Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

Mônica Maia Moterane; Anna Alice Anabuki; Luciane Rezende Costa

Authors

Mônica Maia Moterane
Anna Alice Anabuki
Luciane Rezende Costa

Keywords:

Dental Anxiety, Stress, Physiological, Dental Care for Children, Conscious Sedation, Midazolam

Abstract

Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods:Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.

References

Grisolia BM, Santos APP, Dhyppolito IM, Buchanan H, Hill K, Oliveira BH. Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses. Int J Paediatr Dent 2021; 31(2):168-83. https://doi.org/10.1111/ipd.12712

Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007; 17(6):391-406. https://doi.org/10.1111/j.1365-263X.2007.00872.x

Kyritsi MA, Dimou G, Lygidakis NA. Parental attitudes and perceptions affecting children's dental behaviour in Greek population: a clinical study. Eur Arch Paediatr Dent 2009; 10(1):29-32. https://doi.org/10.1007/BF03262664

Lourenço-Matharu L, Papineni Mcintosh A, Lo JW. Predicting children's behaviour during dental treatment under oral sedation. Eur Arch Paediatr Dent 2016; 17(3):157-63. https://doi.org/10.1007/s40368-015-0205-9

Machado GCM, Wijk AV, Heijden G, Costa LR. Does parental anxiety, coping, and pain catastrophizing influence child behaviour during sedation? Pediatr Dent 2018; 40(5):365-9.

Shim Y, Kim AH, Jeon EY, An SY. Dental fear & anxiety and dental pain in children and adolescents; a systemic review. J Dent Anesth Pain Med 2015; 15(2):53-61. https://doi.org/10.17245/jdapm.2015.15.2.53

Xia B, Wang CL, Ge LH. Factors associated with dental behaviour management problems in children aged 2-8 years in Beijing, China. Int J Paediatr Dent 2011; 21(3):200-9. https://doi.org/10.1111/j.1365-263X.2011.01111.x

Furlan NF, Gaviao MB, Barbosa TS, Nicolau J, Castelo PM. Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children. J Clin Pediatr Dent 2012; 37(1):83-7. https://doi.org/10.17796/jcpd.37.1.n32m21n08417v363

Gomes HS, Corrêa-Faria P, Silva TA, Paiva SM, Costa PS, Batista AC, et al. Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial. Braz Oral Res 2015; 29:S1806-83242015000100305. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0125

Gomes HS, Vieira LAC, Costa OS, Batista AC, Costa LR. Professional dental prophylaxis increases salivary cortisol in children with dental behavioural management problems: a longitudinal study. BMC Oral Health 2016; 16(1):74 https://doi.org/10.1186/s12903-016-0273-1

Rodrigues Gomes SS, Barreto-Bezerra AC, Maia Prado AC. Salivary biomarkers, vital signs and behaviour of pre-school children during their first dental visit. Eur J Paediatr Dent 2013; 14(4):279-83.

Sadi H, Finkelman M, Rosenberg M. Salivary cortisol, salivary alpha amylase, and the dental anxiety scale. Anesth Prog 2013; 60(2):46-53. https://doi.org/10.2344/0003-3006-60.2.46

Yfanti K, Kitraki E, Emmanouil D, Pandis N, Papagiannoulis L. Psychometric and bio hormonal indices of dental anxiety in children. A prospective cohort study. Stress 2014; 17(4):296-304. https://doi.org/10.3109/10253890.2014.918602

Golden SH, Wand GS, Malhotra S, Kamel I, Horton K. Reliability of hypothalamic-pituitary-adrenal axis assessment methods for use in population-based studies. Eur J Epidemiol 2011; 26(7):511-25. https://doi.org/10.1007/s10654-011-9585-2

Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent 2016; 8:35-50. https://doi.org/10.2147/CCIDE.S63626

Campbell C, Soldani F, Busuttil-Naudi A, Chadwick B. Update of Non-Pharmacological Behaviour Management Guideline. British Society of Paediatric Dentistry. Available from: https://www.bspd.co.uk/Portals/0/Public/Files/Guidelines/Non-pharmacological%20behaviour%20management%20.pdf. [Accessed on February 15, 2022].

Nelson TM, Xu Z. Paediatric dental sedation: challenges and opportunities. Clin Cosmet Investig Dent 2015; 7:97-106. https://doi.org/10.2147/CCIDE.S64250

American Academy of Pediatric Dentistry (AAPD). Behavior Guidance for the Pediatric Dental Patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:306-24.

Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev 2018; 12:CD003877. https://doi.org/10.1002/14651858.CD003877

Malhotra PU, Thakur S, Singhal P, Chauhan D, Jayam C, Sood R, et al. Comparative evaluation of dexmedetomidine and midazolam-ketamine combination as sedative agents in paediatric dentistry: a double-blinded randomised controlled trial. Contemp Clin Dent 2016; 7(2):186-92. https://doi.org/0.4103/0976-237X.183058

Akyuz S, Pince S, Hekin N. Children's stress during a restorative dental treatment: assessment using salivary cortisol measurements. J Clin Pediatr Dent 1996; 20(3):219-23.

Curcio WB, Abreu LG, Carrada CF, Ribeiro Scalioni FA, Ribeiro RA. Relationship between salivary cortisol levels and children's behaviour during a dental examination. J Dent Child 2017; 84(2):80-5.

Gomes HS, Miranda AR, Viana KA, Batista AC, Costa PS, Daher A, et al. Intranasal sedation using ketamine and midazolam for paediatric dental treatment (NASO): Study protocol for a randomised controlled trial. Trials 2017; 18(1):37-45. https://doi.org/10.1186/s13063-017-1919-2

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. (Editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook. [Accessed on August 4, 2022].

Gomes HS, Daher A, Costa OS, Batista AC, Costa LR. Crossover studies of paediatric dental sedation are inappropriate. Braz Dent J 2019; 30(4):404-9. https://doi.org/10.1590/0103-6440201902852

Sado-Filho J, Viana KA, Corrêa-Faria P, Costa LR, Costa PS. Randomised clinical trial on the efficacy of intranasal or oral ketamine midazolam combinations compared to oral midazolam for outpatient paediatric sedation. PLoS One 2019; 14(3):e0213074. https://doi.org/10.1371/journal.pone.0213074

Agha RA, Sohrabi C, Mathew G, Franchi T, Kerwan A, O'Neill N, et al. The PROCESS 2020 Guideline: Updating Consensus Preferred Reporting Of CasE Series in Surgery (PROCESS) Guidelines. Int J Surg 2020; 84:231-5. https://doi.org/10.1016/j.ijsu.2020.11.005

Ali N, Pruessner JC. The salivary alpha amylase over cortisol ratio as a marker to assess dysregulations of the stress systems. Physiol Behav 2012; 106(1):65-72. https://doi.org/10.1016/j.physbeh.2011.10.003

Keil MF. Salivary cortisol: a tool for biobehavioural research in children. J Pediatr Nurs 2012; 27(3):287-9. https://doi.org/10.1016/j.pedn.2012.02.003

Lochary ME, Wilson S, Griffen AL, Coury DL. Temperament as a predictor of behaviour for conscious sedation in dentistry. Pediatr Dent 1993; 15(5):348-52.

Mason KP, Green SM, Piacevoli Q; International Sedation Task Force. Adverse event reporting tool to standardise the reporting and tracking of adverse events during procedural sedation: a consensus document from the World SIVA International Sedation Task Force. Br J Anaesth 2012; 108(1):13-20. https://doi.org/10.1093/bja/aer407

Bello LL. Factors affecting efficacy of oral trimeprazine sedation for dental procedures in children: a retrospective study. Saudi Dent J 2011; 23(2):87-90. https://doi.org/10.1016/j.sdentj.2011.01.004

Burns MT, Blinkhorn AS, Asbury AJ. An evaluation of the behaviour of children undergoing dental extraction under general anaesthesia. Anaesthesia 1992; 47(12):1073-4. https://doi.org/10.1111/j.1365-2044.1992.tb04208.x

Isik B, Baygin O, Kapci EG, Bodur H. The effects of temperament and behaviour problems on sedation failure in anxious children after midazolam premedication. Eur J Anaesthesiol 2010; 27(4):336-40. https://doi.org/10.1097/EJA.0b013e32833111b2

Lane KJ, Nelson TM, Thikkurissy S, Scott JM. Assessing temperament as a predictor of oral sedation success using the children's behaviour questionnaire short form. Pediatr Dent 2015; 37(5):429-35.

Nelson TM, Griffith TM, Lane KJ, Thikkurissy S, Scott JM. Temperament as a predictor of nitrous oxide inhalation sedation success. Anesth Prog 2017; 64(1):17-21. https://doi.org/10.2344/anpr-63-03-01

Jacob Gitlin BS, Chamadia S, Locascio JJ, Ethridge BR, Pedemonte JC, Hahm EY, et al. Dissociative and analgesic properties of ketamine are independent. Anesthesiology 2020; 133(5):1021-8. https://doi.org/10.1097/ALN.0000000000003529

Costa LR, Bendo CB, Daher A, Heidari E, Rocha RS, Moreira APSC, et al. A curriculum for behaviour and oral healthcare management for dentally anxious children-Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE). Int J Paediatr Dent 2020; 30(5):556-69. https://doi.org/10.1111/ipd.12635

Adams HA. Endokrine Reaktionennach S-(+)-Ketamin. Anaesthesist 1997; 46:S30-7. https://doi.org/10.1007/pl00002462