Effect of Recreational Intervention on the Approach of Pediatric Patients in Dental Treatment: Analysis of Salivary Cortisol

Rúbia  Zen; Lilian  Rigo; Emanuela  Gaviolli; Luiza Paloma S.  Girotto; Debora N.  Mário

Authors

Rúbia Zen
Lilian Rigo
Emanuela Gaviolli
Luiza Paloma S. Girotto
Debora N. Mário

Keywords:

Pediatric Dentistry, Hydrocortisone, Dental Anxiety, Stress, Psychological

Abstract

Objective: To verify whether recreational interaction with pediatric patient before dental care influences cortisol levels and anxiety. Material and Methods: Twelve children were selected and divided into two groups: 6 children who had not previously received recreational intervention (Group I) and 6 children who received recreational intervention before dental care (Group II). Saliva was collected with Salivettes™ kits before and soon after dental care for the measurement of cortisol. Wilcoxon test was applied to verify the difference in salivary cortisol levels before and after the dental visit in the whole sample, and the Mann- Whitney U test was used to analyze the difference between groups I and II. A significance level of 0.05 was considered. Results: Among patients from Group I, 3 had their cortisol levels increased after dental care, 2 had their cortisol levels decreased, and the other 1 patient remained constant. All participants from Group II had no significant difference in cortisol levels pre- and post-procedure. Mean salivary cortisol level was higher in Group I, pre- and post-procedure, compared to Group II. Conclusion: Pediatric patients who participated in an interactive activity prior to dental care have a lower level of anxiety according to the salivary cortisol levels obtained, compared to patients who did not participate in recreation. The techniques for the dentist to approach the child control the anxiety of the patient and make the procedure calmer and less stressful for both of them.

References

Crego A, Carrillo-Diaz M, Armfield JM, Romero M. From public mental health to community oral health: the impact of dental anxiety and fear on dental status. Front Public Health 2013; 2:16. https://doi.org/10.3389/fpubh.2014.00016

Pohjola V, Rekola A, Kunttu K, Virtanen JI. Association between dental fear and oral health habits and treatment need among University students in Finland: a national study. BMC Oral Health 2016; 16:26. https://doi.org/10.1186/s12903-016-0179-y

Quteish Taani DSM. Dental fear among a young adult Saudian population. Int Dent J 2001; 51(2):62-6. https://doi.org/10.1002/j.1875-595X.2001.tb00823.x

Appukuttan D, Subramanian S, Tadepalli A, Damodaran LK. Dental anxiety among adults: an epidemiological study in South India. N Am J Med Sci 2015; 7(1):13-8. https://doi.org/10.4103/1947-2714.150082

Dou L, Vanschaayk MM, Zhang Y, Fu X, Ji P, Yang D. The prevalence of dental anxiety and its association with pain and other variables among adult patients with irreversible pulpitis. BMC Oral Health. 2018; 18:101. https://doi.org/10.1186/s12903-018-0563-x

Nigam AG, Marwah N, Goenka P, Chaudhry A. Correlation of general anxiety and dental anxiety in children aged 3 to 5 years: a clinical survey. J Int Oral Health 2013; 5(6):18-24.

Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 2007; 7:1. https://doi.org/10.1186/1472-6831-7-1

Gereige RS, Dhepyasuwan N, Garcia KL, et al. Pediatric residents’ knowledge and comfort with oral health Bright Futures concepts: a CORNET study. Acad Pediatr 2015; 15(5):551-6. https://doi.org/10.1016/j.acap.2015.04.036

Anthonappa RP, Ashley PF, Bonetti DL, Lombardo G, Riley P. Non‐pharmacological interventions for managing dental anxiety in children. Cochrane Database Syst Rev 2017; 2017(6):CD012676. https://doi.org/10.1002/14651858.CD012676

Uman LS, Chambers CT, McGrath PJ, Kisely S. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2006;(4):CD005179. https://doi.org/10.1002/14651858.CD005179.pub2

Curcio WB, Scalioni FAR, Soares MRPS, Devito KL, Chaves MGAM, Ribeiro RA. Salivary cortisol levels in children undergoing dental treatment – a pilot study. Pesqui Bras Odontopediatria Clín Integr 2013; 13(1):5-10. https://doi.org/10.4034/pboci.v13i1.1410

Hall JE. Guyton and Hall Textbook of medical physiology. 12th. ed. Philadelphia: Saunders Elsevier; 2011.

McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 2007; 87(3):873-904. https://doi.org/10.1152/physrev.00041.2006

Adam EK, Kumari M. Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology. 2009; 34(10):1423-36. https://doi.org/10.1016/j.psyneuen.2009.06.011

van West D, Claes S, Deboutte D. Differences in hypothalamic-pituitary-adrenal axis functioning among children with ADHD predominantly inattentive and combined types. Eur Child Adolesc Psychiatry 2009; 18(9):543-53. https://doi.org/10.1007/s00787-009-0011-1

Moura LA, Dias IM, Pereira LV. Prevalence and factors associated with preoperative anxiety in children aged 5-12 years. Rev Latinoam Enferm 2016; 24: e2708. https://doi.org/10.1590/1518-8345.0723.2708

Padmanabhan V, Rai K, Hegde AM. Evaluation of stress during dental extractions using salivary cortisol levels and modified dental anxiety scales – a correlation study. Oral Health Dent Manag 2015; 14(2):175-8.

Soares FC, Lima RA, Barros MVG, Colares V. Factors associated with dental anxiety in Brazilian children of 5 to 8 years. Braz Res Pediatr Dent Integr Clin 2014; 14(2):97-105. https://doi.org/10.4034/PBOCI.2014.142.04

Goettems ML, Zborowski EJ, Costa FD, Costa VP, Torriani DD. Nonpharmacologic intervention on the prevention of pain and anxiety during pediatric dental care: a systematic review. Acad Pediatr 2017; 17(2):110-9. https://doi.org/10.1016/j.acap.2016.08.012

Silva RD, Austregélio SC, Ithamar L, Lima LS. Therapeutic play to prepare children for invasive procedures: a systematic review. J Pediatr 2017; 93(1):6-16. https://doi.org/10.1016/j.jped.2016.06.005

Sá Rocha RAS, Rolim GS, de Moraes ABA. Preparatory procedure for treating non-cooperative patients in pediatric dentistry). Acta Comport 2015; 23(4):423-5.

Silva LFP, Freire NC, Santana RS, Miasato JM. Behavioral management techniques non-pharmacological in pediatric dentistry. Rev Odontol Univ Cid São Paulo 2016; 28(2):135-42.

Góes MPS, Domingues MC, Couto GBL, Barreira AK. Anxiety, fear and vital signs of the child signs of the child patients. Odontol Clín-Cient 2010; 9(1):39-44.

Cardoso CL, Loureiro SR. Children's behavioral problems and stress as a consequence of dental treatment anxiety. Estud Psicol 2005; 22(1):5-12. https://doi.org/10.1590/S0103-166X2005000100002

Patil SJ, Shah PP, Patil JA, et al. Assessment of the changes in the stress-related salivary cortisol levels to the various dental procedures in children. J Indian Soc Pedod Prev Dent 2015; 33(2):94-9. https://doi.org/10.4103/0970-4388.155116

McCarthy AM, Hanrahan K, Kleiber C, Zimmerman MB, Lutgendorf S, Tsalikian E. Normative salivary cortisol values and responsivity in children. Appl Nurs Res 2009; 22(1):54-62. https://doi.org/10.1016/j.apnr.2007.04.009

Castro M, Moreira AC. Salivary cortisol on the evaluation of the hypothalamic-pituitary-adrenal axis. Arq Bras Endocrinol Metabol 2003; 47(4):358-67. https://doi.org/10.1590/S0004-27302003000400008

Bakker L, Rubiales J, López M. School stress perception and circadian rhythm of cortisol in children with ADHD. Arch Neurocien 2012; 17(1):39-42.

Lucin KM, Sanders VM, Jones TB, Malarkey WB, Popovich PG. Impaired antibody synthesis after spinal cord injury is level-dependent and is due to sympathetic nervous system dysregulation. Exp Neurol 2007; 207(1):75-84. https://doi.org/10.1016/j.expneurol.2007.05.019

Schleimer RP, Bochner BS. The effects of glucocorticoids on human eosinophils. J Allergy Clin Immunol 1994; 94(2):1202-13. https://doi.org/10.1016/0091-6749(94)90333-6