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Objectives This randomized crossover clinical trial designed to evaluate the impact of visual and auditory distraction techniques on pediatric patients’ anxiety, pain perception, and behavior during dental treatment. The study specifically focuses on children, aiming to determine whether distraction methods can effectively reduce anxiety levels, alleviate pain experiences, and improve cooperative behavior in a clinical setting. Method and materials Children aged 4 to 9 years receiving routine dental care at the Pediatric Dentistry Clinic, Istanbul Medipol University, were randomly assigned to Group 1 (distraction first, then tell-show-do) or Group 2 (tell-show-do first, then distraction), with a two-week washout period before switching interventions. Anxiety was assessed using the Venham Picture Test and pulse rate, pain perception with the Sounds, Eyes, and Motor Scale during local anesthesia and the Wong-Baker FACES Pain Rating Scale during treatment, while cooperation and behavior were evaluated using the Houpt Scale. Statistical analysis was conducted using Mann-Whitney U, Student’s t-test, Paired t-test, and Wilcoxon test, with the significance level set at 0.025 using the Bonferroni correction. Results Sixty-eight patients (37 female, 31 male) with a mean age of 6.69 ± 1.08 years completed the study (Group 1: n  = 32, Group 2: n  = 36). The cartoon-assisted distraction technique did not significantly reduce anxiety compared to the tell-show-do method. A non-significant reduction in pain perception was observed during local anesthesia with distraction. However, this technique significantly reduced self-reported pain during treatment ( p  < 0.025) and improved child cooperation and behavior. Conclusion Cartoon-assisted visual and auditory distraction can alleviate pain perception and improve behavior during pediatric dental procedures. However, it does not appear to reduce dental anxiety or pain perception during local anesthesia. Integrating this technique with the traditional tell-show-do approach may enhance the pediatric dental experience. Trial registration The trial was registered at ClinicalTrials.gov, number NCT04927754, 06/01/2021.

Purpose To examine children’s behaviours during consecutive dental treatments, relative to gender, age, and behaviour guidance techniques. Methods A retrospective study of medical records of children treated by four residents in a Department of Paediatric Dentistry, during 2015–2018. Data included: age, gender, behaviour guidance technique (no medication, inhaled sedation, conscious sedation with hydroxyzine or benzodiazepines) and behaviour according to Frankl scale. Results Of 205 children, 134 were 3–6 yo (Group 1) and 71 were 6.1–11 yo (Group 2). Most presented a positive behavioural profile, with significant difference between groups ( p  = 0.02), no significant difference between genders ( p  = 0.72). A significant association between behaviour guidance techniques and behavioural profile was found ( p  = 0.01). Most children with positive behaviour received inhaled sedation (83%), while most children with negative behaviour received conscious sedation using benzodiazepines (8%). Negative behaviour was observed only in the younger children receiving conscious sedation with benzodiazepines (9%) or hydroxyzine (3%). Conclusions Most 3–11 yo patients exhibited positive behaviour during four consecutive dental treatments, with different behaviour guidance techniques. Negative behaviour was more frequent among 3–6 yo children, where sedation was often required to achieve cooperation, and 4.5% could benefit from general anesthesia.

As an important resource in online learning, video lectures have attracted considerable research attention in the impact of teachers’ nonverbal guidance behaviors on learning. However, few studies have focused on secondary education, and it remains unclear whether the interaction between different guidance frequencies and types leads to variations in the effectiveness of guidance. This study tested the mutual effects of instructor’s guidance frequency and type on secondary school students’ learning performance (retention scores, transfer scores) and affective experiences (cognitive load, learning experience, learning satisfaction). A total of 202 secondary school students were randomly assigned to watch one of the four video lectures, using a 2 (guidance frequency: low-frequency guidance, high-frequency guidance) × 2 (guidance type: gesture guidance, gesture + gaze guidance) between-groups design. The study was conducted in a multimedia classroom setting. The results showed that low-frequency guidance by instructors contributed to improved learning performance. Specifically, under low-frequency guidance conditions, gesture guidance was more effective in enhancing retention, while gesture + gaze guidance facilitated learners’ transfer. Moreover, low-frequency gesture + gaze guidance by teachers resulted in better affective experiences for students, as evident in cognitive load, learning experience, and learning satisfaction. Therefore, it is recommended that instructors lecturing for secondary students adopt appropriate types of low-frequency guidance according to the level of learning difficulty to improve teaching effectiveness.

ABSTRACT Background: Binaural auditory beat is an auditory illusion perceived when two different pure-tone sine waves with less than a 30 Hz difference are presented to a listener dichotically. Monaural beat stimulation is achieved by the superposition of amplitude-modulated signals of nearby frequencies to both ears simultaneously. Aim: The study aims to evaluate and compare anxiety level during restorative treatment using no music, monaural beats, and binaural auditory beats as audio distraction behavior guidance techniques in children aged 6-12 years. Settings and Design: Three-arm, parallel-group randomized study was conducted in the department of pediatric and preventive dentistry. Materials and Methods: The sample size of 45 participants was calculated and allocated into three groups as no music, monaural beats, and binaural auditory beats group. Teeth with Class I cavity in primary or permanent molars were prepared and restored. Anxiety was measured pre and postintervention using pulse oximeter and Venham's picture test. Statistical Analysis Used: Data obtained were analyzed with SPSS software version 20.0 and were carried out using one-way analysis of variance and dependent t-test and significance value < 0.05 was considered. Results: Binaural auditory beats and monaural beats showed a better reduction in anxiety levels as per Venham's picture test scores with statistically significant \"P\" value 0.0001 and 0.064, respectively. Likewise, binaural auditory beats showed better reduction in anxiety levels as per pulse rate scores with statistically significant \"P\" value 0.0001 as compared to conventional treatment technique. Conclusion: Binaural auditory beat was found to be the most effective followed by the monaural beat compared to the control group. Thus, binaural auditory beats and monaural beats can be used effectively as an essential aid to reduce anxiety in children.

Aim To determine the effect of three-dimensional (3D) audiovisual (AV) distraction in reducing dental anxiety of children. Study design A randomised clinical trial with a parallel design carried out on 90 children (49 boys and 41 girls) aged between 7 and 10 years (mean age of 8.4 years) to ascertain the comparative efficacy of audio (music) and AV (3D video glasses) distraction in reducing the dental anxiety of children during local analgesia (LA) administration. Methods Ninety children were randomly divided into three groups; control (basic behaviour guidance techniques without distraction), audio (basic techniques plus music) and AV (basic techniques plus 3D AV) distraction groups. All the children experienced LA administration with/without distraction and the anxiety was assessed using a combination of measures: MCDAS ( f ) (self-report), pulse rate (physiological), behaviour (using Wright’s modification of Frankl behaviour rating scale and Houpt scale) and preferences of children. Results All 90 children completed the study. A highly significant reduction in the anxiety of audiovisual group as reported by the MCDAS ( f ) values ( p  < 0.001) and Houpt scale ( p  = 0.003); whereas pulse rate showed statistically significant increase ( p  < 0.001) in all the three groups irrespective of distraction. The child preferences also affirmed the usage of 3D video glasses. Conclusions LA administration with music or 3D video glasses distraction had an added advantage in a majority of children with 3D video glasses being superior to music. High levels of satisfaction from children who experienced treatment with 3D video glasses were also observed.

Background: Dental fear is a common cause of uncooperative behavior among young children, which poses a challenge in providing effective dental treatment. With the advancements in technology, several behavior guidance techniques in the form of distraction have emerged over time for managing uncooperative pediatric dental patients. Aim: The aim of this study is to compare and evaluate the effectiveness of four different behavior guidance techniques in managing uncooperative pediatric patients by measuring pre- and post-operative dental fear/anxiety levels using physiological and nonphysiological parameters. Methodology: Sixty systemically healthy children aged 5-8 years with negative behavior as per Frankl's Rating Scale, requiring restoration were included in the study and randomly divided into four equal groups (n = 15), based on the guidance techniques used: Tell-Show-Do (TSD) as a control group and audio distraction, audiovisual distraction (AVD) (virtual reality [VR]) and Mobile Phone Game Distraction as test groups. Pre- and post-intervention levels of the child's fear/anxiety were assessed using both physiological (blood pressure and pulse rate) and nonphysiological (facial image scale) parameters. The data were evaluated using t-test and one-way ANOVA test. Results: A statistically significant difference was observed in both physiological and non-physiological parameters post-intervention in the groups with a maximum decrease in the AVD (VR) group. Conclusions: AVD (VR) was found to be the most effective while TSD alone as the least effective behavior guidance technique in reducing dental fear/anxiety in uncooperative pediatric dental patients.

This case report aimed to demonstrate the prosthetic solution of an autism patient with self-injurious behavior using digital dentistry. A 24-year-old male visited our clinic with chief complaints of severe gingival recession associated with self-injurious behavior. Bilateral fixed prosthesis with denture flange were delivered using a digital workflow for the protection of the gingiva. The patient showed healed gingival tissue, behavioral modification, and acceptable oral hygiene during the follow-up period. Also, his caregivers reported no recurrence of the self-injurious behavior. Autism patients usually show self-injurious behavior, which can damage their oral tissue. With adoption of this prosthesis, behavior modification as well as healing of oral tissue was achieved.

Background Autism is a lifelong neurodevelopmental disorder that poses challenges during dental treatment. Advanced behavior guidance techniques (BGTs) have been used to provide dental care for autistic people who have specific characteristics and complex dental treatment. This study was conducted to evaluate parental acceptance and analyze parents’ opinions of advanced BGTs during dental treatment in autistic people. Methods This cross-sectional study was conducted on 141 parents of autistic people from the Mahidol Dental Hospital and the Autism online community. Informed consent was obtained before enrolling participants in the study. All parents were asked to rate their acceptance after watching VDO clips: passive restraint by device (PRBD), oral sedation (OS), and general anesthesia (GA) to evaluate parental acceptance of advanced BGTs through an online questionnaire survey. The online questionnaire included a visual analog scale (VAS) and open-ended questions to collect their opinions on each advanced BGT. Participants were categorized into two subgroups as follows: 81 in the “Experience group” and 60 in the “No experience group” according to their autistic people’ advanced BGT experience. Friedman’s two-way analysis of variance and the Mann–Whitney U test were used for statistical analyses. Open-ended questions were analyzed using quantitative content analysis. Results PRBD was ranked the highest, followed by GA and OS. Parents in the “Experience group” rated significantly higher acceptance of their BGT experience than parents in the “No experience group” in all the three advanced BGTs. Conclusions All advanced BGTs were particularly accepted in this study. Previous experience of advanced BGTs had an influence on parental acceptance. Parents commented on their opinions toward each advanced BGT with a variety of perspectives. Trial registration : The protocol was approved by the ethical committee of the Faculty of Dentistry/Faculty of Pharmacy, Mahidol University (COA.No.MU-DT/PY-IRB 2021/022.1702) and was registered with Thai Clinical Trials Registry (TCTR20220521001).

Background Dental simulation games are virtual educational games that help children get familiar with different dental procedures. This study aimed to evaluate the pretreatment exposure to the “Baby Panda Dental Care” game in reducing pain and anxiety in comparison with the tell-show-do (TSD) technique during primary molars pulpotomy for patients aged 6–10 years. Materials and methods It was a triple-blinded, two-arm, parallel-group, randomized, active-controlled trial. It was done on 60 patients, who were randomly divided into two groups: the control group, TSD technique ( n  = 30), and the experimental group, “Baby Panda Dental” Care ( n  = 30). For the TSD technique, children were provided with a verbal explanation followed by a demonstration of the dental treatment in a non-threatening way. The “do” phase is then initiated during performing treatment. For the “Baby Panda dental care” game, children were asked to play for 5 min before treatment, selecting root canal therapy procedures. Pulse rate and RMS pictorial scale were recorded at four time points: (1) at the baseline (t 0 ). (2) After conditioning the child (t 1 ). (3) During treatment (t 2 ). (4) After finishing the treatment (t 3 ). Face, Legs, Activity, Cry, Consolability (FLACC) behavioral pain scale was recorded during treatment (t 2 ). Results The pulse rate is higher in the control group at t 1 ( p  = 0.012) and t 2 ( p  = 0.015). There was a statistically significant difference in the mean RMS pictorial scale score at t 1 ( p  < 0.001), t 2 ( p  = 0.006), and t 3 ( p  < 0.001), a statistically significant difference was noticed in FLACC behavioral pain assessment between the two groups ( p  = 0.033). Conclusions The mobile dental game showed better results than the TSD technique, but neither technique did not reduce anxiety and pain effectively during dental treatment. Trial registration The trial was registered at the ISRCTN registry (ISRCTN30470866) on 19/04/2024.

Background and Objectives: Behavior management as a set of clinical techniques to induce desirable clinical treatment and subsequent compliance behaviors in children and families varies internationally based on professional training, access to care, health literacy, and societal norms. This report proposes non-typical diagnostic considerations of additional inherent behavioral conditions and familial and social qualifiers that may help predict success both at the chairside and in compliance with home self-care behaviors to reduce caries susceptibility. Methods: A review of the medical and dental literature provides ample support for the consideration of changing characteristics of both the patient and the environment. Results: The current recommendations for choice of behavior guidance in direct clinical care, as used in the USA, often fall short of efficacy for a variety of reasons including the provider limitations, the extent and difficulty of treatment, and most recently appreciated, the complexity of negative childhood experiences, subclinical behavioral disorders, and immutable negative determinants of health outside the dental setting affecting interaction with health professionals. These same factors, such as family dysfunction and societal stresses, also impact compliance with out-of-clinic preventive efforts that many oral health care providers rely upon to help mitigate treatment limitations in reaching children. There are also behavioral elements of compliance and attitudes toward health that dentists need to recognize. Conclusions: A broader, more inclusive concept of behavior guidance to include factors beyond those typically associated with a dental patient affecting treatment and compliance with preventive behaviors may be beneficial. Every population and patient will have differing characteristics and require individualized care.