Effectiveness of behavioral modification techniques with visual distraction using intrasulcular local anesthesia in hearing disabled children during pulp therapy

Abstract

Objective:Assessing the effectiveness of behavioral modification techniques in combination with visual distraction with/without video eyewear using computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in hearing-impaired pediatric patients undergoing pulp therapy of primary molars.Materials and Methods:This randomized, crossover clinical study includes 15 children (7 boys and 8 girls), mean age was 6.1 years. Children were randomly distributed into two groups (Group A, n = 7; Group B, n = 8). The study involved three sessions, 1-week apart. During Session I, employing Tell-Show-Do technique, prophylactic dental cleaning was done while participants were watching a movie with sign-language interpretation with/without visual eyewear. At the end of Session I, score on Smiley Faces Program was used for anxiety assessment. During Session II and III, respectively, both groups underwent pulp treatment of equivalent teeth in the opposite sides of the mouth with/without video eyewear vice versa. After the procedure, children were instructed to rate their pain during treatment on the Wong-Bakers' (WBs') Faces Pain Scale. Changes in pulse oximeter and heart rate were recorded every 5 min. Paired sample t-test and independent sample t-test were used to assess the significance of changes during each visit.Results:There was a significant (P > 0.04) change in the heart rate observed for Group A underwent pulp treatment while watching video using video eyewear. Self-reported mean pain score also increases during treatment sessions' with video eyewear, for both groups.Conclusion:Routine psychological (Tell-Show-Do) intervention along with visual distraction with full visibility of the surrounding and use of CDS-IS system for anesthetic delivery is recommended as an effective behavior management technique for children with hearing impairment undergoing invasive dental treatment.

Effect of audiovisual distraction on the management of dental anxiety in children: A systematic review

“…In respect to pain, Asvanund's study reported that audiovisual eyeglasses significantly reduced pain scores is consistent with our review . But in 2016, Fakhruddin's study reported the results of pain is inconsistent between groups . Regarding behavior, Isong's results support our review .…”

“…With respect to pulse rate, Asvanund and Sullivan's studies were consistent with our review . Fakhruddin's results are inconsistent between groups; however, Vincent and Isong's trial found no significant difference in pulse rate . In the matter of children satisfaction, some studies showed that subjects preferred using audiovisual distraction during dental treatment which supports our review.…”

“…[27][28][29] But in 2016, Fakhruddin's study reported the results of pain is inconsistent between groups. 37 Regarding behavior, Isong's 32 results support our review. 21,[25][26][27]29 In contrast, some studies showed that using virtual reality during dental treatment did not significantly affect behavior.…”

Motivation chart as a supporting tool in pediatric dentistry

“…Of the abovementioned psychological management techniques, the tell-show-do, distraction and molding techniques are seen as good alternatives for reducing anxiety and fear in children during dental treatment, as indicated by the studies of Rezende et al 2 and Fakhruddin et.al. 17 . Unlike in the literature, however, these psychological tactics were not successful in permitting adequate dental treatment and the attempt to become the patient's friend was almost always hampered, mainly due to the mother's conduct.…”

Non-pharmacological methods of fighting dental anxiety

“…However, the operating field should remain fully visible, although in the case of patients with no hearing issues, watching pictures on a screen is less effective than using VR goggles. This may be due to the fact that children with impaired hearing have no control over their surroundings and experience anxiety whenever they are unable to maintain visual contact [33].…”