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Relations between general behavior, temperament, and procedure-related behavior and distress were examined in children receiving intramuscular injections before undergoing restorative dental procedures. Younger children are likely to benefit the most from interventions prior to and during dental procedures. Children's anxiety before dental procedur...
Contexts in source publication
Context 1
... was assessed at several times with the STAI and VASs. Table 2 provides information on the students' ratings of their trait and state anxiety. In- terestingly, months prior to the first procedure, stu- dents predicted that they would be more anxious (Table 1) than they actually were immediately prior to the procedure as measured by both VAS and STAI state scores (Table 2). ...
Context 2
... 2 provides information on the students' ratings of their trait and state anxiety. In- terestingly, months prior to the first procedure, stu- dents predicted that they would be more anxious (Table 1) than they actually were immediately prior to the procedure as measured by both VAS and STAI state scores (Table 2). Students reported being able to relax themselves during the procedure (M = 81.0, ...
Context 3
... = 21.9, range 36-100). However, their pre-and post-treatment ratings of anxiety were virtually iden- tical (i.e., less than one standard deviation; see Table 2), suggesting that they may not have been as re- laxed as they perceived or that they were able to pre- vent their anxiety from increasing during the proce- dure. Future research should clarify this finding. ...
Similar publications
While general dentists have used many modalities to reduce fear and anxiety in the dental office, including iatrosedation (calming words), distraction techniques, conditioning techniques, and empathy, there still are patients who need pharmacologic management of fear and anxiety to receive dental care. Anxiolysis, the lightest level of sedation, ca...
Citations
... 18 Finally, children undergoing dental injections have been found to have increased pain when they feel anxious from previous procedures. 19,20 Although the mechanisms underlying these observations have yet to be fully elucidated, these data show that painful episodes can be encoded into children's implicit and explicit memories. 21 Praising a child after a painful procedure, in an effort to modify negative memories, has been shown to lessen these memories and reduce distress during subsequent procedures. ...
Increasing evidence has demonstrated that pain from venipuncture and intravenous cannulation is an important source of pediatric pain and has a lasting impact. Ascending sensory neural pain pathways are functioning in preterm and term infants, yet descending inhibitory pathways seem to mature postnatally. Consequently, infants may experience pain from the same stimulus more intensely than older children. In addition, painful perinatal procedures such as heel lancing or circumcision have been found to correlate with stronger negative responses to venipuncture and intramuscular vaccinations weeks to months later. Similarly, older children have reported greater pain during follow-up cancer-related procedures if the pain of the initial procedure was poorly controlled, despite improved analgesia during the subsequent procedures. Fortunately, both pharmacologic and nonpharmacologic techniques have been found to reduce children's acute pain and distress and subsequent negative behaviors during venipuncture and intravenous catheter insertion. This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.
Objectives:
Our objectives were to quantify pain experienced by young children undergoing facial laceration repair and identify factors associated with low procedural pain scores.
Methods:
We conducted a prospective cohort study of children's distress among a convenience sample of children aged 1 to 5 years undergoing facial or scalp laceration repair in 2 pediatric emergency departments. We reviewed video recordings and documented pain scores at 15-second intervals using the Face, Leg, Activity, Cry, Consolability-Revised (FLACC-r) scale. We dichotomized FLACC-r into low/high scores (≤3 and >3) to evaluate practice variables.
Results:
We included 11,474 FLACC-r observations from 258 procedures in the analysis. Two-thirds of 3- to 5-year-olds completed their laceration repair without the use of restraint, sedation, or anxiolytics. Mean distress scores were low (≤2.5 out of 10) across all procedure phases for 2- to 5-year-old patients. One-year-old patients experienced significantly more distress than their older counterparts (mean ≤4.2 out of 10). Odds of having low FLACC scores (≤3) were greater for patients with an expert clinician (adjusted odds ratio [aOR]: 1.72; 95% confidence interval [CI], 1.05-2.84). Wound infiltration (aOR, 0.35; 95% CI, 0.13-0.93), patient observation of a needle (aOR, 0.21; 95% CI, 0.14-0.33), and restraint (aOR, 0.04; 95% CI, 0.02-0.06) were negatively associated with low FLACC score.
Conclusion:
The majority of 3- to 5-year-old patients were able to undergo facial laceration repair without restraint, sedation, or anxiolytics and with low mean distress scores. Our findings suggest that children's risk of experiencing moderate and severe distress during facial and scalp laceration repair may be reduced by prioritizing wound closure by expert-level clinicians, ensuring effective lidocaine-epinephrine-tetracaine application, avoiding restraint, and concealing needles from patient view.
There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants’ age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.
The behavior of children in a dental setting is an interesting window through which many domains, including, among others, biological, genetic, psychosocial, cognitive, and emotional are expressed either imperceptibly or overtly in a relatively short period of time. Sedation of children is a common and accepted modality of patient management during potentially painful procedures. The process and need for safety in performing sedation during dental procedures involves several factors that are directed toward positive general outcomes. Airway sounds are more important during sedation as they transmit information on the function and patency of the upper airway as well as secondary anatomical structures and sounds. Common sense, standard protocol, and sedation guide lines will require patient monitoring on the day of the procedure. The American Academy of Pediatric Dentistry's website has a sedation record that is detailed and consistent with all requirements of the sedation guidelines.
Safe and effective management of procedure-related pain and anxiety in the emergency department (ED) has become expected. It facilitates controlled accomplishment of therapeutic and diagnostic procedures, reduces psychological trauma and its sequelae, reduces healthcare provider and parental distress, and improves parental acceptance of rendered care. Many advances in procedural sedation and analgesia (PSA) for nonelective procedures in non-fasted patients in the ED have occurred over the past 30 years as a result of intense interest in this concept and the development of general and pediatric emergency medicine specialties, for whom PSA is now considered core training. This chapter reviews some of the PSA techniques shown to safely and effectively decrease children’s pain and anxiety associated with procedures in the ED. Since pain and anxiety are frequently indistinguishable, the combination will often be referred to as distress.
Aims
To evaluate the prevalence of needle fear and summarize the characteristics of individuals who exhibit this fear.
Background
Injections are among the most common medical procedures, yet fear of needles can result in avoidance of preventive measures and treatment.
Design
Systematic review and meta‐analysis.
Data Sources
MEDLINE (1966‐2017), Embase (1947‐2017), PsycINFO (1967‐2017) and CINAHL (1961‐2017) were searched, with no restrictions by age, gender, race, language, or country.
Review Methods
Prevalence of needle fear was calculated and restricted maximum likelihood random effects models were used for meta‐analysis and meta‐regression.
Results
The search yielded 119 original research articles which are included in this review, of which 35 contained sufficient information for meta‐analysis. The majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20‐50% in adolescents and 20‐30% in young adults. In general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males. Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long‐term care facilities and 8% of healthcare workers at hospitals. Needle fear was common when undergoing venipuncture, blood donation and in those with chronic conditions requiring injection.
Conclusions
Fear of needles is common in patients requiring preventive care and in those undergoing treatment. Greater attention should be directed to interventions which alleviate fear in high risk groups.
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Objective:
Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry.
Study design:
A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children.
Results:
104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia.
Conclusion:
The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.
Aim: In pediatric dentistry, applications sedation or general anesthesia are necessary when the treatment is not carried out because of children's fear or anxiety. After premedication with nitrous oxide (N2O) inhalation for the purpose of sedation is a common application. This research's aim was to investigate effectiveness of different midazolam doses on sedation in anxious children who were scheduledfor dental treatment. Material and methods: Sixty children plannedfor'dental treatment under N2O sedation, ASA 1, 3-7 years of age, with anxiety according to Frankl Behavior Scale (FBS 3-4) were randomized into 4 groups. After completion of fasting 3-5 hours prior to application, 0, 2 mg kg-1(Group I), 0,5 mg kg-1(Group II), 0.75 mg kg-1 (Group III) and 1 mg kg-1 (Group IV) midazolam (Dormicum® 15 mg 3 mL-1) were administered orally 15 minutes before dental treatment. Five minutes later midazolam administrations, Ramsay Sedation Scores (RSS) were recorded. Patients were monitored with pulse oximetry at 15 minutes after giving oral midazolam and followed up in terms of saturation of oxygen (SpO2) and heart rate (HR) values. Dental treatment was carried out applied under % 40/60 N2O/O2 sedation. Patients were inhalated by 100 % O2 at the end of the treatment procedure, and then transported to recovery room. Patients were observed for minimum 45 minutes or until recovery parameters completed. If any side effects happened, it was recorded. Results: Mean RSS values in Groups I were smaller than the others and mean RSS values in Group II smaller than the Group III and Group TV at 15-45 minute time interval (p<0,05). Time dependent mean heart rate and SpO2 values in Groups III and IV were lower than Group I and Group II (p<0.05). Conclusion: It is concluded that giving midazolam orally as premedication in pediatric age group scheduledfor dental treatment is acceptable, and effective at 0, 75 mg kg-1 dose.
Behavior management is a key component when providing dental care to children who have suffered traumatic dental injuries. This article reviews the current status of behavior management including basic communication techniques and advanced techniques used by pediatric dentists. Emphasis is given to oral and inhalation sedation when treating children at initial visits status post dental injury. Little is known about the use of pharmacologic agents in managing young but behaviorally challenging patients who have suffered dental trauma. Future care involving sedation and specialized endodontic procedures of these young patients through collaborative efforts between endodontists and pediatric dentists seems promising and should be pursued.
Procedural sedation offers an effective and humane way to deliver dental care to the young, anxious child and to those with extensive treatment needs. Delivery of sedation requires thorough understanding of its indications and contraindications, patient assessment, pharmacology, monitoring, and office protocol. Safe and successful outcomes depend on a systematic approach to care, and the ability to manage unintended cardiopulmonary events.
