Evaluation of the effectiveness of tell-show-do and ask-tell-ask in the management of dental fear and anxiety: a double-blinded randomized control trial.

Background: The objective of behavioral guidance is to establish effective communication that aligns with a child's requirements to manage disruptive behavior. This study aimed to evaluate the effectiveness of the Tell-Show-Do and Ask-Tell-Ask techniques in managing dental anxiety in children during their initial appointment. Methods: The study included 50 children (28 boys and 22 girls) without any prior experience between the ages of 7 and 11 at their first dental visit. The children were randomly categorized into two groups: Group 1, Tell Shows Do, and Group 2, Ask-Tell-Ask. Subsequently, all children underwent noninvasive treatment procedures such as restorations, sealants, and oral prophylaxis. Furthermore, behavioral management techniques were employed based on the allocated group. Finally, anxiety levels for all children were assessed using the Raghavendra, Madhuri, and Sujata Pictorial Scale (RMS-PS) and heart rate at three different intervals (before, during, and after). The obtained data were entered into Microsoft Excel, and statistical analysis was performed using SPSS software. A paired t-test and Mann-Whitney U-test were used to compare the mean and median values of the two groups and determine their effectiveness. Results: Children in the TSD group exhibited statistically significant heart rates and RMS-PS scores in intra-group comparisons. However, children in the ask-tell-ask group showed a significant reduction only in the RMS-PS scores (P < 0.001) but not in the measures used to assess heart rate (P < 0.001). Conclusion: Tell-Show-Do was more effective than ask-tell-ask in alleviating dental anxiety in children. The simultaneous application of these two strategies can synergistically alleviate dental anxiety during a child's initial dentist appointment.

Comparative evaluation of "Tell-Tell-Tell," "Ask-Tell-Ask," and "Teach back" communication techniques on oral health education among 12-13-year-old children - An educational intervention trial.

Background: Effective communication with children can improve their understanding and aid in complying with oral hygiene instructions. Aim: The aim is to compare the retentiveness of oral hygiene instructions in children educated using three communication techniques. Methodology: One hundred and twenty children in the age range of 12-13 years were included in the study. Baseline awareness of oral hygiene maintenance was assessed using a questionnaire. Twenty children were randomly assigned to each group: Tell-Tell-Tell, Ask-Tell-Ask, Teach-back, and information provided. Knowledge was reassessed after a week; data were tabulated and assessed statistically. Results: There were no statistically significant differences in the baseline data among the groups (P > 0.05). Regardless of the group, there was an improvement in knowledge regarding the frequency and timing of brushing as well as the cause of dental caries after the intervention. However, children in Ask-Tell-Ask and Teach back showed significant improvement over Tell-Tell-Tell (P ≤ 0.01). Conclusion: Communication strategies, such as Ask-Tell-Ask and Teach back, which have a strategy to involve children, have been shown to be superior over Tell-Tell-Tell.

Erratum: Addendum: Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial.

[This corrects the article on p. 345 in vol. 21, PMID: 34395902.].

Erratum: Addendum: Comparative evaluation of efficacy of Physics Forceps versus conventional forceps in pediatric dental extractions: a prospective randomized study.

[This corrects the article on p. 547 in vol. 21, PMID: 34909472.].

Memojis Pain Scale: A novel pain assessment tool.

BACKGROUND: Dental pain exerts a considerable impact on the psychosocial well-being of children; reliable management of pain depends on the ability to assess pain intensity. AIM: To validate and compare a new memojis pain assessment scale with the Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPS) in assessing dental pain experienced by children. DESIGN: Two hundred and fifty healthy children aged 5-9 years without any past dental experience and requiring local anaesthesia (LA) administration were recruited. Three different scales [FPS-R, WBFPS and Memojis Pain Scale (MPS)] were applied to assess the children's pain during LA administration. The preferences of each child based on the ease of understanding the faces were recorded. RESULTS: Pearson correlation test was performed to determine the correlation between MPS with WBFPS and MPS with FPS-R. A strong correlation was seen when comparing MPS with WBFPS (r = .966; p < .001) and MPS with FPS-R (r = .969; p < .001), and 81.6% of the children preferred MPS. CONCLUSION: The Memojis Pain Scale was an effective pain assessment tool. It can be employed as an alternative scale for pain assessment in children.

The clinical and radiographic success of Endoflas compared with other root canal obturating materials in primary teeth: A systematic review.

Pulpectomy aims at retaining the tooth in the asymptomatic state until exfoliation. Root canal obturating materials should resorb in synchronization with the primary root and get eliminated rapidly upon accidental extrusion. This systematic review aims at appraising the clinical and radiographic outcomes of Endoflas as an obturating material for primary teeth. An extensive literature search on obturating materials used for primary teeth using MeSH terms in PubMed, Cochrane library, and Ovid® from September 2002 to March 2020. Studies evaluating the clinical and radiographic success of Endoflas as an obturating material in children were included. From 45 retrieved articles, eight qualified for the systematic review. Moderate quality of evidence was elicited in this review. There was a dramatic reduction of inter radicular radiolucency in Endoflas obturated teeth compared to other root canal filling materials. Even for resorption of the extruded material beyond the apex too, Endoflas has depicted a faster clearance rate. Hence,it was concluded that, Endoflas can be a potential root canal obturating material for treating the primary teeth, even with furcal radiolucency. We recommend randomized clinical trials satisfying all the norms of CONSORT guidelines to provide a high quality of evidence.

Pulp oxygen saturation measurement as a diagnostic tool for assessing pulp status in primary teeth: A systematic review and meta-analysis.

Objectives: This study aimed to determine the mean oxygen saturation values (SpO2) in primary teeth using pulse oximetry. Materials and Methods: This comprehensive literature search on pulse oximeter used for primary teeth in determining pulp vitality using MeSH terms in four electronic databases, including PubMed, Scopus, Cochrane Library, and OvidSP, from January 1990 to January 2022. Studies reported the sample size and the mean SpO2 values (with standard deviations) for each tooth group were included. The quality assessment of all the included studies was done using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa Scale. The meta-analysis included studies reporting means and standard deviations of SpO2 values. The I2 statistics were used to determine the degree of heterogeneity among the studies. Results: A total of 90 studies were identified, of which five met the eligibility criteria that were qualified for the systematic review, and among them, three were included in the meta-analysis. All five included studies were of low quality due to the high risk of bias related to the patient selection, index test, and uncertainties about outcome valuation. In the meta-analysis, the mean fixed-effect measure of oxygen saturation in the pulp of primary teeth was 88.45% (confidence interval: 83.97%-92.93%). Conclusion: Though most of the available studies were of poor quality, the SpO2 in the healthy pulp can be established (minimum saturation, 83.48%) in primary teeth. Reference values established might help clinicians to assess changes in pulp status.

Comparative evaluation of efficacy of Physics Forceps versus conventional forceps in pediatric dental extractions: a prospective randomized study.

BACKGROUND: This study aimed to determine the efficacy of Physics Forceps in pediatric dental extractions. METHODS: This was a double-blind, randomized controlled trial with a parallel-arm design and identical allocation ratio (1:1). Children (n=104) were randomly divided into two groups for extraction of mandibular primary teeth (group I: Physics Forceps; group II: conventional forceps). The outcome variables assessed in the study were the time taken for extraction, pre- and postoperative anxiety (using RMS pictorial scale), incidence of fractured teeth, and postoperative pain on the first and third days (using the Wong-Baker faces pain scale). RESULTS: A significant reduction (P < 0.001) in intraoperative time, anxiety, and incidence of tooth fracture was confined to group I. The pain significantly reduced from the first to the third postoperative day in both groups, but the mean reduction in RMS scores in the physics forceps group was far better than that in the conventional forceps group. CONCLUSION: Physics Forceps aid in extraction of primary teeth with minimal trauma to supporting structures, as well as reducing anxiety in the pediatric population.

Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial.

BACKGROUND: This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration. METHODS: This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4-11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05. RESULTS: Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group. CONCLUSION: External vibration using a Buzzy® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.

Evidence based management guidelines in dentistry during the COVID-19 pandemic - a review of the literature.

The present COVID-19 pandemic presents a high risk of transmission. Several infection control procedures have been employed to alleviate the further spread of this disease. The dental practice could be a potential risk factor for the transmission of this virus, which has a potential for aerosol generation. For a successful dental practice, effective infection control guidelines have to be established using relevant scientific research. In this perspective, the present article focused on current systematic reviews with evidence based effective treatment protocols during this pandemic.

Comparative evaluation of the effectiveness of a mobile app (Little Lovely Dentist) and the tell-show-do technique in the management of dental anxiety and fear: a randomized controlled trial.

BACKGROUND: Behavior guidance is a technique used to subdue inappropriate behavior by establishing communication that meets the needs of a child. This study aimed to measure the effectiveness of a mobile app (Little Lovely Dentist) compared to the tell-show-do (TSD) technique in managing anxious children during their first dental visit. METHODS: Fifty children (30 boys and 20 girls) without any past dental experience, aged from 7 to 11 years, were randomly allocated into either the dental app group or the TSD group. The pre- and post-operative anxiety of children who underwent prophylactic cleaning was assessed both physiologically and subjectively using a heart rate measurement and the RMS pictorial scale, respectively. RESULTS: The intragroup comparison of heart rate and RMS scores for children allocated to the dental app group was statistically significant (P value ≤ 0.001). However, a significant reduction only occurred in the RMS scores, but not the heart rate measurements, in the TSD group. Conversely, there was an increase in heart rates in the TSD group. CONCLUSION: Educating the child prior to a dental procedure using a smartphone application such as Little Lovely Dentist can significantly alleviate the anticipatory anxiety and engage children in dental treatment during their first visit.