The use of nitrous oxide-oxygen inhalation sedation to relieve anxiety and pain in dental outpatient treatment has been a very mature and safe technique in the world. This technology has been introduced into China for nearly 20 years, and many clinical cases have proved its safety, practicability and effectiveness, which can meet the clinical needs of patients. To further standardize and popularize this technique, the Society of Sedation and Analgesia, Chinese Stomatological Association formed the recommended application guidelines after many discussions and revisions on the basis of widely soliciting opinions and referring to relevant literatures. It covers indications, contraindications, standardized operation procedures, occupational protection, identification and treatment of adverse reactions, training and other aspects. This guideline can be used as a reference for the use of nitrous oxide-oxygen inhalation sedation techniques in the outpatient setting of dentistry.
Anesthesia, Dental ; Anesthetics, Inhalation/adverse effects* ; Conscious Sedation/methods* ; Dental Anxiety/prevention & control* ; Humans ; Nitrous Oxide/adverse effects* ; Outpatients ; Oxygen

Background: Dental anxiety (DA) creates a vicious cycle of dentist avoidance, oral health neglect, increased unmet treatment needs, compromised well-being and quality of life (QoL), which then generates added anxiety. The prevalence of DA among adult Filipinos has not been investigated. Objectives: This study aimed to establish baseline data on dental anxiety among the adult residents of Barangay (Brgy.) Cambaog, Bustos, Bulacan, Philippines. Methodology: Three hundred thirty-six (336) randomly selected adult residents completed a questionnaire that included demographics, frequency of dental visits, self-assessment of their oral health status, the Corah's Dental Anxiety Scale (DAS), and reasons for their DA. Results: The study showed that 11% of the 336 participants had DA, were young adults, affecting twice as many women than men, had lower levels of education, and with a lessening of anxiety with age. Participants with DA were also found to have infrequent dental visits, were symptom-driven, had poorer self-assessed oral health status, and only 13% of the respondents with DA viewed their oral health as healthy. Needles, tooth extraction, pain, previous negative experience, and sound of the drill were some of the triggers that elicited anxiety. Conclusion DA affects a proportion of the adult residents of Brgy. Cambaog and can be considered a dental public health problem. The use of screening tools like DAS should be considered for the early recognition of patients with DA so that management measures may be taken to enhance the delivery of oral health services.
Dental Anxiety

ABSTRACT The first dental examination is a major step that is affected by many factors and determines the dental treatment process. The main objective of this study was to evaluate the association of child temperament with child dental anxiety, parental dental anxiety, dental behaviour and dental caries. The study consisted of 100 children aged 3 to 6 who were attending their first dental examination and their accompanying parents. The Facial Image Scale (FIS), Frankl’s Behaviour Scale (FBS), Corah’s Dental Anxiety Scale (CDAS) and the Short Temperament Scale for Children (STSC) were used for assessment. The DMFT (decayed, missing and filled teeth) score of each child was recorded. Children who exhibited negative behaviour on the FBS had the highest rhythmicity scores (p = 0.008). The mean DMFT score of children in the rhythmicity temperamental dimension was relatively high (p = 0.008). The parents of children defined as negative on the FBS had high dental anxiety levels on CDAS (p < 0.001). Children whose parents had higher dental anxiety levels showed higher dental anxiety (p = 0.007). The success rate of dental treatment procedures may be increased by improving dentists’ knowledge of dental anxiety related to the child’s temperament and integrating parental support to reduce dental anxiety.
Dental Care for Children ; Dental Anxiety ; Cognitive Behavioral Therapy ; Temperament ; Dental Caries

Introduction: Dental anxiety is a common problem faced by dental practitioners worldwide. Generally, the management of dental anxiety can be classified as pharmacological and non-pharmacological approaches, in multiple studies and reports available on this subject. Aims and objectives: This paper will provide a general overview of the pharmacological and nonpharmacological strategies in the management of dental anxiety, supported by dental literature. This would help dental practitioners understand the benefits and limitations of the different methods of treating their anxious patients. Methodology: This is a narrative review and a summary of the different approaches and methods available in the management of dental anxiety. Relevant articles were searched from the online databases of PubMed, ScienceDirect, and Google Scholar, and the keywords used to identify the papers were ‘Dental Anxiety’, ‘Pharmacological’, and ‘Non-pharmacological’. Conclusion Appropriate management of dental anxiety is crucial to ensure a successful dental procedure. The choice of the anxiety management must be based on the complete understanding of the particular patient, identifying the source of anxiety, and working hand-in-hand with the patient for better oral health care.
Dental Anxiety ; Pharmacological

BACKGROUND: In dentistry, pain is a factor that negatively affects treatments and drug use. The aim of this study was to evaluate the correlations of the postoperative analgesic use with pain catastrophizing and anxiety in patients who underwent removal of an impacted mandibular third molar.METHODS: We recruited 92 patients who underwent the extraction of impacted mandibular third molar. In this study, the Pederson index was used to preoperatively determine the difficulty of surgical extraction. Patients were asked to note the number of analgesics used for 7 postoperative days. Patients were divided into two groups based on the Pain Catastrophizing Scale: low and high score groups. State-Trait Anxiety Inventory-trait and State-Trait Anxiety Inventory-state questionnaires were used to determine the anxiety levels of the patients. The obtained data were examined to evaluate the correlations of pain catastrophizing and anxiety with the postoperative analgesic use.RESULTS: In this study, 92 patients, including 60 women and 32 men, were recruited. The analgesic use was higher in women than in men but with no significant difference (P > 0.05). Pain Catastrophizing Scale scores were higher in women than in men but with no significant difference (P > 0.05). The analgesic use was higher in patients with high pain catastrophizing than in those with low pain catastrophizing but with no significant difference (P > 0.05). State-Trait Anxiety Inventory-trait scores were higher in women than in men but with no significant difference. However, state-Trait Anxiety Inventory-state scores were significantly higher in women than in men (P < 0.05).CONCLUSION: The postoperative analgesic use may be higher in patients who catastrophize pain than in others. Knowing the patient's catastrophic characteristics preoperatively would contribute to successful pain management and appropriate drug selection.
Analgesics ; Anxiety ; Catastrophization ; Dental Anxiety ; Dentistry ; Female ; Humans ; Male ; Molar, Third ; Pain Management ; Tooth, Impacted

BACKGROUND: Behavior guidance is a technique used to subdue inappropriate behavior by establishing communication that meets the needs of a child. This study aimed to measure the effectiveness of a mobile app (Little Lovely Dentist) compared to the tell-show-do (TSD) technique in managing anxious children during their first dental visit.METHODS: Fifty children (30 boys and 20 girls) without any past dental experience, aged from 7 to 11 years, were randomly allocated into either the dental app group or the TSD group. The pre- and post-operative anxiety of children who underwent prophylactic cleaning was assessed both physiologically and subjectively using a heart rate measurement and the RMS pictorial scale, respectively.RESULTS: The intragroup comparison of heart rate and RMS scores for children allocated to the dental app group was statistically significant (P value ≤ 0.001). However, a significant reduction only occurred in the RMS scores, but not the heart rate measurements, in the TSD group. Conversely, there was an increase in heart rates in the TSD group.CONCLUSION: Educating the child prior to a dental procedure using a smartphone application such as Little Lovely Dentist can significantly alleviate the anticipatory anxiety and engage children in dental treatment during their first visit.
Anxiety ; Child ; Dental Anxiety ; Dentists ; Heart Rate ; Humans ; Love ; Mobile Applications ; Smartphone

BACKGROUND: Although studies on dental fear in relation to sex and age have been conducted, there have been few nationwide studies particularly on the youth sector. In addition, no validity and reliability verifications have been implemented for new research groups on the Korean version of the Dental Fear Survey (K-DFS). Therefore, this study aimed to apply the K-DFS developed in a previous study on Korean youth to draw conclusions on dental fear among the youth.METHODS: This study used the K-DFS, a Korean translation of Kleinknecht's Dental Fear Survey for elementary school, middle school, and high school students. This study selected 2,161 young people of various ages as participants and increased the validity of the research results by expanding nationwide the scope of the study area.RESULTS: Differences in fear levels according to sex were higher in boys fear behavior scores than in girls' regarding dental treatment (P < 0.05). Students with dental fear had higher scores on items associated with dental treatment and fear of dental stimuli compared with students without dental fear (P < 0.05). Differences were observed among the three groups (P < 0.05). However, the results of logistic regression analysis showed no statistically significant differences for dental visits based on sex, grade, and other subcomponents (P > 0.05).CONCLUSION: By verifying the validity of the newly developed K-DFS, this research confirmed its utility as a dental fear questionnaire. Therefore, there can be no objection that the grounds for criticism have been established according to conventional wisdom. In the future, however, developing and studying the limits of K-DFS that overcome the factors of dental fear, especially pain, will help reduce dental fear in adolescents.
Adolescent ; Dental Anxiety ; Humans ; Logistic Models ; Reproducibility of Results ; Surveys and Questionnaires

Objective To evaluate the safety and effectiveness of oral midazolam sedation combined nitrous oxide sedation for reducing dental fear in children.Methods Totally 77 children with a Frankl's Behavior Rating Scale score of 1 were included in this study,among whom 41 received a total of 78 person-times of oral midazolam sedation (0.50-0.75 mg·kg ) (midazolam group) and 36 children were treated with the combination of 0.4 mg/kg oral midazolam with 30%-40% nitrous oxide (totally 73 person-times)(combination group). At each visit,heart rate,arterial oxygen saturation,and treatments were recorded. The behaviors of children during the treatment were assessed by Frankl's Behavior Rating Scale,the completion of treatment was assessed by Houpt Scale,and the sedation status was assessed by Ramsay Scale. Telephone follow-up was performed to record the side effects 24 hours after treatment. Results The vital signs were stable among all the 77 subjects,with a Ramsay score of 2 or 3. In the midazolam group, the behaviors were cooperative in 52 person-times (66.7%) and not cooperative in 26 person-times (33.3%);the planned treatments were completed in 62 person-times (79.5%) and partially completed in 16 person-times(20.5%). In the combination group,the behaviors were cooperative in 56 person-times (76.7%) and not cooperative in 17 person-times (23.3%);64 person-times (87.7%) completed the planned treatments and 9 person-times (12.3%) partially completed the treatments. The success rates of sedation (χ =1.87,P= 0.17) and treatment (χ =1.83,P= 0.18) were not significantly different between these two groups. The median Frankl scale score was significantly higher in the combination group [3 (3,4)] than in the midazolam group [3 (2,4)] (Z=2.647,P=0.008]. The median score of Houpt scale in the combination group [5(4,6)] was also significantly higher than in midazolam group [5(3,5)] (Z=2.236,P=0.026]. In midazolam group,there were 7 person-times of dysphoria,3 person-times of diplopia,and 2 person-times of hiccough among 78 person-times;in the combination group,there were 5 person-times of dysphoria,5 person-times of diplopia,1 person-time of hiccough,and 2 person-times of vomit among 73 person-times of treatment. Thus,there was no significant difference in the incidence of side effects (15.4% vs.17.8%,χ =0.160,P=0.689). Logistic regression analysis showed that the success rate of treatment was not associated with sex (OR=1.704,P=0.174),dose (OR=1.289,P=0.516),and treatment types (OR=0.555,P=0.143). Children over 3 years old had a significantly high success rate than those under 3 years old (OR=3.372,P=0.011). Conclusions Oral midazolam is safe and effective for reducing dental fear in children. The combination of oral midazolam with 30%-40% nitrous oxide can improve the behaviors of children during the dental treatment,especially in children over 3 years old.
Administration, Oral ; Anesthesia, Dental ; Child ; Child, Preschool ; Conscious Sedation ; Cross-Over Studies ; Dental Anxiety ; Humans ; Hypnotics and Sedatives ; Midazolam ; therapeutic use ; Nitrous Oxide

BACKGROUND: Dental anxiety in children is a major barrier in patient management. If dental anxiety in pediatric patients is assessed during the first visit, it will not only aid in management but also help to identify patients who are in need of special care to deal with their fear. Nowadays, children and adults are highly interested in multimedia and are closely associated with them. Children usually prefer motion pictures on electronic devices than still cartoons on paper. Therefore, this study was conducted to evaluate a newly designed scale, the animated emoji scale (AES), which uses motion emoticons/animojis to assess dental anxiety in children during their first dental visit, and compare it with the Venham picture test (VPT) and facial image scale (FIS). METHODS: The study included 102 healthy children aged 4–14 years, whose dental anxiety was measured using AES, VPT, and FIS during their first dental visit, and their scale preference was recorded. RESULTS: The mean anxiety scores measured using AES, FIS, and VPT, represented as mean ± SD, were 1.78 ± 1.19, 1.93 ± 1.23, and 1.51 ± 1.84, respectively. There was significant difference in the mean anxiety scores between the three scales (Friedman test, P < 0.001). The Pearson's correlation test showed a very strong correlation (0.73) between AES and VPT, and a strong correlation between AES and FIS (0.88), and FIS and VPT (0.69), indicating good validity of AES. Maximum number of children (74.5%) preferred AES. CONCLUSION: The findings of this study suggest that the AES is a novel and child-friendly tool for assessing dental anxiety in children.
Adult ; Anxiety ; Child ; Dental Anxiety ; Humans ; Motion Pictures as Topic ; Multimedia ; Pediatric Dentistry ; Weights and Measures

BACKGROUND: This study evaluated the efficacy of virtual reality (VR) distraction and counter-stimulation (CS) on dental anxiety and pain perception to local anesthesia in children. METHODS: A prospective, randomized, single-blinded interventional clinical trial with a parallel design was used. Seventy children 7–11 years old who required local anesthesia (LA) for pulp therapy or tooth extraction were recruited and allocated to two groups with equal distribution based on the intervention. Group CS (n = 35) received CS and Group VR (n = 35) received VR distraction with ANTVR glasses. Anxiety levels (using pulse rate) were evaluated before, during, and after administration of local anesthesia, while pain perception was assessed immediately after the injection. Wong-Baker faces pain-rating scale (WBFPS), visual analog scale (VAS), and Venham's clinical anxiety rating scale (VCARS) were used for pain evaluation. Student's t-test was used to test the mean difference between groups, and repeated measures ANOVA was used to test the mean difference of pulse rates. RESULTS: Significant differences in mean pulse rates were observed in both groups, while children in the VR group had a higher reduction (P < 0.05), and the mean VCARS scores were significant in the VR group (P < 0.05). Mean WBFPS scores showed less pain perception to LA needle prick in the CS group while the same change was observed in the VR group with VAS scores. CONCLUSIONS: VR distraction is better than CS for reducing anxiety to injection in children undergoing extraction and pulpectomy.
Anesthesia, Local ; Anxiety ; Child ; Dental Anxiety ; Eyeglasses ; Glass ; Heart Rate ; Humans ; Needles ; Pain Perception ; Prospective Studies ; Pulpectomy ; Tooth Extraction ; Visual Analog Scale