and multivariate Poisson regression. RESULTS: In the multivariate regression, higher levels of parents' DA were associated with a household income equal to or less than the Brazilian monthly minimum wage (prevalence ratio [PR]=4.9; 95 percent confidence interval [CI]=2.1 to 11.7) and a lower degree of OHL (PR=1.68; 95 percent CI=1.01 to 2.8). Associations between parents' DA and children's DA and DMFT/dmft index were not found. CONCLUSION: Parents' dental anxiety was related to a low household income and low oral health literacy.

Relationship Between Salivary Cortisol Levels and Children's Behavior During a Dental Examination.

PURPOSE: To correlate the salivary cortisol levels in children attending a university dental clinic with their behavior during the dental appointment. METHODS: A prospective study was conducted with 43 seven- to 10-year-old children whose behavior during the dental appointment was assessed using the Frankl scale. Participants were divided into two groups: (1) cooperative children; and (2) uncooperative children. All children had four saliva samples collected as follows: prior to the dental examination (S1); shortly after the dental examination (S2); 30 minutes after waking up in the morning after the day of the appointment (S3); and in the afternoon, 24 hours after the dental appointment (S4). Salivary cortisol levels were measured by the chemiluminescent assay method. Statistical analysis included the Friedman and the Wilcoxon signed rank tests. RESULTS: For the cooperative group, salivary cortisol levels were significantly lower at S1 (P=0.004), S2 (P=0.006), and S4 (P=0.001) compared to S3. For the uncooperative group, salivary cortisol levels were significantly higher at S1 compared to S2 (P=0.005). CONCLUSIONS: Uncooperative children presented high levels of salivary cortisol prior to and shortly after the dental appointment. The period anticipating the consultation was considered highly stressful.

State, trait, and dental anxiety in caregivers of individuals with disabilities.

PURPOSE: The aim of this study was to compare state anxiety, trait anxiety, and dental anxiety in caregivers of patients with special needs and caregivers of pediatric patients without special needs at dental clinics. MATERIALS AND METHODS: A quantitative, cross-sectional study was conducted. Data were collected using a semistructured questionnaire. All respondents were older than 18 years of age. Individuals with cognitive impairment and those taking anxiolytics, antidepressants, or sleep-inducing medication were excluded from the study. The sample consisted of 55 caregivers of patients with special needs and 55 caregivers of pediatric dental patients. A questionnaire was administered to determine the sociodemographic profile of the patients based on the 2015 Brazilian Economic Classification Criteria. Anxiety regarding dental treatment was measured using the dental anxiety scale. The state-trait anxiety inventory was used to identify state and trait anxiety levels. RESULTS: Caregivers of individuals with disabilities had a similar level of anxiety as caregivers of pediatric dental patients. Most caregivers of individuals with disabilities were mothers with an older age and a greater frequency of trait anxiety, especially when these mothers had health problems. State anxiety was associated with a lower education level. CONCLUSIONS: Higher dental anxiety levels were found among caregivers with a higher level of trait anxiety, independently of the type of patient to which care was given.

Influence of maternal anxiety on child anxiety during dental care: cross-sectional study.

CONTEXT AND OBJECTIVES:: Anxiety is usually classified as a disorder of neurotic nature and is often related to contexts of stress, which may include worries, motor tension and autonomic hyperactivity. The aim of this study was to assess the influence of mothers' anxiety on their children's anxiety during dental care. DESIGN AND SETTING:: Analytical cross-sectional study conducted at in a private dentistry school in the south of Brazil. METHODS:: Convenience sampling was used. All mothers of children undergoing treatment were invited to participate in this study. Data to investigate anxiety related to dental treatment among the children were collected through applying the Venham Picture Test (VPT) scale. For the mothers, the Corah scale was applied. A self-administered sociodemographic questionnaire with questions about demographic, behavioral, oral health and dental service variables was also used. RESULTS:: 40 mother-child pairs were included in the study. The results showed that 40% of the children were anxious and 60% of the mothers were slightly anxious. Local anesthesia was the procedure that caused most anxiety among the mothers, making them somewhat uncomfortable and anxious (60%). Family income higher than R$ 1,577.00 had an influence on maternal anxiety (75.6%). Maternal anxiety had an influence on child anxiety (81.3%). CONCLUSION:: Most of the children showed the presence of anxiety, which ranged from fear of dental care to panic, inferring that maternal anxiety has an influence on children's anxiety. Dental procedures did not interfere with the mothers' anxiety, but caused positive feelings, whereas they affected the children more.

Influence of maternal anxiety on child anxiety during dental care: cross-sectional study / Influência da ansiedade materna na ansiedade infantil frente ao atendimento odontológico: estudo transversal

ABSTRACT CONTEXT AND OBJECTIVES: Anxiety is usually classified as a disorder of neurotic nature and is often related to contexts of stress, which may include worries, motor tension and autonomic hyperactivity. The aim of this study was to assess the influence of mothers’ anxiety on their children’s anxiety during dental care. DESIGN AND SETTING: Analytical cross-sectional study conducted at in a private dentistry school in the south of Brazil. METHODS: Convenience sampling was used. All mothers of children undergoing treatment were invited to participate in this study. Data to investigate anxiety related to dental treatment among the children were collected through applying the Venham Picture Test (VPT) scale. For the mothers, the Corah scale was applied. A self-administered sociodemographic questionnaire with questions about demographic, behavioral, oral health and dental service variables was also used. RESULTS: 40 mother-child pairs were included in the study. The results showed that 40% of the children were anxious and 60% of the mothers were slightly anxious. Local anesthesia was the procedure that caused most anxiety among the mothers, making them somewhat uncomfortable and anxious (60%). Family income higher than R$ 1,577.00 had an influence on maternal anxiety (75.6%). Maternal anxiety had an influence on child anxiety (81.3%). CONCLUSION: Most of the children showed the presence of anxiety, which ranged from fear of dental care to panic, inferring that maternal anxiety has an influence on children’s anxiety. Dental procedures did not interfere with the mothers’ anxiety, but caused positive feelings, whereas they affected the children more.

RESUMO CONTEXTO E OBJETIVO: A ansiedade é geralmente classificada como um transtorno de caráter neurótico, frequentemente relacionado a contextos de estresse variando entre preocupações, tensão motora e hiperatividade autonômica. O objetivo desta pesquisa foi avaliar a influência da ansiedade materna na ansiedade de seu filho durante o atendimento odontológico. TIPO DE ESTUDO E LOCAL: Estudo analítico transversal realizado em uma faculdade particular do sul do Brasil. MÉTODOS: Amostragem por conveniência foi utilizada. Todas as mães das crianças em tratamento foram convidadas a participar da pesquisa. A coleta dos dados para verificar a ansiedade relacionada com o tratamento odontológico nas crianças foi realizada a partir da aplicação da escala “Venham Picture Test” (VPT). Para as mães, foi utilizada a escala de Corah. Também se utilizou um questionário sociodemográfico autoaplicativo sobre variáveis demográficas, comportamentais, de saúde bucal e de serviço odontológico. RESULTADOS: Foram incluídos 40 pares de mães e crianças. Os resultados mostraram que 40% das crianças estavam ansiosas e 60% das mães estavam levemente ansiosas. A anestesia local foi o procedimento que causou mais ansiedade entre as mães, deixando-as um pouco desconfortáveis e ansiosas (60%). Renda familiar maior de R$ 1.577,00 influenciou a ansiedade materna (75.6%). A ansiedade materna influenciou a ansiedade das crianças (81.3%). CONCLUSÃO: A maioria das crianças apresentou ansiedade, o que variou do medo ao pânico ao atendimento odontológico, inferindo que a ansiedade materna tem influência na ansiedade dos seus filhos. Os procedimentos odontológicos não interferem na ansiedade das mães, atingindo mais as crianças, porém provocam sentimentos positivos.

Factors associated with dental anxiety in Brazilian children during the first transitional period of the mixed dentition.

AIMS: To determine the prevalence of dental anxiety in children during the first transitional period of the mixed dentition and associated factors. METHODS: A Cross-sectional study was performed with 1367 children of both genders aged 6-7 years old conducted in schools in Recife, Brazil in 2013. The data were collected through interviews and intra-oral examinations. Dental anxiety data were obtained using the dental anxiety questionnaire (DAQ). The associated factors considered were: age, gender, social group, child's experience with the dentist, history of dental pain, experience of caries and phase of exfoliation. RESULTS: The prevalence of children with some level of dental anxiety was 54.4%. Visit to the dentist and social group were associated with dental anxiety (p < 0.001). CONCLUSIONS: The prevalence of dental anxiety was high, although children attending private schools and those who had visited the dentist before had a lower prevalence of dental anxiety.

Child Behaviour in the Dental Clinic: Parent's Perception Regarding various Influencing Factors

Objective: To evaluate the parents' view regarding factors influencing child behaviour in dental clinic. Materials and Methods: This was a cross-sectional study conducted among parents who brought their children to the Paediatric Dental Clinic in Malaysia. Parents completed a close-ended questionnaire (n=274). The questionnaire was divided into 4 separate categories. The questionnaire assessed parental views on the following 4 parameters: dentist, dental clinical settings, dental treatments and child related factors. Data were analyzed using descriptive statistics. Results: According to parent's perception, dental treatment plays the most significant role on a child's behaviour in the clinic when compared to other parameters. No significant difference between the "yes" and "no" responses for dentist, dental settings and child related factors as agreed by parents. Conclusion: Parental attitudes are constantly changing as the society evolves. So it is important to reassess their beliefs regularly and update our understanding of their attitudes. This will help to modify and shape the patient's attitude toward dental care and dental caregivers.

Sinais vitais em crianças e adolescentes submetidos à diferentes tratamentos em Odontopediatria / Vital signs in children and adolescents subjected to different treatments in pediatric dentistry

O objetivo do presente estudo foi monitorar os sinais vitais em crianças e adolescentes submetidos aos diferentes tratamentos na Odontopediatria. Inicialmente foi realizada uma revisão sistemática da literatura para avaliar se procedimentos odontológicos em crianças são capazes de provocar mudanças na pressão sanguínea. Com relação a revisão sistemática, cinco artigos preencheram os critérios de inclusão, na busca eletrônica nas bases Lilacs, PubMed, Web of Science, e Scopus, e concluiu-se que existe evidencia moderada para suportar as mudanças na pressão sanguínea em crianças submetidas a procedimentos odontológicos. Posteriormente, foi elaborado a pesquisa que gerou o segundo artigo da Tese denominado Aferição das alterações nos sinais vitais em crianças frente aos procedimentos em Odontopediatria e o seu perfil social foi dividido em duas fases. A fase I: clínica e a fase II: questionários. A fase I examinou 64 crianças e adolescentes atendidos na clínica de Odontopediatria da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro divididos em 2 grupos: 32 pacientes compareceram para Revisão (Grupo R) com aferição da pressão arterial (PA), frequência cardíaca e saturação periférica de oxigênio antes e depois do procedimento odontológico. O outro Grupo A, também com 32 pacientes foram submetidos a anestesia para o tratamento, sendo aferido a pressão arterial, frequência cardíaca e oximetria, no início do tratamento, após a anestesia e no final do tratamento. Os responsáveis pelos pacientes dos dois grupos receberam o questionário para obter dados da saúde, hábitos alimentares, atividade física e nível socioeconômico. A frequência cardíaca mostrou diferença significativa (p<0,001) entre o início e o final dos tratamentos nos dois grupos. Houve elevação da pressão sistólica e diastólica em 28,8% dos pacientes do grupo R e em 38,4% dos do Grupo A, tendo retornado ao normal em 96,8% dos pacientes. As alterações de elevação da pressão arterial ocorreram na fase inicial dos procedimentos. Podemos supor que o fator ansiedade e medo iniciais contribuem para esta alteração. Na fase II (questionário) a elevada ingestão de biscoitos (79,7%) e de refrigerantes (84,4%) durante a semana pelos participantes do estudo além da prática de atividade física (37,5%) apenas uma vez por semana, foram achados relevantes e preocupantes nesta pesquisa. O presente estudo demonstrou pequenas alterações nos parâmetros cardíacos avaliados nos dois grupos, sendo que o retorno à normalidade após o final dos procedimentos foi verificado. Uma atenção maior aos hábitos alimentares não saudáveis capazes de produzir alterações cardíacas nas crianças e adolescentes em longo prazo e a falta da prática de atividades físicas regulares devem ser mais bem divulgadas e discutidas nas mídias sociais e nos consultórios odontopediátricos. (AU)

The research underscores the fact that little is known about the influence of cardiac alterations on the child's health and its implications on dental treatment. Primary factors such as, Obesity, sodium concentrations in food, inadequate diet and idleness in the present day, are generating a new lifestyle. The objective of the present study was to monitor the vital signs in children and adolescents submitted to different treatments in Pediatric Dentistry. A systematic review of the literature was carried out to evaluate whether dental procedures in children are capable of causing changes in blood pressure. Regarding the systematic review, five articles met the criteria for inclusion in the electronic search in the databases: Lilacs, PubMed, Web of Science, and Scopus, and concluded that there is moderate evidence to support changes in blood pressure in children undergoing dental procedures. Article 2, titled Measurement of changes in the body in children in relation to procedures in Pediatric Dentistry and its social profile was divided into two phases. Phase I: clinical and phase II: questionnaires. Phase I examined 64 children and adolescents attending the Pediatric Dentistry Clinic of the Faculty of Dentistry of the Federal University of Rio de Janeiro. Subjects were divided into two groups: 32 patients attended for Revision (Group R) for gauging blood pressure, heart rate and peripheral saturation of Oxygen before and after the dental procedure. The other group, A, also with 32 patients underwent anesthesia for the treatment, being measured arterial pressure, heart rate and oximetry, at the beginning of treatment, after anesthesia and at the end of the treatment. Patients in both groups received the questionnaire to obtain health data, eating habits, physical activity and socioeconomic status. The heart rate showed a significant difference (p <0.001) between the beginning and the end of treatments in both groups. There was an increase in systolic and diastolic pressure in 28.8% of patients in-group R and in 38.4% of patients in-group A, and returned to normal in 96.8% of patients. Changes in blood pressure occurred in the initial phase of the procedures. We may assume that the initial anxiety and fear factors contribute to this change. In phase II (questionnaire) the high intake of biscuits (79.7%) and soft drinks (84.4%) during the week by study participants beyond practice of physical activity (37.5%) only once a week were found to be relevant and worrying in this study. The present study showed small changes in the cardiac parameters evaluated in both groups, and the return to normal after the end of the procedures was verified. Greater attention to unhealthy eating habits capable of producing cardiac changes in children and adolescents in the long term and lack of regular physical activity should be better publicized and discussed in social media and pediatric dental care. (AU)

La encuesta pone de relieve la atención sobre el hecho de que se sabe poco acerca de la influencia de los cambios cardíacos en la salud del niño y sus implicaciones para el tratamiento dental. factores primarios tales como la obesidad, las concentraciones de sodio en los alimentos, la dieta poco saludable y la inactividad en estos días, la creación de un nuevo estilo de vida. El propósito de este estudio fue monitorear los signos vitales en niños y adolescentes sometidos a distintos tratamientos en odontología pediátrica. Una revisión sistemática de la literatura se realizó para evaluar si los procedimientos dentales en los niños son capaces de provocar cambios en la presión arterial.. En cuanto a la revisión sistemática cinco artículos cumplieron los criterios de inclusión, la búsqueda electrónica en las bases de datos: lilas, PubMed, Web of Science y Scopus, y resulta que hay evidencia moderada de cambios en la presión arterial en niños sometidos a procedimientos dentales. Posteriormente fue elaborado um segundo artículo medición de los cambios en el cuerpo en frente de los niños en los procedimientos de odontología pediátrica y su perfil social, dividido en dos fases. Fase I: Clinica y fase II cuestionarios. Em La fase de exame clínico fueron examinados 64 niños y adolescentes en atendidos em La clínica de odontología pediátrica de la Faculadad de Odontología de la Universidad Federal de Río de Janeiro.divididos en 2 grupos: 32 pacientes procedían de Revisión (Grupo R) con la presión arterial, la frecuencia cardíaca y la saturación periférica de oxígeno antes y después del procedimiento dental. El otro (grupo A), de 32 pacientes también se sometió a anestesia para el tratamiento, y se mide la presión arteriall, ritmo cardíaco y oximetría de pulso al comienzo del tratamiento, después de la anestesia y el final de tratamento.Os responsable de los pacientes de ambos grupos recibido el cuestionario para los datos de salud, hábitos alimenticios, actividad física y el estatus socioeconómico. La frecuencia cardíaca fue significativamente diferente (p <0,001) entre el inicio y el final del tratamiento en ambos grupos. No hubo aumento en la presión arterial sistólica y diastólica en 28,8% del grupo R y el 38,4% del grupo A, retornando a la normalidad en 96,8% de los pacientes. Los cambios de elevación de la presión arterial se producen en la etapa inicial del procedimiento. Podemos suponer que la ansiedad inicial y factor miedo que contribuye a esta fase alteração. En la fase II (cuestionario) alto consumo de galletas (79,7%) y bebidas no alcohólicas (84,4%) durante la semana por los participantes en el estudio y la práctica actividad física (37,5%) una vez por semana, fueron hallazgos relevantes y preocupantes en esta investigación. El presente estudio demostró pequeños cambios en parámetros cardíacos evaluados en dos grupos, con el retorno a la normalidad después de que el final del procedimiento fueron verificados. Una mayor atención a los malos hábitos alimenticios pueden producir anomalías cardíacas en niños y adolescentes en el largo plazo y la falta de actividad física regular debería estar mejor difusión y debate en los medios de comunicación y consultorios Odontopediatricos. (AU)

Evaluation of children's dental anxiety levels at a kindergarten and at a dental clinic.

This study evaluated the dental anxiety levels of preschool children at a kindergarten and at a dental clinic. The anxiety levels of ninety 4-6-year-old (4.99 ± 0.81) preschool children were evaluated according to pulse rates, the facial image scale (FIS), the Venham picture test (VPT), and the Frankl behavior rating scale. The children's mothers were asked to complete the state-trait anxiety inventory (STAI) forms 1 and 2 (STAI 2 and STAI 2). The sample t-test, Mann-Whitney U test, and Pearson's correlation test were used. A statistically significant difference was observed between the children's pulse rates when measured at the dental clinic and those when measured at the kindergarten (p < 0.001). Although the results were not statistically significant, more negative facial expressions were observed in the children at the dental clinic than in those at the kindergarten when assessed using FIS and VPT (p = 0.090 and p = 0.108, respectively). There was a statistically significant correlation between the transient anxiety levels (STAI 1) of mothers and the VPT scores of their children evaluated at the dental clinic (r = 0.506, p < 0.001). The continuous anxiety level of the mothers of males was found to be significantly higher (p = 0.033) than that of the mothers of females (STAI 2). Although the children had been informed about dentistry and were introduced to a dentist at the kindergarten, their anxiety levels seemingly increased as they arrived at the dental clinic. The significant increase observed in the children's pulse rates was a physical indicator that their anxiety levels had increased. It can be concluded that the children felt more anxious at the dental clinic that at the kindergarten.

Perception of dental care among children

Children that arrive at dental offices with fear and anxiety usually tend to resist conditioning mechanisms. The aim this study was to evaluate children's perception about dental treatment and to identify factors that influence this perception. Material and Methods: A random sample of 100 children of both genders aged 3 to 12, who were treated at the Department of Dentistry of a University (group I) and at a Children's Hospital (group II), was selected. A structured questionnaire about the child's perception about dental care was applied and the children were asked to draw a picture of this topic. Most of children expressed a positive perception in the questionnaire and in the drawings (93.8%). This positive perception was more pronounced in group I (94%) and in children aged 3 to 5 years (100%), particularly in girls (78%). The main cause of fear was the use of needles (42.4%). Many children (24.2%) reported to prefer the noninvasive procedures. A positive perception of dental treatment was observed in the majority of the sample. Therefore, dental pediatricians must be aware of the perception of children for better conditioning (Au)

Changes in preschool children's OHRQoL after treatment of dental caries: responsiveness of the B-ECOHIS.

BACKGROUND: Oral health-related quality of life (OHRQoL) measures should be tested for responsiveness to change if they are to be used as outcomes in randomized clinical trials. AIM: To assess the responsiveness of the Brazilian ECOHIS (B-ECOHIS) to dental treatment of dental caries. METHODS: One hundred parents of 3- to 5-year-old children completed the B-ECOHIS prior to their children's treatment and 7-14 days after completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed parent's perceptions of change in their children's oral health following treatment. Change scores, longitudinal construct validity, standardized effect sizes (ES) and standardized response mean (SRM) were calculated. RESULTS: Improvements in children's oral health after treatment were reflected in mean pre- and post-treatment B-ECOHIS scores. They declined considerably significantly from 17.4 to 1.6 (P < 0.0001), as did the individual domain scores (P < 0.0001). There were significant differences in the pre- and post-treatment scores of children who reported little improvement (P < 0.0001) as well as in those who reported large improvements (P < 0.0001). The ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were large. CONCLUSIONS: Dental treatment resulted in significant improvement of the preschool children's OHRQoL. The B-ECOHIS is responsive.