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      Effectiveness of audiovisual distraction eyewear and computerized delivery of anesthesia during pulp therapy of primary molars in phobic child patients

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          The aim of this study is to assess the effectiveness of audiovisual distraction technique with video eyewear and computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in phobic pediatric patients undergoing pulp therapy of primary molars.

          Materials and Methods:

          This randomized, crossover clinical study includes 60 children, aged between 4 and 7-year-old (31 boys and 29 girls). Children were randomly distributed equally into two groups as A and B. This study involved two treatment sessions of pulp therapy, 1-week apart. During treatment session I, group A had an audiovisual distraction with video eyewear, whereas group B had audiovisual distraction using projector display only without video eyewear. During treatment session II, group A had undergone pulp therapy without video eyewear distraction, whereas group B had the pulp treatment using video eyewear distraction. Each session involved the pulp therapy of equivalent teeth in the opposite sides of the mouth. At each visit scores on the Modified Child Dental Anxiety Scale (MCDAS) (f) were used to evaluate the level of anxiety before treatment. After the procedure, children were instructed to rate their pain during treatment on the Wong Bakers’ faces pain scale. Changes in pulse oximeter and heart rate were recorded in every 10 min.


          From preoperative treatment session I (with video eyewear) to preoperative treatment session II (without video eyewear) for the MCDAS (f), a significant ( P > 0.03) change in the mean anxiety score was observed for group A. Self-reported mean pain score decreases dramatically after treatment sessions’ with video eyewear for both groups.


          The use of audiovisual distraction with video eyewear and the use of CDS-IS system for anesthetic delivery was demonstrated to be effective in improving children's cooperation, than routine psychological interventions and is, therefore, highly recommended as an effective behavior management technique for long invasive procedures of pulp therapy in young children.

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          Most cited references 40

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          Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.

          For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.
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            Dental fear and avoidance: causes, symptoms, and consequences.

             G Meynert,  U Berggren (1984)
            A specialized community dental unit for dental fear treatment was used to investigate 160 adult patients. The patients, predominantly women 20 to 40 years old, had avoided regular dental care for an average of 16 years. Psychosocial and psychosomatic conditions were common. Dental fear generally had started in childhood (85%) and the dominating causative factor was previous traumatic dental experiences. For fear of early origin, the dentist's professional behavior was most important, whereas for fear acquired in adult years, pain was important. The most feared events in dentistry ranked by the patients were drilling, having an anesthetic, and extraction. The most desired dentist attributes were understanding and trying to avoid pain, whereas the most undesired were being heavy-handed, critical, and remote and distant. The dental status was strongly affected by fear and avoidance, and the deterioration was significantly more pronounced in men.
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              Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale.

              A new version of the Modified Child Dental Anxiety Scale (MCDAS) was formed by adding a faces rating scale to the original numeric form. To describe the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDAS(f)), and to provide normative data for dental anxiety for children using the MCDAS(f). To determine the test-retest reliability, 287 schoolchildren aged 8-10 years completed the MCDAS(f) on two separate occasions 17 weeks apart. To determine the criterion validity, 207 schoolchildren aged 10-12 years completed the MCDAS(f) and the CFSS-DS at the same sitting. Construct validity was assessed using a cohort of 206 consecutive child dental patients and their parents. The MCDAS(f) showed good test-retest reliability (intraclass correlation coefficient = 0.80) and internal consistency (Cronbach's alpha = 0.82). The MCDAS(f) significantly correlated with the CFSS-DS (r = 0.80, P < 0.001). Dental anxiety assessed using the MCDAS(f) was related to the dmft (t = -2.17, P = 0.03), DMFT (t = -4.19, P < 0.001), and dental general anaesthetic experience (t = -4.46, P < 0.01). The mean MCDAS(f) score for the normative sample (n = 475) was 19.81 (95% CI: 19.20, 20.43). The MCDAS(f) is a reliable and valid measure of dental anxiety in children aged 8-12 years.

                Author and article information

                [1 ]College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
                [2 ]Department of Endodontics, Hacettepe University, Faculty of Dentistry, Turkiye
                Author notes
                Correspondence: Dr. Kausar Sadia Fakhruddin Email: kfakhruddin@
                Eur J Dent
                Eur J Dent
                European Journal of Dentistry
                Medknow Publications & Media Pvt Ltd (India )
                Oct-Dec 2015
                : 9
                : 4
                : 470-475
                Copyright: © European Journal of Dentistry

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Original Article


                pulp therapy, audiovisual distraction eyewear, dental anxiety


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