Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator
Citation Information :
Aggarwal P, Mathur S, Chopra R. Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator. Int J Clin Pediatr Dent 2024; 17 (1):59-66.
Aim: To investigate the potential effectiveness of “medical clowns” on preoperative, intraoperative, and postoperative anxiety of children undergoing various dental treatments and also its effect on the operator's stress levels in a dental setup.
Materials and methods: A total of 170 pediatric patients, aged 4–8 years, indicated for preventive therapy, extractions, restorative, and endodontics were included and divided into two groups [group I—audiovisual (A-V) aids; group II—medical clowns], group of 85 patients each after recording Modified yale preoperative scale. Both pre- and postoperatively, Frankl's behavior score was recorded for each patient. During treatment, the face, legs, activity, cry, consolability (FLACC) pain scale, and dental operator's stress level were recorded.
Results: Intervention of medical clowns positively influenced children during dental treatment by increasing their pain threshold. The majority of children showed positive Frankl rating scales after dental treatment. Also, the operator's stress was significantly reduced, which led to enhanced treatment outcomes.
Conclusion: Humor yields the power of healing, distracts pediatric patients, reduces their anxiety, and alleviates their pain, conferring the patients with a sense of laughter, creativity, and care.
Therefore, medical clowns in pediatric dentistry can prove to be serviceable and valuable as a nonpharmacological approach to behavior management.
Manyande A, Cyna AM, Yip P, et al. Nonpharmacological interventions for assisting the induction of anesthesia in children. Cochrane Database Syst Rev 2015;2015(7):CD006447. DOI: 10.1002/14651858.CD006447.pub3
Moore R, Brødsgaard I. Dentists’ perceived stress and its relation to perceptions about anxious patients. Community Dent Oral Epidemiol 2001;29(1):73–80.
Carp E. “Clown therapy: the creation of a clown character as a treatment intervention.” Art Psychother 1998;25:245–255.
Adams P. The best medicine. Interview by Jim Montague. Hos Health Net 1994;14:6–7.
Oren-Ziv A, Hanuka P, Rotchild M, et al. Medical clowns – dream doctors as important team members in the treatment of young children with juvenile idiopathic arthritis. Harefuah 2012;151(6):332–334.
Kain ZN, Mayes LC, Cicchetti DV, et al. The yale preoperative anxiety scale: how does it compare with a “gold standard”? Anesth Analg 1997;85(4):783–788. DOI: 10.1097/00000539-199710000-00012
Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23(3):293–297.
Riba H, Al-Zahrani S, Al-Buqmi N, et al. A review of behavior evaluation scales in pediatric dentistry and suggested modification to the Frankl scale. EC Dent Sci 2017;16(6):269–275.
Davidovich E, Pessov Y, Baniel A, et al. Levels of stress among general practitioners, students and specialists in pediatric dentistry during dental treatment. J Clin Pediatr Dent 2015;39(5):419–422. DOI: 10.17796/1053-4628-39.5.419
American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill. Am Acad Pediatric Dent 2023:359–377.
Akmal NLHBI, M D. Effects of audio visual aids on convincing patients for dental treatment – a review. Int J Ind Psychol 2019;7(2):224–233. DOI: 10.25215/0702.027
Prado IM, Carcavalli L, Abreu LG, et al. Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: a systematic review of randomized controlled trials. Int J Paediatr Dent 2019;29(5):650–668. DOI: 10.1111/ipd.12499
Tevatia S, Dua R, Dahiya V, et al. Clown language training in dental education: dental student's perspective. J Oral Health Craniofac Sci 2017;2(2):049–056. DOI: 10.29328/journal.johcs.1001011
Sridharan K, Sivaramakrishnan G. Erratum to: therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials. Eur J Pediatr 2017;176(5):681–682. DOI: 10.1007/s00431-017-2889-9
Bennett MP, Lengacher C. Humor and laughter may influence health IV. Humor and immune function. Evid Based Compl Alternat Med 2009;6(2):159–164. DOI: 10.1093/ecam/nem149
Ben-Pazi H, Cohen A, Kroyzer N, et al. Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- a quasi-randomized controlled crossover study. PLoS One 2017;12(4):e0175028. DOI: 10.1371/journal.pone.0175028
Tener D, Ofir S, Lev-Wiesel R, et al. Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals. Soc Work Health Care 2016;55(4):296–313. DOI: 10.1080/00981389.2016.1141826
Kocherov S, Hen Y, Jaworowski S, et al. Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: a randomized controlled trial. J Paediatr Child Health 2016;52(9):877–881. DOI: 10.1111/jpc.13242
Efrat-Triester D, Altman D, Friedmann E, et al. Exploring the usefulness of medical clowns in elevating satisfaction and reducing aggressive tendencies in pediatric and adult hospital wards. BMC Health Serv Res 2021;21(1):15. DOI: 10.1186/s12913-020-05987-9
