International Journal of Clinical Pediatric Dentistry

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2021 | Special Issue (Behaviour Management) | Volume 14 | Issue S2

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Guest Editorial

Sharath Asokan

Art of Listening

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:2] [Pages No:S105 - S106]

   DOI: 10.5005/jp-journals-10005-2334  |  Open Access | 



Asha Nara, Ashwini Avanti, Prakashchandra Shetty

Child Dental Patient's Anxiety and Preference for Dentist's Attire: A Cross-sectional Study

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:4] [Pages No:S107 - S110]

Keywords: Behavior management, Child, Dental anxiety

   DOI: 10.5005/jp-journals-10005-1940  |  Open Access | 


Aim and objective: Initial perceptions of physicians can affect the level of comfort. Creating a strong rapport on the child's first visit helps to create a comfortable atmosphere. Child-friendly clothing of the dentists might possibly contribute to the dentist's empathy. Different attires may evoke different feelings. Hence, the purpose of the study was to assess the children's preferences for dentist's attire and its relation with anxiety. Materials and methods: Eighty children aged 5–12 years were included in the study. Five photographs of dentists wearing different attires were placed in the same order for every child. The child was asked to look at the photographs and decide which dentist they would prefer to take care of them. A facial image scale was used to evaluate the child's anxiety level. The children were asked to point at which face they felt almost like at that moment. Results: 42.7% of males and 38.5% of females chose child-friendly attire. The least preferred by males was a pink apron (7.5%) compared with females (28.1%). Whereas the blue apron was least preferred by females (5.1%) compared with males (20%). A Chi-square test was done to access the association between dental anxiety and the dental attire the children chose, where statistically significant (0.030) results were found. Anxious children were found to prefer child-friendly attire. Conclusion: Although the view that children are fearful of the white coat was not found, the concept of child-friendly attire might be more appropriate for anxious children and enhance an easy first communication with them.



Navaneetha Krishnan Srinivasan, Pradeep Karunagaran, Veerale Panchal, EMG Subramanian

Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:6] [Pages No:S111 - S116]

Keywords: Anxiety, Dental fear, Intranasal midazolam, Nitrous oxide, Overall behavior, Pediatric dentistry, Sedation

   DOI: 10.5005/jp-journals-10005-2085  |  Open Access | 


Background: Management of children has always been a challenging task in the dental office, as many children exhibit extreme fear, apprehension, and anxiety toward dental procedures. Pharmacological means of behavior management such as sedation are now at the forefront. Midazolam and nitrous oxide are the commonly employed pharmacological agents for sedation in pediatric dentistry. Though each route has its advantages and disadvantages, we compared the effect of atomized intranasal midazolam (dosage 0.3 mg/kg body weight) and nitrous oxide oxygen sedation in evaluating the behavior of child, pain experienced during local anesthesia administration, sedation level, and patient's acceptance. Materials and methods: A total of 35 (n = 35) anxious pediatric patients aged 4–7 years with negative and definitely negative behavioral rating were randomized to receive intranasal midazolam and inhalational nitrous oxide through mask. The overall behavior, alertness, and cry were recorded using Houpt rating scale while pain and sedation were assessed by face, legs, activity, cry, and consolability (FLACC) and Ellis sedation scores, respectively. Results: The children who received intranasal midazolam sedation were calm, had less adverse effects, and had better acceptance of the drug. Both the techniques of sedation were found to be equally effective in terms overall behavior rating. Conclusion: Intranasal midazolam was found to be as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. It can also be an effective alternative for anxious patients who are unable to maintain the nitrous oxide mask throughout the dental procedure.



Arpit Gupta

Oral Health-related Quality of Life of Children with Early Childhood Caries before and after Receiving Complete Oral Rehabilitation under General Anesthesia

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:7] [Pages No:S117 - S123]

Keywords: Complete oral rehabilitation, Early childhood caries (ECC), Early childhood oral health impact scale (ECOHIS), General anesthesia, Oral health-related quality of life (OHRQoL)

   DOI: 10.5005/jp-journals-10005-2086  |  Open Access | 


Introduction: Early childhood caries (ECC) significantly affects the quality of life of children due to recurrent pain, infection, and other associated problems. Aim and objective: To assess the change in oral health-related quality of life of children aged <5 years undergoing complete oral rehabilitation under general anesthesia. Materials and methods: A total of 50 healthy children affected with ECC were enrolled for the present study. Oral health-related quality of life (OHRQoL) of every child was assessed by interviewing the mothers using a prevalidated Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire one day prior to the treatment appointment and comparing the scores with those at 1 and 3 months post-treatment to evaluate the changes in the OHRQoL, if any and assess the stability of the changes. Results: The results revealed a statistically significant reduction in Ouality of Life (QoL) scores of all the domains and total ECOHIS scores between baseline and 1 month, and baseline and 3 months. Conclusion: The oral health-related quality of life showed a significant improvement after complete oral rehabilitation under general anesthesia and the improvement persisted beyond the immediate post-treatment period.



Poornima Dubey

Effect of Digitalized Previsit Imagery on Behavior of Children in the Dental Operatory

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:7] [Pages No:S124 - S130]

Keywords: Cartoon, Dental anxiety, Dentist voice, Digitalized previsit imagery, WhatsApp

   DOI: 10.5005/jp-journals-10005-2089  |  Open Access | 


Aim and objective: The present study was aimed to determine the impact of exposure to digitalized previsit imagery technique on the anticipatory dental anxiety levels of children. Design: 40 children, aged 4–8 years requiring noninvasive dental treatment were included in the study. Preintervention anxiety levels were assessed using Venham picture test (VPT) in the waiting room and randomly divided into two groups. The study group was exposed to the digitalized previsit imagery technique which included a customized cartoon video of dental operatory and the concerned pediatric dentist in his/her own voice through WhatsApp messenger. The other group was dealt with the conventional approach using verbal and nonverbal communication. Postintervention anxiety was assessed in both the groups and the difference was compared. Result: A significant difference in anticipatory dental anxiety was found between the two groups (p<0.001) using SPSS software. There was no marked relation of age and sex with the reduction of anxiety levels after exposure to digitalized previsit imagery. Conclusion: The idea of digitalizing previsit imagery can be a time saving approach which is helpful in managing anxious children before entering the dental operatory.



Vineet Khinda, Dinesh Rao, Surender PS Sodhi, Nikhil Marwah

Physiological Effects, Psychomotor Analysis, Cognition, and Recovery Pattern in Children Undergoing Primary Molar Extractions under Nitrous Oxide Sedation Using Two Different Induction Techniques: A Split-mouth Randomized Controlled Clinical Trial

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:7] [Pages No:S131 - S137]

Keywords: Cognition, Conscious sedation, Induction, Nitrous oxide, Oxygen, Psychomotor analysis, Rapid analgesia, Recovery

   DOI: 10.5005/jp-journals-10005-2090  |  Open Access | 


Nitrous oxide inhalation sedation (NOIS) has been in use as a tool for pharmacological behavior modification and relative analgesia (RA) for well over 170 years now since its discovery in 1844 by the American Dentist Horace Wells. Advantages include raising of the pain reaction threshold, alteration of both pain sensitivity and pain reaction, reduction of fatigue, and time awareness that helps to handle stress and lengthy appointments. In addition, the most important clinical consequences of Nitrous Oxide (N2O) pharmacokinetics are rapid induction and recovery, reversibility, titrability, and adjustability. The goal of the current investigation was to analyze the safety aspects of nitrous oxide sedation. It was carried out on 25 patients within the age group 7–10 years requiring extractions of two primary molars in each patient. Split-mouth design was followed, with the first extraction done under traditional slow induction while the second extraction was done following the rapid induction technique of NOIS. N2O was studied for its physiological effects, psychomotor analysis was done, cognition and recovery patterns were analyzed utilizing the two different induction techniques. Based on the results obtained, it was found that N2O is a very safe and useful drug that delivers a comfortable patient for dental treatment.



Iqbal Musani, Sabina Bhure, Shikha Choubey, Smita Iqbal Musani, Safa Surve

Intranasal Midazolam Premedication for Anxiolysis in Children Reluctant to Receive Nitrous Oxide Sedation via Nasal Hood: An In Vivo Randomized Control Trial

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:5] [Pages No:S138 - S142]

Keywords: Behavior management, Conscious sedation, Dental anxiety, Midazolam, Premedication

   DOI: 10.5005/jp-journals-10005-2092  |  Open Access | 


Aim and objective: The aim of the study was to compare administration of 0.1 mg/kg intranasal midazolam as premedication against a normal saline control in alleviating anxiety relating to and increasing acceptance of nasal hood by child patients receiving nitrous oxide sedation. Materials and methods: After ethical clearance and informed consent, on the basis of odd and even numbers patients were allocated to group midazolam (group M) or group normal saline (group N), respectively. The physical parameters were recorded at the beginning and after the procedure; time required for the procedure was also recorded. The level of cooperation during acceptance of the nasal mask by the patient was evaluated using the four-point scale. Result: Group M (midazolam premedication) was more effective in improving the acceptance of the nasal hood in children than the normal saline/traditional/conventional method of treating the teeth. The p-value is .002308. Conclusion: In the present study the combination of midazolam and nitrous oxide proved to be an effective combination, resulting in good to excellent behavior in children who were Frankl's behavior rating definitely negative and negative. Clinical significance: For successful sedation premedication with nitrous oxide, midazolam is an excellent premedication drug.



Yogita Sharma

Effectiveness of Virtual Reality Glasses Digital Screens and Verbal Command as a Method to Distract Young Patients during Administration of Local Anesthesia

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:5] [Pages No:S143 - S147]

Keywords: Audiovisual distraction, Dental anxiety, Pain, Verbal command

   DOI: 10.5005/jp-journals-10005-2094  |  Open Access | 


Aim and objective: The study investigates the effect and compares three techniques-video-eyeglasses earphone system, Digital screens and verbal methods as distracting technique to assess dental pain reaction in children during administration of local anesthesia (LA). Materials and methods: Pain or its anticipation can cause fear and anxiety in a child which could complicate further dental treatment. This cross-sectional study consists of 97 children of age-group 4–8 years who required local anesthesia for their dental treatment were selected. Children were randomly allocated into three groups namely- Verbal method (group A), video eyeglass/earphone system (group B) and digital screens (group C). In group A, instructions were given to the patient by the dentist while administering local anesthesia. In group B, VR box was used to show age appropriate videos according to subjects’ choice. In group C, digital screens were placed on dental chair for patient to watch while nerve block was administered. Pain was measured using face, legs, activity, cry, consolability (FLACC) scale behavioral anxiety/pain assessment scale. Results: FLACC score was found to be significantly different among three groups. The mean FLACC scale score for pain was less in video eyeglass/earphone (1.94) than digital screens (3.67) and highest in Verbal group (6.88). Conclusion: Video eyeglasses/earphone method proved to be most effective as a distraction method in children and helped in reducing children's disruptive behavior in the dental setting. Clinical significance: This study was conducted to find a better distraction technique among video eyeglasses/earphone system, digital screens and Verbal command that will make child less apprehensive during administration of local anesthesia.



Vallala Pranitha, Uma Ramana Prakhya, Dwijendra Subbaraya Kocherlakota, Nagarjun Gali, Meghana Chiramchetty, Mounika Pininti Bhavya Naga

Communication as a Key for Imparting Oral Health Knowledge in Special Needs Patients Attending Special Schools in Sangareddy District in Telangana

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:3] [Pages No:S148 - S150]

Keywords: Attitudes, Children with disabilities, Cross-sectional study, Oral health education, Oral hygiene status, Treatment needs

   DOI: 10.5005/jp-journals-10005-2095  |  Open Access | 


Aim and objective: To assess the oral health status of special health care needs children, adequacy of awareness on oral hygiene among their parents, and recognition of the critical role of teachers as oral health moderators. Materials and methods: This study included 78, 4–15 years aged children of Government Special Schools, Sangareddy. Both parents and teachers took part in the study. A self-administered questionnaire was given to their parents, OHI-S score and DMFT/deft score of the children were noted followed by a dental health awareness program through customized charts and models. Results: Out of 78 children, 89% of their parents showed a lack of awareness in providing dental care for their children. Only 6% visited a dental surgeon previously. 69% had treatment needs. Conclusion: Communication plays an important role in bringing a change in the knowledge and rendering dental care for specially-abled children and actively promoting oral health care in the school curriculum.



Kalpana Verma

Evaluation of Efficacy of Oral Ketamine and Midazolam Combination Drug in Different Doses in Different Groups Used for Moderate Sedation in Pediatric Dentistry Randomized-comparative Trial

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:6] [Pages No:S151 - S156]

Keywords: Ketamine-midazolam, Moderate sedation, Pediatric dentistry

   DOI: 10.5005/jp-journals-10005-2096  |  Open Access | 


Background: Dental phobia and apprehension in children lead to difficulty with behavior management. During dental procedure if a child had a bad experience, he will develop greater apprehension, which makes further treatment difficult. Aim and objective: The aim and objective of the present study is to assess and compare the sedation and wake-up behavior status of oral combinations of three different doses of ketamine and midazolam drugs in three different groups mixed in 1 mL of honey. Methodology: This study was a randomized, clinical study that included patients ranging from 3 to 9 years of age with American Society of Anesthesiologists–I status with carious teeth, were randomly allocated among three groups where group (A) received 0.2 mg/kg of oral midazolam and 5 mg/kg oral ketamine combination drugs, group (B) received 0.3 mg/kg of oral midazolam with 3 mg/kg of oral ketamine combination drugs and group (C) received 0.4 mg/kg of oral midazolam with 2 mg/kg of oral ketamine combination drugs mixed in 1 mL of honey. Child patient's who fulfilled the inclusion criteria, heart rate, blood pressure, and oxygen saturation was recorded from starting of the treatment until discharged from the monitoring room. Ease of treatment completion was evaluated according to the Houpt scale, patients’ behavior, sedation, and wake-up behavior status were evaluated with modified observer assessment of alertness and sedation scale (MOAAS). Results: In the study, various doses of ketamine-midazolam combination drugs in three different groups resulted in a clement increase in heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) during the procedure but variations among the groups were not significant. As per MOAAS, the sedation success rate in group B (83.3%) was more than group A (66.6%) and group C (66.6%). All the three groups equally showed the same i.e., (91.6%), behavior score during treatment. Ease of treatment completion was excellent in group B (83.3%) followed by group A and group C [i.e.], (66.7%). Whereas, wake-up behavior score as per MOAAS scale was found to be calm and cooperative in group B (91.7%) followed by group C (88.9%) and group A (83.3%). Conclusion: In the present study oral ketamine-midazolam combination drugs can be used without harm and effectively as moderate sedation in an uncooperative pediatric patient.



Shrirang Sevekar, Mihir Nawal Jha, Ashwini Avanti

Characteristics and Comparison of Dental Treatment under General Anesthesia in Healthy Children and Children with Special Healthcare Needs: A Retrospective Study

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:5] [Pages No:S157 - S161]

Keywords: Child behavior, Dental care for children, Dental care for disabled, General anesthesia

   DOI: 10.5005/jp-journals-10005-2098  |  Open Access | 


Aim and objective: To evaluate the characteristics and treatment modalities performed under general anesthesia in very young children and children with special healthcare needs (SHCN) from January 2016 to December 2018. Materials and methods: The data was retrospectively collected from the records of the patients who underwent dental rehabilitation under general anesthesia from January 2016 to December 2018. The healthy patients were assigned to group H and children with SHCN were assigned to group S. Comprehensive dental treatment included preventive (oral prophylaxis, fluoride, pit, and fissure sealant), restorations, pulp therapies, and surgical procedures, which were compared. Results: A total of 46 patients were comprehensively treated under dental general anesthesia (DGA) during the study period. There were 34 males (73.91%) and 12 females (26.08%) with M:F ratio of 2.8:1. The patients in group H were significantly younger than group S. Extraction and restoration were more frequently performed in group S (p < 0.01, p < 0.05). While pulpectomy, pulpotomy, and stainless steel crown (SSC) were more frequently performed in group H (p < 0.01, p < 0.01, p < 0.05). Conclusion: There was more number of extraction and less number of pulpectomies, pulpotomies, and SSC performed in children with special healthcare needs. Clinical significance: Dental management of very young children and children with SHCN is a challenging task. DGA is an excellent alternative to undergo full mouth rehabilitation in such patients. Every effort should be made towards restoring oral health of children.



Jaikiran Kaur, A Sanguida

Effectiveness of Visual Distraction with and without Virtual Reality Glasses in Reducing Dental Anxiety among Children with Hearing and Speech Disability: A Pilot Study

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:5] [Pages No:S162 - S166]

Keywords: Behavior management, Dental anxiety, Distraction, Hearing impairment, Virtual reality

   DOI: 10.5005/jp-journals-10005-2100  |  Open Access | 


Aim and objective: To assess the effectiveness of visual distraction with and without virtual reality glasses in reducing dental anxiety among children with hearing and speech disabilities undergoing dental treatment. Materials and methods: Twenty-four children with hearing and speech disabilities aged 6–12 years were selected and were randomly divided into three groups (N = 8). Children in group A received no distraction, group B received visual distraction using virtual reality (VR) glasses and group C received visual distraction without VR glasses during dental treatment. The anxiety levels were measured using PJS- Pictorial Scale and physiological parameters - before, during, and after a dental procedure. Then intragroup and intergroup comparison was done. Results: Intragroup comparison showed that \"During\" and \"Post\" treatment anxiety scores were significantly (p < 0.05) lower than that of \"baseline\" in group B. Intergroup comparison of anxiety scores in the three groups, at all three intervals, showed a statistically significant difference in the “during treatment” anxiety score (p = 0.049) with least score in group B. Conclusion: Visual distraction using VR glasses can be recommended as an effective distraction technique in reducing dental anxiety among children with speech and hearing disabilities.



Olubunmi O Bankole, Omobola M Olanloye, Olusola E Ayebameru, Bamidele O Popoola

Attitude of Some Nigerian Parents toward their Presence in the Operatory during Dental Treatment of their Children

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:6] [Pages No:S167 - S172]

Keywords: Accompaniment, Attitude, Child, Dental clinic, Operatory, Parent

   DOI: 10.5005/jp-journals-10005-2102  |  Open Access | 


Background: Parental accompaniment of children during dental treatment has been a contentious issue with diverse opinions. One of the factors to be considered is the preference of the parent. The purpose of this study was to assess the attitude of some Nigerian parents toward their presence in the dental operatory while their children undergo dental treatment. Materials and methods: A cross-sectional study was conducted among 100 accompanying parents of children who attended the Paediatric Dentistry Clinic at the University College Hospital, Ibadan using a pretested questionnaire. Results: Majority of the parents (91.0%) preferred to accompany their child when receiving dental treatment. Reasons for their choice were that they would motivate the child (65.9%) and child would feel safe (58.2%). Of those who wanted to remain with their children, (83.5%) reported that their presence would reduce child's fear by comforting and touching them during dental care. Child's age, parents’ age, previous dental visits of child and parent were not found to significantly influence the attitude of parents toward their presence in the operatory. Reason for seeking treatment was related to preference for parental presence. Conclusion: Majority of the parents preferred to stay with their children during dental treatment. The clinical significance is that dentists should endeavor as much as possible to maintain the child - parent pair during treatment since it is preferred by parents as they believe their children will be better motivated and feel safe. However, dentists sometimes may need to separate child from the parent for smooth treatment of their children.



Greeshma SG, Sageena George, S Anandaraj, Shaniya Sain, Deepak Jose, Arjun Sreenivas, GadhaRajendran Pillai, Noufila Mol

Comparative Evaluation of the Efficacy of Virtual Reality Distraction, Audio Distraction and Tell-show-do Techniques in Reducing the Anxiety Level of Pediatric Dental Patients: An In Vivo Study

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:6] [Pages No:S173 - S178]

Keywords: Pediatric dental care, Pain, Pain perception, Parental acceptance, Patient accept, Pharmacological management, Nonpharmacological, Tell-show-do (TSD)

   DOI: 10.5005/jp-journals-10005-2106  |  Open Access | 


Objectives and methods: Children, in the age-group of 6 to 8 years, with moderate level of anxiety, (measured with M-DAS), requiring inferior alveolar nerve block (IANB) for mandibular tooth extraction were selected. Informed consent was obtained from parents. Selected children were allocated randomly into 3 groups virtual reality (VR) distraction group, audio distraction group and Tell-show-do (TSD) group. Pre- and post- distraction anxiety level of children was measured subjectively with facial image scale and objectively with pulse rate and oxygen saturation (measured with pulse oxymeter). Results: There was a statistically significant decrease in pulse rate after distraction (with a p < 0.01) in all the three groups. Postdistraction pulse rate was lowest in the VR distraction group when compared to other groups .While comparing postdistraction pulse rate values in the three groups, the difference in pulse rate between TSD and VR distraction group was significant. But while comparing the pulse rate between audio distraction and TSD group ( p = 0.06), and audio distraction and VR distraction group (p = 0.24) was not statistically significant. Oxygen saturation increased in all the three groups which was statistically significant (p < 0.01). There was a statistically significant difference in the postdistraction oxygen (O2) saturation levels between TSD and audio distraction groups (p < 0.05) with more O2 saturation in audio distraction group. But while comparing the audio distraction with VR group and TSD with VR group, the difference was not significant. Facial image scale (FIS) scores decreased in all the three groups (p < 0.01). Conclusion: The overall results revealed by all the parameters indicate that children were most relaxed in VR group, followed by audio group and were least relaxed in TSD group during dental visits. Hence VR distraction can be considered as a useful technique for behavior management of pediatric patients during a conventional dental treatment.



Lavanya Govindaraju, EMG Subramanian

Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:7] [Pages No:S179 - S185]

Keywords: Behavior, Primary teeth, Pulpectomy, Rotary files

   DOI: 10.5005/jp-journals-10005-2108  |  Open Access | 


Background: Pulpectomy has gained popularity in the pediatric dental practice for preserving the primary teeth in its position until exfoliation. There has been a paradigm shift from using manual instrumentation to rotary instrumentation for canal preparation in primary teeth. While studies show that there is a reduction in the instrumentation time with the use of rotary instruments which in turn influences the behavior of the child, its direct effect on the behavior of the children has not been evaluated. Aim: To compare the behavior of the children during manual and rotary instrumentation for pulpectomy in the primary molars. Materials and methods: A single-blinded randomized clinical trial was conducted in 88 children in any one of the mandibular primary molars indicated for pulpectomy. The canal preparation was done using manual K files and rotary ProTaper (44 children in each group). The influence of these instrumentation techniques on the children was assessed with three different scales- Frankl Behavior Rating Scale; Venham Interval Rating Scale; Wong Baker FACES Pain Scale for evaluating the behavior, anxiety, and the pain experienced by the children, respectively during canal preparation. Results: A total of 88 participants, comprising 50 females and 38 males, participated in the study. An equal distribution of the participants with respect to age (p = 0.064), gender (p = 0.389), and teeth (p = 0.877) was observed between the groups. More cooperative behavior (p < 0.001); lesser anxiety levels (p < 0.001); lower intensity of pain (p < 0.001) were recorded in the children instrumented using Rotary files. Conclusion: The present study concludes that it is preferable to use rotary instrumentation for primary canal preparation in pediatric practice as it has a more positive influence on the behavior of the children, which eventually determines the success of the treatment. Clinical significance: With rise in the use of rotary files for pulpectomy in primary teeth, the present paper demonstrates the influence of rotary instrumentation technique for canal preparation during pulpectomy on the behavior of the children in a dental chair. This paper throws light for the pedodontists to effectively perform pulpectomy in children with ease without leaving a psychological impact on the children.



Umadevi Erappa, V Devi, Suryoday Ghosh

Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:7] [Pages No:S186 - S192]

Keywords: Acupressure, Anxiety rate, audiovisual aid, Hypnosis, Pulse rate, Respiratory rate

   DOI: 10.5005/jp-journals-10005-2113  |  Open Access | 


Aim: The present study aimed to assess and compare the efficacy of acupressure, hypnosis and audiovisual aids in reducing anxiety in children during the administration of local anesthesia (LA). Methodology: Two hundred apparently healthy children were selected randomly between 6 and 10 years of age and were divided into 4 groups with 50 children in each group. Group I: children were subjected to hypnosis, group II: acupressure, group III: AV aids i.e., VPT, and group IV: children were the control group where no anxiety-reducing techniques were used during administration of LA. The anxiety scores were recorded at three different time intervals by recording the pulse rate (PR), respiratory rate (RR) and anxiety rate (AR) and subjected to statistical analysis. Results: The results showed that, all the three distraction techniques showed a significant reduction in PR, RR and AR at all time intervals, when compared to the control group. A significant reduction in PR, RR and AR was seen in the hypnosis group when compared to acupressure and only PR in comparison to AV aids. There was no significant difference between group II and III in reducing anxiety. Conclusion: The present study indicates that all the three distraction techniques were effective in reducing anxiety in children. Hypnosis was most promising, followed by audiovisual aids and acupressure. Clinical significance: The techniques can be utilized in a day-to-day practice to manage patients with anxiety.



Harshita Shukla, Sadanand Kulkarni, Milind B Wasnik, Nilesh Rojekar, Durga Bhattad, Pratima Kolekar

Acceptance of Parents for Behavior Management Technique with Reference to Previous Dental Expertise and Dental Anxiety

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:6] [Pages No:S193 - S198]

Keywords: Audiovisual technique, Behavior management (BMT), Parental dental anxiety

   DOI: 10.5005/jp-journals-10005-2115  |  Open Access | 


Introduction: Behavior management of pediatric patients may be done by behavioral and pharmacological techniques. Parents play a vital role when making a decision for treatment for the kid. Aim: To evaluate parental acceptance towards behavior management techniques (BMT) at the side of its reference to previous dental expertise and dental anxiety. Materials and methods: A descriptive cross-sectional survey was conducted among forty parents of children between three to twelve years before dental treatment. The statistical analysis was done using the Chi-square test, Student's paired and unpaired t-test. p < 0.05 was considered statistically significant. Data analysis was performed using software package of statistical analysis (SPSS 22.0 version and GraphPad Prism 6.0 version). Results: The most accepted technique was audiovisual technique followed by tell-show-do and anesthesia. The least accepted technique was oral sedation. Parents whose children were treated at the Postgraduate Clinic of Department of Pediatric Dentistry had lower incomes than those from the private practice. 24% preferred general anesthesia compared to active restraint. Conclusion: Audiovisual technique is the most accepted behavior management technique by parents and is an efficient distraction technique for behavior management for anxious pediatric patients. Postgraduate clinic parents had lower incomes than those at the private practice. Parental dental experience and dental anxiety didn't have an effect on the acceptance of any specific behavior management technique.



Vijaya S Dhote, Priyanti M Dharmadhikari, Rakesh N Bahadure, Nilima R Thosar, Aniket V Dhote

Separation Anxiety—An Unseen Cause for Development of Abnormal Oral and Paraoral Habits and Malocclusion: A Review of Literature and Report of Two Cases

[Year:2021] [Month:Special Issue (Behaviour Management)] [Volume:14] [Number:S2] [Pages:7] [Pages No:S199 - S205]

Keywords: Habits, Malocclusion, Separation anxiety

   DOI: 10.5005/jp-journals-10005-2091  |  Open Access | 


A child's overall well-being depends on its mutual relationship with the caregiver and social environment. Its attachment with the caregiver forms an emotional bond at six months to two years of age. Separation anxiety refers to fear of separation from the attachment figure. In some neglected children in early age of attachment formation, symptoms of separation anxiety persist and they may show debilitating nervous behaviors during growth. It thus becomes an unseen cause of psychological problem and development of abnormal oral habits occlusal dysfunctions and further psychological problems. Oral habits being learnt patterns of muscle contraction are displayed for release of mental tension due to fear and anxiety often associated with anger, hunger, sleep, tooth eruption and fear. Pediatric dentist plays an important role in patient education through anticipatory guidance. Proper diagnosis and early interception of oral habits as a result of separation anxiety disorder can prevent occlusal disturbances in children. The present paper includes review of literature along with the management of two cases of separation anxiety as an unseen cause of development of unique socially unacceptable abnormal oral and paraoral habits and resultant malocclusion.


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