International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 18 , ISSUE 2 ( February, 2025 ) > List of Articles

ORIGINAL RESEARCH

Comparative Evaluation of Acupressure, Aromatherapy, and Stress Ball Efficacy in Reduction of Anxiety Levels in Children during Prophylactic and Restorative Procedures

Anushree P Koyande, Lumbini Pathivada, Karthik M Krishna, Vandana Shukla, Archana Singh, Nafeesa J Samnani

Keywords : Acupressure, Aromatherapy, Behavior management, Dental anxiety, Frankl behavior rating scale, Pediatric dentistry

Citation Information : Koyande AP, Pathivada L, Krishna KM, Shukla V, Singh A, Samnani NJ. Comparative Evaluation of Acupressure, Aromatherapy, and Stress Ball Efficacy in Reduction of Anxiety Levels in Children during Prophylactic and Restorative Procedures. Int J Clin Pediatr Dent 2025; 18 (2):210-214.

DOI: 10.5005/jp-journals-10005-3070

License: CC BY-NC 4.0

Published Online: 20-03-2025

Copyright Statement:  Copyright © 2025; The Author(s).


Abstract

Background: Dental anxiety among pediatric patients needs to be tackled efficiently. Various nonpharmacological interventions, though proven effective, cannot be generalized for all. The use of complementary and alternative medicine has surged globally and is effective in reducing anxiety associated with dental procedures. Aim: This study aimed to compare the efficacy of acupressure, aromatherapy, and stress ball for reduction of dental anxiety in children during prophylactic and restorative procedures. Settings and design: Randomized controlled clinical trial. Materials and methods: The study comprised 160 children aged 8–12 years requiring scaling or restoration on the first visit. The children were randomly allocated to four groups: group I (n = 40)—control, group II (n = 40)—acupressure, group III (n = 40)—aromatherapy, and group IV (n = 40)—stress ball. For all the children, a self-report measure of anxiety [Modified Child Dental Anxiety Scale (MCDAS) and Chota Bheem–Chutki Scale (CBCS)], along with pulse rate, SpO2, and respiratory rate, were recorded at three different time frames. The Frankl scale was used as the behavioral measure for all the children. Statistical analysis used: Student's t-test and ANOVA test were used to analyze the data. Results: Aromatherapy showed significant results in all the six parameters used. The MCDAS scores of groups II, III, and IV showed significant mean differences when compared to the control group (p = 0.000). In the Frankl behavior rating scale and SpO2 readings, differences in the aromatherapy and acupressure groups were found statistically significant in comparison with other groups (p = 0.000 and 0.005). Aromatherapy was found statistically significant compared to other groups in parameters like the CBCS and pulse rate. All the three groups showed significant results in the respiratory rate interval. Conclusion: Aromatherapy was highly effective in reducing anxiety compared to the acupressure and stress ball groups during prophylactic and restorative procedures in children.


PDF Share
  1. Kohli N, Hugar SM, Soneta SP, et al. Psychological behavior management techniques to alleviate dental fear and anxiety in 4–14–year–old children in pediatric dentistry: a systematic review and meta–analysis. Dent Res J 2022;19:47.
  2. Avisa P, Kamathan R, Vanjari K, et al. Effectiveness of acupressure on dental anxiety in children. Pediatr Dent 2018;40(3):177–183.
  3. James J, Retnakumari N, Vadakkepurayil K, et al. Effectiveness of aromatherapy and music distraction in managing pediatric dental anxiety: a comparative study. Int J Clin Pediatr Dent 2021;14(2):249–253. DOI: 10.5005/jp-journals-10005-1911
  4. Torres-Gomez J, Arnason SC, Hoopes WL, et al. Management of dental anxiety via distraction technique. J Clin Exp Dent 2021;13(4):e350–e356. DOI: 10.4317/jced.57660
  5. Goettems ML, Zborowski EJ, Costa FDS, et al. Nonpharmacologic intervention on the prevention of pain and anxiety during pediatric dental care: a systematic review. Acad Pediatr 2017;17(2):110–119. DOI: 10.1016/j.acap.2016.08.012
  6. Wong HM, Humphris GM, Lee GT. Preliminary validation and reliability of the modified child dental anxiety scale. Psychol Rep 1998;83:1179–1186. DOI: 10.2466/pr0.1998.83.3f.1179
  7. Sadana G, Grover R, Mehra M, et al. A novel Chotta Bheem-Chutki scale for dental anxiety determination in children. J Int Soc Prevent Community Dent 2016;6:200–205. DOI: 10.4103/2231-0762.183108
  8. Jafarzadeh M, Arman S, Pour FF. Effect of aromatherapy with orange essential oil on salivary cortisol and pulse rate in children during dental treatment: a randomized controlled clinical trial. Adv Biomed Res 2013;2:10. DOI: 10.4103/2277-9175.107968
  9. Muzzarelli L, Force M, Sebold M. Aromatherapy and reducing preprocedural anxiety: a controlled prospective study. Gastroenterol Nurs 2006;29(6):466–471. DOI: 10.1097/00001610-200611000-00005
  10. Toet A, Smeets MAM, van Dijk E, et al. Effects of pleasant ambient fragrances on dental fear: comparing apples and oranges. Chemosens Percept 2010;3:182–189. DOI: 10.1007/s12078-010-9078-9
  11. Cianetti S, Lombardo G, Lupatelli E, et al. Dental fear/anxiety among children and adolescents. A systematic review. Eur J Paediatr Dent 2017;18(2):121–130. DOI: 10.23804/ejpd.2017.18.02.07
  12. Lehrner J, Marwinski G, Lehr S, et al. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiol Behav 2005;86:92–95. DOI: 10.1016/j.physbeh.2005.06.031
  13. Purohit A, Singh A, Purohit B, et al. Is aromatherapy associated with patient's dental anxiety levels? A systematic review and meta-analysis. J Dent Anesth Pain Med 2021;21(4):311–319. DOI: 10.17245/jdapm.2021.21.4.311
  14. Hou PW, Hsu HC, Lin YW, et al. The history, mechanism, and clinical application of auricular therapy in traditional Chinese medicine. Evid Based Complement Alternat Med 2015;2015:495684. DOI: 10.1155/2015/495684
  15. Erappa U, Konde S, Agarwal M, et al. Comparative evaluation of efficacy of hypnosis, acupressure and audiovisual aids in reducing the anxiety of children during administration of local anesthesia. Int J Clin Pediatr Dent 2021;14(Suppl 2):S186–S192. DOI: 10.5005/jp-journals-10005-2113
  16. Wang J, Zhang J, Sun D. Randomized crossover study of auricular plaster therapy to relieve dental anxiety in children. Front Psychiatry 2022;13:862575. DOI: 10.3389/fpsyt.2022.862575
  17. Spence DW, Kayumov L, Chen A, et al. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. J Neuropsychiatry Clin Neurosci 2004;16(1):19–28. DOI: 10.1176/jnp.16.1.19
  18. Errington-Evans N. Acupuncture for anxiety. CNS Neurosci Ther 2012;18(4):277–284. DOI: 10.1111/j.1755-5949.2011.00254.x
  19. Bussell J. Acupuncture and anxiety 2013: the year in (literature) review. OA Altern Med 2014;2(1):3.
  20. Wang SM, Escalera S, Lin EC, et al. Extra-1 acupressure for children undergoing anesthesia. Anesth Analg 2008;107(3):811–816. DOI: 10.1213/ane.0b013e3181804441
  21. Borji M, Pouy S, Yaghobi Y, et al. Effectiveness of acupressure on anxiety of children undergoing anesthesia. Int J Adolesc Med Health 2019;33(4). DOI: 10.1515/ijamh-2018-0177
  22. Özkan TK, Balcı S. The effect of acupressure on acute pain during venipuncture in children: implications for evidence-based practice. Worldviews Evid Based Nurs 2020;17(3):221–228. DOI: 10.1111/wvn.12437
  23. Koller D, Goldman RD. Distraction techniques for children undergoing procedures: a critical review of pediatric research. J Pediatr Nurs 2012;27(6):652–681. DOI: 10.1016/j.pedn.2011.08.001
  24. Shekhar S, Suprabha BS, Shenoy R, et al. Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial. Eur Arch Paediatr Dent 2022;23:417–427. DOI: 10.1007/s40368-022-00698-7
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.