Effects of Pretreatment Exposure to Dental Practice Using a Smartphone Dental Simulation Game on Children’s Pain and Anxiety: A Preliminary Double-Blind Randomized Clinical Trial
Objectives: Studies on modeling a pre-exposure technique for the prevention of anxiety in children are rare, and there is no study on interactive modeling using computer games. We assessed the effect of playing a dental simulation game before operation on pain and anxiety in 4- to 7-year-old children during their first dental treatment session.
Materials and Methods: In this double-blind randomized clinical trial, 50 children needing unilateral pulpotomy and placement of stainless-steel crowns (SSC) on mandibular primary first molars were enrolled and randomly divided into experimental (a simulation game) and control (no intervention) groups. The experimental group played the game twice a day for two weeks before the scheduled visit. At the dental session, their pre- and post-operative pains were recorded using the Wong-Baker Facial Rating Scale (W-BFRS). Also, heart rate (HR; as an indicator of anxiety) was measured using a finger pulse oximeter at six treatment stages: (1) baseline (at the initial session, two weeks before treatment) and (2-6) during different stages of treatment. Effects of playing the simulation on pain and HR were analyzed using t-test and repeated-measures two-way analysis of covariance (ANCOVA).
Results: Game playing significantly reduced the HR (P=0.031). The interaction of playing with the treatment period was also significant (P=0.004). When the groups were compared in each of the six time points, the experimental group showed reduced HR during anesthetic injection and cavity preparation using a high-speed handpiece (P<0.003).
Conclusions: Based on the results, playing certain dental simulation games before the first dental visit might reduce the anxiety felt during anesthetic injections and drilling.
- Pop-Jordanova N, Sarakinova O, Pop-Stefanova-Trposka M, Zabokova-Bilbilova E, Kostadinovska E. Anxiety, Stress and Coping Patterns in Children in Dental Settings. Open Access Maced J Med Sci. 2018 Apr 10;6(4):692-7.
- Cianetti S, Paglia L, Gatto R, Montedori A, Lupatelli E. Evidence of pharmacological and non-pharmacological interventions for the management of dental fear in paediatric dentistry: a systematic review protocol. BMJ Open. 2017;7:e016043.
- Armfield JM, Milgrom P. A clinician guide to patients afraid of dental injections and numbness. SAAD Dig. 2011 Jan;27:33-9.
- Doebling S, Rowe MM. Negative perceptions of dental stimuli and their effects on dental fear. J Dent Hyg. 2000 Spring;74(2):110-6.
- Erten H, Akarslan ZZ, Bodrumlu E. Dental fear and anxiety levels of patients attending a dental clinic. Quintessence Int. 2006 Apr;37(4):304-10.
- Siegel K, Schrimshaw EW, Kunzel C, Wolfson NH, Moon-Howard J, Moats HL, et al. Types of dental fear as barriers to dental care among African American adults with oral health symptoms in Harlem. J Health Care Poor Underserved. 2012 Aug;23(3):1294-309.
- Randall CL, Wright CD, Chernus JM, McNeil DW, Feingold E, Crout RJ, et al. A Preliminary Genome-Wide Association Study of Pain-Related Fear: Implications for Orofacial Pain. Pain Res Manag. 2017;2017:7375468.
- Rakhshan H, Rakhshan V. Pain and discomfort perceived during the initial stage of active fixed orthodontic treatment. Saudi Dent J. 2015 Apr;27(2):81-7.
- Gebhart GF. Scientific issues of pain and distress, in Definition of Pain and Distress and Reporting Requirements for Laboratory Animals: Proceedings of the Workshop Held June 22, 2000. National Research Council (US) Committee on Regulatory Issues in Animal Care and Use. Washington (DC): National Academies Press (US); 2000.
- Brosschot JF, Verkuil B, Thayer JF. The default response to uncertainty and the importance of perceived safety in anxiety and stress: An evolution-theoretical perspective. J Anxiety Disord. 2016 Jun;41:22-34.
- Carleton RN. Fear of the unknown: One fear to rule them all? J Anxiety Disord. 2016 Jun;41:5-21.
- ten Berg M. Dental fear in children: clinical consequences. Suggested behaviour management strategies in treating children with dental fear. Eur Arch Paediatr Dent. 2008 Feb;9 Suppl 1:41-6.
- Gorka SM, Lieberman L, Shankman SA, Phan KL. Startle potentiation to uncertain threat as a psychophysiological indicator of fear-based psychopathology: An examination across multiple internalizing disorders. J Abnorm Psychol. 2017 Jan;126(1):8-18.
- Elmore JL, Bruhn AM, Bobzien JL. Interventions for the Reduction of Dental Anxiety and Corresponding Behavioral Deficits in Children with Autism Spectrum Disorder. J Dent Hyg. 2016 Apr;90(2):111-20.
- Fortier MA, Kain ZN. Treating Perioperative Anxiety and Pain in Children: A Tailored and Innovative Approach. Paediatr Anaesth. 2015 Jan;25(1):27-35.
- Storjord HP, Teodorsen MM, Bergdahl J, Wynn R, Johnsen JA. Dental anxiety: a comparison of students of dentistry, biology, and psychology. J Multidiscip Healthc. 2014 Sep 23;7:413-8.
- Shahnavaz S, Rutley S, Larsson K, Dahllof G. Children and parents' experiences of cognitive behavioral therapy for dental anxiety--a qualitative study. Int J Paediatr Dent. 2015 Sep;25(5):317-26.
- Klingberg G, Arnrup K. Dental fear and behavior management problems, in Koch G, Poulsen S, Espelid I, Haubek D (editors). Pediatric Dentistry: A Clinical Approach. Hoboken, NJ, USA, Wiley-Blackwell, 2017:55-102.
- Afshar H, Baradaran Nakhjavani Y, Mahmoudi-Gharaei J, Paryab M, Zadhoosh S. The Effect of Parental Presence on the 5 year-Old Children's Anxiety and Cooperative Behavior in the First and Second Dental Visit. Iran J Pediatr. 2011 Jun;21(2):193-200.
- Marwah N, Prabhakar AR, Raju OS. Music distraction--its efficacy in management of anxious pediatric dental patients. J Indian Soc Pedod Prev Dent. 2005 Oct-Dec;23(4):168-70.
- Navit S, Johri N, Khan SA, Singh RK, Chadha D, Navit P, et al. Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients. J Clin Diagn Res. 2015 Dec;9(12):ZC05-9.
- Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J. 2013 Dec;58(4):390-407.
- Garrocho-Rangel A, Ibarra-Gutierrez E, Rosales-Berber M, Esquivel-Hernandez R, Esparza-Villalpando V, Pozos-Guillen A. A video eyeglasses/earphones system as distracting method during dental treatment in children: A crossover randomised and controlled clinical trial. Eur J Paediatr Dent. 2018 Mar;19(1):74-9.
- Mitrakul K, Asvanund Y, Arunakul M, Paka-Akekaphat S. Effect of audiovisual eyeglasses during dental treatment in 5-8 year-old children. Eur J Paediatr Dent. 2015 Sep;16(3):239-45.
- Anthonappa RP, Ashley PF, Bonetti DL, Lombardo G, Riley P. Non-pharmacological interventions for managing dental anxiety in children. Cochrane Database Syst Rev. 2017 Jun;6:CD012676.
- Roberts JF, Curzon ME, Koch G, Martens LC. Review: behaviour management techniques in paediatric dentistry. Eur Arch Paediatr Dent. 2010 Aug;11(4):166-74.
- Shapiro M, Melmed RN, Sgan-Cohen HD, Eli I, Parush S. Behavioural and physiological effect of dental environment sensory adaptation on children's dental anxiety. Eur J Oral Sci. 2007 Dec;115(6):479-83.
- Greenbaum PE, Melamed BG. Pretreatment modeling. A technique for reducing children's fear in the dental operatory. Dent Clin North Am. 1988 Oct;32(4):693-704.
- Paryab M, Arab Z. The effect of Filmed modeling on the anxious and cooperative behavior of 4-6 years old children during dental treatment: A randomized clinical trial study. Dent Res J (Isfahan). 2014 Jul;11(4):502-7.
- Melamed BG, Hawes RR, Heiby E, Glick J. Use of filmed modeling to reduce uncooperative behavior of children during dental treatment. J Dent Res. 1975 Jul-Aug;54(4):797-801.
- Melamed BG, Yurcheson R, Fleece EL, Hutcherson S, Hawes R. Effects of film modeling on the reduction of anxiety-related behaviors in individuals varying in level of previous experience in the stress situation. J Consult Clin Psychol. 1978;46(6):1357-67.
- Rouleau J, Ladouceur R, Dufour L. Pre-exposure to the first dental treatment. J Dent Res. 1981 Jan;60(1):30-4.
- Al-Namankany A, Petrie A, Ashley P. Video modelling for reducing anxiety related to the use of nasal masks place it for inhalation sedation: a randomised clinical trial. Eur Arch Paediatr Dent. 2015 Feb;16(1):13-8.
- Farhat-McHayleh N, Harfouche A, Souaid P. Techniques for managing behaviour in pediatric dentistry: comparative study of live modelling and tell-show-do based on children's heart rates during treatment. J Can Dent Assoc. 2009 May;75(4):283.
- Howard KE, Freeman R. An evaluation of the PALS after treatment modelling intervention to reduce dental anxiety in child dental patients. Int J Paediatr Dent. 2009;19:233-42.
- Stigers JI. Nonpharmacologic Management of Children’s Behaviors, in Dean JA (editor). McDonald and Avery's Dentistry for the Child and Adolescent. Maryland Heights, MO, USA, Mosby Elsevier Health Sciences, 2015:286-302.
- Garra G, Singer AJ, Taira BR, Chohan J, Cardoz H, Chisena E, et al. Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Acad Emerg Med. 2010 Jan;17(1):50-4.
- Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988 Jan-Feb;14(1):9-17.
- Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet. 2011 Mar 19;377(9770):1011-8.
- Akyuz S, Pince S, Hekin N. Children's stress during a restorative dental treatment: assessment using salivary cortisol measurements. J Clin Pediatr Dent. 1996 Spring;20(3):219-23.
- Milgrom P, Coldwell SE, Getz T, Weinstein P, Ramsay DS. Four dimensions of fear of dental injections. J Am Dent Assoc. 1997 Jun;128(6):756-66.
- Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne‐Davis LM, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016 May 26;(5):CD008646.
- Rondon S, Sassi FC, Furquim de Andrade CR. Computer game-based and traditional learning method: a comparison regarding students’ knowledge retention. BMC Med Educ. 2013 Feb 25;13:30.