Watching cartoons could help children overcome anxiety of dental treatment

Watching cartoons through video glasses during dental treatment could help lessen children's anxiety and distress as well as reducing disruptive behaviour, according to a randomized controlled trial published in Acta Odontologia Scandinavica.

Anxiety about visiting the dentist and during treatment is common in children. Estimates suggest that as many as 1 in 5 school age children are afraid of dentists. Children with dental phobias end up experiencing more dental pain and are more disruptive during treatment. Although studies have shown that audiovisual distraction (eg, playing video games and watching TV) can be successful in minimizing distress and the perception of pain during short invasive medical procedures, the issue of whether distraction is beneficial during dental procedures is still hotly debated. Research to date has produced conflicting results.

In this study, 56 'uncooperative' children (aged 7 to 9 years) attending a dental clinic at the Royal College of Dentistry, King Saud University in Saudi Arabia were randomly assigned to receive either audiovisual distraction (watching their favourite cartoons using the eyeglass system Merlin i-theatre™) or no distraction (control group). Children underwent three separate (max 30 min) treatment visits involving an oral examination, injection with local anaesthetic, and tooth restoration. The researchers measured the anxiety levels and cooperative behavior of the children during each visit using an anxiety and behavior scale, and monitored each child's vital signs, blood pressure, and pulse (indirect measures of anxiety). Children also rated their own anxiety and pain during each procedure.

During treatment, the children in the distraction group exhibited significantly less anxiety and showed more cooperation than those in the control group, particularly during the local anaesthetic injection. What's more, the average pulse rate of children in the control group was significantly higher during the injection compared with children in the distraction group. However, the children themselves did not report differences in treatment-related pain and anxiety.

The authors conclude that audiovisual distraction seems to be a useful technique to calm children and ensure that they can be given the dental treatment they need. However, they caution that because of the limited number of participants, further larger studies will be needed in general clinical settings to confirm the value of this audiovisual distraction tool.

Article: Effects of audiovisual distraction on children's behaviour during dental treatment: a randomized controlled clinical trial, Amal Al-Khotaniabc, Lanre A'aziz Belloc, Nikolaos Christidisab, Taylor & Francis Online, doi: 10.1080/00016357.2016.1206211, published online 13 July 2016.

Anterior Post Traumatic Immediate Implant Manuscript

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Fractured teeth are the mist common encountered dental emergency. This manuscript presents an anterior trauma case from initial presentation to final treatment through use of an interdisciplinary approach to diagnosis, planning, and treatment.


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Evidence-practice gap for sealant application: Results from a dental PBRN

At the 45th Annual Meeting & Exhibition of the American Association for Dental Research, researcher Naoki Kakudate, Kyushu Dental University, Kyushu Dental University, Japan, presented a study titled "Evidence-Practice Gap for Sealant Application: Results from a Dental PBRN." The AADR Annual Meeting was held in conjunction with the 40th Annual Meeting of the Canadian Association for Dental Research.

In this study, the researchers aimed to examine dentist practice patterns regarding treatment recommendation of dental sealants and identify characteristics associated with this recommendation. The study was conducted using a cross-sectional questionnaire survey in Japan. Participants were Japanese dentists (N=282) recruited from the Japanese Dental Practice Based Research Network (JDPBRN) who indicated that they do at least some restorative dentistry. Scenarios, images and questionnaire items were the same as those used in a previous U.S. DPBRN study. A series of three clinical photographs of the occlusal surface of a mandibular first molar, together with a description, were presented portraying increasing depths of cavitation. The researchers inquired about the treatment decision for each case, which had a 12-year-old patient with high caries risk. Chi-square tests were performed to assess the association between belief about the effectiveness of caries risk assessment and sealant recommendation. Multiple logistic regression analysis were conducted to evaluate the association between the decision to recommend sealants and dentist, practice and patient characteristics.

Responses were obtained from 189 dentists (67 percent). In the hypothetical scenarios, dentists' recommendations of sealants for the 12-year old patient varied from 16 percent to 26 percent. Nineteen percent of dentists recommended sealants in the absence of dark brown pigmentation. Forty-eight percent of dentists (n=91) recommended sealants to more than 25 percent of patients ages 6-18 years. Multiple logistic regression analysis suggested that the dentist's belief in the effectiveness of caries risk assessment was significantly associated with the percentage of patients who would receive sealants. Dentist practice patterns for sealant treatment recommendation vary widely. Recommending a sealant was significantly related to the dentist having a higher belief about the effectiveness of caries risk assessment.

GKAS Institute ambassador success stories span the U.S.

By Michelle Manchir

Photo of Dr. Jonathan Zsambeky, Lori Pinion and Adilene at Give Kids A Smile event in North Carolina
Give kids a thumbs up: Dr. Jonathan Zsambeky, right, Lori Pinion, dental hygienist, and Adilene, center, smile following a treatment during the Give Kids A Smile event in Cabarrus County, N.C. on March 4.

When Tracy Ginder walks into dental offices across Cabarrus County in central North Carolina, she’s often greeted with a wave of hellos and familiar smiles.

That’s because Ms. Ginder, for the last 10 years, has coordinated the Give Kids A Smile event there. Under her watch, thousands of youngsters here have accessed dental care and education they may not have received otherwise.

This year, Ms. Ginder had some newly acquired expertise when it came to coordinating the event. That’s because she was one of 10 GKAS Ambassadors who in October participated in the ADA Foundation Give Kids A Smile Community Leadership Development Institute in St. Louis.

Ambassadors are chosen from state and local dental societies and community-based organizations to learn best practices for initiating, expanding and enhancing a Give Kids A Smile program, in part by attending and helping facilitate one of the country’s largest GKAS events in St. Louis. The ADA Foundation will post the application for the 2016 GKAS Institute April 4 on ADAFoundation.org. The application deadline is May 13.

Here are three of the 2015 ambassadors’ stories.

Tracy Ginder — Cabarrus County, North Carolina

This year, 12 dental offices across Cabarrus County, North Carolina participated in a March 4 Give Kids A Smile event, treating more than 200 underserved kids. Patients received education, cleanings, treatment and in most cases, an invitation to return for future cleanings and treatment when necessary.

Thanks to Ms. Ginder’s GKAS Institute experience, the Cabarrus County program expanded this year to include “Tiny Smiles” — inviting children ages 0 to 5 to see a dentist for the first time. She estimates 40 children in this age group saw dentists this year.

Ms. Ginder also organized a pilot program in which the Cabarrus Health Alliance donated books so children in some of the offices would receive a book on their way out the door — in addition to a goody bag that included toothpaste and a toothbrush.
 

Photo of Erica Pankey with Juan at Give Kids A Smile event in North Carolina
No waiting for a smile: Erica Pankey, above, a dental assistant with the Cabarrus Health Alliance, sits with Juan, 6, as he awaits treatment at the March 4 Give Kids A Smile event in North Carolina.

Ms. Ginder, a marketing coordinator at the Cabarrus County Health Alliance, said she took the reins of the GKAS program when the county’s dental task force was eliminated a few years ago. If she hadn’t stepped up, she worried the program would cease in the county.

“I couldn’t let that happen,” Ms. Ginder said. “As a parent I know what it’s like when your child needs something. I hear the relief in parents’ voices when they call us and make a dental appointment. It’s one more concern they can check off their list.”

Ms. Ginder said she gleaned new information and ideas – and made new friends and contacts – thanks to attending the Institute.

“If I had a problem, someone else there had a solution,” she said.

In Cabarrus County, the Cabarrus Health Alliance that employs Ms. Ginder set up a phone bank with bilingual operators so the county’s growing Spanish-speaking population could make appointments. A local nonprofit, Cabarrus Partnership for Children, pitched in for support – thanks in part to Ms. Ginder’s networking.

“We are fortunate in this county to have a lot of willing collaborators,” she said.

Dr. Tim Kinnard — Oklahoma City

Dr. Tim Kinnard attributes the Oklahoma City Indian Clinic’s record GKAS year to his participation in the GKAS Institute. The clinic, which serves Native American patients, provided more than 50 children with screenings, sealants, radiographs, fluoride treatments and restorations during its Feb. 5 event.

Meeting dentists and others at the Institute in October who had experience streamlining their GKAS programs helped Dr. Kinnard and his team make their event more efficient, he said.

“The Institute helped us find ideas on how to be efficient in evaluating a patient to provide for them a range of treatment – from getting their teeth cleaned to following up right away with any other needs,” he said.

Dr. Kinnard and his team also recruited volunteers from other parts of the clinic to pitch in during the GKAS event, including staff from maintenance and reception who volunteered to offer face painting.

“The positive effects of having a wealth of volunteers is something else that I gathered from the ambassador program,” Dr. Kinnard said.

Dr. Kinnard and his group treated many children who “might not be able to get this type of dental treatment and education anywhere else.”

The Indian Health Service has established that oral health disparities exist among American Indian and Alaskan Native preschool children, and that significant oral health disparities exist among Indian Health Service areas.

Dr. Kinnard said the clinic has always worked to make itself culturally relevant and comfortable place for its target patients so that they are motivated to return for follow-up care.

“A lot of these kids are at risk and there is misinformation about dentistry out there,” Dr. Kinnard said. “Getting kids coming in regularly is so important.”

Dr. Stephen Gasparovich — Biloxi, Mississippi

The days when the dental team at the 81st Dental Squadron at Keesler Air Force Base scrambled to fill 40 open appointment spots during its Give Kids A Smile Event are over.

That’s in part because Dr. Stephen Gasparovich, Lieutenant Colonel and a Support Flight Commander, attended the October Give Kids A Smile Institute.

“At the Institute, I learned skills to form partnerships with medical specialties and key civilian groups on the base,” he said, which helped get more patients scheduled for treatment.
 

Photo of Give Kids a Smile near Biloxi, Miss.
Tiny Smiles: a child of Biloxi, Miss. Give Kids A Smile event on Feb. 10 engages in dental hygiene education with a toy. 

During the event Feb. 10, the group doubled the number of participating children from last year, providing treatment that ranged from well-baby exams to extractions for 120 children. Also different this year was “100 percent staff participation” on the behalf of the dental squadron, Dr. Gasporavich said.

“The Institute helped me present a clear vision of GKAS event objectives to leadership.  That support allowed us to expand the event and increase the outreach to more children,” he said.

Many of the children treated at Keesler were also rescheduled for follow-up care in the dental clinic. Dr. Gasparovich’s team also implemented a Tiny Smiles component to the event this year – allocating a specific location for these young children separate from the older kids.

Dr. Gasparovich said he foresees the GKAS event at the air force base continuing to grow and build momentum.

“In the past, I took on most of the responsibilities myself.  Delegating the tasks allowed more individuals to participate in the planning process.  Hopefully this will translate into a broader perspective and understanding of the event by fellow committee members, and they will feel more comfortable with future GKAS leadership roles,” he said.