Experiential learning for children's dental anxiety: a cluster randomized trial

Abstract

Background Dental anxiety (DA) has an impact on the quality of dental treatment and may have long-lasting implications for children. A recent study introducing experiential learning (EL) into children's oral health promotion resulted in better oral hygiene. The purpose of the study is to evaluate whether EL can reduce children's DA. Methods In September 2018, we recruited 988 children aged 7-8 years from 24 classes to participate in a cluster-randomized trial. Classes were randomly assigned to EL (in which children received a lively presentation on oral health and participated in a role play in a simulated dental clinic in the classroom) or the Tell-Show-Do (TSD) group (in which children received a conventional TSD behavior management). The primary outcome was the prevalence of DA after the procedure of pit and fissure sealant (PFS), assessed by a modified children's fear survey schedule-dental subscale. Secondary outcomes were changes in blood pressures (BP) and pulse rates (PR) before and after the PFS procedure. The intervention effects were estimated by means of mixed effect models, which included covariates of gender and school (and baseline value for BP and PR only), and a random cluster effect. Results In 396 children of the EL group who received the PFS treatment, the prevalence of DA (score > 38) was 18.5%, compared with 24.3% in 391 children of the TSD group (OR=0.65; 95% confidence interval, 0.46-0.93; P =0.019). The increases in BP and PR after the PFS were also significantly less in the EL group. Conclusions School-based experiential learning intervention before a dental visit is feasible and effective in lowering children's dental anxiety.