Basic behavioral management techniques in pediatric dentistry: A systematic review and meta-analysis.

OBJECTIVE: To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in pediatric patients. DATA SOURCES: Electronic and hand searches were conducted to locate Randomized Controlled Trials (RCTs) reporting on objective and subjective evaluation of anxiety and behavior of children up to 12 years of age. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool (RoB 2.0 Tool), were performed independently and in duplicate for all included studies. Mean differences and standard deviations were used to summarize the data from each study and meta-analyses were conducted with studies of limited heterogeneity. STUDY SELECTION: A total of 708 papers were identified and screened, 122 retrieved for full text appraisal and 62 finally included. Results suggested that all basic BMTs have acceptable effectiveness on pediatric patients' anxiety, fear and behavior during dental treatment. Meta-analysis showed a statistically significant difference in favor of distraction for subjective anxiety using Facial scale (Mean diff.: 2.78; 95% CI: -3.08, -0.53; p = 0.005) and Modified Child Dental Anxiety Scale (Mean diff.: 12.76; 95% CI: -6.09, -4.47; p = 0.001) and a non-significant difference for heart rate (Mean diff.: 1.70; 95% CI: -6.54, 0.46; p = 0.09). Music significantly reduced heart rate when compared to a control comparator, underlining the superiority of the BMT (Mean diff.: 2.71; 95% CI: -3.70, -0.59; p = 0.007). CONCLUSIONS: Limited evidence about efficacy of one technique over another raises important issues on the topic for future research regarding the management of the child patient in the dental setting of the 21st century. CLINICAL SIGNIFICANCE: Behavioral management comprises a challenge for clinicians, who need to be familiar with a range of techniques to meet patients' needs at individual level and be flexible in their implementation. Appropriate technique should incorporate patients' personality and parents' active involvement, within the contents of the changes in modern societies.

Rehabilitation Considerations for Very Young Children with Severe Oligodontia due to Ectodermal Dysplasia: Report of Three Clinical Cases with a 2-Year Follow-Up.

Introduction: Management of oligodontia can be complicated and requires multidiscipline care, involving a wide spectrum of interventions. The aim of this report is to describe the challenges of oral rehabilitation of three very young children with oligodontia. Report. Three preschool aged Caucasian males, diagnosed with ectodermal dysplasia, were treated with interim removable dentures in order to replace missing teeth, reclaim vertical dimension, and improve function and aesthetics. The main challenges faced were patient cooperation, dental and skeletal characteristics, and parental expectations. Two years post-treatment, both patients and parents reported excellent adaptation to prosthesis and satisfaction with aesthetics. Conclusion: Rehabilitation of oligodontia may be challenging due to accompanying oral findings, dentofacial growth considerations, and behavioral issues. Establishment of good rapport between patients, parents, and clinician is the key for the success of the treatment even with the use of nonpharmacological behavioral management techniques.