Dealing with dental anxiety in children – the evidence on type of sedation

Fear of the dentist may be expressed as unco-operative behaviour in children requiring dental treatment. Behaviour management problems can result in a child’s tooth decay going untreated. While behavioural techniques play an important role in managing children, some children still find it difficult to co-operate with dental treatment and may require sedation. This review examined the effects of drugs to sedate a child whilst keeping them conscious. Continue reading

Review of the Month: Is your child scared of the dentist? Can hypnosis help?

pocket-watchThis week is Face Your Fears week. Many children are scared of going to the dentist, studies have shown a world-wide variation in the prevalence of dental anxiety with estimates ranging between 3% and 43% (Folayan, 2004). Our review of the month aimed to find out whether hypnosis can help children to cope with dental treatment.  The advantage of hypnosis is that it requires no specialist equipment, the patient remains conscious, and there are no side effects of the kind you may see with sedation or drug interventions.

What was the research?

A systematic review of the evidence to find out the effectiveness of hypnosis for behaviour management of children who are receiving dental care.

Who conducted the research?

The research was conducted by a team led by Sharifa Al-Harasi from the Military Dental Centre in Oman, on behalf of the Cochrane Oral Health Group. Paul F. Ashley, David R. Moles, Susan Parekh and Val Walters were also on the team.

What evidence was included in the review?

Data was extracted from 3 randomised controlled trials. A total of 69 children participated in the trials, and were randomly assigned to hypnosis or non-hypnosis groups. The children in the hypnosis groups could also be having some form of sedation in addition to the hypnosis. The children in the control groups either had sedation or nothing. The participants were all under the age of 16, and could be having any form of dental treatment.

What did the evidence say?

Very few studies on hypnosis for children undergoing dental treatment have been carried out, and only 3 trials were found that met the inclusion criteria. Two studies found that hypnosis had some beneficial effects during the administration of local anaesthetic, but it was not as effective during the removal of teeth. The majority of the children in one of the studies preferred sedation to hypnosis. One study found that hypnosis could make children undergoing orthodontic treatment more co-operative.

How good was the evidence?

Two of the studies were at high risk of bias, and one study at moderate risk of bias. Reporting of methods was generally poor. Only one of the studies was double-blind.

What are the implications for dentists and the general public?

There is some anecdotal evidence of the benefits of hypnosis for children undergoing dental treatment, when they are showing signs of anxiety. However, on the basis of these three studies there is not enough evidence to recommend it as a practice.

What should researchers look at in the future?

There is a need for well-conducted randomized controlled trials on this topic. Future research should follow-up patients to find out if the effect of hypnosis has modified the patient’s perception towards having dental treatment. Study design should be parallel and how the sample size was calculated should be reported.

Link

Al-Harasi S, Ashley PF, Moles DR, Parekh S, Walters V. Hypnosis for children undergoing dental treatment. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD007154. DOI: 10.1002/14651858.CD007154.pub2.

Reference

Folayan MO, Idehen EE, Ojom OO. The modulating effect of culture on the expression of dental anxiety in children: a literature review. International Journal of Paediatric Dentistry, 2004, 14(4): 241-5

New publications from the Cochrane Oral Health Group

CCUIssue 8 of the Cochrane Library for 2013 has been published, and features two new reviews and one new protocol from the Cochrane Oral Health Group.

Follow the links for more information!

New review
Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia
by Zongdao Shi, Huixu Xie, Ping Wang, Qi Zhang, Yan Wu, E Chen, Linda Ng, Helen V Worthington, Ian Needleman, Susan Furness

Ventilator associated pneumonia is a potentially serious complication in patients who are already critically ill. This new systematic review looks at whether keeping the mouth and teeth clean and preventing the build up of plaque on the teeth helps to reduce the risks. 35 randomized controlled trials were included, involving 5,374 participants. The review found that chlorhexidine mouthrinses or gels reduces the risk of ventilator-associated pneumonia by 40% but there was not enough research information available to provide evidence of the effects of other mouth care rinses such as water, saline or triclosan.

New review
Interventions for the management of dry mouth: non-pharmacological interventions
by Susan Furness, Gemma Bryan, Roddy McMillan, Helen V Worthington

This new review looks at non-drug treatments used to stimulate saliva production for the relief of dry mouth. Nine clinical trials were included in the review, and they covered treatments including acupuncture, electrostimulation and powered toothbrushes. 366 people participated in the trials. The review found that the evidence was generally of poor quality.

New protocol
Hypnosis for alleviation of anxiety in adults undergoing dental treatment
by Catherine Potter, Paul Coulthard, Richard Brown, Tanya Walsh

This is a protocol for a new Cochrane Oral Health Group review, which will consider the effects of hypnosis (with or without conscious sedation) in reducing anxiety in dental treatment.

Other highlights of the Cochrane Library, Issue 8, 2013 include:

Three new editorials:

Highlighted reviews:

New titles for the Cochrane Oral Health Group – December 2011

The Cochrane Oral Health Group met for their December Editorial Meeting and agreed to register the following two titles:

Systemic antibiotics for apical periodontitis and localised apical abscess
This review is being undertaken by a team based in Cardiff, Wales. The objective is to provide reliable evidence regarding the effects of prescribing systemic antibiotics for acute apical periodontitis and localised apical abscess in adults.

Hypnosis for alleviation of anxiety in adults undergoing dental treatment
The team leading this review are based at the Universities of Manchester and Leeds in the UK. The review will look at the effectiveness of hypnosis (with or without conscious sedation or general anaesthesia) in reducing dental anxiety.

The Oral Health Group looks forward to publishing both protocols in the near future.