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.

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.

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.

Intraoral clinical examinations of pediatric patients with anticipatory anxiety and situational fear facilitated by therapy dog assistance: A pilot RCT.

OBJECTIVE: To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients. METHODS: The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance. RESULTS: Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population. CONCLUSION: Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care.

Evaluation of dental anxiety in children with Down's syndrome using dog-assisted therapy: A pilot study.

BACKGROUND: Dental anxiety and fear are the major treatment challenges faced by pediatric dentists. Oral hygiene in children with Down's syndrome is highly compromised in comparison to their healthy counterparts. Animal-assisted therapy, through dogs, has been beneficial in alleviating dental fear and anxiety in healthy pediatric population. AIM: The aim of the study was to assess the impact of dog-assisted therapy (DAT) on children with Down's syndrome undergoing dental examination and fluoride varnish application in dental operatory. MATERIALS AND METHODS: Twenty children with Down's syndrome between 5 and 12 years of age were selected. Group A (intervention group): DAT was carried out in the dental operatory. Group B (control group): Dental treatment was performed in the absence of a therapy dog in the dental operatory. Anxiety levels were evaluated by recording the pulse rate and revised modified faces version of the Modified Child Dental Anxiety Scale (MCDAS[f]). STATISTICAL ANALYSIS: The intergroup comparison of pulse rate was done using an unpaired t-test, whereas the variation in intragroup pulse rate was analyzed using the Analysis of Variance test. The anxiety scores were subjected to a paired t-test for intragroup comparison with P < 0.05 considered to be statistically significant. RESULTS: Reduction in dental anxiety was observed in the intervention group (P < 0.001). CONCLUSION: DAT can be used as an effective behavior management technique for children with Down's syndrome undergoing dental examination and simple dental procedures in the dental operatory.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient.

AIM: Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients. METHODS: Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety. CONCLUSION: Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

Effect of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels. MATERIALS AND METHODS: A randomized, controlled, single-blinded, and observational study was conducted with 60 children, aged 8-12, who were recruited to high dental anxiety level (HDAL) and low dental anxiety level (LDAL) groups. Both groups were divided into two equal subgroups (with or without Mozart's music). In the Mozart's music subgroups, children were exposed to Mozart's Sonata for 7 min and toothbrushing training was given accompanied by music. The training was instructed to the second subgroup without listening to Mozart's music. The periodontal measurements were repeated after 15 days. Three-factor variance analysis was used to analyze the data. RESULTS: There was a statistically significant decrease in plaque index (PI) and gingival index (GI) scores in the follow-up visits for all groups (p < 0.05). A statistically significant decrease was found in PI values between groups with or without music in those with HDAL (p < 0.001). However, no statistically significant differences were found between groups with or without music in those with LDAL (p = 0.07). CONCLUSIONS: Listening to Mozart's music before toothbrushing training had a significant effect on plaque removal in children with high dental anxiety, while Mozart's music did not have a positive effect in the group with low dental anxiety. CLINICAL RELEVANCE: The use of Mozart's music may be beneficial in oral hygiene education for children with high dental anxiety levels.

A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth extraction: A randomized clinical trial.

INTRODUCTION: Behavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety. METHODS: The aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS-DS), Wong-Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness. RESULTS: CFSS-DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p = .02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p = .015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p = .35, p = .305). CONCLUSION: The use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness.

Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial.

PURPOSE: The aim of the study was to compare the effect of a stress ball, an active distraction technique with audio-visual eyeglasses, a passive distraction technique during local anaesthesia administration, on dental anxiety (primary outcome), behaviour and pain levels of children (secondary outcomes). METHODS: In this randomised controlled parallel arm trial involving 123 children aged 8-12 years, who required dental treatment under inferior alveolar nerve block, children were randomly allocated into the following three groups: Group 1: Stress ball, Group 2: Audio-visual eyeglasses, Group 3: Control group (basic behaviour guidance without distraction). Dental anxiety was measured using modified child dental anxiety scale and pulse rate, behaviour was rated using Venham's scale and pain was measured by both self-reporting and observational scales. RESULTS: No significant difference between the groups was observed for dental anxiety, but a significant decrease was seen in dental anxiety scores within all groups. No significant differences were seen between the groups for behaviour ratings and pain scores. CONCLUSION: Use of active stress ball distraction or passive audio-visual eyeglasses during local anaesthesia administration decreased dental anxiety but did not result in a significant improvement in the dental anxiety, behaviour and pain levels when compared to basic behaviour guidance without distraction. CLINICAL TRIAL REGISTRATION: The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2019/04/018768, Dated 24 April 2019).

The Effect of Music Therapy in Reducing Dental Anxiety and Lowering Physiological Stressors.

BACKGROUND AND AIM: The anxiolytic effects of music have been studied during the past twenty years in different medical therapies. The aim of this study is to evaluate the effect of music therapy on patients' dental anxiety, salivary cortisol, heart rate, blood pressure and body temperature during dental treatment. METHODS: In this randomized control study, 46 patients were randomly selected from the Urgent Care dental clinic who needed urgent endodontic treatment (endodontic access and pulp extirpation). Participants were divided into two groups: intervention group (N=23) which was exposed to slow rhythm melody music and had no lyrics throughout the entire procedure and a control group (N=23) who undergoes the same dental procedure without being exposed to music. Participants' blood pressure, heart rate, body temperature and salivary cortisol were measured before and after the treatment for both groups. RESULTS: Patients in the intervention group showed lower salivary cortisol, blood pressure, heart rate and body temperature compared to those in the control group, however, the differences did not reach to statistical significance. CONCLUSION: -Despite the change in the dental anxiety and stress during treatment with music, the findings of this study could not establish evidence of the effect of music in reducing dental anxiety and lowering physiological stressors. Therefore, further studies with larger sample size may be needed. (www.actabiomedica.it).

Effectiveness of biofeedback relaxation and audio-visual distraction on dental anxiety among 7- to 12-year-old children while administering local anaesthesia: A randomized clinical trial.

BACKGROUND: Local anaesthesia (LA) administration provokes dental anxiety in children. BrightHearts is a biofeedback relaxation application designed to reduce anxiety in children during painful procedural interventions. AIM: To compare the effectiveness of biofeedback relaxation (BR) and audio-visual (AV) distraction on dental anxiety among 7- to 12-year-old children while administering LA. DESIGN: A total of 70 children requiring dental treatment under LA for three visits were recruited for this single-blinded randomized control trial. They were randomly divided into two equal groups. Group A received BR and Group B received AV distraction during LA delivery in the first two visits, and both groups did not receive any intervention during LA in third visit. Outcomes were measured using heart rate and a cartoon-based anxiety measuring scale (Chotta Bheem-Chutki (CBC) scale). RESULTS: AV group had statistically significant higher mean heart rates than BR group (P < .001) during needle penetration and post-intervention, respectively. CBC scale showed no statistical differences between the groups. CONCLUSION: Both the interventions are effective in reducing dental anxiety during LA administration. Based on objective measures, BR is found to be better than AV distraction. Subjective scores, however, show no differences between the two.

Effect of Heartfulness Meditation on Anxiety and Perceived Pain in Patients Undergoing Impacted Third Molar Surgery.

PURPOSE: Oral-maxillofacial surgical procedures like impacted third molar surgery (ITMS) may lead to increased perioperative anxiety and pain perception in patients. Psychological interventions like meditation have been shown to decrease acute anxiety levels in individuals. The purpose of this study was to investigate the effect of heartfulness (HFN) meditation during ITMS. We hypothesized that heartfulness meditation would reduce the intraoperative anxiety and pain perception in patients undergoing ITMS procedures. PATIENTS AND METHODS: The prospective interventional study included 60 participants. They were randomly assigned to heartfulness meditation group (26 participants) and control group (34 participants). The heartfulness meditation group was given meditation before their ITMS procedure. Perioperative anxiety and pain perception were assessed using the Spielberger State - Triat Anxiety Inventory (STAI - T, STAI - S), Modified Dental Anxiety Scale (MDAS) and Numerical Rating Scale (NRS). Descriptive statistics such as frequency, percentage, mean and standard deviation were used to describe the data. Inferential statistics such as Chi-square test, Unpaired T test and Pearson correlation were used to analyze the data. RESULTS: The heartfulness meditation group reported less intraoperative anxiety (STAI - S) compared to the control group which was statistically significant (P < 0.002). There was a positive correlation between triat and situational anxiety levels of the participants. There was no significant difference between the groups in relation to dental anxiety and intraoperative pain perception. CONCLUSION: A single session of heartfulness meditation was effective in reducing the intraoperative anxiety levels in impacted third molar surgery. However, its effectiveness in reducing dental anxiety and pain perception was not significant.

The influence of distinct techniques of local dental anesthesia in 9- to 12-year-old children: randomized clinical trial on pain and anxiety.

OBJECTIVES: To evaluate pain, disruptive behavior, and anxiety in children undergoing different local dental anesthetic techniques. METHODS: This randomized/parallel clinical trial analyzed three groups of patients (9-12 years old) (n = 35) who received infiltrative anesthesia using conventional (CA), vibrational (VBA), and computer-controlled techniques (CCLAD). The outcomes were pain self-perception (Wong-Baker Faces Pain Rating Scale (WBF); Numerical Ranting Scale (NRS)), disruptive behavior (Face, Legg, Activity, Crying, Consolability Scale (FLACC)), anxiety (Corah's Dental Anxiety Scale; modified Venham Picture test (VPTm)), and physiological parameters (systolic (SBP)/diastolic pressure (DBP); heart rate (HR); oxygen saturation (SpO2); respiratory rate (RR)). Statistical analysis was accomplished using Kruskall-Wallis test and ANOVA for repeated measures (α = 0.05). RESULTS: Dental anxiety levels at the baseline were similar for all patients. CA promoted less pain than VBA in WBF (p = 0.018) and NRS (p = 0.006) and CCLAD in WBF (p = 0.029). There were no differences in disruptive behavior (FLACC p = 0.573), anxiety (VPTm p = 0.474), blood pressure (SBP p = 0.954; DBP p = 0.899), heart rate (p = 0.726), oxygen saturation (p = 0.477), and respiratory rate (p = 0.930) between anesthetic techniques. CONCLUSION: Conventional technique resulted in less pain perception for dental local anesthesia. CLINICAL RELEVANCE: Conventional technique reduces the self-reported pain in children 9-12 years old, and therefore, the use of additional devices or different anesthetic techniques is not justified.

Efficacy of aromatherapy on dental anxiety: A systematic review of randomised and quasi-randomised controlled trials.

OBJECTIVES: To evaluate the efficacy of aromatherapy on dental anxiety. METHODS: A detailed protocol was registered a priori (PROSPERO: CRD42019141093). PubMed, EMBASE, CDSR, CENTRAL, CNKI and grey literature databases were searched from inception to 10 January 2020. Randomised controlled trials (RCTs) and quasi-randomised controlled trials (CCTs) that examined the effects of aromatherapy on dental anxiety, compare to either negative control (i.e. no aromatherapy) or other positive control approaches (e.g. music), were included. The risk of bias of the selected studies was evaluated using the Cochrane Collaboration's tool and ROBINS-I, while the certainty of evidence was assessed using GRADE. A narrative synthesis was performed, rather than meta-analysis, due to the high level of heterogeneity across studies. RESULTS: Eleven RCTs and six CCTs were included. The risk of bias was identified as either high or unclear in RCTs, and moderate to serious in CCTs. Performance bias and detection bias were the most prevalent in RCTs, followed by selection bias and reporting bias. As to CCTs, greater risk of bias was found in the selection of participants into the study and in the measurement of outcomes. Based on the selected studies, the most commonly used aromatherapy for dental anxiety management was lavender fragrance, followed by orange. Compared to the negative control condition, aromatherapy might reduce the anxiety-related physiological parameters and psychometric rating, pain, and mood, alertness, and calmness compared to the negative control condition; and there might be no intergroup difference in such outcomes between aromatherapy and music. However, GRADEs of the relevant evidence were judged as low to very low. CONCLUSIONS: Compared to the negative control condition, aromatherapy is more effective to reduce dental anxiety and has comparable effects on dental anxiety compared to music intervention; however, the certainty of evidence is relatively limited. Further high-quality randomised trials with robust study design and large sample size are warranted to confirm our findings and to confirm the role of aromatherapy in relieving dental anxiety.

Assessment of dental anxiety in children between 5 and 10 years of age in the presence of a therapy dog: a randomized controlled clinical study.

PURPOSE: Children are often afraid to visit a dentist. Dental anxiety is a worldwide issue and a barrier to successful treatment outcome. Pet therapy, especially through dogs, has been demonstrated to be beneficial in reducing anxiety. In today's generation, where dopamine is prevalent, attention is hijacked, and children are tethered to screens-this research on animal-assisted therapy outlines the impact on children undergoing simple dental procedures, and to evaluate its use in long-term behavior management, and child and parental acceptance of this technique. METHODS: One hundred and two children between five and 10 years of age and requiring simple dental procedures were selected randomly and divided into two groups. In Group A, dental treatment was carried out in the presence of a therapy dog, and in Group B (the control group), dental treatment was carried out in a regular dental setup. Anxiety levels were evaluated by pulse rate and anxiety rating scale. Prior to exiting the room, the parents were asked to rate the child's interaction with therapy dogs. RESULTS: According to an independent t test, reduction in anxiety was highly significant (p < 0.001). CONCLUSION: Animal-assisted therapy is an effective behavior management strategy.

Virtual Reality Relaxation to Decrease Dental Anxiety: Immediate Effect Randomized Clinical Trial.

INTRODUCTION: Dental anxiety is common and causes symptomatic use of oral health services. OBJECTIVES: The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety. METHODS: A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking. RESULTS: Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (ß = -0.75, P < .001, for MDAS total score; ß = -0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (ß = -1.08, P < .001) and treatment-related dental anxiety (ß = -0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (ß = -0.217, P < .026) and women (ß = -0.498, P < .001). CONCLUSION: Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080). KNOWLEDGE TRANSFER STATEMENT: Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

Conscious Sedation in Dentistry.

Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.

Effect of Lavender Oil Inhalation on Reducing Presurgical Anxiety in Orthognathic Surgery Patients.

PURPOSE: We hypothesized that lavender oil inhalation, before orthognathic surgery, would have an anxiolytic effect on patients. MATERIALS AND METHODS: We executed a single-blinded, randomized, prospective study. The study comprised 90 patients (43 men and 47 women) scheduled to undergo orthognathic surgery (bilateral sagittal split, Le Fort I, and bimaxillary osteotomies). The patients were exposed to different concentrations of lavender oil diffusions in 120 mL of water during a 1-hour period before surgery (group 1, 0.1-mL oil diffusion; group 2, 0.3-mL oil diffusion; and group 3, no oil). The predictor variable was the State-Trait Anxiety Inventory (STAI). The STAI-2 was used to assess trait anxiety scores, and the STAI-1 was used to assess state anxiety scores at the time of admittance (STAI-1-A) and after 1 hour, before operating room transfer (STAI-1-OR). We performed a χ2 analysis for categorical variables, 1-way analysis of variance for continuous variables, and paired-samples t test for patients' state and trait anxiety levels. The P value was set at .05. RESULTS: No significant differences were found between groups concerning gender, age, working status, educational background, and surgical operation to be performed. When the demographic data and STAI scores were compared, the STAI-2 scores of patients in group 3 aged between 18 and 30 years and high school graduates were significantly higher. The mean trait anxiety scores were significantly higher in group 2 than in group 1. The STAI-1-OR scores in all 3 groups were significantly higher than the STAI-1-A scores. However, no statistically significant difference was found between the groups. CONCLUSIONS: The results of this study suggested that 1 hour of presurgical inhalation of 0.1-mL and 0.3-mL lavender oil diffusions in 120 mL of water did not have an anxiolytic effect on patients undergoing orthognathic surgery. Future studies will focus on different concentrations, different inhalation times, and higher study samples.