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Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial
Background
Dental fear and anxiety can significantly hinder the treatment of children. The aim of this research is to compare the effect of puppet play therapy (PPT) and tell-show-do (TSD) behavior guidance technique on child’s behavior and anxiety in emergency dental clinics during local anesthesia (LA) administration.
Methods
This randomized clinical trial included 50 children aged 3–6 years in need of emergency dental treatment under LA. The subjects were randomized into 2 equal groups: the PPT group, where behavior management was provided using PPT, and the TSD group where TSD was used as the behavior guidance technique. Dental anxiety levels were evaluated using the Facial Index Scale (FIS) and Venham Anxiety Rating Scale. Pulse rates were measured before, during and after anesthesia administration. Patient behavior was also scored using the Frankl Behavior Rating Scale and Venham Behavior Rating Scale. The Face, Legs, Activity, Cry, Consolability (FLACC) scale was used to assess pain.
Results
The mean heart rates were lower for patients who received PPT (94.12 ± 15.71; 106.88 ± 12.67 and 103.16 ± 13.6) compared to TSD (103.4 ± 20.94, 112.5 ± 23.17 and 111.48 ± 25.07) before, during and after the LA, respectively. Anxiety levels measured by FIS were significantly reduced using PPT (
p
< 0.001) compared to TSD.
Conclusions
This study presents a behavior modification method demonstrating efficacy in reducing anxiety among young children who had no previous dental exposure and underwent immediate invasive dental procedures, utilizing puppet play therapy.
Trial registration
ClinicalTrials.gov with registration number NCT06326307 on March 21, 2024.
Journal Article
Handy health guide to your teeth
\"An overview of how to care for your teeth and diseases that can affect your mouth\"-- Provided by publisher.
Book
The child dental care reform in Israel - age-related patterns of uptake: 2011 to 2022
Background
The Child Dental Care Reform introduced in Israel in 2010 aimed to provide universal dental coverage for children, addressing high caries morbidity and inequalities in access to care. The reform initially covered ages 0–8 and expanded to include all children up to age 18 by 2019. This study examines age-related patterns of dental service utilization during the first decade of its implementation.
Methods
This retrospective study analyzed anonymized dental service data from 2011 to 2022, submitted by the four Health Maintenance Organizations to the Israeli Ministry of Health. The data included the number of children treated, categorized by age group, and the types of treatments provided.
Results
Service utilization showed distinct age-related patterns, with rates peaking at age 8 (48%) and gradually declining through adolescence (
p
< 0.001). Restorative care consistently outnumbered preventive care across all age groups (
p
< 0.001), with children aged 3–5 receiving the most restorative procedures per child. Preventive treatments increased with age, from 1.0 per patient in young children to 1.5 in teenagers, transitioning from mainly dental examinations in younger children to hygienist visits in adolescents. Restorative treatments included dental restorations (peaking at 50% at ages 8–9), extractions (25% at ages 10–11), and pulp treatments (25% at ages 6–8). Emergency dental visits were most common in infants and increased by 83% over the course of a decade (
p
< 0.001). General anesthesia utilization increased significantly in the younger age groups, with the 4–5 age group showing the most dramatic increase (2.39-fold increase,
p
< 0.001).
Conclusion
This study highlights distinct age-related patterns in dental service utilization among children in Israel, emphasizing the need for targeted prevention strategies and policy reforms to address current challenges disparities, including the increasing rate of treatment under general anesthesia. Preventive interventions, such as community water fluoridation and early childhood programs, alongside improved access to specialized dental care, are essential for fostering better long-term oral health outcomes. Integrating quality indicators will facilitate better incorporation of dental services into the national health system, ensuring comprehensive and equitable oral care.
Journal Article
Effects of animal-assisted therapy on dental anxiety, behavior, and perceptions in young pediatric patients: a blinded randomized controlled trial
Background
Between 6 and 22% of children are affected by dental anxiety. Dental anxiety is a significant barrier to dental care and is associated with dental avoidance and negative oral health outcomes. Pharmacological methods of anxiety management are costly, carry risks of adverse outcomes, and may not be acceptable to some families. Alternative non-pharmacological methods are needed for the safe and effective delivery of dental care. Although there is an abundance of literature regarding animal-assisted therapy (AAT) in medicine, only preliminary studies on AAT exist in dentistry. To identify optimal outcome measures for evaluating AAT in pediatric dental contexts, a randomized controlled trial protocol was developed.
Methods
A prospective randomized controlled trial protocol was developed to examine the impact of AAT on objective (heart rate, salivary stress and pain markers, and observational coding) and subjective self-reported measures of anxiety, pain, and dental expectations in pediatric patients. The study is designed to enroll 180 pediatric patients (4–8 years old), randomized into three arms (
n
= 60 per arm) with stratification by age (< 6.5 vs ≥ 6.5) and gender (block size = 4). Two therapy protocols (+ Short AAT and + Long AAT exposures) will be compared relative to an active control (coloring a dog picture) during a diagnostic dental visit consisting of an oral exam, dental cleaning, and simulated bitewing intraoral radiographs.
Discussion
This study will provide information on optimal outcome measures to evaluate the impact of AAT on dental anxiety and behavior in pediatric dental patients. Determining the effects of AAT in pediatric dental care may provide a safe, non-pharmacological method of anxiety and behavior management, with broad translational impact.
Trial registration
This trial was registered on ClinicalTrials.gov with number NCT05464888, on 15 July 2022 (first submitted to ClinicalTrials.gov) and 19 July 2022 (first posted to ClinicalTrials.gov).
Journal Article
Sensory Adapted Dental Environments to Enhance Oral Care for Children with Autism Spectrum Disorders: A Randomized Controlled Pilot Study
This pilot and feasibility study examined the impact of a sensory adapted dental environment (SADE) to reduce distress, sensory discomfort, and perception of pain during oral prophylaxis for children with autism spectrum disorder (ASD). Participants were 44 children ages 6–12 (n = 22 typical, n = 22 ASD). In an experimental crossover design, each participant underwent two professional dental cleanings, one in a regular dental environment (RDE) and one in a SADE, administered in a randomized and counterbalanced order 3–4 months apart. Outcomes included measures of physiological anxiety, behavioral distress, pain intensity, and sensory discomfort. Both groups exhibited decreased physiological anxiety and reported lower pain and sensory discomfort in the SADE condition compared to RDE, indicating a beneficial effect of the SADE.
Journal Article
Cartoon-assisted visual/auditory distraction usage in paediatric dental care, assessment of effects on patient anxiety, pain, and behaviour: a randomised crossover clinical trial
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.
Journal Article