Evaluation of the effects of pregabalin and dexamethasone coadministration on preemptive multimodal analgesia and anxiety in third molar surgeries: a triple-blind randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of pregabalin and dexamethasone coadministration in preemptive analgesia and anxiety control in lower third molar surgery. MATERIALS AND METHODS: A triple-blind, split-mouth clinical trial conducted with patients divided into two groups: control group, receiving placebo and dexamethasone, and test group, receiving pregabalin and dexamethasone preoperatively. The evaluated variables were pain, measured by the Visual Analog Scale (VAS), anxiety assessed through the State-Trait Anxiety Inventory (STAI) questionnaires, hemodynamic parameters [Blood Pressure (BP), Heart Rate (HR), Oxygen Saturation (SpO2)], and sedation assessed by the Ramsay scale. RESULTS: A total of 31 patients were included. The test group exhibited a significant reduction in pain at 2,4,6,8,12,16,24, and 48 h after surgery and in the consumption of rescue analgesics. Anxiety, evaluated by STAI and VAS, showed a significant decrease in the test group (p < 0.001). Additionally, there was a significant decrease in BP at most of the assessed time points (p < 0.05) and a significant reduction in HR at two different time intervals (p = 0.003 and p = 0.009), indicating a positive effect in the test group. There was no significant difference in SpO2 between the groups. Sedation assessment revealed a significant difference at all time points favoring the test group (p < 0.05). There were no significant postoperative adverse effects. CONCLUSIONS: Pregabalin coadministered with dexamethasone demonstrated significant efficacy in controlling postoperative pain and anxiety, as well as a sedative effect. CLINICAL RELEVANCE: The coadministration of pregabalin with dexamethasone may presents potential advantages in both pain modulation and psychological well-being of individuals undergoing third molar surgeries. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (REBEC), No. RBR-378h6t6.

Effectiveness of Animal-Assisted Activity on Pain Perception and Anxiety of Children Undergoing Intraoral Local Anesthetic Administration.

Purpose: To investigate the impact of animal-assisted activity (AAA) involving a dog (play therapy) on reducing the pain experienced by children during the administration of local anesthetic (LA). Methods: Children between the ages of eight and 12 years who required LA administration were randomized into an AAA group and a control group. Baseline data for the simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS[f]) was recorded, followed by the implementation of either AAA with standard care or standard care alone. The conventional protocol was followed for the administration of LA. Procedural pain was evaluated using both the Faces Pain Scale-Revised (FPS-R) and the Faces, Legs, Activity, Cry, and Consolability Scale (FLACC). All variations in pulse were also recorded. After the procedure, a simplified MCDAS(f) was recorded once again. The data were tabulated and statistically analyzed. Results: The children in the AAA group reported lower pain scores, as measured by FPS-R, compared to the control group (P =0.009). Pain, as observed in the FLACC scores, was also low in the experimental group (P <0.001). A notable reduction in anxiety scores (P <0.001) was observed among children assigned to the AAA group. Conclusion: AAA involving a dog led to a reduction in the pain experienced by children undergoing LA administration, subsequently decreasing anxiety.

[Comfortable initial periodontal therapy: step by step].

With the transition of the medical model from the traditional biomedical model to the biopsychosocial one, there is a growing trend and requirement for oral operations that prioritize comfort, pain management, minimally invasive techniques, and visualization. Consequently, demands for comfortable dental treatments among individuals are increasing. However, initial periodontal therapy is often accompanied by pain, and patients' reactions to pain range from nervousness to dental fear, such as irritability, hyperventilation, even nausea, vomiting, and refusal to cooperate, which make the implementation of initial periodontal therapy difficult or even impossible. This article will focus on three key steps: firstly, the preparation of the clinic, the acquisition of patients' trust and the implementation of preventive sedation before treatment; secondly, the use of comfort operation and nursing, psychological intervention measures, local anesthesia, and sedation techniques during treatment; thirdly, the health education and follow-up after treatment. By addressing these aspects, we aim to clarify how to perform comfortable initial periodontal therapy step by step.

Preoperative Multisensory Room Use in Pediatric Patients With Autism: A Randomized Clinical Trial.

Purpose: To evaluate the impact of multisensory room (MSR) use on preoperative anxiety and postoperative outcomes in children with autism spectrum disorder (ASD) undergoing dental treatment with general anesthesia. Methods: Forty children, ages six to 17 years, with ASD re- quiring general anesthesia for dental treatment, participated in this study. Participants were randomized to either the control group (standard pre- operative waiting room) or intervention group (MSR) for 20 minutes prior to general anesthesia induction. Pre- and post-intervention preoperative anxiety were measured. Following surgery, postoperative emergence delirium was assessed. Short- and long-term postoperative pain and adverse behavioral effects were evaluated six hours, 24 hours, one week, and one month post-surgery. Data analysis employed repeated measures analysis of variance with two groups and either two or four time periods. Results: The sample was predominantly male (62.5 percent) and identified as either White or Black (53 percent) and non-Hispanic (60 percent). Preoperative behavioral anxiety levels increased post-intervention in the control group (P<0.05) and decreased in the MSR group (P<0.001). Following surgery, pain intensity was greater in the control group compared to the MSR group at six hours (P<0.05) and 24 hours (P<0.01), and similar at one and four weeks. Pre- and post-intervention measures of preoperative heart rate, postoperative emergence delirium, and behavioral effects were similar between groups and over time. Conclusion: These findings suggest a novel, nonpharmacologic technique that can be utilized by various health care specialties to reduce preoperative anxiety and improve post- operative outcomes in children with autism spectrum disorder.

The application of drug behavior management methods in the treatment of dental fear and oral diseases in children: A review.

Oral behavior management methods include basic behavior management methods and drug behavior management methods. In many cases, dental treatment that cannot be done simply through basic behavior management is not possible. The uncooperative behavior of children with dental fear in oral treatment has increased the demand for medication based behavior management methods. Drug sedation can provide more effective analgesic and anti-anxiety effects, thereby helping to provide comfortable, efficient, and high-quality dental services. This article will review the drug sedation methods selected in clinical treatment of pediatric dental fear in recent years, as well as the safety and effectiveness of commonly used drugs, in order to provide guidance for dental professionals in clinical practice.

Effectiveness of auditory distraction on the management of dental anxiety in patients undergoing tooth extraction at a tertiary care hospital in Islamabad.

OBJECTIVES: The study aimed to assess the effectiveness of anxiety reduction protocol using auditory distraction in alleviating dental anxiety among patients undergoing tooth extraction. MATERIALS AND METHODS: A randomized controlled trial was conducted at the Oral Surgery Department at Islamabad Dental Hospital from July to December 2022, involving 50 patients scheduled for tooth extraction. Participants were randomly divided into two groups: an interventional group, exposed to auditory distraction, and a noninterventional group, without exposure to auditory distraction before the dental extraction. Dental anxiety was measured using the modified dental anxiety scale (MDAS) questionnaire, which scores anxiety levels on a range from 5 (not anxious) to 25 (extremely anxious). Anxiety levels were assessed in the waiting room and just before extraction, and the results were compared across both groups to evaluate the effectiveness of auditory distraction in reducing dental anxiety. RESULTS: The sample size of 50 was randomly and equally allocated to the interventional and noninterventional groups. The study population consisted of 28 (56%) female and 22 (44%) male participants. No significant difference was observed between the anxiety scores of interventional and noninterventional groups at baseline. A significant reduction in anxiety scores was observed in the intervention group during postintervention assessment, while no significant difference was seen in the noninterventional group's anxiety scores. CONCLUSIONS: The study supports the efficacy of anxiety reduction protocol using auditory distraction as a practical tool for reducing dental anxiety among patients undergoing tooth extraction.

A test of pre-exposure spacing and multiple context pre-exposure on the mechanisms of latent inhibition of dental fear: A study protocol.

BACKGROUND: Latent inhibition occurs when exposure to a stimulus prior its direct associative conditioning impairs learning. Results from naturalistic studies suggest that latent inhibition disrupts the learning of dental fear from aversive associative conditioning and thereby reduces the development of dental phobia. Although theory suggests latent inhibition occurs because pre-exposure changes the expected relevance and attention directed to the pre-exposed stimulus, evidence supporting these mechanisms in humans is limited. The aim of this study is to determine if two variables, pre-exposure session spacing and multiple context pre-exposure, potentiate the hypothesized mechanisms of expected relevance and attention and, in turn, increase latent inhibition of dental fear. METHODS: In a virtual reality simulation, child and adult community members (ages 6 to 35) will take part in pre-exposure and conditioning trials, followed by short- and long-term tests of learning. A 100ms puff of 60 psi air to a maxillary anterior tooth will serve as the unconditioned stimulus. Pre-exposure session spacing (no spacing vs. sessions spaced) and multiple context pre-exposure (single context vs. multiple contexts) will be between-subject factors. Stimulus type (pre-exposed to-be conditioned stimulus, a non-pre-exposed conditioned stimulus, and an unpaired control stimulus) and trial will serve as within-subject factors. Baseline pain sensitivity will also be measured as a potential moderator. DISCUSSION: It is hypothesized that spaced pre-exposure and pre-exposure in multiple contexts will increase the engagement of the mechanisms of expected relevance and attention and increase the latent inhibition of dental fear. It is expected that the findings will add to theory on fear learning and provide information to aid the design of future interventions that leverage latent inhibition to reduce dental phobia.

A study protocol testing pre-exposure dose and compound pre-exposure on the mechanisms of latent inhibition of dental fear.

BACKGROUND: Dental stimuli can evoke fear after being paired - or conditioned - with aversive outcomes (e.g., pain). Pre-exposing the stimuli before conditioning can impair dental fear learning via a phenomenon known as latent inhibition. Theory suggests changes in expected relevance and attention are two mechanisms responsible for latent inhibition. In the proposed research, we test whether pre-exposure dose and degree of pre-exposure novelty potentiate changes in expected relevance and attention to a pre-exposed stimulus. We also assess if the manipulations alter latent inhibition and explore the possible moderating role of individual differences in pain sensitivity. METHODS: Participants will be healthy individuals across a wide range of ages (6 to 35 years), from two study sites. Participants will undergo pre-exposure and conditioning followed by both a short-term and long-term test of learning, all in a novel virtual reality environment. The unconditioned stimulus will be a brief pressurized puff of air to a maxillary anterior tooth. Pre-exposure dose (low vs. high) and pre-exposure novelty (element stimulus vs. compound stimuli) will be between-subject factors, with stimulus type (pre-exposed to-be conditioned stimulus, a non-pre-exposed conditioned stimulus, and an unpaired control stimulus) and trial as within-subject factors. Pain sensitivity will be measured through self-report and a cold pressor test. It is hypothesized that a larger dose of pre-exposure and compound pre-exposure will potentiate the engagement of the target mechanisms and thereby result in greater latent inhibition in the form of reduced fear learning. Further, it is hypothesized that larger effects will be observed in participants with greater baseline pain sensitivity. DISCUSSION: The proposed study will test whether pre-exposure dose and compound stimulus presentation change expected relevance and attention to the pre-exposed stimulus, and thereby enhance latent inhibition of dental fear. If found, the results will add to our theoretical understanding of the latent inhibition of dental fear and inform future interventions for dental phobia prevention.

Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial.

BACKGROUND: Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. OBJECTIVE: The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. METHODS: This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery. RESULTS: The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05). LIMITATIONS: We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up. CONCLUSIONS: Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.

Dog-assisted therapy for control of anxiety in pediatric dentistry.

Anxiety is common in pediatric dental care, and affects the behavioral management of children. Animal-assisted therapy (AAT) has been shown to improve children's behavior. However, few studies have applied this technique in dentistry. The aim of the present study was to evaluate the applicability of dog-assisted therapy to control anxiety during pediatric dental treatment. Twenty children were selected from the Pediatric Dentistry Clinic of the Pontifical Catholic University of Campinas (PUC-Campinas), Brazil. Participants were divided into two groups: Control (n = 11; visits = 16), in which children were conditioned by methods routinely used in the clinic; and AAT (n = 9; visits = 23), in which children had contact with a dog therapist first at the reception desk and then again inside the office. The dog therapist stayed beside the dental chair with the child throughout the procedures. Corah's Dental Anxiety Scale (CS) and heart rate (HR) were used for evaluation of child anxiety. The results were tested for normality of distribution with the Shapiro-Wilk method, and subsequently analyzed in BioEstat 5.0. HR results were compared by Analysis of Variance (ANOVA) with Tukey's test, and CS scores, with the Wilcoxon test. There was a significant reduction in HR in the AAT group (p = 0.0069). In the Control group, HR did not change before, during, or after treatment (p = 0.6052). Controls showed a significant increase in anxiety measured by CS before and after treatment (p = 0.0455). In the AAT group, there was no change in CS scores before and after treatment (p = 0.3739). AAT could be an alternative to reduce anxiety during pediatric dental care.

Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses.

BACKGROUND: People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety. METHODS: This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by full text retrieval. Quality of the included studies was assessed using Cochrane Risk of Bias (ROB)-2 for crossover trials and data extracted by two reviewers. The details of the interventions and effectiveness were compared and discussed narratively, and comparable outcomes were included to meta-analyses using R software. RESULTS: A total of 622 articles were identified and five articles met eligibility for inclusion. Three studies used multi-sensory adaptations and one used single sensory adaptation of music. Narrative synthesis showed some evidence of SADE reducing magnitude and duration, although, questionable for reducing the number of maladaptive behaviours. Two studies demonstrated conflicting evidence of the effect of SADE on cooperation. Three studies demonstrated significant positive impact of SADE on psychophysiological outcomes. Despite an overall tendency to favour SADE, no statistically significant difference of maladaptive behaviours was found between SADE and regular dental environment (RDE) (Standardised mean change (SMC) = 0.51; 95% Confidence Interval (CI) -0.20 to 1.22; p = 0.161). SADE was superior to RDE (SMC -0.66; 95% CI -1.01 to -0.30; p = < 0.001) in reducing psychophysiological responses of dental anxiety. CONCLUSION: Current evidence suggests that adapting visual, tactile, and auditory aspects of the dental environment in a single or multi-sensory approach demonstrates small positive effects on psychophysiological responses and maladaptive behaviours of dental anxiety for people with IDD. TRIAL REGISTRATION: The title of this review was registered with PROSPERO (CRD42022322083).

Nonpharmacological Behavior Guidance for the Pediatric Dental Patient.

Purpose: To present evidence-based recommendations on nonpharmacological behavior guidance for the pediatric dental patient. Methods: The work group assessed eight systematic reviews for effectiveness of nonpharmacological behavior guidance techniques in children undergoing preventive care or a dental treatment visit. The key outcomes assessed included cooperative behavior, anxiety, and procedural pain. To formulate the recommendations, the work group used the GRADE framework to obtain consensus on domains such as priority of the problem, certainty of the evidence, balance between desirable and undesirable consequences, patients' values and preferences, acceptability, and feasibility. Results: Overall, the use of basic nonpharmacological behavior guidance techniques resulted in trivial-to-small effect on improvement in behavior or reduction in anxiety. However, for children and adolescents undergoing preventive care, mobile applications and modeling showed large effects in reduction of anxiety. For those undergoing dental treatment, strategies such as modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal-assisted therapy, combined tell-show-do, audiovisual distraction, and cognitive behavior therapy showed large reduction in anxiety. For children and adolescents with special health care needs, audiovisual distraction and sensory-adapted dental environment showed large reduction of anxiety. Conclusions: All the formulated recommendations were conditional and were mostly based on very low certainty of evidence. Conditional recommendations imply that different choices or combinations of behavior guidance techniques may be most appropriate for different patients. Clinicians should use techniques consistent with the parent/patient values and preferences. These recommendations are based on the best available evidence to-date and are intended to aid clinical decision making.

A systematic review and network meta-analysis of virtual reality, audiovisuals and music interventions for reducing dental anxiety related to tooth extraction.

BACKGROUND: Tooth extraction is a common procedure performed by oral and maxillofacial surgeons or dentists, often resulting in dental fear and anxiety. The use of relaxing music, audiovisuals, and virtual reality (VR) technologies has been employed to reduce dental anxiety. This network meta-analysis (NMA) aimed to assess the comparative effectiveness of relaxing music, audiovisuals, and VR in reducing dental anxiety associated with tooth extraction. METHODS: Four electronic databases were searched up to March 8, 2023, to identify randomized controlled trials (RCTs) evaluating different multimedia interventions, including the application of using relaxing music, audiovisuals, and VR technologies for dental anxiety. Studies utilizing various anxiety scales for tooth extraction were considered eligible. The pooled standard mean difference (SMD) and 95% confidence interval (CI) of anxiety scale scores were analyzed using Bayesian NMA. RESULTS: A total of 11 RCTs were included in this NMA. The Bayesian NMA results demonstrated that relaxing music (SMD = -0.64, 95% CI: -1.04, -0.25) and VR (SMD = -0.54, 95% CI: -1.08, -0.02) were associated with a reduction in dental anxiety, while audiovisuals (SMD = -0.34, 95% CI: -0.97, 0.33) required further consideration. Ranking probabilities indicated that relaxing music might be the most acceptable method for individuals with dental anxiety. The frequentist NMA yielded consistent rankings in a sensitivity analysis. CONCLUSIONS: Relaxing music shows the greatest potential for reducing dental anxiety related to tooth extraction when compared to other multimedia interventions.

Comparative evaluation of Tell-Show-Do technique and its modifications in managing anxious pediatric dental patients among 4-8 years of age.

Background: Dentistry has made a remarkable progress in techniques, materials and technologies, however the anxiety of the child related to dental treatment still remains constant. Tell Show Do is the most common technique behaviour management of the child in the dental clinic since many years. Recently, many modifications of Tell Show Do technique have been researched and most of them provided an enhanced potential for the conventional technique research but were always individually compared to conventional technique. Aim: To evaluate the effectiveness of Tell Show Do technique in comparison with its 4 modifications Tell Play Do, Tell Play Do with Smart Phone Dentist Game, Tell Show Play Doh, Ask Tell Ask among 4-8 years old children during restorative treatment. Methodology: 150 children aged 4-8 years were randomly selected divided into 5 groups comprising of 30 patients each. Evaluation of anxiety was done using Physiologic-Pulse Rate, Facial Image Scale and Venham's Anxiety Scale. Results: Except for Ask Tell Ask Group the anxiety level of the subjects decreased in all groups according to physiologic readings and facial image score. Anxiety Score decreased preoperatively to postoperatively in all groups except for Tell Play Do and Ask Tell Ask group according to venhams anxiety scale. Conclusion: Although Tell Show Do technique is most widely accepted and modified technique, due to changing scenarios of today's children Tell Play Do, Tell Play Do with Smart Phone Dentist Game and Tell Show Play Doh are also showing encouraging results.

The effect of virtual reality distraction on anxiety level during dental treatment among anxious pediatric patients: a randomized clinical trial.

This study evaluated the effect of Virtual Reality Distraction (VRD) on dental anxiety among anxious children undergoing prophylactic dental treatment by utilizing both subjective (Venham Anxiety and Behavioral Rating Scale (VABRS)) and objective (heart rate (HR) and salivary cortisol level (SCL)) measures. This randomized controlled study included 36 (6- to 14-year-old) healthy and anxious children who needed prophylactic dental treatment and had a history of previous dental treatment. The eligible children's anxiety level was evaluated using a modified version of the Abeer Dental Anxiety Scale-Arabic version (M-ACDAS) and those who scored at least 14 or more out of 21 were included. Participants were randomly distributed to either the VRD or control group. In the VRD group, participants wore the VRD eyeglasses during prophylactic dental treatment. In the control group, subjects received their treatment while watching a video cartoon on a regular screen. The participants were videotaped during the treatment, and their HR was recorded at four time points. Also, a sample from each participant's saliva was collected twice, at the baseline and after the procedure. The mean M-ACDAS score at baseline in the VRD and the control groups was not statistically significant (p = 0.424). At the end of the treatment, the SCL was significantly lower in the VRD group (p < 0.001). Neither the VABRS (p = 0.171) nor the HR significantly differed between the VRD and control groups. Virtual reality distraction is a non-invasive method that has the potential to significantly reduce anxiety during prophylactic dental treatment among anxious children.

Feasibility of minimum intervention oral healthcare delivery for individuals with dental phobia.

BACKGROUND: People with dental phobia often present with more active dental caries and fewer teeth. Minimally Intervention oral Healthcare offers a possible solution to address the high care needs of this group. The aim was to determine this patient group's eligibility and willingness to participate and the effect of MIOC, compared to treatment as usual (TAU), on their oral health outcomes for planning a future randomised controlled trial (RCT). Minimum intervention oral healthcare (MIOC) comprises of four interlinked domains. In the first domain, we identified and diagnosed the disease status and participants' anxiety status (≥ 19 MDAS). In the second domain, an individualised prevention-based personalised care plan was designed. During this process, patients with dental phobia were exposed to the dental environment in a stepped manner ('graded exposure') and had their urgent care provided with conscious sedation. In the 3rd domain, we took a minimally invasive operative approach to restore teeth while preserving tooth substance and limiting the use of fear-provoking stimuli (e.g., rotary instruments) when possible. At the review and the recall appointment(s) (4th domain), the patients' oral health care behaviours, disease risk/susceptibility and fear levels were re-assessed. METHODS: This two-arm randomised feasibility trial (N = 44) allocated participants to the experimental arm (MIOC) or the control arm (treatment as usual [TAU]). The primary outcomes were the eligibility and willingness to participate and feasibility to conduct a trial of MIOC for people with dental phobia. The secondary outcomes were oral health status, oral health related quality of life and care completion. A written and verbal consent for participation and dental care provision were obtained. RESULTS: Forty-four people diagnosed with dental phobia were allocated randomly to the two study arms. At the six-month recall after completed care, the outcome of each study arm was assessed. It was feasible to conduct a clinical trial (eligibility rate [56%], completion rate [81%], declined to participate [12%]). The intervention group showed improvements in all health care outcomes, and oral health related quality of life. CONCLUSION: A clinical trial of MIOC vs TAU in people with dental phobia is feasible. Preliminary findings suggest that patients in the MIOC arm are more likely to successfully complete their course of treatment. The study was 'retrospectively registered' on 02/05/2018 (ISRCT15294714) with the International Standard Randomised Controlled Trial (ISRCT).

[Dental care avoidance: catering to four different subtypes of patients]. / Zorgmijdende patiënten: benadering voor 4 subtypen van patiënten.

Only too often, it is automatically assumed that dental checkups or treatments are avoided by a subset of the patient population out of fear. To put it more correctly: to avoid the anxiety associated with dental appointments - anxiety believed to be based on fear of pain and pain increase. Following this assumption, three other subtypes of avoidant patients are being overlooked. These are care-avoiders with fear caused by trauma, self-effacing behavior or depression. Well-informed questions can initiate an understanding conversation which can break and stop this care-avoiding behavior. Patients can be referred to the general practitioner (formental health care), or to special dentistry, in more complex cases.

Comparative evaluation of the effect of audio and virtual reality distraction on the dental anxiety of healthy and mild intellectually disabled children.

Context: Dental environment is one of the most anxiety-provoking stimuli for children, which makes patient management a constant challenge in both typically growing and intellectually disabled children. Distraction is a nonpharmacological technique to manage anxiety in children during dental treatment. Aim: This study compares the effect of audio and virtual reality (VR) distraction on the dental anxiety of healthy and mild intellectually disabled children. Methods: Forty children aged 6-14 years were divided into two groups (Group I: children with mild intellectual disability and Group II: healthy children). Groups I and II were further subdivided into two subgroups of 10 children each, based on the distraction technique given to them during the first appointment. After 1 month, we carried out a cross-over of the subgroups. Anxiety levels were measured using physiological and observational parameters at three-time intervals. Statistical Analysis: Performed using paired t-test for the intergroup comparison and Wilcoxon Signed Rank test for the intra-group comparison. Results: A decrease in the pulse rate, improvement in oxygen saturation levels, and lower Venham's anxiety rating scores were observed on introducing audio and VR distraction in all the subgroups. The inter-group comparison revealed that audio and VR were more effective in healthy children than children with mild intellectual disabilities. Conclusions: Audio and VR distraction techniques can be employed successfully to reduce anxiety in children with mild intellectual disability and healthy children undergoing dental restorative treatment.

Can music therapy and aroma therapy really reduce dental anxiety and fear?

DESIGN: This study was a randomised controlled trial (RCT) designed to evaluate the effectiveness of music therapy and aromatherapy on reducing dental anxiety and fear in children during a fissure sealant treatment. CASE SELECTION: Participants were selected from three primary schools from the Phitsanulok Province in Thailand. These children were randomly allocated to a (1) Control group (n = 33), (2) Music Therapy Experimental Group (n = 33), (3) Aromatherapy Group (n = 33) and (4) Combination Experimental Group (n = 33). Measures included dental anxiety and fear scores as well as vital signs (blood pressure, heart rate and oxygen saturation level) pre- and post-fissure sealant treatment. DATA ANALYSIS: Descriptive statistics were used for categorical data. Mean and standard deviations were calculated for continuous data. For the four arms, Chi-squared tests and one-way ANOVA were used to compare base line characteristics of the participants. Paired t-tests were used to compare changes within groups in dental anxiety and fear and vital signs pre- and post-treatment. RESULTS: Overall, 128 participants took part in were in the final analysis (32, 33, 31 and 32 in groups 1-4, respectively). In the music therapy group and aromatherapy group, there was a decrease in dental anxiety and fear, blood pressure and increase in oxygen saturation level (p = 0.05). In the combination group, there was a decrease in dental anxiety and fear, heart rate, blood pressure and increase in oxygen saturation level (p = 0.05). A statistically significant interaction effect was found between combination therapy on dental anxiety and fear (F = 22.22; P < 0.001) and oxygen saturation level (F = 17.40; P < 0.001). CONCLUSIONS: The authors conclude that the findings of this RCT suggest that the use of music therapy and aromatherapy reduces dental anxiety and fear in children, and is more effective when used in combination.