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.

Impact of Laughter Therapy on Anxiety and Pain in Pediatric Dentistry: A Double-Blinded Randomized, Controlled Clinical Trial

Abstract Objective: To evaluate the effect of laughter therapy on reducing anxiety and pain during dental procedures in children 5-7 years of age. Material and Methods: 48 children aged 5-7 years were included in this cross-over double-blinded clinical trial after the parents completed the Screen for Child Anxiety Related Disorder questionnaire (SCARED). After allocation into two groups: laughter intervention (A) and neutral intervention (B), the anxiety as well as pain were determined by Modified Child Dental Anxiety Scale Faces questionnaire (MCDASF) and the Wong-Baker Faces Scale, respectively. Also, the child's behavior during the treatment was recorded using the Sound, Eye, Motor scale (SEM). Data were analyzed by SPSS 21 using Paired t-test, Independent t-test, Chi-square, Mann-Whitney and Wilcoxon's test. Results: The mean score of anxiety in the laughter intervention group (17.42±2.74) was significantly less than (22.06±2.16) in the neutral intervention group (p=0.000) and lower in boys in both groups (p=0.000, p=0.047). The mean pain severity reported by the children in the neutral intervention group (5.33±1.81) was higher than in the laughter intervention group (2.38±1.87; p=0.00) and higher in girls in both groups (p=0.02; p=0.03). Conclusion: The laughter intervention before dental procedures had a significant effect on reducing anxiety and pain during dental treatment (AU).

Real-life dental examination elicits physiological responses different to visual and auditory dental-related stimuli.

BACKGROUND: Previous studies on dental anxiety have examined the psychophysiological responses evoked in dentally anxious subjects by dental-related stimuli, but not during a real-life dental examination, which was achieved in the present study. METHODS: The heart rate, skin conductance level, and heart rate variability of 25 subjects with dental anxiety and 25 healthy controls were examined. Anxiety was determined by the Modified Dental Anxiety Scale and the Dental Anxiety Scale-Revised. The psychophysiological reactions of the two groups were compared during exposure to dental-related pictures, dental-related sounds, and an actual examination in a dental surgery. RESULTS: All the dental-related stimuli provoked an increase in heart rate, i.e. visual stimuli (p<0.001; 95% CI 0.98-3.95 bpm), auditory stimuli (p<0.001; 95% CI 1.34-4.99 bpm), and a dental examination (p<0.001; 95% CI 1.26-5.39 bpm). Dental-related pictures provoked inferior skin conductance level changes compared to dental-related sounds and the dental examination (visual modality vs auditory p<0.001; 95% CI 0.039-0.152; visual modality vs examination p<0.001; 95% CI 0.083-0.275). Heart rate variability manifested in a complex pattern of responses to the dental examination. However, when exposed to all three dental-related stimuli presentation conditions, the heart rate (F = 0.352, p = 0.556), skin conductance level (F = 0.009, p = 0.926), and heart rate variability parameters of subjects with dental anxiety did not differ in comparison to the healthy controls. CONCLUSIONS: This pilot study represents an evaluation of psychophysiological reactions during a real-life dental examination compared to single modality stimuli, and shows that a real-life dental examination provokes an increase in heart rate, heart rate variability and skin conductance level. Additionally, autonomic responses did not differ between the experimental and control groups. The key issue for future studies is the effect of real-life situations on the physiological and psychological state of the subjects, which should be considered when planning new research and studied in depth.

Eficacia de la musicoterapia para reducir la ansiedad dental en niños con discapacidad / Eficacia da musicoterapia para redução da ansiedade dental em crianças com discapacidades / Effectiveness of Music Therapy in reducing dental anxiety in children with disabilities

Objetivo: Evaluar la eficacia de la musicoterapia para la reducción de la ansiedad dental en niños entre 5 a 12 años con discapacidad durante la atención odontológica. Materiales y métodos: Estudio cuasi experimental. Se evaluaron 40 pacientes, divididos aleatoriamente en 2 grupos: grupo de expuestos y no expuestos a musicoterapia. El nivel de ansiedad fue registrado por la escala de imagen facial antes y después de la atención clínica, el comportamiento durante la atención a través de la escala de Frankl y el nivel de ansiedad de los padres a través de la escala modificada de Corah. Se registraron las funciones vitales de ambos grupos antes y después de dicha atención. El análisis de los datos se realizó análisis descriptivo (media ± desviación estándar) y análisis inferencial: Test de T-Student y Chi cuadrado (p<0,05). Resultados: Se encontró que la presión arterial inicial/ final en el grupo expuesto fue (Sístole: 108.75 ± 8.56/ 95.50 ± 6.86, Diástole: 67.75 ± 7.15 / 57.75 ± 6.38), y en el grupo no expuesto (Sístole: 101.75 ± 8.77/ 110.15 ± 13.31, Diástole: 59.20 ± 6.08) respectivamente, y la frecuencia cardiaca inicial/final en el grupo expuesto (72.30 ± 7.18 / 63.95 ± 6.12); y en el grupo no expuesto (66.50 ± 9.88 / 73.90 ± 11.46). Se encontraron diferencias estadísticamente significativas en los valores de la presión arterial (sístole, p<0,001 y diástole, p=0,007) y frecuencia cardiaca final (p=0,001), así como una reducción de los niveles de ansiedad final en el grupo expuesto a musicoterapia (p=0,001).

Objetivo:Avaliar a eficacia da musicoterapia para redução da ansiedade dental em crianças com discapacidades entre 5 a 12 anos durante o atendimento odontológico. Materiais e métodos: Estudo quase experimental. Avaliou-se 40 pacientes divididos aleatoriamente em dois grupos: grupos de expostos e não expostos a musicoterapia. O nível de ansiedade foi registrado pela escala de imagem facial antes e durante o atendimento odontológico, o comportamento durante o atendimento foi através da escala de Frankl e o nível de ansiedade dos padres através da escala modificada de Corah. As funções vitais foram registradas antes e depois do atendimento. O análises de dados foi realizado através análises descritivas (média ± ds) e análises inferenciais: Teste de T-Student e Chi Quadrado (p<0,05). Resultados: A pressão arterial inicial/final no grupo exposto foi (Sístole: 108.75 ± 8.56/95.50 ± 6.86, Diástole: 67.75 ± 7.15/ 57.75 ± 6.38), e no grupo não exposto (Sístole: 101.75 ± 8.77/110.15 ± 13.31, Diástole: 59.20 ± 6.08) respetivamente, e a frequência cardíaca inicial/final no grupo exposto (72.30 ± 7.18/ 63.95 ± 6.12); e no grupo não exposto (66.50 ± 9.88 / 73.90 ± 11.46). Se encontraram diferenças estatisticamente significativas nos valores da pressão arterial (sístole, p=0,000 e diástole, p=0,007) e frequência cardíaca final (p= 0,001), assim como na redução dos níveis de ansiedade final no grupo exposto à musicoterapia (p=0,001). Conclusão: O uso da musicoterapia diminuiu significativamente os níveis da ansiedade durante o atendimento odontológico nos pacientes com discapacidades

Objective: To evaluate the effectiveness of music therapy in reducing dental anxiety in children with disabilities between 5 and 12 years old during dental care. Materials and methods: Quasi-experimental study. 40 patients were evaluated, randomly divided into 2 groups: a group exposed to music therapy and a group not exposed to it. The levels of anxiety were registered using the Facial Image Scale before and after the dental care, the behaviour during dental care using the Frank Scale and the level of anxiety of the parents using the Modified Corah Scale. The vital functions of both groups were registered before and after the dental care. The data analysis was performed using descriptive analysis (media ± standard deviation) and inferential analysis: T- Student test and Chi square (p<0,05). Results: It was found that the initial/final blood pressure in the exposed group was (Systole: 108.75 ± 8.56/ 95.50 ± 6.86, Diastole: 67.75 ± 7.15/ 57.75 ± 6.38), and in the unexposed group (Systole: 101.75 ± 8.77/ 110.15 ± 13.31, Diastole: 59.20 ± 6.08), and the initial/final heart rate in the exposed group was (72.30 ± 7.18/ 63.95 ± 6.12); and in the unexposed group (66.50 ± 9.88/ 73.90 ± 11.46). Statistically significant differences were found in the values of blood pressure (systole, p=0,000 y diastole, p=0,007) and heart rate (p= 0,001), as well as a reduction in the levels of anxiety in the exposed group to music therapy (p=0,001). Conclusion: The use of Music therapy significantly reduces levels of anxiety during dental care in patients with disabilities.

Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G).

Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G) (AU).

Fear, Avoidance, and Disability in Headache Disorders.

PURPOSE OF REVIEW: The purpose of this review is to summarize the role of avoidance behavior in headache-related disability and overview relevant clinical implications. RECENT FINDINGS: Avoidance occupies a central role in contemporary psychological perspectives on headache disorders and other chronic pain conditions. Several cognitive constructs of relevance to headache are influenced and maintained by avoidance behavior. A growing body of literature attests to the notion that avoidance of headache triggers, of stimuli that exacerbate headache, and of broader life domains can negatively affect headache progression, disability/quality of life, and comorbid psychiatric symptoms. Interventions targeting avoidance behavior, such as therapeutic exposure to headache triggers, mindfulness, and acceptance and commitment therapy (ACT), hold promise for headache disorders but need to be tested in larger trials. Researchers and clinicians are encouraged to attend to functional impairment as a critically important treatment outcome. Comprehensive understanding of headache disorders necessitates attention not merely to diagnostic symptoms and their reduction, but to patterns of avoidance behavior that inadvertently exacerbate headache and contribute to functional impairment.

Effect of music at 432 Hz and 440 Hz on dental anxiety and salivary cortisol levels in patients undergoing tooth extraction: a randomized clinical trial.

Objective The aim of this study was to compare the effects of music at 432 Hz, 440 Hz, and no music on the clinical perception of anxiety and salivary cortisol levels in patients undergoing tooth extraction. Methodology A parallel-group randomized clinical trial was conducted. Forty-two patients (average age: 23.8±7.8 years, 27 women) with a moderate level of anxiety were distributed in three groups: use of music for 15 minutes at a frequency of 432 Hz (n=15), at 440 Hz (n=15) and a control group without music (n=12). The CORAH Dental Anxiety Scale and salivary cortisol levels, estimated by the solid phase enzyme-linked immunosorbent assay (ELISA), were measured and compared before and after the music intervention between groups (two-way ANOVA-Tukey p<0.05, RStudio). Results Significantly lower anxiety level values were observed at 432 Hz (8.7±2.67) and 440 Hz (8.4±2.84) compared to the control group (17.2±4.60; p<0.05). The salivary cortisol level at 432 Hz (0.49±0.37 µg/dL) was significantly lower than 440 Hz (1.35±0.69 µg/dL) and the control group (1.59±0.7 µg/dL; p<0.05). Conclusion The use of music significantly decreased clinical anxiety levels, and the frequency of 432 Hz was effective in decreasing salivary cortisol levels before tooth extraction.

Effect of music at 432 Hz and 440 Hz on dental anxiety and salivary cortisol levels in patients undergoing tooth extraction: a randomized clinical trial

Abstract Objective The aim of this study was to compare the effects of music at 432 Hz, 440 Hz, and no music on the clinical perception of anxiety and salivary cortisol levels in patients undergoing tooth extraction. Methodology A parallel-group randomized clinical trial was conducted. Forty-two patients (average age: 23.8±7.8 years, 27 women) with a moderate level of anxiety were distributed in three groups: use of music for 15 minutes at a frequency of 432 Hz (n=15), at 440 Hz (n=15) and a control group without music (n=12). The CORAH Dental Anxiety Scale and salivary cortisol levels, estimated by the solid phase enzyme-linked immunosorbent assay (ELISA), were measured and compared before and after the music intervention between groups (two-way ANOVA-Tukey p<0.05, RStudio). Results Significantly lower anxiety level values were observed at 432 Hz (8.7±2.67) and 440 Hz (8.4±2.84) compared to the control group (17.2±4.60; p<0.05). The salivary cortisol level at 432 Hz (0.49±0.37 μg/dL) was significantly lower than 440 Hz (1.35±0.69 μg/dL) and the control group (1.59±0.7 μg/dL; p<0.05). Conclusion The use of music significantly decreased clinical anxiety levels, and the frequency of 432 Hz was effective in decreasing salivary cortisol levels before tooth extraction.

El Miedo en Relación a la Odontología Uso de la Escala del Miedo Dental / Fear in Relation to Dentistry Using the Dental Fear Scale

La atención odontológica despierta en numerosos pacientes, especialmente en los niños, miedo y ansiedad que pueden originar conductas de rechazo a la misma o dificultar el trabajo del profesional. Para registrar la prevalencia e identificar los miedos más frecuentes en relación a la atención odontológica, se realizó un estudio observacional, descriptivo y longitudinal en un trabajo interdisciplinario con Musicoterapia. Se utilizó la Escala del Miedo (CFSS-DS), Dental Subscale of the Childrens' Fear Survey. Los resultados en un promedio de edades en años 11,41; desvío = 2,80, registraron el 53% en la puntuación 38:39. Corresponde 54.34% al sexo femenino y 45.66% al sexo masculino. El mayor porcentaje de miedo se registró a los 10 años de edad 15.24% y en el sexo femenino 54.34%. En conclusión, registrar y reconocer los miedos dentales ofreció un espacio de reflexión y elaboración de los mismos, con docentes y alumnos de grado, para desarrollar, en un tratamiento interdisciplinario con musicoterapia, estrategias que favorezcan una mejor adherencia de los pacientes al tratamiento odontológico y habilidades inherentes y habilidades sociales inherentes a la relación odontólogo-paciente. El miedo manifiesto a la atención odontológica sin ser resuelto satisfactoriamente puede entorpecer las mejores intenciones del profesional en el desarrollo de su tarea (AU)

Nocebo/Placebo Effects in Dental Practice: Two Key Protagonists / Efectos Nocebo/Placebo en la práctica dental: Dos protagonistas clave

ABSTRACT Understanding the possible effects that a patient's psycho-neurobiological processes (such as the nocebo effect) may have on the every-day dental treatments, could assist the clinicians in preventing the onset of adverse events not related directly with the clinical procedure. At the same time, employing pathways to trigger plausible placebo effects could aid the clinician to enhance the outcome of ordinary clinical procedures and the patient's perspective. Identified factors, which could lead both to positive or negative effects, may be present in different ways. Prior personal experiences, second-hand information, alternative medicine, catastrophizing or patient motivation; all could have an indirect effect in the treatment outcome. A well-informed clinician should use such factors to individualize each patient treatment.

RESUMEN Comprender los posibles efectos que los procesos psico-neurobiológicos de un paciente (como el efecto nocebo) pueden tener en los tratamientos dentales diarios, podría ayudar a los clínicos a prevenir la aparición de eventos adversos que no estén relacionados directamente con el procedimiento clínico. Al mismo tiempo, el uso de vías para favorecer posibles efectos placebo podría ayudar al clínico a mejorar el resultado de sus procedimientos rutinarios y la perspectiva del paciente. Los factores identificados, ya sean positivos o negativos, pueden estar presentes de diferentes maneras. Experiencias personales anteriores, información de segunda mano, medicina alternativa, actitud catastrófica o motivación del paciente; todos podrían tener un efecto indirecto en el resultado del tratamiento. Un médico bien informado debe usar dichos factores para individualizar el tratamiento de cada paciente.

[Effect of psychological nursing based on relaxation training for the psychological state in patients with impacted third molar removal surgery].

Objective: To discuss the effect of psychological nursing based on relaxation training for the psychological state in patients with impatced third molar removal surgery. Methods: A total of one hundred patients with impacted third molar removal surgery were selected from June 2015 to June 2017 in People's Liberation Army No. 105 hospital. According to the nursing method, all patients were divided into psychological intervention group and the control group, 50 cases in each group, the control group was given routine nursing intervention and the psychological intervention group was given psychological nursing intervention based on relaxation training. Results: The after intervention Corah's modified dental anxiety scale (6.3±1.2), Stouthard dental fear scale (62.9±6.5) scores and heart rate [(76.4±5.2) bpm], systolic blood pressure [(102.5±6.3) mmHg], diastolic blood pressure [(75.3±3.1) mmHg] levels of psychological group were significantly lower than those of the control group. The once removal success rate, intraoperative relaxation sense rate of psychological group were significantly higher than those of the control group, the teeth extraction time of psychological group was significantly lower than that of the control group, the difference was statistically significant (P=0.013, P=0.003). Conclusions: Psychological nursing intervention based on relaxation training can effectively improve the mental state and stress state of patients with impacted third molar removal surgery, which is beneficial to the process of the surgery.

Mental imagery in dentistry: Phenomenology and role in dental anxiety.

Dental anxiety is a prevalent problem with marked psychological, physical and public health implications. Based on cognitive theory and evidence, we hypothesized that vivid, sensory image-based cognitions play a role in dental anxiety. A quantitative online survey (N = 306) and qualitative semi-structured interviews (N = 18) found that vivid sensory images were common irrespective of dental anxiety levels, but that their content, associated distress and responses varied. Participants reporting higher anxiety experienced intense and intrusive fear-provoking dental imagery focusing on unpleasant sensations, which were associated with the intrusive recollection of negative past experiences and avoidance of dentistry. Participants with lower anxiety ratings, reported images that were less distressing and centered around reassuring aspects and positive appointment outcomes, potentially acting as protective factors against dental anxiety and facilitating appointment attendance. The inclusion of components aimed at reducing intrusive memories and dental imagery rescripting may help improve interventions for dental anxiety.

Effectiveness of Acupressure on Dental Anxiety in Children.

PURPOSE: Acupressure is a non-invasive variant of acupuncture and is known to reduce general anxiety. The purpose of this study was to test acupressure's effect on children's dental anxiety. METHODS: Eight- to 12-year-old children undergoing scaling and/or restorative procedures were randomly assigned to one of the following groups: acupressure (Group 1); sham (Group 2); or control (Group 3). Anxiety was recorded for all the children using the Modified Child Dental Anxiety scale (MCDAS). Acupressure beads with a piece of adhesive strip were employed over the selected acupoints for groups one and two. Anxiety was further recorded for all the children prior to and after completion of the treatment using MCDAS. The Frankl scale was used as the objective measure to assess the behavior of all the children. A physiologic parameter (pulse rate) was also recorded. The scores obtained from all the three groups were tabulated, compared, and analyzed statistically. RESULTS: A significant difference was found in MCDAS, pulse rate, and the Frankl behavior ratings among the three groups of children, with acupressure group displaying a lower level of anxiety. CONCLUSION: Acupressure can be a viable alternative to reduce dental anxiety in children undergoing scaling and restorative procedures.

Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective.

OBJECTIVE: The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective. MATERIAL AND METHODS: The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls. RESULTS: Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear. CONCLUSIONS: The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.

Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis.

OBJECTIVES: This meta-analysis investigates the efficacy of non-pharmacological interventions in adults undergoing dental procedures under regional or general anesthesia compared to standard care alone or an attention control group on the reduction of mental distress, pain, and analgesic use. DATA SOURCES: To identify relevant papers a comprehensive literature search was carried out in MEDLINE, CENTRAL, Web of Science, and PsycINFO (last search August 2017). Additionally, lists of references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text Database was screened to identify any unpublished material. STUDY SELECTION: A total of 29 eligible randomized controlled trials were included, comprising a total of 2.886 patients. Included trials investigated the effects of hypnosis, enhanced information, relaxation, music, or cognitive-behavioral approaches including distraction. RESULTS: Random effects meta-analyses revealed significant positive treatment effects on the reduction of mental distress (g = 0.58, CI 95% [0.39; 0.76]). Effects on pain relief (g = 0.00, CI 95% [-0.28; 0.28]) and the reduction of analgesic use (g = 0.26, CI 95% [-0.22; 0.73]) were not significant. Because effects on mental distress were substantially heterogeneous, subgroup analyses were run yielding significantly larger effects for studies with low risk of bias compared to studies with high or unclear risk of selection and attrition bias. No significant differences appeared between various types of non-pharmacological interventions. CONCLUSIONS: In summary, benefits of non-pharmacological interventions on reducing mental distress were demonstrated with largest effects being shown for hypnosis. However, further high quality trials are needed to strengthen the promising evidence. CLINICAL SIGNIFICANCE: This systematic review and meta-analysis indicated that non-pharmacological interventions may be beneficial for reducing mental distress in patients undergoing dental procedures and could thus be considered as valuable adjunct to standard care.

Effects of music intervention on anxiety and pain reduction in ambulatory maxillofacial and otorhinolaryngology surgery: a descriptive survey of 27 cases.

PURPOSE: The aim of this study is to determine patients' opinion regarding listening to music before an ambulatory maxillofacial surgery and effects on anxiety and pain reduction. METHODS: This study was conducted on outpatients having a maxillofacial surgery between December 2015 and April 2016 at Poissy/Saint-Germain-en-Laye hospital (France). Patients listened with headphones to an easy-listening music in the operation theater before the first ambulation. A questionnaire including a visual analog scale (VAS) for pain and anxiety was given to participants. The primary endpoint was to determine patients' opinion regarding listening to music before surgery. Secondary endpoints were to determine VAS pain mean, VAS anxiety mean before surgery, VAS anxiety mean after surgery, and if patients wanted to listen to their own playlist. We decided to compare VAS anxiety and pain mean between patients who accepted to listen to music (ALM) and who refused to listen to music (RLM). RESULTS: Nineteen patients ALM and 8 patients RLM to music. 78.9% of patients considered that listening to music before surgery decreased their anxiety. In patients who ALM, the mean (standard deviation, SD) of VAS pain after surgery was 3.42 (1.95), the mean (SD) of VAS anxiety before surgery was 3.1 (2.3), and the mean (SD) of VAS anxiety was 1.21 (0.85). There was a statistically significantly difference of the VAS anxiety mean (SD) before surgery between patients who ALM 3.10 (2.30) and who RLM 6.12 (1.88) (p = 0.005). There was a statistically significantly difference of the VAS anxiety mean (SD) after surgery between patients who ALM 1.21 (0.85) and who RLM 2.62 (1.30) (p = 0.009). Fifty percent of the patients wanted to choose their own music. CONCLUSION: Music seems to reduce anxiety before maxillofacial surgery. An interventional randomized study is needed to demonstrate the positive impact of music on anxiety before maxillofacial surgery.

[Is supplemental ear acupuncture for surgical tooth removal with local anesthesia effective? : A pilot study]. / Ist die Supplementierung der Ohrakupunktur bei operativer Zahnentfernung in Lokalanästhesie effektiv? : Eine Pilotstudie.

BACKGROUND: The application of ear acupuncture can contribute to a reduction of acute pain. Data on the application of ear acupuncture following oral surgery in odontology is insufficient. OBJECTIVE: This study investigated the effectiveness of ear acupuncture as an auxiliary analgesic treatment in addition to local anesthesia for operative tooth removal. METHODS: In this prospective open non-randomized pilot study (in accordance with the CONSORT publication) 2 cohorts of 50 patients each with the indications for an operative tooth removal either with or without the application of ear acupuncture in addition to local anesthesia with articain were observed. Patients were allocated to the groups according to their preference. Pain intensity while resting and while chewing was recorded as the primary parameter for a period of 10 days. The secondary parameters were the subjective experience of anxiety and symptoms, such as headaches, dizziness and nausea. RESULTS: The two groups did not differ significantly with respect to demographic variables or the use of local anesthetics. At the various measurement intervals, pain intensity while resting or chewing differed significantly between the two groups (ANOVA, p = 0.004, p = 0.007, respectively). Furthermore, the experience of anxiety (ANOVA, p = 0.0001), the number of patients taking analgesics (χ2-test, p = 0.017) and the total postoperative consumption of analgesics (t-test, 0.001) revealed significant differences. In both groups the numerical rating scales (NRS) for postoperative headaches, dizziness and nausea were low. DISCUSSION AND CONCLUSION: Despite a potential bias and methodological limitations of the study design, the results of this investigation suggest that ear acupuncture influences the experience of pain and anxiety in the postoperative period after tooth removal. As a treatment method with low adverse effects ear acupuncture can contribute to postoperative pain control, especially in patients with preoperative anxiety.

Relationship between Child and Parental Dental Anxiety with Child's Psychological Functioning and Behavior during the Administration of Local Anesthesia.

OBJECTIVES: The aims of this study were to determine: 1) the relationship between children's psychological functioning, dental anxiety and cooperative behavior before and during local anesthesia, 2) the relationship of parental dental anxiety with all the above child characteristics. STUDY DESIGN: There was a convenient sample of 100 children (4-12 years). Child dental anxiety and psychological functioning were measured using the "Children's Fear Survey Schedule" (CFSS-DS) and the "Strengths and Difficulties Questionnaire" (SDQ) respectively. Parental dental anxiety was measured using the "Modified Dental Anxiety Scale" (MDAS). All questionnaires were completed by parents. Before and during local anesthesia, the child behavior was scored by one experienced examiner, using the Venham scale. Non-parametric tests and correlations (Mann-Whitney, Spearman's rho) were used for the analysis. RESULTS: The mean SDQ score was 10±5.6 for boys (n=60) and 8.3±4.8 for girls (n=40) (p=0.038), but there was no correlation with children's age. The mean CFSS-DS score was 33.1±11.86 and there was no correlation with age or gender. Children with higher levels in the pro-social subscale of the SDQ had significantly less anxiety and better behavior before local anesthesia. Higher mean CFSS-DS scores were significantly associated with uncooperative behavior during local anesthesia (p=0.04). There was no correlation between parents' and their children's dental anxiety, psychological functioning and behavior. 46% of the children had previous dental experience in the last 6 months. As time since the last dental treatment increased, an improvement was found in children's behavior during local anesthesia. CONCLUSIONS: Child psychological functioning was related to dental anxiety and behavior during dental appointment involving local anesthesia.