Pain and anxiety in children receiving atraumatic and conventional restorative dental treatment - a randomized clinical study

Abstract

ABSTRACT:The aim of this study was to assess previous anxiety and pain perceived by children while receiving atraumatic restorative treatment (ART) and conventional restorative treatment (CT). Seventy-nine children, aged between 5 and 8, who had at least two decayed deciduous molars, were selected. Each child agreed to the two kinds of treatment dispensed, one for each tooth and one for each treatment appointment, at random. The sample was distributed into two groups: Group 1 (G1) -children were submitted to CT in the first appointment and to ART in the second appointment -and; Group 2 (G2) -children were submitted to ART in the first appointment and to CT in the next appointment. The children reported dental anxiety before receiving the treatment and intensity of pain after the procedures, using the Facial Image Scale (FIS) and the Wong-Baker FACES ® Pain Rating Scale, respectively. The heart rate was also measured before and during the procedures. The results demonstrated that anxiety (heart rate and FIS scale) exhibited a statistical difference in G1 (p <0.05), however, there was no difference between the groups when ART was performed first (p >0.05). Children subjected to CT experienced higher levels of pain than those who were subjected to ART, regardless of the order of treatment (p <0.001). It was concluded, therefore, that ART possibly caused lower levels of pain in 5 to 8-year-old children when compared to CT, however, it did not reduce prior anxiety levels in the second session, using CT.

The Impact of Minimal Intervention Dentistry on Patient-Reported and Observation-Based Outcomes in the Pediatric Population: A Systematic Review and Meta-Analysis

“…Out of the 56 texts, 30 were excluded due to the following reasons: irrelevance ( n = 2), non-randomized controlled trial ( n = 2), no retrieval of English full text ( n = 7), registered protocol only ( n = 1), reporting oral health-related quality of life ( n = 8), clinical success ( n = 5), subjects were adolescents (1) or with special healthcare needs (1) and caregiver-reported outcomes ( n = 3). Subsequently, only 26 [ 14 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] studies were included for the final qualitative and quantitative analysis and data extraction (Kappa k: 1) ( Supplementary Table S2 ). A summary of the PRISMA flowchart [ 50 ] for identification and screening the eligibility of the papers, final inclusion of the studies and reasons for exclusion are illustrated in Figure 1 .…”

“…Ultimately, the 26 included studies [ 14 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] represented 4699 participants from 5 Asian countries [ 34 , 37 , 38 , 43 , 45 ], 1 Australasian country [ 29 ], 8 European countries [ 14 , 27 , 31 , 35 , 42 , 46 , 47 , 48 ], 11 Southern American countries [ 25 , 26 , 28 , 30 , 32 , 33 , 39 , 40 , 41 , 44 , 49 ] and 1 African country […”

“…Ten [ 25 , 27 , 29 , 30 , 31 , 32 , 36 , 42 , 44 , 49 ] of the studies used Facial Image Scale (FIS) or variants of this scale (e.g., Delighted Terrible Faces scale, Visual Analogue scale) to measure the participant’s level of anxiety. An additional seven [ 26 , 28 , 33 , 38 , 40 , 42 , 44 ] studies employed the WBFS or the Hedonic scale to assess the child’s pain, discomfort and acceptance during the treatment. Eight studies [ 37 , 41 , 42 , 43 , 45 , 46 , 47 , 48 ] utilized FS, VS or Venham Picture Test (VPT) to evaluate the child’s cooperation.…”

“…Eight studies [ 37 , 41 , 42 , 43 , 45 , 46 , 47 , 48 ] utilized FS, VS or Venham Picture Test (VPT) to evaluate the child’s cooperation. Of the twelve studies included in the meta-analysis [ 14 , 25 , 28 , 29 , 34 , 35 , 36 , 38 , 39 , 44 , 46 , 48 ], two studies presented their findings in categorical data, while the rest presented their findings in continuous data, which to be extracted for performing the quantitative syntheses.…”

“…Such interventions are in line with the principles of remineralization and repair outlined in the FDI policy statement [ 7 ] on MID. Seventeen [ 25 , 26 , 28 , 29 , 30 , 34 , 35 , 37 , 38 , 39 , 41 , 43 , 44 , 46 , 47 , 48 , 49 ] studies used ART restorations as their intervention, and of these studies, ten studies compared ART with CR [ 25 , 26 , 29 , 35 , 39 , 43 , 44 , 46 , 47 , 48 ], three compared ART with cavity modifications [ 26 , 37 ], two used ART together with oral health education [ 41 ] or Brix3000™ papain gel [ 33 ] and compared to ART alone, and three [ 28 , 34 , 38 ] compared ART restorations to HT in terms of patient-reported outcomes, observation-based outcomes, and anxiety using the abovementioned quantitative scales. Another two [ 27 , 40 ] studies assessed resin infiltration as their intervention.…”