Dental Fear/Anxiety in Children and Child Emotional and Behavioural Problems

ABSTRACT Objective: To investigate the association between emotional and behavioural problems and dental fear/anxiety (DFA) in children aged four to 12 years treated at a clinic in southern Brazil. Material and Methods: In this cross-sectional study where mother-child dyads were interviewed, emotional and behavioural problems were investigated using the Strengths and Difficulties Questionnaire (SDQ) (considering five subscales). Children's DFA was evaluated through the Venham Picture Test. For each SDQ subscale, Poisson regression model was explored. Prevalence ratios (PR) were estimated, considering a significant level of p ≤ 0.05. Results: Overall, 128 children participated in this study. Most children were female (54.7%) and aged between 7 and 9 years (39.8%). The prevalence of emotional problems was 47.7% and behavioural problems were 46.1%. The prevalence of DFA was 18.8%. Children with emotional problems had a 2.3 higher prevalence of DFA (95%CI 1.06-5.04). In general, behavioural problems were not associated with DFA (95%CI 0.84-3.34) only when conduct problems were considered (2.20; 95%CI 1.02-4.70). Conclusion: Children aged between 4 and 12 years who present emotional and conduct problems tend to show higher DFA.

Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

ABSTRACT Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods: Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.

Associação entre características infantis e estresse de alunos de graduação durante atendimento odontopediátrico / Association between childhood characteristics and stress in undergraduate students during pediatric dental care

Objetivo: O objetivo desse trabalho foi avaliar a associação entre as características das crianças com o estresse apresentado por estudantes de graduação em Odontologia durante o atendimento odontopediátrico. Materiais e métodos: Participaram 48 crianças com idade entre 6 e 10 anos e 37 alunos voluntários do 7º, 8º e 9º semestres de um curso de Odontologia. Foi realizado um questionário sobre aspectos socioeconômicos e também coletados dados sobre comportamento, percepção de dor e ansiedade da criança e do responsável. Ainda, foram coletados dados relacionados aos alunos da graduação: sexo, semestre, nível de estresse, tipo de procedimento realizado. Foram obtidas as frequências absolutas e relativas por meio da análise descritiva dos dados. As comparações nos desfechos de interesse foram feitas utilizando o teste quiquadrado para variáveis dicotômicas e categóricas, teste linear por linear para variável ordinal e teste exato de Fischer para contagens menor do que 5. Foi adotado um nível de significância de 5%. Resultados: Os resultados mostraram que a maioria dos operadores que atenderam crianças não colaboradoras relataram nível de estresse alto (83,33%) (p<0,001). Os operadores que atenderam crianças com nível de ansiedade médio ou alto relataram nível de estresse alto (p= 0,043) e em pacientes com dor, o nível de estresse da maioria dos operadores foi considerado alto (75%) (p=0,001). Conclusão: as características das crianças influenciaram no estresse apresentado pelo aluno operador durante o atendimento odontológico infantil. Crianças ansiosas, não colaboradoras e que estavam sentindo dor durante o atendimento deixaram o operador mais estressado.

Objective: The aim of this study was to evaluate the association between the characteristics of children and the stress presented by undergraduate dentistry students during pediatric dental care. Materials and Methods: Participants were 48 children aged between 6 to 10 years old and 37 volunteer students from the 7th, 8th and 9th semesters of a Dentistry course. A questionnaire on socioeconomic aspects was carried out and data on behavior, perception of pain and anxiety of the child and the guardian were also collected. Also, data related to undergraduate students were collected: sex, semester, stress level, type of procedure performed. Absolute and relative frequencies were obtained through descriptive data analysis. Comparisons in the outcomes of interest were made using the chi-square test for dichotomous and categorical variables, linear by linear test for ordinal variable, and Fisher's exact test for counts less than 5. A significance level of 5% was adopted. Results: The results showed that students who assisted non-cooperative children reported a high level of stress (83.33%) (p<0.001). Students who assisted children with medium or high levels of anxiety reported high levels of stress. (p=0.043) and in patients with pain, the students' stress level was considered high (75%) (p=0.001). Conclusion: The characteristics of the children influenced the stress presented by the student during child dental care. Anxious children, noncooperative and who were in pain during care left the student more stressed.

Factores asociados con la colaboración de los niños peruanos durante el tratamiento odontológico / Factors associated with the collaboration of peruvian children during dental treatment

Resumen Objetivo: Determinar los factores asociados con la colaboración de los niños peruanos durante el tratamiento odontológico. Materiales y método: Estudio observacional, analítico y transversal. Se realizó una entrevista estructurada a los acompañantes y una evaluación de la colaboración en los niños (escala de Frankl). Se investigaron los factores sociodemográficos, odontológicos (experiencia dental previa, visita dental anterior, pieza tratada y procedimiento odontológico) y psicológicos (ansiedad materna e infantil). Se utilizó la prueba de Kruskal-Wallis, chicuadrado y la regresión logística binaria. Resultados: La muestra estuvo conformada por 175 niños y sus acompañantes, estos presentaron baja ansiedad (54.95%) y los niños presentaron colaboración positiva (72.57%). La edad del acompañante y la experiencia dental previa tuvieron un valor de OR= 0.42; 95% IC: 0.103 - 1.717 y OR= 1.941; 95% IC: 0.39 - 9.656 respectivamente (p>0.05). El procedimiento odontológico y la ansiedad del niño tuvieron un valor de OR= 0.201; 95% IC: 0.043 - 0.930 y OR= 5.733; 95% IC: 1.478 - 22.238 respectivamente (p<0.05). Conclusión: Los factores asociados con la colaboración de los niños peruanos durante el tratamiento odontológico son la ansiedad del niño y el procedimiento odontológico.

Abstract Objective: To determine the associated factors with collaboration of Peruvian children during dental treatment. Materials and methods: An observational, analytical and cross-sectional study. A structured interview was carried out with the companions and an evaluation of the collaboration in the children (Frankl scale). Sociodemographic, dental (previous dental experience, previous dental visit, tooth treated and dental procedure) and psychological factors (maternal and infant anxiety) were investigated. The Kruskal-Wallis test, chisquare and binary logistic regression were used. Results: The sample consisted of 175 children and their companions, these presented low anxiety (54.95%) and the children presented positive collaboration (72.57%). The age of the companion and previous dental experience had an OR = 0.42; 95% CI: 0.103 - 1.717 and OR = 1.941; 95% CI: 0.39 - 9.656 respectively (p> 0.05). The dental procedure and the child's anxiety had an OR = 0.201; 95% CI: 0.043 - 0.930 and OR = 5.733; 95% CI: 1,478 - 22,238 respectively (p <0.05). Conclusion: The factors associated with the collaboration of Peruvian children during dental treatment are the child's anxiety and the dental procedure.

Are anxiety and the presence of siblings risk factors for dental neglect and oral health status in children?

OBJECTIVE: Neglect has a negative effect on all aspects of a child's overall health. Dental neglect is the intentional failure of parents or caregivers to take precautions and ensure the necessary dental treatment, and is closely related to dental caries and anxiety. We aimed to determine whether the presence of siblings causes dental neglect, and whether there is a relationship between dental neglect and anxiety. METHODS: The cross-sectional study included 100 children and their parents. The children's oral health status was evaluated using the DMFT/dmft and PUFA/pufa indices. In addition, the parents completed the Dental Neglect Scale and a questionnaire, while the Modified Child Dental Anxiety Scale was administered to the children to assess their dental anxiety. RESULTS: Multivariate linear regression analysis showed that the number of children in the family was statistically significantly associated with DMFT/dmft (ß=2.963; P<0.001), PUFA/pufa (ß=1.271; P=0.005), and dental neglect scores (ß=5.449; P<0.001). The PUFA/pufa scores were statistically higher among children who had visited a dentist before (ß=1.181; P=0.043). CONCLUSIONS: The high level of dental anxiety and neglect in children with more than one sibling indicates that families should be more aware of the importance of oral health.

Using Guided Imagery to Relieve the Anxiety of Preschool Children Undergoing Dental Procedures.

PURPOSE: Negative experiences in dental clinics can induce anxiety in patients, and the effects are particularly pronounced in children. When behavior guidance methods (eg, direct observation, tell-show-do, and ask-tell-ask) fail, general anesthesia is an important alternative; however, the procedure of anesthesia can also induce fear and anxiety. This study assessed the effectiveness of guided imagery in relieving the anxiety associated with dental surgery in children and caregivers. DESIGN: A prospective randomized trial with two groups. METHODS: The guided imagery in this study was meant to establish a rapport between the medical team and the patient, by encouraging the child to imagine having an adventure while riding in a spacecraft. Anxiety levels and behavior were measured using five well-established scales: the modified Yale Preoperative Scale-Short Form, the State-Trait Anxiety Inventory-6 items, the Watcha score, the Pediatric Anesthesia Emergent Delirium scale, and the Posthospitalization Behavioral Questionnaire-Ambulatory Surgery. FINDINGS: The results indicate that the guided imagery had no significant effects on anxiety levels. CONCLUSIONS: Guided imagery is a low-cost, easy-to-implement, interesting exercise capable of enhancing interactions between nursing staff and children. It may also help to condition children to the environment and thereby assist them in overcoming their fears.

Validade da Escala de Imagens Faciais (FIS) para uso com crianças brasileiras na clínica odontopediátrica / Validity of the Facial Image Scale (FIS) for use with Brazilian children in the pediatric dental clinic

O objetivo deste estudo foi avaliar a validade da Escala de Imagens Faciais (Facial Image Scale; FIS) em pacientes odontopediátricos do Rio de Janeiro, Brasil, por meio da: 1) validade de critério concorrente, medida através do Venham Picture Test ­ versão brasileira; 2) validade de construto, medida através da correlação da FIS com as variáveis idade, sexo, ansiedade percebida pelos pais/cuidadores, classificação socioeconômica (renda), primeira visita ao dentista, tipo de tratamento realizado, uso de anestesia local, experiência prévia e atual de dor de dente, índice de cárie dentária e comportamento durante a consulta odontológica; 3) avaliação qualitativa com 30 crianças de forma a conhecer se o instrumento estava capturando o sentimento da criança em relação à ATO. A forma de aplicação da FIS foi adaptada para o contexto brasileiro por um grupo de quatro odontopediatras brasileiras e uma psicóloga britânica (autora da FIS). O trabalho foi aprovado pelo comitê de ética em pesquisa do Hospital Universitário Pedro Ernesto - HUPE/UERJ. Foram incluídas crianças de três a 12 anos de idade e seus responsáveis, que compareceram ao tratamento odontológico em clínicas de odontopediatria da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro, do serviço de Odontologia da Policlínica Piquet Carneiro e do Ambulatório Naval da Penha da Marinha do Brasil. Foram excluídas crianças com deficiências e que não quiseram participar do estudo. Foi realizado um estudo piloto com objetivo de avaliar a compreensão da FIS e testar os procedimentos que seriam empregados no estudo principal, em uma amostra não probabilística de 15 crianças/responsáveis. Os resultados sugeriram que a idade poderia influenciar na mensuração da validade da escala e foi decidido realizar um processo de amostragem por cotas, adaptações das instruções de aplicação da FIS e VPT para uma linguagem mais acessível e decisão de realizar o estudo qualitativo. A amostra selecionada por cotas do estudo de validação compreendeu 150 crianças, divididas em grupos de 31 crianças nas faixas etárias 3-4 anos, 5-6 anos, 7-8 anos, 9-10 anos e 26 crianças na faixa etária de 11-12 anos; 65 (43%) eram do sexo feminino; 20 (13,3%) estavam indo ao dentista pela primeira vez; 47 procedimentos invasivos foram realizados no dia da entrevista (tratamento restaurador, procedimentos sob isolamento absoluto, exodontia e/ou tratamento endodôntico); 55 (36,7%) não tiveram experiência de cárie na dentição decídua (ceod=0) e 111 (74%) na dentição permanente (CPOD=0). O coeficiente de correlação de Spearman (rs) com a Venham Picture Test foi moderado (rs= 0,50; p<0,01) e foram encontradas associações estatisticamente significativas (p <0,05) com sexo feminino, ansiedade percebida pelos cuidadores, uso de isolamento absoluto, dor de dente atual e experiência de cárie. O estudo qualitativo encontrou discrepâncias entre a escolha da FIS e o sentimento da criança em relação à ATO em todas as faixas etárias. Os resultados sugerem que a FIS não parece ser capaz de medir de forma válida a ATO em crianças brasileiras

This study aimed to evaluate the validity of the Facial Image Scale (FIS) in pediatric dental patients in Rio de Janeiro, Brazil, based on: 1) the criterion validity, which was measured with the Venham Picture Test - Brazilian version; 2) the construct validity, using the correlation of FIS with the following variables: age, sex, DA perceived by parents/caregivers, socioeconomic classification (income), first visit the dentist, type of treatment performed, use of local anesthesia, previous and current experience of toothache, dental caries index and behavior during the dental appointment; and 3) a qualitative assessment with 30 children to evaluate if the instrument was capturing the child's feeling regarding DA. The form of application of the FIS was adapted to the Brazilian context by a group of four Brazilian pediatric dentists and a British psychologist (author of the FIS). The work was approved by the research ethics committee of the Pedro Ernesto University Hospital ­ HUPE/UERJ. Children aged 3 to 12 years old and their guardians who attended a dental appointment in the pediatric dentistry clinics of the Faculty of Dentistry of the Rio de Janeiro State University, the dental service of the Policlínica Piquet Carneiro Polyclinic and Penha's Naval Ambulatory of the Brazilian Navy were included. Children with special needs and who did not want to participate in the study were excluded. A pilot study was carried out to assess the understanding of FIS and test the procedures that would be used in the main study, in a non-probabilistic sample of 15 children/guardians. The results suggested that age could influence the measurement of FIS validity and it was decided to carry out a sampling process by quotas, adaptations of the FIS and VPT application instructions for a more accessible language and decision to carry out the qualitative study. The sample selected by quotas of the validation study comprised 150 children, divided into groups of 31 children aged 3-4 years, 5-6 years, 7-8 years, 9-10 years, and 26 children aged 11-12 years; 65 (43%) were female; 20 (13.3%) had their first dental appointment; 47 invasive procedures were performed on the day of the interview (restorative treatment, procedures under rubber dam, extraction and/or endodontic treatment); 55 (36.7%) had no experience of caries in the primary dentition (dmft=0) and 111 (74%) in the permanent dentition (DMFT=0). Spearman's correlation coefficient (rs) with the Venham Picture Test was moderate (rs=0.50; p<0.01); statistically significant associations (p<0.05) was found with female gender, anxiety perceived by caregivers, use of rubber dam, current toothache, and caries experience. The qualitative study found discrepancies between the choice of FIS and the child's feelings towards DA in all age groups. The results suggest that FIS does not seem to be able to measure DA in Brazilian children.

Sedación consciente, inhalatoria y farmacológica, su efectividad en la reconducción de la conducta del paciente pediátrico en la consulta dental: estudio observacional de corte transversal / Conscious inhalation and pharmacological sedation, its effectiveness in the reconduction of the behavior of the pediatric patient in the dental office: cross-sectional observational study

OBJETIVO: El objetivo del estudio fue evaluar si la sedación consciente reconduce o no la conducta del paciente pediátrico, en la consulta dental. METODOLOGÍA: La muestra del estudio clínico se obtuvo de sesenta y cinco pacientes que no permiten el tratamiento dental en la consulta odontológica,con edades comprendidas entre los 4 y 9 nueve años de edad. RESULTADOS: De los 65 pacientes que representa el 100% de la muestra, se obtuvo que el 86,15% pudo reconducir la conducta después de la sedación consciente. Sin embargo, en el 13,85% el comportamiento después de la sedación consciente no se pudo reconducir. CONCLUSIÓN: La sedación conscientepuede ayudar a reducir la fobia, estrés que los pacientes pediátricos presentes en la consulta dental. Asimismo, nos permiten llevar a cabo el tratamiento previsto, además de ayudar a reconducir la conducta del paciente

INTRODUCTION: The objective of the study was to evaluate whether conscious sedation redirected or not the behavior of the pediatric patient, in the dental office. MATERIALS AND METHODS: The clinical study sample was obtained from sixty-five patients who do not allow treatment in the dental office, aged between 4 and 9 years. RESULTS: Of the 65 patients representing 100% of the sample, it was obtained that 86.15% was able to redirect the behavior after conscious sedation. However, in 13.85% the behavior after conscious sedation could not be redirected. CONCLUSION: Conscious sedation can help reduce phobia, stress that pediatric patients present in the dental office. They also allow us to carry out the planned treatment, in addition to helping to redirect the patient's behavior

Técnicas en el manejo de la conducta del paciente odontopediátrico / Techniques in the management of the odontopediatric patient's conduct

INTRODUCCIÓN: El objetivo del presente trabajo fue evaluar las técnicas convencionales más utilizadas por el odontólogo para el manejo de la conducta del paciente infantil en la consulta dental. Diversas técnicas pueden ser aplicadas dependiendo del desarrollo físico y emocional del paciente y de la capacidad del profesional. La Academia Americana de Odontopediatría, en su guía sobre técnicas del comportamiento, las divide en: técnicas de comunicación, otras técnicas básicas y técnicas avanzadas, recomendando las pertenecientes al primer grupo. MATERIAL Y MÉTODO: Se realizó un cuestionario en la plataforma de Google, remitido vía email a 190 odonto/estomatólogos que tratasen pacientes infantiles, obteniendo un total de 115 respuestas adecuadas para el análisis de 8 técnicas convencionales de manejo de la conducta. El estudio estadístico se realizó en el programa SPSS aplicando el test de ANOVA para una significación de p= 0,05. RESULTADOS: La técnica más utilizada por los diferentes profesionales fue la técnica decir-mostrar-hacer seguida de refuerzo positivo y control de voz. Técnicas de modificación de la conducta ocuparon un segundo término: desensibilización seguida muy de cerca por imitación. La técnica menos empleada fue la anestesia general. No encontramos diferencias significativas en relación al sexo en ninguna de las técnicas analizadas excepto en el uso de premedicación (p: 0,027), siendo los varones los que más frecuentemente la utilizaban. No se encontraron diferencias significativas en relación a la especialidad ni con la edad de los profesionales. CONCLUSIONES: Las técnicas comunicativas fueron las preferidas por los odontoestomatólogos siendo las técnicas avanzadas las menos utilizadas

INTRODUCTION: The objective of this work was to evaluate the conventional techniques most used by the dentist for the management of the behavior of the child patient in the dental office. Various techniques can be applied depending on the physical and emotional development of the patient and the professional's ability. The American Academy of Pediatric Dentistry, in its guide on behavioral techniques, divides them into: communication techniques, other basic techniques and advanced techniques, recommending those belonging to the first group. MATERIAL AND METHOD: A questionnaire was carried out on the Google platform, sent via email to 190 dentists / stomatologists who treated child patients, obtaining a total of 115 appropriate responses for the analysis of 8 conventional behavior management techniques. The statistical study was carried out in the SPSS program by applying the ANOVA test for a significance of p = 0.05. RESULTS: The technique most used by different professionals was the say-show-do technique followed by positive reinforcement and voice control. Behaviour modification techniques occupied a second term: desensitization followed closely by imitation. The least used technique was general anesthesia. We found no significant differences in relation to sex in any of the techniques analyzed, except in the use of premedication (p: 0.027), with men being the most frequently used. No significant differences were found in relation to the specialty or the age of the professionals. CONCLUSIONS: The communication techniques were preferred by the professionals, with the advanced techniques being the least used

Percepção do paciente infantil frente à aparência dos odontopediatras e inter-relação com ansiedade e histórico odontológico / Perception of the infant patient the appearance of pediatric dentists and their relationship with anxiety and dental history

Identificar fatores que possam estar relacionados à percepção das crianças é essencial para otimizar a comunicação não verbal atribuída à aparência dos odontopediatras. Objetivou-se desenvolver e validar um instrumento para avaliar a percepção dos pacientes infantis frente à aparência dos odontopediatras, para aplicá-lo observando a influência da ansiedade e da experiência odontológica prévia. Além disso, caracterizar o perfil da ansiedade, identificando o efeito exercido por fatores socioeconômicos e histórico odontológico. O estudo incluiu 120 crianças na faixa etária de 7-12 anos. Responsáveis informaram sobre aspectos socioeconômicos, parte do histórico odontológico e experiência odontológicas prévias. As crianças responderam ao Children's Fear Survey Schedule (CFSS-DS) para verificação da ansiedade odontológica e foram examinadas para a avaliação da experiência de cárie (ceo-d/CPO-D). As crianças também avaliaram imagens de odontopediatras de ambos os sexos com diferentes paramentações (A: controle: paramentação toda branca; B: jaleco e touca estampadas, máscara colorida; C: jaleco, touca e máscara estampados; D: jaleco e touca brancos, máscara estampada) e responderam ao questionário desenvolvido, gerando um escore. Foi definido que quanto maior a pontuação, mais positiva a percepção. O instrumento passou por avaliação das propriedades psicométricas: aceitabilidade, validade e confiabilidade. Os dados foram analisados pelos testes do x2 ; Mann-Whitney; Testes de Friedman e Wilcoxon, no software IBM SPSS® , versão 21.0, considerando p<0,05. O questionário apresentou excelente aceitabilidade, validade de construto com correlações moderadas e fortes (Spearman > 0,40), estabilidade temporal satisfatória (Intervalo de Correlação Intraclasse > 0,70) e consistência interna (Coeficiente alfa de Cronbach > 0,70). Os resultados mostraram que a percepção das crianças em relação à aparência dos odontopediatras foi mais positiva com as paramentações C e D (p<0,05, Friedman). As análises intergrupos não identificaram diferenças estatisticamente significantes (p>0,05, Mann-Whitney). Comparadas à paramentação A, as crianças mais jovens apresentaram percepções mais positivas quando usada a paramentação D; meninas, crianças sem ansiedade e experiência prévia pontuaram melhor nas paramentações C e D; em crianças com experiência prévia, não houve diferença quando comparada à A, apenas entre B e C (p<0,05, Wilcoxon). Em relação à ansiedade odontológica, não houve diferença entre meninos e meninas, no entanto, as crianças mais jovens apresentaram escores médios mais altos do CFSS-DS (p=0,036; Mann-Whitney). Foi encontrada maior prevalência de ansiedade em crianças com famílias de baixa renda e que não receberam tratamento endodôntico. Escores médios mais altos do CFSS-DS também foram observados em crianças que não receberam tratamento endodôntico (p<0,05; Mann-Whitney). Assim, conclui-se que o instrumento validado exibiu boas propriedades psicométricas e avaliou que, quando comparadas à paramentação toda branca, outras opções (C e D) melhoraram a percepção em relação à aparência do odontopediatra. Ressalta-se que fatores inerentes ao paciente, como idade, sexo, experiência prévia e ansiedade odontológica não influenciaram os escores de percepção. Já, os aspectos socioeconômicos e do histórico odontológico exerceram efeito sobre o perfil de ansiedade odontológica na amostra estudada. (AU)

Identifying factors that may be related to children's perception is essential to optimize non-verbal communication attributed to the appearance of pediatric dentists. This study aimed to develop and validate an instrument for assessing the perception of child patients regarding the appearance of pediatric dentists, as well as applying it, observing the influence of anxiety and previous dental experience. Moreover, characterize the profile of anxiety, identifying the effect exerted by socioeconomic factors and dental history. The study included 120 children aged 7-12 years. Guardians informed about socioeconomic aspects, part of dental history, and previous dental experience. Children responded to the Children's Fear Survey Schedule (CFSS-DS) for verification of dental anxiety and were examined for the dmft/DMFT index assessment. The children also evaluated images of both sexes pediatric dentists with different attires (A: control: All white attire; B: Printed coat and head cap, colorful face mask; C: Printed coat, head cap, and face mask; D: White coat and head cap, printed face mask) and answered a questionnaire that generated a score. It was defined that the higher it was, the better the perception. The following psychometric properties of the instrument were assessed: acceptability, validity and reliability. The data were analyzed with the x 2 ; Mann-Whitney; Friedman, and Wilcoxon tests, in IBM SPSS® software, version 21.0, considering the level of significance in 5% (p<0.05). The questionnaire showed excellent acceptability, construct validity with moderate and strong correlations (> 0.40), satisfactory temporal stability (ICC, >0.70), and consistency internal (Cronbach's alpha coefficient, >0.70). Considering only the attires, the children's perception was more positive with the use of attires C and D (p<0.05, Friedman test). Intergroup analyses in all variables did not identify a statistically significant difference (p>0.05, MannWhitney test). In intragroup analyses, comparing to attire A: younger children showed higher perception?s scores when used attire D; Girls, children without anxiety and previous experience, attires C and D; in children with previous experience, there was no difference when compared to A, only between B and C (p<0.05, Wilcoxon test). Regarding dental anxiety, there was no difference between boys and girls, however, younger children had higher mean CFSS-DS scores (p= 0.036; Mann-Whitney test). A higher prevalence of anxiety was found in children with low-income families, and who did not receive endodontic treatment (p<0.05, x2 test). Higher mean CFSS-DS scores also observed in children that no received endodontic treatment (p<0.05; Mann-Whitney test). Thus, it is concluded that the validated instrument exhibited good psychometric properties and evaluated that although some attire options (C e D) when compared to all white attire, can improve perception regarding the appearance of pediatric dentists. It is emphasized that factors inherent to the patient, such as age, sex, previous experience, and dental anxiety, did not influence the perception scores. The socioeconomic and dental history aspects had an effect on the profile of dental anxiety in the sample studied.

Dentinogenesis Imperfecta Type II in Children: A Scoping Review.

Dentinogenesis Imperfecta type II (DI2), also known as hereditary opalescent dentin, is one of the most common genetic disorders affecting the structure of dentin, not related with osteogenesis imperfecta, which involves both primary and permanent dentitions. The purpose of this article is to perform a scoping review of the published peer-reviewed literature (1986-2017) on DI2 management in children and to outline the most relevant clinical findings extracted from this review. Forty four articles were included in the present scoping review. According to the extracted data, the following are the most important tasks to be performed in clinical pediatric dentistry: to re-establish the oral mastication, esthetics, and speech, and the development of vertical growth of alveolar bone and facial muscles; to reduce the tendency to develop caries, periapical lesions and pain; to preserve vitality, form, and size of the dentition; to avoid interfering with the eruption process of permanent teeth; to decrease the risk of tooth fractures and occlusion disturbances; to return the facial profile to a more normal appearance; and to prevent or treat possible temporomandibular joint problems. Therefore, Pediatric Dentists should bear in mind that early diagnosis and treatment, together a long-term follow-up of DI2 in children, continue to be the best approaches for achieving enhanced patient psychological well-being and, in consequence, their quality of life.

Parental Expressed Concerns about Silver Diamine Fluoride (SDF) Treatment.

Background: The staining associated with its caries arrest may be a deterrent for the use of Silver Diamine Fluoride (SDF). This study aims to elucidate the concerns that inform parents' perceptions and acceptance of SDF as a treatment option for their child. Study Design: We analyzed qualitative data obtained through an investigation in which parents attending a pediatric dental appointment participated in a survey, which included an open-ended question to evaluate their opinions about SDF staining. Thematic analysis of the comments, offered by the subsample of participants who replied to this question (n=43), yielded insights about perception of SDF therapy. Results: Most parents who provided comments were mothers (83.7%), college graduates (72.1%), primarily white (48.8%) or Hispanic (27.9%). Six themes emerged from the thematic analysis of the parents' responses: Esthetic Concerns, Psychosocial Concerns, SDF Treatment Process, Risks and Side Effects, Situational Benefits, and Dental Treatment Process. While many of the parents' comments are related to appearance, other topics that merit consideration when discussing SDF treatment were mentioned. Conclusions: Although parents are concerned about the esthetic impact of SDF, they understand the risks of alternative treatments and welcome information that will allow them to make an informed decision. Location of the cavities and visibility of the staining appear to heavily influence the decision to accept or reject this therapy.

Effect of Three Behavior Guidance Techniques on Anxiety Indicators of Children Undergoing Diagnosis and Preventive Dental Care.

Objective(s): To assess the effect of three behavior guidance techniques on anxiety indicators of children undergoing diagnosis and preventive dental care. Study Design: Sixty-three subjects (7-9 years) were divided into three groups as per the behavior guidance technique namely tell-show-do, live and filmed modeling (using Tablet Computer) to receive diagnostic (Oral examination & radiographic assessment using intraoral periapical radiographs) and preventive dental care (Oral prophylaxis and topical fluoride application). Anxiety indicators-Facial Image Scale (FIS) scores and heart rate were recorded before, during and after diagnosis/preventive treatment. Three-way repeated measures ANOVA with post-hoc analysis was performed at significance of p-value < 0.05. Results: There was a statistically significant difference in the anxiety indicators of children under the influence of different behavior guidance approaches undergoing diagnosis/preventive treatments except for mean heart rate of children while oral examination. Multiple comparison results reveal that the mean FIS scores and heart rate of children with modeling techniques were significantly better as compared to tell-show-do technique with no significant difference between the two modeling techniques. Conclusion: This study suggests that the modeling techniques (filmed and live) seem to be an efficient behavioral guidance approach for children aged 7-9 years undergoing routine diagnosis and preventive dental care as compared to tell-show-do technique.

Knowledge, attitude, and practical behavior of parents regarding their child's oral health in New Delhi.

OBJECTIVE: The objective of this study was to determine the knowledge, attitude, and practical behavior of parents regarding their children's oral health in New Delhi. METHODOLOGY: A cross-sectional study was conducted among 500 parents who reported in outpatient department in the Department of General Medicine at Maulana Azad Medical College and in the Department of Pedodontics and Preventive Dentistry at Maulana Azad Institute of Dental Sciences, New Delhi. Data were collected through a self-administered questionnaire. The statistical analysis was performed using the Statistical Package for Social Sciences software (21.0 version; Inc., Chicago IL, USA) for descriptive and multivariate analysis, and the level of statistical significance used in this study was chosen at P < 0.005. RESULTS: The results of this explorative research showed that the sample selected had a relatively good knowledge regarding the importance of the primary teeth, the fact that problems in primary teeth can affect the permanent teeth, brushing frequency on daily basis, and brushing aids. Participants were aware about the effect of prolonged bottle feeding and sticky foods on the dentition. On the other hand, the majority of participants failed to recognize the ideal time of first dental visit. Parents showed positive attitudes regarding the importance of regular dental visit and their role in their children's daily oral hygiene habits. CONCLUSION: In New Delhi, parental awareness and attitudes regarding their children's oral health are relatively good. However, the high dental caries prevalence in children in Central New Delhi contradict the study findings, which prove the fact that changing parental behavior and attitudes toward their children's oral health is far more important than increasing their knowledge only.

Prevalence of pacifier use and the impact of maternal education and regularity of dental visits on the age of pacifier withdrawal.

AIM: The aim of this study was to assess the prevalence of pacifier use among Saudi children and analyze the effects of maternal education and dental visits on the age of pacifier withdrawal. METHODS: The dental histories of mothers of 300 children with age group of 2-7 years were obtained along with their educational level, frequency of dental checkups, and age of pacifier withdrawal. Data were analyzed using the cross-tabulation and Chi-square tests. RESULTS: Forty percent (n = 133) of the children used pacifier. There was an effect of maternal education on the age of pacifier withdrawal: higher the maternal education, younger the age of pacifier withdrawal. The frequency of dental visits influenced the relationship between maternal education and age of pacifier withdrawal. CONCLUSIONS: Unhealthy oral habits such as prolonged pacifier use can be reduced with regular dental checkups and higher levels of mother education. Hence, we recommend that children should start dental visits at an early age and maintain visits at regular intervals.

The effect of the waiting room's environment on level of anxiety experienced by children prior to dental treatment: a case control study.

BACKGROUND: In addition to visit purpose, one of the environmental factors that can cause anxiety prior to dental treatment includes the waiting room experience, specifically the amount of time spent awaiting treatment and the waiting room environment. The purpose of this study was to compare the effect of the waiting room's environment on the level of anxiety experienced by children in multisensory and traditional waiting rooms. METHODS: Case control study. Test group waited for treatment in a multisensory waiting room, which consisted of a lighting column that children could touch and climb; as well as, rhythmic music played on loudspeakers. Control group waited for treatment in a traditional waiting room. Study participants were asked to answer the "Venham Picture Test", a dental anxiety scale, while in the waiting room prior to entering the treatment room. Chi-squared, Fisher's Exact tests, and linear regression were utilized. A p-value less than 0.05 was considered statistically significant. RESULTS: No significant difference in dental anxiety scores was found between the test and control groups according to waiting room type (p > .05). Dental anxiety was significantly higher in patients who had longer waiting time prior to treatment (p = 0.019). In addition, dental anxiety was significantly associated with visit purpose (p < .001): children waiting for dental examination or those scheduled for dental treatment with conscious sedation were less anxious than children waiting for emergency treatment. CONCLUSIONS: A sensory adapted waiting room environment may be less important in reducing children's anxiety prior to dental treatment. Children's dental anxiety can be reduced by preventing emergency treatments, scheduling routine dental visits and decreasing waiting time. TRIAL REGISTRATION: TRN NCT03197129, date of registration June 20, 2017.

Sedation of children undergoing dental treatment.

BACKGROUND: Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. This is the second update of the Cochrane Review first published in 2005 and previously updated in 2012. OBJECTIVES: To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 22 February 2018); MEDLINE Ovid (1946 to 22 February 2018); and Embase Ovid (1980 to 22 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted, in duplicate, information regarding methods, participants, interventions, outcome measures and results. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. Cochrane statistical guidelines were followed. MAIN RESULTS: We included 50 studies with a total of 3704 participants. Forty studies (81%) were at high risk of bias, nine (18%) were at unclear risk of bias, with just one assessed as at low risk of bias. There were 34 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Studies were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data for the primary outcome (behaviour) was possible for studies investigating oral midazolam versus placebo only. There is moderate-certainty evidence from six small clinically heterogeneous studies at high or unclear risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 1 mg/kg is associated with more co-operative behaviour compared to placebo; standardized mean difference (SMD) favoured midazolam (SMD 1.96, 95% confidence interval (CI) 1.59 to 2.33, P < 0.0001, I2 = 90%; 6 studies; 202 participants). It was not possible to draw conclusions regarding the secondary outcomes due to inconsistent or inadequate reporting or both. AUTHORS' CONCLUSIONS: There is some moderate-certainty evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is a need for further well-designed and well-reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.

Consideration of childhood psychological factors at dental appointment.

OBJECTIVE: Introduction: Paediatric dentistry is a special field of dental practice. The scope of professional activities within this field covers not only high level of expertise and technical skills tailored to the needs of young patients, but requires searching and creating positive psychological environment and communicative management of each child in order to improve daily service methods. The aim of this study is to identify and describe the main psychological characteristics of the age developmental periods of child's personality that dental professionals should regard dealing with the paediatric patients. PATIENTS AND METHODS: Materials and methods: The study involved 124 paediatric participants aged 2,5 - 15 years, who were referred to get specialized dental care at the Department of Paediatric Dentistry at the Municipal Paediatric Dentistry Hospital, Poltava. We have collected and identified behavioural patterns of children of all age groups during their contacts with dentists at the dental offices as well as studied the characteristics of childhood psyche age periods through the available literature. The data obtained were thoroughly As a result of the analysis of the obtained data, the principles for managing paediatric patients' behaviour at the dental office have been elaborated and introduced into the practice. RESULTS: Results: Outer evaluation of the children's activities performed is perceived by children as an assessment of personality, so any negative doctor's remark can provoke anxiety, irritability, and discomfort, apathy. Therefore, the paediatric specialists should remain attentive to physical and emotional indicators of stress when dealing with young patients. CONCLUSION: Conclusions: Hence, among the key tasks of a paediatric dentist is to create the friendliest and most comfortable conditions for small patients, where they have the opportunity to play toys and receive little gifts for patience and courage.

Pharmacologic management for pediatric dental patients in the 21st century.

Most children are able to cooperate during conventional, in-office dental treatment using traditional, communicative behavior guidance techniques that are carefully selected and applied to the developmental needs of a particular child. Children who are unable to cooperate during conventional treatment due to a lack of psychological or emotional maturity and/or the existence of a mental, physical, or medical disability may require pharmacologic techniques such as procedural sedation or general anesthesia to complete rehabilitative dental treatment. Patient safety dictates that careful preparation and robust case selection processes guide clinical decision-making related to pharmacologic behavior guidance. Before using these techniques, the sedation provider must demonstrate an adequate understanding of these techniques, from definitions and best practices to case selection and patient safety. This article presents essential information-with an emphasis on best practices and patient safety-for dentists who are considering pharmacologic behavior guidance for the children they treat.