International Journal of Clinical Pediatric Dentistry

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VOLUME 16 , ISSUE S2 ( September, 2023 ) > List of Articles

ORIGINAL RESEARCH

Children's Anxiety Levels and Their Perspectives on Dental Experiences in Students’ Clinical Evaluation

Silvia Ortiz, Minn Yoon, Monica Gibson, Ida Kornerup, Mehdi S Zeinabadi, Hollis Lai

Keywords : Anxiety, Art, Dental, Education, Patient satisfaction, Pediatric dentistry

Citation Information :

DOI: 10.5005/jp-journals-10005-2620

License: CC BY-NC 4.0

Published Online: 01-11-2023

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


Abstract

Aim: The purpose of this study is to present a framework for the potential implementation of children's anxiety levels and perspectives of their experiences receiving treatment from dental students through interviews and drawing into the clinical assessment of dental students. Materials and methods: A total of 51 patients between the ages of 5 and 8 years were included in the study. Pulp therapy and/or restorative treatment was performed during the first therapeutic session for all participants. Children were asked to draw about themselves at the dentist's and then verbally explain their drawings. Drawings were analyzed using Child Drawing: Hospital (CD: H) to determine the child's anxiety score. Interviews were analyzed using thematic analysis to establish the factors contributing to the patient having a positive/negative experience. The relationships between the children's level of anxiety and their experience were analyzed using correlation and regression analyses against the student clinical assessment data. Results: Most children in the study exhibited average levels of anxiety and had an overall positive perception of the dentist. The correlation and regression analyses determined that when children presented higher levels of anxiety, the students received statistically significant higher scores in evidence-informed practice (EIP), skills, and their tolerance for error during procedures. No other rubric item was related to the children's anxiety or whether their experience was positive/negative. Conclusion: Although this study provided a framework for exploring children's anxiety levels and perspectives of their experiences in teaching clinical settings, more research is needed to refine the method for student evaluation. Clinical significance: This study will enable dental students to meet the needs of child patients, which consequently increases treatment motivation and adherence to dental services as well as reduces the likelihood of patient anxiety and improves patient self-care skills over time.


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  1. Wong HM, Bridges SM, Mcgrath CP, et al. Impact of prominent themes in clinician-patient conversations on caregiver's perceived quality of communication with paediatric dental visits. Plos One 2016;12(1):1–15. DOI: 10.1371/journal.pone.0169059
  2. Rodd H, Timms L, Noble F, et al. ‘Message to dentist’: facilitating communication with dentally anxious children. Dent J 2019;7(3):69. DOI: 10.3390/dj7030069
  3. Perry S, Bridges SM, Burrow MF. A review of the use of simulation in dental education. Simul Healthc 2015;10(1):31–37.
  4. Fadel HT, Baghlaf K, Ben Gassem A, et al. Dental students’ perceptions before and after attending a centre for children with special needs: a qualitative study on situated learning. Dent J (Basel) 2020;8(3):69. DOI: 10.3390/dj8030069
  5. Werkkala CM, Bäckmand HM, Kuosmanen LM, et al. Efficacy of a real-time patient feedback system: Patient satisfaction study in psychiatry. Nord J Psychiatry 2020;74(2):155–162. DOI: 10.1080/08039488.2019.1684989
  6. Dubosh N, Hall M, Novack V, et al. A multimodal curriculum with patient feedback to improve medical student communication: pilot study. Western J Emerg Med 2018;21(1):115–121. DOI: 10.5811/westjem.2018.11.44318
  7. Baier K, Milgrom P, Russell S, et al. Children's fear and behavior in private pediatric dentistry practices. Pediatr Dent 2004;26(4):316–321.
  8. American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:306–324.
  9. Torriani DD, Goettems ML, Cademartori MG, et al. Representation of dental care and oral health in children's drawings. Br Dent J 2014;216(12):E26. DOI: 10.1038/sj.bdj.2014.545
  10. Baines R, Zahra D, Bryce M, et al. Is collecting patient feedback “a futile exercise” in the context of recertification? Acad Psychiat 2019;43(6):570–576. DOI: 10.1007/s40596-019-01088-w
  11. Aguilar BA. The efficacy of art therapy in pediatric oncology patients: An integrative literature review. J Pediatr Nurs 2017;36:173–178. DOI: 10.1016/j.pedn.2017.06.015
  12. Searle MJ, Shulha LM. Capturing the imagination: arts-informed inquiry as a method in program evaluation. Can J Program Eval 2016;31(1):34–60.
  13. Driessnack M. Children's drawings as facilitators of communication: a meta-analysis. J Pediatr Nurs 2005;20(6):415–423. DOI: 10.1016/j.pedn.2005.03.011
  14. Moreau KA, Eady K, Jabbour M. Exploring residents’ reactions to and use of parent feedback in a pediatric emergency department: a grounded theory study. Med Teach 2019;41(2):207–214. DOI: 10.1080/0142159x.2018.1460658
  15. Crossley J, Eiser C, Davies HA. Children and their parents assessing doctor-patient interaction: a rating system for doctors’ communication skills. Med Educ 2005;39(8):820–828. DOI: 10.1111/j.1365-2929.2005.02230.x
  16. Bardgett RJ, Darling JC, Webster E, et al. What makes a good children's doctor? Exploring the child perspective in the OSCE setting. Med Teach 2016;38(5):471–475. DOI: 10.3109/0142159x.2015.1060301
  17. Gross J, Hayne H. Drawing facilitates children's verbal reports of emotionally laden events. J Exp Psychol Appl 1998;4(2):163–179. DOI: 10.1037/1076-898X.4.2.163
  18. Fawson S. Drawing development: historical perspectives, developmental stages, current approaches. Psychol Educ Rev 2009;33(1):1–9.
  19. Malchiodi CA. Understanding children's drawings. New York, NY: Guilford Pres; 1998.
  20. Koppitz E. Psychological evaluation of human figure drawings by middle school pupils. Orlando: Grune and Stratton; 1984.
  21. Goodenough F, Harris D. The Goodenough-Harris drawing test. New York, NY: SP Medical and Scientific Books; 1963.
  22. Machover K. Personality projection in the drawing of the human figure: A method of personality investigation. Third Printing. Springfield: Charles C Thomas; 1953.
  23. Clatworthy S, Simon K, Tiedeman ME. Child drawing: hospital – an instrument designed to measure the emotional status of hospitalized school-aged children. J Pediatr Nurs 1999;14(1):2–9. DOI: 10.1016/S0882-5963(99)80054-2
  24. Koppitz E. Psychological evaluation of children's human figure drawings. New York, NY: Grune & Stratton; 1968.
  25. Burns-Nader S. Examining children's health care experiences through drawing. Early Child Dev Care 2017;187(11):1809–1818.
  26. Baghdadi ZD, Jbara S, Muhajarine N. Children's drawing as a projective measure to understand their experiences of dental treatment under general anesthesia. Children (Basel) 2020;7(7):73. DOI: 10.3390/children7070073
  27. Onur SG, Altin KT, Yurtseven BD, et al. Children's drawing as a measure of dental anxiety in paediatric dentistry. Int J Pediatr Dent 2020;30(6):666–675. DOI: 10.1111/ipd.12657
  28. Aminabadi NA, Ghoreishizadeh A, Ghoreishizadeh M, et al. Can drawing be considered a projective measure for children's distress in pediatric dentistry? Int J Pediatr Dent 2011;21:1–12. DOI: 10.1111/j.1365-263X.2010.01072.x
  29. Taylor D, Roth G, Mayberry W. Children's drawings about dentistry. Community Dent Oral Epidemiol 1976;4(1):1–6. DOI: 10.1111/j.1600-0528.1976.tb00960.x
  30. Frauches M, Monteiro L, Rodrigues S, et al. Association between children's perceptions of the dentist and dental treatment and their oral health-related quality of life. Eur Arch Paediatr Dent 2018;19(5):321–329. DOI: 10.1007/s40368-018-0361-9
  31. Clatworthy S, Simon K, Tiedeman M. Child drawing: hospital manual. J Pediatr Nurs 1999;14(1):10–18. DOI: 10.1016/S0882-5963(99)80055-4
  32. Neale J. Iterative categorization: a systematic technique for analysing qualitative data. Addiction 2016;111(6):1096–1106. DOI: 10.1111/add.13314
  33. Clarke V, Braun V. Teaching thematic analysis. Psychologist 2013;26(2):120–123.
  34. Cramer H. Mathematical methods of statistics. 1st ed. Princeton, NJ: Princeton University Press; 1946.
  35. Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics 1997;33(1):159–174.
  36. Catte M, Cox MV. Emotional indicators in children's human figure drawings. Eur Child Adolesc Psychiatry 1999;8(2):86–91. DOI: 10.1007/s007870050089
  37. Wesson M, Salmon K. Drawing and showing: helping children to report emotionally laden events. Appl Cogn Psychol 2001;15(3): 301–319. DOI: 10.1002/acp.706
  38. Yon MJY, Chen KJ, Gao SS, et al. An introduction to assessing dental fear and anxiety in children. Healthcare (Basel) 2020;8(2):86. DOI: 10.3390/healthcare8020086
  39. Yadav A, Garg S, Shrivastava A, et al. Child drawing: a projective tool for dental anxiety assessment. Int Healthc Res J 2020;4(1):19–25. DOI: 10.26440/IHRJ/0401.04331
  40. Alshoraim MA, El-Housseiny AA, Farsi NM, et al. Effects of child characteristics and dental history on dental fear: cross-sectional study. BMC Oral Health 2018;18(1):33. DOI: 10.1186/s12903-018-0496-4
  41. Ahmad A, Ayub Kazi MS, Ahmad I. Evaluation of dental anxiety among children visiting Paediatric Dental Department at Children Hospital. J Pak Med Assoc 2017;67(10):1532–1535.
  42. Kakkar M, Wahi A, Thakkar R, et al. Prevalence of dental anxiety in 10-14 years old children and its implications. J Dent Anesth Pain Med 2016;16(3):199–202. DOI: 10.17245/jdapm.2016.16.3.199
  43. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007;17(6):391–406. DOI: 10.1111/j.1365-263X.2007.00872.x
  44. El-Housseiny AA, Alsadat FA, Alamoudi NM, et al. Reliability and validity of the children's fear survey schedule-dental subscale for Arabic-speaking children: a cross-sectional study. BMC Oral Health 2016;16:49. DOI: 10.1186/s12903-016-0205-0
  45. El-Housseiny AA, Farsi N, Alamoudi N, et al. Assessment for the children's fear survey schedule-dental subscale. J Clin Pediatr Dent 2014;39(1):40–46. DOI: 10.17796/jcpd.39.1.ml4h38626g66p750
  46. Caprioglio A, Mariani L, Tettamanti L. A pilot study about emotional experiences by using CFSS-DS in young patients. Eur J Paediatr Dent 2009;10(3):121–124.
  47. Weinstein P. Child-centred child management in a changing world. Eur Arch Paediatr Dent 2008;9(S1):6–10. DOI: 10.1007/BF03262649
  48. Shindova MP, Belcheva AB. Dental fear and anxiety in children: a review of the environmental factors. Folia Med (Plovdiv) 2021;63(2):177–182. DOI: 10.3897/folmed.63.e54763
  49. Nash DA. Engaging children's cooperation in the dental environment through effective communication. Pediatr Dent 2006;28(5):455–459.
  50. Oppenheim MN, Frankl SN. A behavioral analysis of the preschool child when introduced to dentistry by the dentist or hygienist. J Dent Child 1971;38:317–325.
  51. Klein H. Psychological effects of dental treatment on children of different ages. J Dent Child 1967;34:30–36.
  52. Jones J, Bion J, Brown C, et al. Reflection in practice: How can patient experience feedback trigger staff reflection in hospital acute care settings? Health Expect 2019;23(2):396–404. DOI: 10.1111/hex.13010
  53. Plant J, Li STT, Blankenburg R, et al. Reflective practice in the clinical setting: a multi-institutional qualitative study of pediatric faculty and residents. Acad Med 2017;92(11):S75–S83. DOI: 10.1097/ACM.0000000000001910
  54. Wenner ME, Schonwetter DJ, Mazurat N. Developing new dental communication skills assessment tools by including patients and other stakeholders. J Dent Educ 2011;75(12):1527–1541.
  55. Schmid KL, Hopkins S, Huynh T. Involving patients in the development of interpersonal skills of optometry students. Clin Exp Optom 2020;103(3):361–367. DOI: 10.1111/cxo.12939
  56. Gharib I, Rolland SL, Bateman H, et al. Just one thing: a novel patient feedback model. Br Dent J 2017;222(10):797–802. DOI: 10.1038/sj.bdj.2017.457
  57. Fiedgal RJ. Guiding and managing the child dental patient: a fresh look at old pedagogy. J Dent Educ 2001;65(12):1369–1377.
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