Evaluation of Maternal & Children Reaction to Local Anesthesia During Dental Treatment

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1 ORIGINAL ARTICLE Evaluation of Maternal & Children Reaction to Local Anesthesia During Dental Treatment Venkatesh Babu, Vivek Dhruv Kumar, Hemanth Kumar Department of Pedodontics & Preventive Dentistry, VS Dental College & Hospital Bangalore Karnataka India JOURNAL OF DENTAL SCIENCES AND RESEARCH Vol. 3, Issue 1, Pages 5-9 ABSTRACT The aim of the study was to assess the reaction of five & six year old children to two different local anaesthesia techniques during dental treatment & to find out if there was any correlation between child's reaction & mother's attitude towards dental treatment. 20 children aged 5-6 years were selected randomly from patients reporting to the department. The sample was divided into group A & group B. The study was done in two different sessions in first session group A was shown the needle before anaesthetic administration while group B was not shown. During the next visit local anaesthesia administered, in which the needle was shown to group B & was concealed to group A. Mothers completed the questionnaire form. In group A, 65% children showed positive rating code & 35% showed negative rating code. Similarly in group B 60% children showed positive rating code & 40% showed negative rating code. There was no statistically significant difference in reaction of children between group A & group B. There was no association between child reaction & mother's attitude to local anaesthesia. In group B the sequence of anaesthesia followed was statistically significant compared to group A i.e. Concealed technique in the initial appointment followed by Tell Show Do technique in the subsequent appointments. Keywords: local anaesthesia, dental treatment, children, fear & anxiety. INTRODUCTION One of the most delicate and difficult procedure in paediatric dental treatment is the administration of local anaesthesia. Modern paediatric dental treatment encourages painless procedures. The fear of the needle and the pricking, which is associated with the word injection, makes children anxious. Glassman recommended showing the needle in the final steps of a [1] desensitization process. Duff recommends showing the needle to the child prior to anaesthesia, because if not shown, the child may imagine a needle that is much larger [2] and procedure more painful than they actually are. Incidence of fear of dentistry ranges between 3% & 20% [3,4,5,6,7] in children older ones tend to be less fearful. Often the child, lacking the background experience of an adult, will be triggered by inadvertent pain, into an uncooperative state. This is unfortunate as pain can be Address for correspondence: Dr. Venkatesh Babu drnsvbabu@yahoo.co.in Access this article online Website: IEC Clearance certificate provided by author Non plagiarized content declaration provided by author No reduced or controlled through several different mechanisms. The tell-show-do technique was [8] introduced by Addelston.The aim of this technique is to guide the behaviour and reduce the normal fear of children, during different stages of their psychological development. Paediatric dentistry textbooks recommend showing instruments before using them in the clinical [9,10,11,12] procedure. It is necessary always to explain in brief the functions of these instruments and to prepare the child of what he/she would feel before using them. The concealed technique is a rather standard one and has been described by several authors, more recently by Mink and Spedding. The basic considerations of this technic are that the syringe is concealed from the patient's view at all times. There are literary data showing that dental anxiety in children might be due to maternal anxiety, family influences, personality and psychological development of the children, and previous painful medical and dental [13,14,15] experience. The study was undertaken to compare children's reaction to two techniques of local anaesthesia administration. It also aims at investigating if there is any connection between mother's and child's attitude to dental treatment 5

2 Journal of Dental Sciences and Research and reaction of the child during anaesthetic administration. MATERIALS & METHODOLOGY: Patients selected from the OPD attending Department of Pedodontics & Preventive Dentistry, V. S. Dental College & Hospital Bangalore. Age criteria years children, Sample size - 20 children, Gender: Male-10 Female-10 Inclusion criteria Lack of any dental injection experience. All participants needed local anesthesia injection as a part of their treatment plan. Exclusion criteria Mentally handicapped children Poor hearing / eye sight which could interfere with their understanding the explanation of procedure. The aim of the study was explained to each mother and informed consent for local anaesthesia administration was obtained. Mothers completed a questionnaire. The aim was to assess their attitude toward dental treatment and the attitude of their children (dental fear, child's personality, etc.) (Table 1) The sample was divided into two groups of 10 children (5 girls and 5 boys) in order of arrival to the department. Each child was treated in two different sessions. In the first visit a complete oral health status assessment of each child was done and discussed the necessity of local anaesthesia administration as part of his/her treatment plan. Using the tell-show-do technique mother and her child was explained the aim of the anaesthesia, the procedure and needed instruments, but with one group (group A) the needle was shown in the first session before anaesthetic administration and with the other (group B) the needle was not shown. After showing the needle, the child was asked to help by holding the syringe, and then the dentist assembled the syringe, anaesthetic cartridge and needle while the child watched (Fig 1.). Hiding the needle, principles described by Spedding and Mink was Table I. The questionnaire for participant mothers ANSWERS 1. Are you afraid of going to the dentist for dental treatment Not afraid at all (Including aesthetic administration)? Very afraid A little afraid 2. Are there other family members who are afraid No of dental treatment, Who? 3. Have you ever used a dental visit as a threat of No punishment for your child? 4. Do you think your child has discipline problems? No 5. What is your child's response to a new situation? Approach Withdrawal 6. What is your child's previous experience with injections? Crying, refusing to cooperate Worried Calm Positive 7. Has your child ever been to the dentist before? No If yes, how would you rate his/her previous dental experience? Crying, refusing to cooperate Worried Cooperates reservedly Positive 8. Has your child ever been exceptionally afraid of a No specific dental procedure?, Which? 6

3 Vol. 3, Issue 1, February 2012 followed the child was told that his tooth would fall asleep, but he would stay awake and that it might feel like [16] a slight prick. During the next visit local anaesthesia was administered, in which the needle was shown to the children from Group B, and was not shown to the children from Group A. The study was conducted by three examiners - dentists. Two of them gave all explanations, spoke with the children and carried out the anaesthesia procedure; the other one was watching and assessing the child's reaction (Fig 2 rating code- definitely negative, Fig 3 rating codenegative & fig 4 rating code-positive.). The reactions of the children were rated as per Frankl Behavioural rating [17] scale, for local anaesthesia (Table 2.). RESULTS From all 20 children, who were examined, 16 were assessed as positive (rating codes 3 and 4, Fig. 4) during local anaesthesia administration, and 4 children as negative (rating codes 1 and 2, respectively Fig. 2. and Fig. 3.) during the two visits. In this study 19 children were given local anaesthesia successfully from group A & group B, whose reactions were assessed as rating code 2, 3 or 4, & failed with only 1 child assessed as rating code 1. (graph I - reaction assessment of group A & Graph IIreaction assessment of group B) Fig. 1 Fig. 2 Fig. 3 Fig. 4 7

4 Journal of Dental Sciences and Research Table 2. Frankel scale adapted for local anaesthesia Behaviour Rating code Description Definitely Negative 1 Refusal of anaesthesia administration, crying forcefully, fearful, or any other evidence of extreme negativism. Negative 2 Reluctant to accept anaesthesia administration, uncooperative, some evidence of negative attitude but not pronounced, i.e. sullen, withdrawn Positive 3 Acceptance of anaesthesia administration, at times cautious, willingness to comply with the dentist, at times with reservation but patient follows the dentist's directions cooperatively Definitely Positive 4 Good rapport with the dentist, interested in the dental procedures, laughing & enjoying situation Wilcoxon Signed Rank test was used to see the difference between group A and group B. There was no significant difference between them (P>0.05). So the two techniques (concealed & TSD) did not change the reaction of the children. There was no statistically significant correlation between child's reaction & mother's attitudes towards local anaesthesia, as per the answers for the questionnaire given were negative. Graph 1 Mann - Whitney test was used to test the sequence difference between two groups. Statistically significant difference was observed in group B (P<0.05) i.e. more children reacted positively when concealed technique followed by Tell-Show-Do technique was followed. DISCUSSION In this study, dental anxiety and gender were not associated among children, which is in agreement with [18] the study by Caraciolo & Colares. Many workers have found that, to a certain extent, mothers have been able to predict correctly the behaviour [19,20,21,22] of their children in the dental clinic. The findings in this study did not show that there is a direct association between the predicted behaviour of the child and actual manifested behaviour during dental appointments. Basic maternal attitudes toward life profoundly affect the behaviour of the young children, as it was suggested by a number of workers in child development. Cramer and Szmyd working with military patients suggested that those patients with a history of dental or medical trauma, or at least a recollection of such, tended to react more Graph 2 negatively during oral surgery than did patients without [23] such a history. Although the present results with young children suggested that the level of anxiety in the mother did not influence the child's behaviour in spite of his past dental or medical experiences. Several studies have reported that dental fear seems to [6,7] decrease with increasing age. However, Klinberg zet al has shown that age is strongly associated with dental [13] anxiety. 8

5 Vol. 3, Issue 1, February 2012 Rantavuori et al reported that dental fear was higher among 12 and 15 year old children than among younger [24] ones. Despite the fact that the dental fear scores decreased with increasing age, the scores between the age groups were irregular in the present study. Maragakis GM evaluated the practice of hiding the needle prior to dental anaesthesia administration to [17] children. Eleven children were cooperative and 3 uncooperative irrespective of approach. The children's behaviour correlated with fears expressed by the mothers. So Maragakis findings do not support the practice of hiding the needle. Contrary to it in this study child's behaviour did not correlate with the fears expressed by the mother. Initially hiding the needle followed by Tell-Show-Do technique gave more positive behaviour in children when adapted. CONCLUSION This study showed that the two techniques (TSD & Concealed) do not influence the reactions of children during local anaesthesia administration. There was no association found between mother's attitude, fear of local anaesthesia and the behaviour of the children. This study showed that the concealed technic in initial appointment followed by Tell-Show-Do Technique in the subsequent appointment, the children reacted more positively. This decreased anxiety and increased desired behaviour of the child. This study revealed that local anaesthesia can be successfully given even at 5 and 6 years old children, which encourages the paediatric dentists to conduct painless dental treatments in the early childhood. REFERENCES 1. Glassman, P., B. Peltier. Guidelines for the administration of local anesthesia in fearful dental patients. J Calif Dent Assoc, 1995:23: Duff, A. J. A. Incorporating psychological approaches into routine Paediatric venipuncture. 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