RGUHS Nat. J. Pub. Heal. Sci Vol No: 17 Issue No: 1 pISSN:
Dear Authors,
We invite you to watch this comprehensive video guide on the process of submitting your article online. This video will provide you with step-by-step instructions to ensure a smooth and successful submission.
Thank you for your attention and cooperation.
1Dr. Sahana Bhatt, Post Graduate Student, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India.
2Department of Paediatrics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
3Department of Paediatrics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
4Department of Paediatrics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
*Corresponding Author:
Dr. Sahana Bhatt, Post Graduate Student, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India., Email: shnbhtt96@gmail.com
Abstract
Background: Dental anxiety in children, primarily triggered by the anticipation of pain, often discourages them from seeking necessary dental treatment.
Aim: This study compares the effectiveness of camouflaged metal cartridge syringes and conventional disposable 2 mL syringes with insulin syringes in delivering nerve block anesthesia among children aged 6 to 10 years.
Method: This randomized, crossover clinical trial included 20 pediatric patients aged 6-11 years from the outpatient ward of the Department of Paediatrics and Preventive Dentistry. Each patient required treatment in two quadrants of the same jaw and underwent two clinical sessions. Local anesthesia was administered using either a conventional 2 mL disposable syringe and an insulin syringe or a camouflaged metal cartridge syringe. Pain perception and anxiety levels were assessed using the FLACC behavior pain scale, pulse rate monitoring, and the Wong-Baker Faces Rating Scale (FRS). Patient preferences were recorded and behavioral assessment was conducted using the Wright et al. (1991) scale. Statistical analyses were performed using SPSS Version 22.0.
Results: Findings reveal a significant reduction in pain perception and anxiety levels in children receiving injections via camouflaged syringes. Additionally, physiological responses, such as pulse rate measurements post-procedure, were notably lower in the camouflaged syringe group, highlighting decreased anxiety. Patient preferences strongly leaned towards camouflaged syringes, reinforcing the need to prioritize patient comfort.
Conclusion: These results suggest that integrating camouflaged syringes into a pediatric dental practice can enhance patient cooperation, alleviate fear and encourage consistent dental visits, ultimately improving oral health outcomes.
Keywords
Downloads
-
1FullTextPDF
Article
Introduction
Many children avoid dental care due to anxiety associated with pain. Research highlights the crucial role of pain perception in shaping dental fear, emphasizing the importance of accurate and pain-minimized administration of local anesthesia during pediatric dental treatments.1,2
Addressing dental fear requires creative solutions such as the Syringe Sleeve by AngelusTM, which conceals the appearance of a syringe within a playful, autocla-vable toy-like casing resembling an alligator. This approach effectively diverts a child's attention, enhancing their overall dental experience.3,4
Dental anxiety has a considerable impact on children's oral health and willingness to seek treatment, according to studies by Olak et al. and Bedi et al.5,6 Rantavuori et al. and Klingberg & Berren found that parental dental dread influences a child's level of anxiety.7,8 Fear of injections causes significant dental suffering in youngsters, demanding effective management measures.
Various interventions have been proposed to mitigate these concerns. Studies by Chhabra & Chhabra and Kumar et al., emphasize the role of parental education in shaping children's attitudes toward dental care.9,10 Ozbek et al., and Alkhadra explore how distraction techniques, such as camouflaged syringes, can effectively reduce dental anxiety in pediatric patients.11,12
Understanding the psychological underpinnings of dental fear is essential for formulating effective intervention strategies. The conditioning theory of fear development, examined by Rachman, and qualitative analyses by Gao et al., provide insights into dental anxiety in children.13,14 Prospective studies by Ortiz et al. and Tickle et al., further highlight the importance of long-term assessment in managing procedural anxiety.15,16
To address dental fear in children, a comprehensive approach integrating behavioral strategies, psycholo-gical interventions and parental education is necessary. Utilizing distraction techniques such as camouflaged syringes can significantly improve children's experiences, fostering positive attitudes toward dental visits.
This study seeks to assess and compare the efficacy of camouflaged metal cartridge syringes, conventional disposable 2mL syringes, and insulin syringes in administering nerve block anesthesia to children aged 6 to 10 years. Objectives of the study includes evaluating the effectiveness of camouflaged syringes in reducing pain perception during local anesthesia administration and comparing the efficiency of disposable 2mL syringes and insulin syringes in delivering nerve block anesthesia in 6 to 11-year-old children when combined with camouflaged metal cartridge syringes.
Materials and Methods
Study setting: A randomized, crossover study was conducted on subjects from the Department of Paediatrics and Preventive Dentistry outpatient ward, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru.
Selection Criteria: Children from 6 to 12 years of age have treatment needs in two different quadrants (either in the maxillary or mandibular arch), a minimum of two clinical appointments of similar operative procedures on both sides of the same jaw preceded by LA injection, children demonstrating positive behavior during pretreatment evaluation (ranking 3 or 4 on the Frankl scale) were included in the study. Children with emergency treatment needs, such as abscess, cellulitis, and space infection, and those needing premedication for dental treatment, medically compromised patients, uncooperative children, and children allergic to local anesthetic agents were excluded from the study.
Sample Size: The required sample size for each group was 20 patients. Each patient has 2 quadrants involved, leading to 40 arches. Power of Study = 0.80.
Method: Each child received injections using different syringe types across two sessions, ensuring they acted as their own control. The study utilized insulin syringes, camouflaged syringes, and standard disposable 2mL syringes.
In the first and second sessions, participants were randomly assigned to receive injections with either a conventional syringe and an insulin syringe or a camouflaged metal cartridge syringe. Pain perception and anxiety levels were assessed using the FLACC behavior pain scale, pulse rate monitoring, and the Wong- Baker Faces Rating Scale (FRS). Patient preferences for syringe type were also recorded.
The child's response was monitored and documented using the validated Wright et al. (1991) scale. Additionally, verbal instructions were provided to help children express their pain levels using the Wong- Baker FRS, which ranges from 0 (no pain) to 5 (severe pain). Data collected were analyzed to determine the effectiveness of different syringe types in reducing pain and anxiety during local anesthesia administration.
Statistical Analysis
Statistical analyses was performed using the Statistical Package for Social Sciences (SPSS) for Windows Version 22.0, Released 2013, Armonk, NY: IBM Corp.
Results
Age & Gender Distribution: The study included 40 participants, 60% of whom were between 6 and 8 years old and 40% of whom were in the 9-11 age group. The mean age of the study population was 8.3 years, with a standard deviation of 1.46.
Comparison of FLACC Scale Scores: When comparing the FLACC scale scores between the two groups using the Chi-Square test, it was found that 80% of participants in the alligator Group (Group 1) reported only mild discomfort during local anesthesia administration, whereas only 40% in the conventional Group (Group 2) experienced mild pain (Figure 1). The discomfort was more severe in the conventional group, with 35% experiencing moderate pain and 20% experiencing severe discomfort or pain.
The discomfort was more severe in Group 2 compared to Group 1.
Comparison of Wong Baker Facial Pain Rating Scale Scores: Significant differences were observed between the two groups in terms of the Wong Baker Facial Pain Rating Scale scores. Participants in the alligator group had a mean score of 4.10, while those in the conventional group had a mean score of 8.20 (Figure 2). This suggests that participants in the alligator group experienced significantly less pain compared to those in the conventional group.
Comparison of SEM Scale Scores: The Mann Whitney test revealed a significant difference in SEM scale scores between the two groups. Participants in the alligator group had a mean score of 4.40, whereas those in the conventional group had a mean score of 6.85 (Figure 3). This indicates that participants in the alligator group exhibited lower levels of discomfort during the injection procedure than those in the conventional group.
Comparison of Pulse Rate Before & After Treatment: When comparing the mean pulse rate before and after treatment between the two groups using the Independent Student t-test, it was found that there was a statistically significant decrease in pulse rate after treatment in both groups. However, the decrease was more pronounced in the alligator group (from 76.30 to 88.80 bpm) compared to the conventional group (from 77.20 to 95.80 bpm) (Figure 4).
Conclusion
Camouflaged syringes significantly reduce pain and anxiety levels in children during local anesthesia administration compared to conventional syringes. Their implementation in pediatric dentistry can improve patient experiences, reduce dental fear, and encourage positive attitudes towards dental care.
Conflicts of Interest
Nil
Supporting File
References
1. Peretz B, Nazarian Y, Bimstein E. Dental anxiety in a students' paediatric dental clinic: children, parents and students. Int J Paediatr Dent 2004;14(3):192-8.
2. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007;17(6):391-406.
3. Wright GZ, Alpern GD. Variables influencing children's cooperative behavior at the first dental visit. J Dent Child 1971;38(2):124-8.
4. Primosch RE, Kavita M. Assessment of pain control in children undergoing restorative dentistry using a computerized local anesthetic delivery system. Pediatr Dent 2001;23(5):401-6.
5. Olak J, Saag M, Vahlberg T, et al. Children's dental fear in relation to dental health and parental dental fear. Stomatologija 2013;15(1):26-31.
6. Bedi R, Sutcliffe P, Donnan PT, et al. The prevalence of dental anxiety in a group of 13- and 14-year-old Scottish children. Int J Paediatr Dent 1992;2(1):17-24.
7. Klingberg G, Berren J. Dental fear and behavior management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007;17(6):391-406.
8. Rantavuori K, Zerman N, Ferro R, et al. Dental fear of Finnish children in the light of different measures of dental fear. Acta Odontol Scand 2002;60(4):231-6.
9. Chhabra N, Chhabra A. Parental knowledge, attitudes, and cultural beliefs regarding oral health and dental care of preschool. Int J Clin Pediatr Dent 2012;5(2):91-5.
10. Kumar S, Mohammadi JJ, Mehta S, et al. The prevalence of dental anxiety among children of public and private schools of Panchkula, Haryana, India. J Indian Soc Pedod Prev Dent 2013;31(1): 8-13.
11. Ozbek M, Ceyhan D, Atac A, et al. Behavioral evaluation of child dental patients with the aid of digital video disc. J Oral Sci 2007;49(3):189-95.
12. Alkhadra TA. Reducing dental anxiety in children: comparing the efficacy of behavioral management techniques. Saudi J Dent Res 2016;7(1):1-5.
13. Rachman S. The conditioning theory of fear-acquisition: a critical examination. Behav Res Ther 1977;15(5):375-87.
14. Gao X, Hamzah SH, Yiu CK, et al. Dental fear and anxiety in children and adolescents: qualitative exploration of child-related factors. BMC Oral Health 2013;13:82.
15. Ortiz FR, Zanetti CH, Delli K, et al. Procedural pain and dental anxiety in children: a prospective investigation. J Oral Facial Pain Headache 2018; 32(2):176-84.
16. Tickle M, Marshman Z, Humphris G, et al. Relative effects of dental pain and dental anxiety on the behavioural change in children. J Dent Res 2012;91(5):460-5.
17. Kuhn BR, Allen KD. Expanding child behavior management technology in pediatric dentistry: a behavioral science perspective. Pediatr Dent 1994;16(1):13-7.
18. Wright GZ, Alpern GD. Variables influencing children's cooperative behavior at the first dental visit. J Dent Child 1971;38(2):124-8.
19. Primosch RE, Kavita M. Assessment of pain control in children undergoing restorative dentistry using a computerized local anesthetic delivery system. Pediatr Dent 2001;23(5):401-6.
20. Wright GZ, Weinberger SJ, Marti R, et al. The use of imagery suggestions during administration of local anesthetic in pediatric dental patients. ASDC J Dent Child 1977;44(1):10-3.