International Journal of Clinical Pediatric Dentistry

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VOLUME 16 , ISSUE 2 ( March-April, 2023 ) > List of Articles

ORIGINAL RESEARCH

The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study

Sravanthi Kunta, Ruchi V Arora, Rashmi Jain, Parul Rawat

Keywords : Dental anxiety, Nitrous oxide inhalation sedation, Salivary α-amylase, Salivary cortisol

Citation Information : Kunta S, Arora RV, Jain R, Rawat P. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023; 16 (2):302-307.

DOI: 10.5005/jp-journals-10005-2534

License: CC BY-NC 4.0

Published Online: 12-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N2O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC). Materials and methods: A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N2O IHS) and TII (after N2O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N2O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N2O IHS. Results: There were significant differences in the dental anxiety level in child patients after administration of N2O IHS, and it also showed an increased rate of acceptance of dental treatment. Conclusion: This study showed that N2O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects. Clinical significance: Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N2O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior.


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  1. Adolphs R. The biology of fear. Curr Biol 2013;23(2):R79–R93.
  2. Hallonsten AL, Koch G, Schröder U. Nitrous oxide-oxygen sedation in dental care. Community Dent Oral Epidemiol 1983;11(6):347–355. DOI: 10.1111/j.1600-0528.1983.tb01390.x
  3. Manepalli S, Nuvvula S, Kamatham R, et al. Comparative efficacy of a self-report scale and physiological measures in dental anxiety of children. J Investig Clin Dent 2014;5(4):301–306. DOI: 10.1111/jicd.12046
  4. Swetah CSV, Ramakrishnan M. Dental anxiety among children regarding different dental treatment-modified child dental anxiety scale (MCDAS)—a cross sectional study. Indian J Public Health Res Dev 2019;10(11):3668. DOI: 10.5958/0976-5506.2019.04159.7
  5. Polat C, Düzer S, Ayyıldız H, et al. Association between anxiety, depression, and salivary cortisol levels in patients with recurrent aphthous stomatitis. Turk Arch Otorhinolaryngol 2018;56(3):166–169. DOI: 10.5152/tao.2018.3242
  6. https://www.aapd.org/globalassets/media/policies_guidelines/bp_useofnitrous.pdf.
  7. Kupietzky A, Emmanouil D. Nitrous Oxide/Oxygen Inhalation Sedation in Children. Wright's Behavior Management in Dentistry for Children. 2021 Sep 10:189–203.
  8. Paterson SA, Tahmassebi JF. Paediatric dentistry in the new millennium: 3. Use ofinhalation sedation in paediatric dentistry. Dent Update 2003;30(7):350–358. DOI: 10.12968/denu.2003.30.7.350
  9. Houpt MI, Limb R, Livingston RL. Clinical effects of nitrous oxide conscious sedation in children. Pediatr Dent 2004;26(1):29–36.
  10. Harbuz DK, O'Halloran M. Techniques to administer oral, inhalational, and IV sedation in dentistry. Australas Med J 2016;9(2):25–32. DOI: 10.4066/AMJ.2015.2543
  11. Kapur A, Kapur V. Conscious sedation in dentistry. Ann Maxillofac Surg 2018;8(2):320–323. DOI: 10.4103/ams.ams_191_18
  12. Priya KY, Prathibha KM. Methods of collection of saliva-a review. Int J Oral Health Dent 2017;3(3):149–153. DOI: 10.18231/2395-499X.2017.0032
  13. Viswanath D, Kumar M, Prabhuji MLV. Dental anxiety, fear and phobia in children. Int J Dent Res Dev 2014;4(1):1–14.
  14. Newton JT, Buck DJ. Anxiety and pain measures in dentistry: a guide to their quality and application. J Am Dent Assoc 2000;131(10):1449–1457. DOI: 10.14219/jada.archive.2000.0056
  15. Taani DQ, El-Qaderi SS, Abu Alhaija ES. Dental anxiety in children and its relationship to dental caries and gingival condition. Int J Dent Hyg 2005;3(2):83–87. DOI: 10.1111/j.1601-5037.2005.00127.x
  16. Klein U, Manangkil R, DeWitt P. Parents' ability to assess dental fear in their six-to 10-year-old children. Pediatr Dent 2015;37(5):436–441.
  17. Alexopoulos E, Hope A, Clark SL, et al. A report on dental anxiety levels in children undergoing nitrous oxide inhalation sedation and propofol target controlled infusion intravenous sedation. Eur Arch Paediatr Dent 2007;8(2):82–86.
  18. Prud'homme T, Allio A, Dajean-Trutaud S, et al. Assessment of an equimolar mixture of oxygen and nitrous oxide: effects in pediatric dentistry. Int J Clin Pediatr Dent 2019;12(5):429–436. DOI: 10.5005/jp-journals-10005-1658
  19. Arch LM, Humphris GM, Lee GT. Children choosing between general anaesthesia orinhalation sedation for dental extractions: the effect on dental anxiety. Int J Paediatr Dent 2001;11(1):41–48. DOI: 10.1046/j.1365-263x.2001.00238.x
  20. Veerkamp JS, van Amerongen WE, Hoogstraten J, et al. Dental treatment of fearful children, using nitrous oxide. Part I: treatment times. ASDC J Dent Child 1991;58(6):453–457.
  21. Kashyap V, Suneja B, Kaur J, et al. Comparison of patient and parental preference between nitrous oxide sedation and conventional behavior management technique for dental treatment: a randomized crossover study. Int J Appl Dent Sci 2021;7:398–401. DOI: 10.22271/oral.2021.v7.i1f.1159
  22. Rayen R, Muthu MS, Sivakumar N, et al. Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children. Indian J Dent Res 2006;17(1):27–34. DOI: 10.4103/0970-9290.29895
  23. Emmanuel BJ, Raja J, Packiaraj I, et al. Nitrous oxide and special healthcare children in dentistry: a review article. J Adv Clin Res Insights 2021;8:3–5. DOI: 10.15713/ins.jcri.319
  24. Holroyd I, Roberts GJ. Inhalation sedation with nitrous oxide: a review. Dent Update 2000;27(3):141–146. DOI: 10.12968/denu.2000.27.3.141
  25. Mohan R, Asir VD, Dakir A, et al. Nitrousoxide as a conscious sedative in minor oral surgical procedure. J Pharm Bioallied Sci 2015;7(Suppl 1):S248–S250. DOI: 10.4103/0975-7406.155939
  26. Becker DE, Rosenberg M. Nitrous oxide and the inhalation anesthetics. Anesth Prog 2008;55(4):124–130. DOI: 10.2344/0003-3006-55.4.124
  27. Samir PV, Namineni S, Sarada P. Assessment of hypoxia, sedation level, and adverse events occurring duringinhalation sedation using preadjusted mix of 30% nitrous oxide+ 70% oxygen. J Indian Soc Pedod Prev Dent 2017;35(4):338–345. DOI: 10.4103/JISPPD.JISPPD_15_17
  28. Javadinejad S, Farajzadegan Z, Madahain M. Iranian version of a face version of the modified child dental anxiety scale: transcultural adaptation and reliability analysis. J Res Med Sci 2011;16(7):872–877.
  29. Madouh M, Tahmassebi JF. Utilising a paediatric version of the indicator of sedation need for children's dental care: a pilot study. Eur Arch Paediatr Dent 2016;17(4):265–270. DOI: 10.1007/s40368-016-0238-8
  30. Padmanabhan V, Rai K, Hegde A. Salivary cortisol changes in children during dental extractions. J Evol Med Dent Sci 2014;3(4):811–814. DOI: 10.14260/jemds/2014/1907
  31. Rashkova MR, Ribagin LS, Toneva NG. Correlation between salivary [alpha]-amylase and stress-related anxiety. Folia Medic (Plovdiv) 2012;54(2):46–51. DOI: 10.2478/v10153-011-0088-4
  32. Vreeburg SA, Zitman FG, van Pelt J, et al. Salivary cortisol levels in persons with and without different anxiety disorders. Psychosom Med 2010;72(4):340–347. DOI: 10.1097/PSY.0b013e3181d2f0c8
  33. Chaturvedi Y, Chaturvedy S, Marwah N, et al. Salivary cortisol and alpha-amylase—biomarkers of stress in children undergoing extraction: an in vivo study. Int J Clin Pediatr Dent 2018;11(3):214–218. DOI: 10.5005/jp-journals-10005-1514
  34. Yıldırım S, Bakkal M, Bulut H, et al. Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia. Clin Oral Investig 2018;22(6):2373–2380. DOI: 10.1007/s00784-018-2340-2
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