Outcome of Conventional versus Digital Mode of Behaviour Modification With or Without Maternal Presence in Paediatric Dental Patients- A Pilot Study

Abstract

Introduction: In managing paediatric patients most common challenge is to encounter child’s fear and anxiety during dental procedures. In modern era smart phone dentist games can be used as a modification of Tell Show Do (TSD) technique. Aim: To evaluate the effectiveness of different behaviour modification techniques in paediatric patients at first dental visit and to compare conventional techniques: TSD, TSD + maternal presence, Mobile Dental game (MD) and MD + maternal presence as behaviour modification techniques in preschool children. Materials and Methods: The present pilot study (a randomized parallel group clinical trial) was conducted in the Department of Paediatric and Preventive Dentistry of Faculty of Dental Sciences, SGT University, Gurugram,Haryana from July 2021 to December 2021 over a period of 6 months in 80 children Between the age group of 4 to 6 years with deft (d=decayed, e=extracted due to caries, f=filled, t=teeth) <3 and caries in any primary second molar indicated for Glass Ionomer Cement (GIC) filling, visiting the dentist for the first time. Patient with Frankl behaviour rating score of 1 and 2 accompanied by their mothers with positive dental attitude were included. Patients were equally divided into four groups. Behaviour was assessed using Frankl behaviour rating scale, Raghavendra, Madhuri, Sujata Pictorial scale (RMS-PS) and Face, Leg, Activity, Cry, Consolability (FLACC) scale before and after treatment. Results: The mean age of patients in the study was 4.99±0.92 years. The difference between pre and post Frankl behaviour rating score and RMS-PS were statistically significant in all the four groups (p<0.01), whereas difference in pre and post FLACC score was significant in group 2 and 4 (p<0.01). On comparing mean RMS-PS between four groups, significant difference was observed in group 1 and 4 (p<0.01). When mean FLACC score was compared, significant difference was observed between mean scores of Group 1 compared to Group 2 and Group 4. Conclusion: In the present study all the behaviour modification techniques showed improvement in child’s behaviour but use of digital mode of behaviour management along with maternal presence in paediatric dental operatory had displayed significantly better results.

Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis

“…There were 3 studies published during or before the 1990s [ 57 , 58 , 59 ], 4 studies published in the 2000s [ 60 , 61 , 62 , 63 ], and the majority of the included studies were published in the 2010s ( n = 30) [ 31 , 35 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ] and 2020s ( n = 29) [ 50 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , ...…”

“…The age of the participants ranged from 3 to 12 years old. The investigated NPBIs included Tell–Show–Do ( n = 2) [ 75 , 92 ], distraction ( n = 6) [ 50 , 75 , 81 , 92 , 109 , 110 ], video modelling ( n = 4) [ 77 , 80 , 87 , 88 ], virtual reality (n = 9) [ 72 , 74 , 82 , 85 , 93 , 100 , 102 , 109 , 110 ], and visual pedagogy ( n = 3) [ 69 , 78 , 95 ].…”

“…Two independent reviewers (S.S.A, H.C) evaluated the risk of bias across the 66 included studies using the Cochrane risk of bias 2 tool [ 53 ]; the results varied. Overall, most of the included studies were assessed to be of some concern (n = 44) [ 19 , 31 , 35 , 58 , 59 , 60 , 61 , 64 , 65 , 67 , 68 , 69 , 70 , 72 , 74 , 75 , 77 , 79 , 80 , 82 , 83 , 87 , 88 , 89 , 91 , 92 , 95 , 96 , 97 , 98 , 100 , 102 , 105 , 106 , 107 , 109 , 110 , 111 , 113 , 114 , 115 , 116 , 117 , 118 , 119 ], 10 studies were evaluated to have an overall high risk, likely due to the risk of bias in randomisation and allocation concealment [ 44 , 50 ,…”

“…The effect of distraction versus TSD in reducing DFA was evaluated in 6 studies while children first received their dental examination [ 50 , 75 , 81 , 92 , 109 , 110 ]. The distraction technique resulted in a significant reduction in child-reported DFA, as shown in the FIS (MD: −0.55; 95% CI: −0.80, −0.30; p < 0.001) [ 75 , 92 , 109 ], VPT (MD: −0.56; 95% CI: −0.88, −0.23; p = 0.001) [ 75 , 81 ] and CFSS-DS (MD: −0.40; 95% CI: −0.79, −0.01; p < 0.043) [ 110 ].…”

“…Secondary outcomes were other indirect evaluations of children’s DFA, including scales of children’s behaviours, pain levels, and behavioural scales include the Frankl Scale (FS) [ 2 ], Venham Behaviour Rating Scale (VBRS) [ 45 ], and other validated scales [ 46 , 47 , 48 ]. Pain levels scales included the Wong–Baker Faces Pain Rating Scale (WBFS) [ 49 ], Face, Legs, Activity, Cry, Consolability (FLACC) Scale [ 50 ], Visual Analogue Scale (VAS) [ 51 ], or other validated scales (3), and physiological responses in response to DFA, such as heart rate/pulse rate (HR/PR) and blood pressure [ 52 ].…”