Assessment of psychological changes in young children during dental treatment: Analysis of the autonomic nervous activity and electroencephalogram.

BACKGROUND: Understanding the emotional changes in children during dental treatment is necessary for providing stress-free care. AIM: To objectively assess the stress associated with dental treatment in children, based on the autonomic nervous activity and the electroencephalogram (EEG). DESIGN: Twenty-two children aged 4-9 years were recruited from outpatients of a paediatric clinic. Electrocardiogram and EEG were recorded throughout the treatment to analyze the autonomic nervous activities and the powers of brain waves, respectively. Changes in these measurements during each treatment process were evaluated in two age groups: 4-6 years and 6-9 years. RESULTS: Elevations in sympathetic activities accompanied by decreased parasympathetic activities induced by stress were observed during rubber dam setting (RD) in the age group of 4-6 years and during infiltration anesthesia (IA), RD, and cavity preparation with a dental turbine (CP-T) in the age group of 6-9 years. Stress-related beta wave increments in EEG were observed during IA and CP-T in the age group of 6-9 years but not in the age group of 4-6 years. CONCLUSION: Monitoring the autonomic nervous activities during treatments is useful in assessing stresses in a wide age of young children, whereas EEG monitoring is applicable only to children older than 6 years.

Perception of pungent, gustatory and olfactory stimuli in patients with congenital insensitivity to pain with anhidrosis.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare disease caused by a mutation in the nerve growth factor (NGF) receptor, which results in an absence of Aδ and C fibers. It can be considered that this defect may also lead to deterioration of oral sensations. The aim of the present study was to clarify the ability of CIPA patients to perceive pungent, gustatory, and olfactory stimuli, which is essential for eating function, and the impact of the defect on dietary habits. Sensitivities to capsaicin and the five basic tastes were evaluated by measuring their threshold values, and dietary habits were examined using a questionnaire. Additionally, odor identification ability was evaluated using the odor stick method. The detection threshold for capsaicin and the recognition threshold for sour taste were significantly higher in the patients than in healthy volunteers. The questionnaire responses showed that the patients consumed spicy food more often. All patients were able to identify the tested odors, except those to which they had not been well accustomed. Since the abilities of CIPA patients to perceive taste and smell were not basically impaired, despite their lower sensitivity to capsaicin, it was suggested that their dietary habits were only minimally affected, except for intake of pungent foods.

Emotional relationships between child patients and their mothers during dental treatments.

BACKGROUND/PURPOSE: The behavioral control of child patients is an important issue in pediatric dentistry. The emotional states of the mothers of patients may influence the attitudes of their children. The aim of this study was to investigate the emotional states estimated from physiological responses of child patients and the subjective anxieties of their mothers during dental treatments and discuss the emotional relationships between children and their mothers. MATERIALS AND METHODS: To assess physiological responses associated with emotional changes induced by dental treatments in child patients aged 3-6 years, activity in the autonomic nervous were analyzed from variations in inter-beat intervals in electrocardiogram. Anxiety levels of accompanying mothers were examined using the State Trait Anxiety Inventory, which was filled out during the treatment of their child. RESULTS: Regarding the stress of child patients from the aspect of autonomic nervous activities during dental treatments, comparison between the cooperative and uncooperative patient groups showed that the uncooperative group demonstrated significantly higher sympathetic nervous activity and significantly lower parasympathetic nervous activity relative to the cooperative group, and their accompanying mothers showed significantly higher state anxiety scores relative to the mothers of cooperative children. Moreover, positive correlation between state anxiety scores of mothers and sympathetic nervous activities of their children was observed. CONCLUSION: These results indicated that uncooperative child patients undergo more stress and their mothers feel more anxiety from dental treatments, resulting in an emotional relationship between children and their mothers, which requires dental professionals to make special considerations to calm the anxiety of the mother, as well as the stress of the child patient.

Analysis of physiological responses associated with emotional changes induced by viewing video images of dental treatments.

Since the understanding of emotional changes induced by dental treatments is important for dentists to provide a safe and comfortable dental treatment, we analyzed physiological responses during watching video images of dental treatments to search for the appropriate objective indices reflecting emotional changes. Fifteen healthy young adult subjects voluntarily participated in the present study. Electrocardiogram (ECG), electroencephalogram (EEG) and corrugator muscle electromyogram (EMG) were recorded and changes of them by viewing videos of dental treatments were analyzed. The subjective discomfort level was acquired by Visual Analog Scale method. Analyses of autonomic nervous activities from ECG and four emotional factors (anger/stress, joy/satisfaction, sadness/depression and relaxation) from EEG demonstrated that increases in sympathetic nervous activity reflecting stress increase and decreases in relaxation level were induced by the videos of infiltration anesthesia and cavity excavation, but not intraoral examination. The corrugator muscle activity was increased by all three images regardless of video contents. The subjective discomfort during watching infiltration anesthesia and cavity excavation was higher than intraoral examination, showing that sympathetic activities and relaxation factor of emotion changed in a manner consistent with subjective emotional changes. These results suggest that measurement of autonomic nervous activities estimated from ECG and emotional factors analyzed from EEG is useful for objective evaluation of subjective emotion.