Effectiveness of the "pain-free dental injection" (PaFein) teaching model in reducing children's pain: A randomized, controlled study.

PURPOSE: This study explores the effectiveness of a comprehensive structured teaching model - the "PaFein" - for instructing postgraduate pediatric dental residents in the provision of pain-free local anesthesia to children. METHODS: Ten postgraduate pediatric dental residents and 172 children between the ages 5 and 13 participated in the study following ethical approval. The previously measured baselines guided the randomization of study and control groups. The study group (five residents) attended the PaFein course (9 hours). Based on power calculations, residents performed dental injections (8 mandibular block, 8 palatal/lingual and 14 buccal infiltrations) in randomly assigned child patients. Demographic data of residents/children, parental and self-report anxiety scores and Visual Analogue Scale (VAS) pain scores were noted to examine children's anxiety and pain during dental injections. RESULTS: Children's mean anxiety score did not differ significantly between groups; however, VAS pain reports during dental injections (a, b, c, d) were found lower in the PaFein study group than the control group (p < 0.05). VAS pain reports for (a) buccal injections were 1.08 and 1.9 (p = 0.02); (b) inferior alveolar nerve blocks were 1.58 and 3.37 (p = 0.0002); (c) palatal/lingual injections were 1.34 and 3.02 (p < 0.0001); (d) total means were 1.28 and 2.59, respectively (p = 0.0001). VAS pain reports of anxious and non-anxious children in the PaFein study group (1.63 and 1.17) were also lower than the control group (3.33 and 2.39) (p < 0.0001 and p = 0.005). CONCLUSION: The "PaFein" teaching model was found to be effective in training dental residents to reduce dental injection pain in children, including the anxious ones.

Effect of self-efficacy and empathy characteristics of post-graduate residents on local anesthesia administration performances: Pilot study.

PURPOSE: The "Profile and Competences for the European Dentist" document addresses some competencies as a must for graduating dentists, some of which are stated as providing humane and compassionate care to all patients and administering local anesthesia for pain management. Within this perspective, this study aims to investigate the effect of self-efficacy and empathy characteristics of post-graduate residents (post-grads) on the perceived pain and anxiety scores of children during local anesthesia administrations. MATERIALS AND METHODS: Ten pediatric dentistry post-grads and 91 children aged between 5 and13 years participated in the study. Post-grads performed 120 injections as part of their routine dental treatment in children. Demographic data, self-efficacy, and empathy scale scores of post-grads, anxiety, and pain scores of children were recorded during injections. RESULTS: Self-efficacy scale scores of residents ranged between 66 and 74 with a mean score of 69.80 ± 2.69. Empathy scale scores were between 77 and 97 and the mean was 89.20 ± 6.24. Significant and negative correlations were observed between self-efficacy scores of post-grads and pain scores of children (r = -0.205 and p = 0.025). Empathy scores of post-grads established a significant and positive correlation with children's anxiety scores (r = 0.244 and p < 0.007). CONCLUSIONS: Self-efficacy and empathy characteristics of post-grads were found to have an impact on the perceived pain and anxiety scores of children during local anesthesia administrations. Empathetic post-grads with higher self-efficacy provided an enhanced local anesthesia experience for child patients. Therefore, educational programs should also be organized aiming to develop self-efficacy and empathy characteristics of post-grads for a more humane and compassionate dental experience in child patients.

Association of amoxicillin use and molar incisor hypomineralization in piglets: visual and mineral density evaluation.

AIM: The aim of the present study was to determine the prevalence of MIH both visually and quantitatively, and describes the range of mineral densities of enamel specimens from three groups of piglets where two groups were given different doses of amoxicillin in infancy. METHODS: In this blind randomized clinical study, 20 piglets were randomly divided into three groups. Group A received a standard dose (50mg/kg/day) and Group B received a high dose (90mg/kg/day) of amoxicillin in selected days of the month (20 working days) they were born. Group K did not receive any medication and served as control. Thirteen right mandibular permanent first molars (PFMs) were randomly collected from 3 groups of piglets at age 10 months for evaluation under X-ray micro-tomography. Tomographic data were obtained using a Skyscan 1174 compact micro-CT in the Department of Anatomy. RESULTS: Prevalence of MIH was 0% in all groups. MD values were quantified after enamel grey level (0-255) measurements on horizontal cross-sectional slices. After MD measurements, the effects of amoxicillin use on MIH are presented. CONCLUSIONS: While MIH is a multifactorial disturbance, the present study attempted to highlight the clinical findings of a possible relationship between amoxicillin use and MIH with the aid of X-ray micro-tomography.

Is it the injection device or the anxiety experienced that causes pain during dental local anaesthesia?

AIM: The aim of this study was to investigate the influence of anxiety and type of dental injection, a plastic syringe or an electronic computerized device, on the pain perceived by children. DESIGN: Two dental injectors, a computerized device (Wand, Milestone Scientific, Livingston, NJ, USA) and a traditional plastic syringe, were compared. Forty-one children, aged 9-13 years, who had registered for treatment in Marmara University, Istanbul, Turkey, were included in the study. Both anxious and non-anxious children were included in the study group. The Children's Fear Survey Schedule-Dental Subscale, Facial Image Scale, Spielberger's State Anxiety Index for Children, and heart rates were used to determine the anxiety levels. Participants were assigned to interventions by using random allocation. The first appointment was designed as an introductive familiarization session and injections were administered in the second and third sessions, with one or the other injector. The visual analogue scale was used for pain measurement after injections. RESULTS: No significant differences in injection pain scores were observed between the Wand and traditional plastic injector. Higher levels of pre-injection anxiety were found to be related to more severe pain reports by the children. CONCLUSIONS: Anxiety plays an important role in the pain reaction of children, and was found to be more determinative in pain perception than the injection devices preferred.

Children's preferences concerning the physical appearance of dental injectors.

PURPOSE: This pilot study was carried out to assess how the physical appearance of dental injectors influenced children's choice. METHODS: The study group consisted of 34 randomly selected children (17 boys, 17 girls) between the ages of 7 and 11 (mean age=8.6 +/- 1.4), who had been registered for treatment at the School of Dentistry, Marmara University. A combination of tests-the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Venham Picture Test (VPT), and facial image scale (FIS)-were used to assess the multi-dimensional character of children's dental anxiety. Dental injectors (Wand, Citoject, traditional metal injector [MI], and plastic injector [PI]) were displayed on a tray and introduced to the children. The children were asked to consider which injectors they would choose "if their tooth had to be put to sleep," and their preferences were noted starting with their first choice. RESULTS: The children's first choice was: (1) the Wand (56%); (2) PI (29%); (3) Citoject (12%); and (4) MI (3%). The anxious children (n= 13) preferred the Wand with significantly higher ratings (Wand=84%; Citoject=8%; MI=8%; PI=0%). CONCLUSION: The physical appearance of dental injectors is important to children and even more important for children who are anxious.