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.

The influence of immigrant background on the choice of sedation method in paediatric dentistry.

The effects of immigration on the demographics of the Swedish population have changed the situation for many dental care providers, placing increased demand on cultural competence. The aim of this investigation was to study the choice of sedation method among children with immigrant background, referred to paediatric dentistry specialists, because of behaviour management problems or dental fear in combination with treatment needs. The material consisted of dental records from children referred to two clinics for paediatric dentistry: 117 records from children with an immigrant background and 106 from children with a non-immigrant background. Information about choice of sedation method (conventional treatment, conscious sedation with midazolam, nitrous oxide, or general anaesthesia) and dental status was collected from the records. The number of missed appointments (defaults) was also registered. Binary logistic regression analyses were used to calculate the influence of potential predictors on choice of sedation method. The mean age of the patients in the immigrant group was 4.9 yrs, making them significantly younger than the patients in the non-immigrant group (mean 5.7 yrs). In the immigrant group, 26% of the patients defaulted from treatments, while the corresponding frequency was significantly lower for the reference group (7%). The numbers of primary teeth with caries and permanent teeth with caries were positively and significantly correlated with the choice of treatment under general anaesthesia. Conscious sedation was used significantly more often in younger children and in the non-immigrant group, while nitrous oxide was preferred in the older children. In conclusion, conscious sedation was more frequently used in the non-immigrant group. The choice of sedation was influenced by caries frequency and the age of the child.

A four-year longitudinal study of palatal plate therapy in children with Down syndrome: effects on oral motor function, articulation and communication preferences.

The orofacial function in 20 children with Down syndrome was evaluated after 4 years of palatal plate therapy in 9 of the children (PPG); the remaining 11 were untreated age-matched controls (CG). All 20 children had received continuous orofacial physical therapy from their speech therapist during the treatment period. A clinical extra- and intraoral examination was performed, including oral motor function, facial expression, the occurrence of malocclusions, and hypertrophic tonsils. A questionnaire requesting data on breathing patterns, drooling, eating problems, and communicative preferences was answered by the parents. An articulation assessment was performed by two speech and language pathologists blinded to the treatment status of the children in order to find out whether the palatal plate had stimulated to improved oral speech behavior. The results for oral motor function showed significant differences between the groups in favor of the PPG for the summary variables for: visible tongue (P < 0.01), visible tongue during non-speech periods (P < 0.05), and lip-rounding during spontaneous speech (P < 0.01). During non-speech time, the PPG had their mouths open significantly less than the CG (P < 0.05). Expressivity of facial expression on a visual analog scale in the PPG scored 75.6 +/- 13.3 compared to 51.8 +/- 25.7 in the CG (P < 0.05). The intraoral examination showed that 6/9 children in the PPG and 7/11 in the CG had enlarged tonsils, resulting in more than 50% inter-tonsillary space reduction. Despite these findings, and no significant differences between the groups with respect to mouth/ nose breathing, nocturnal snoring was significantly less in the PPG than in the CG (P < 0.05), according to the parental questionnaire. After 4 years of palatal plate therapy, orofacial function had improved significantly in the 9 PPG children and specifically in terms of tongue position and lip activity.