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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 14  |  Issue : 3  |  Page : 116-120

Miniature pediatric dental office model: A tool for assessing the behavior of school-going children in dental setting


Department of Pediatrics and Preventive Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India

Date of Submission15-Jan-2022
Date of Decision25-Mar-2022
Date of Acceptance29-Mar-2022
Date of Web Publication27-Aug-2022

Correspondence Address:
Shivani Singh
House No. 2, Sector 31, Faridabad, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijds.ijds_8_22

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  Abstract 


Background: Dental fear and anxiety remains the most common emotions experienced by the child who visit the pediatric dentist. The success of pedodontics is determined by the odontologist's capability to gain the confidence and maintain the cooperation of the child. Objective/Aim: The aim of the study was to assess the behavior and anxiety levels of school-going children in a dental setting using a Miniature Pediatric Dental Office Model during the first dental visit of the child. Study Design: This cross-sectional research was carried out in a dental institute in the department of pediatrics and preventive dentistry. The study protocol was explained to the parents of 3–9-year-old children. Demographics were elicited from the parents and their correlation with the placement of the doll in the pediatric dental office model and a modified Frankl's behavior rating scale was used to assess the child's behavior. Results: Of 84 participants, 47 children were under the age of 6 years and 37 children were ≥6 years of age. In the doll placement test, the majority (36.9%) of the children preferred pattern 2 (the child is on the chair, the dentist is inside the operatory, the mother is inside the operatory, and the father is outside the operatory) in the doll placement test, and the least (8.3%) preferred pattern 1 (the child is on the chair, the dentist is inside the operatory, the father is inside the operatory, the mother is outside the operatory). Thirty-four percent children up to the age of 6 years exhibited a mix of negative-positive behavior, and 43.2% of children aged 6 years showed a positive behavior according to the modified Frankl's rating scale. Conclusion: The doll placement test using a miniature pediatric office aided us in determining the child's anxiety level during their first dental visit. To achieve emotional support and avoid the impact of traumatic separation, especially in younger children, our study showed that mothers should be present in the dental office to remove behavior-related problems.

Keywords: Behavior, dental anxiety, dental fear, dental office


How to cite this article:
Singh S, Mendiratta P, Saraf BG, Sheoran N, Kapil D, Singh R. Miniature pediatric dental office model: A tool for assessing the behavior of school-going children in dental setting. Indian J Dent Sci 2022;14:116-20

How to cite this URL:
Singh S, Mendiratta P, Saraf BG, Sheoran N, Kapil D, Singh R. Miniature pediatric dental office model: A tool for assessing the behavior of school-going children in dental setting. Indian J Dent Sci [serial online] 2022 [cited 2022 Dec 9];14:116-20. Available from: http://www.ijds.in/text.asp?2022/14/3/116/354897




  Introduction Top


Children's dentistry is not difficult, but it is different from adult dentistry. Children react differently to people and places around them. Odontophobia (dental fear) is a unique phobia with distinct psychosomatic components that affects odontophobic patients' dental health.[1] Dental anxiety is worry, anxiety, or stress related to a dental setting; it describes a feeling of fear that something horrible will happen during dental treatment, as well as a feeling of powerlessness.[2] Dental phobia is a severe kind of dental anxiety characterized by a continuous and extreme fear of clearly discernible situations or things (e.g., drilling and injections) or dental environments in general.[3] Generalized anxiety disorder is characterized by a high level of anxiety and worry.[4] If dental fear and anxiety are not diagnosed and treated during the initial dental visit, the patient's dental health will deteriorate.[5] The general perception of dental treatment in the population is pain and discomfort. This is certain to have an impact on the conduct of pediatric dental patients prior to their first dental visit. Many types of behavior rating scales are being used by professionals, such as the Visual Analog Scale, Categorical Rating Scale, Frankl's Behavior Rating Scale, Behavior Profile Rating Scale, Venham Behavior Rating Scale, The Facial Image Scale, Modified Child Dental Anxiety Scale, and modified Frankel's behavior rating scale.[6]

Thus, the present study was conducted in the department of pediatrics and preventive dentistry, to assess the behavior and anxiety levels of school-going children in a dental setting using a Miniature Pediatric Dental Office Model during the first dental visit of the child.


  Materials and Methods Top


The present cross-sectional study was conducted after obtaining approval from the Institutional Ethics Committee (Ref. No. SRCDSR/ACAD/2021/10457). Using the nMaster software, the sample size was calculated (version 2, CMC, Vellore, Tamil Nadu, India).

Procedure

The research was carried out on 84 children at a dental institute in Faridabad, the department of pediatrics and preventive dentistry. In the waiting room, the study methodology was explained to parents of 3–9-year-old children and informed written consent (English/Hindi) was obtained from the parents who agreed to participate in the study.

Inclusion criteria

  1. Children between the age of 3–9-year-old
  2. First examination visit of the child, where only a checkup was to be done
  3. Parents who filled the consent form.


Exclusion criteria

  1. Children who were already undergoing dental treatment
  2. Dental emergencies (swelling, trauma, pus discharge, and pain)
  3. Children with special health care needs.


Demographics were elicited from the parents such as age, sex, number of siblings, education, and total family income through a pretested and prevalidated self–administered questionnaire which comprised of six questions regarding the behavior of the child in general life situations.

A set up of a Miniature dental office model was made using doll models representing mother, father, dentist, and child (boy/girl) with a dental chair in the operatory and a barrier separating the operatory from the waiting area [Figure 1]. Children were first explained what each doll represented and then they were asked who they preferred inside the operatory. The placement patterns observed were thereby marked in an information sheet [Figure 2]. Later, while carrying out the dental examination, the behavior of the child was rated according to the modified Frankl's behavior rating scale,[6] and its correlation with the placement of the doll in the pediatric dental office model was assessed.
Figure 1: Miniature dental office model

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Figure 2: Marking of the patterns

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The evaluation was conducted based on six different patterns [Table 1].
Table 1: Patterns

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Statistical analysis

The Statistical Package for Social Sciences (SPSS) version 21 (IBM Corp. Armonk, NY) was used to analyze the data. Graphs were prepared in Microsoft Excel.

Absolute and relative frequencies of responses to different questions were compared using the Chi-square test. The level of statistical significance was set at 0.05.


  Results Top


Using a questionnaire, the other factors linked to the child's behavior were assessed during the child's first dental visit [Table 2]. Of 84 participants, 47 children were under the age of 6 years and 37 children were ≥6 years of age. Forty-seven children were boys, and 37 children were girls. On the basis of the association between behavior and age of the child, it was seen that 16 (34.0%) children up to the age of 6 years mostly showed negative-positive behavior, 16 (43.2%) children ≥6 years showed a positive behavior, and while evaluating the behavior and questions, we asked in the study, it was seen that the behavior of the mostly children was pleasant (35.9%) during the encounter with medical doctors, and a maximum number of children 24 (40%) were happy when they went to school. When assessing the child's separation anxiety, it was discovered that many (38.0%) children felt sad when their parents were away; the majority of children (41.9%) accepted the new environment positively; approximately 21 (41.2%) children were outgoing around their peers; and the majority of the children (35.1%) complied with support to the instructions given by the adults [Table 3]. While evaluating the pattern of the placement of the doll in the miniature pediatric dental office model, the majority of the children preferred pattern 2, and the least preferred was pattern 1 [Figure 3] and [Table 1].
Figure 3: Representing percentage of the patterns marked

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Table 2: Association of multiple other factors with modified Frankl's behavior rating scale

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Table 3: Questions × modified Frankl's behavior scale)

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  Discussion Top


This research was conducted to assess the behavior and anxiety levels of school-going children in a dental setting using a Miniature Pediatric Dental Office Model during the first dental visit of the child. The need of early detection and management of pediatric dental fear and anxiety should be emphasized to identify children with high dental fear and, as a result, to prevent the negative consequences of high dental fear in these children.[7] Fear is a natural reaction to danger, whether it is imagined or real and is considered to be an essential and configurable part of normal development.[8] Phobia of the dentist is very common in children, which causes serious problems in the treatment of children. In pediatric dentistry, the long-term efficacy of any dental treatment provided by a dentist is largely determined by the child's degree of participation.[9]

The doll placement test is a recommended technique for assessing child's anxiety conditions.[5] Since it is performed in simulated natural conditions, it is a method of objectively observing the child's behavior and opinions on dental procedures and the dentist.[5] Assessing dental anxiety and fear are an essential component of a child's oral care and are widely regarded as the greatest deterrent to the effective completion of dental therapy. Thus, early identification and control of dental anxiety are critical to providing appropriate dental care to the child patient.[7] Our study showed that, no statistical significant correlation was found between the socioeconomic status and the behavior of the child [Table 2] whereas a study conducted by Bhardwaj et al. discovered that children from poor socioeconomic backgrounds experienced less dental anxiety than children from higher socioeconomic backgrounds, possibly because to differences in the types of services provided to them.[10] From the results of our study, it can be correlated that the majority of the children who placed the dolls in the pattern 2, i.e., the child is on the chair, the dentist is inside the operatory, the mother is inside the operatory, and the father is outside the operatory showed a positive behavior toward the first dental visit (36.9%). The current findings are comparable to a study conducted Vasiliki et al., who concluded that when parent was not around, the children's behavior deteriorated.[11] However, according to Ahuja et al., no association was seen between parental presence/absence and behavior of the child.[9] The children who placed the dolls in pattern 6, i.e., dentist outside the operatory showed definitely negative behavior toward the first dental visit (9.5%) This was in accordance to the study done by Suresh et al. who found that children who placed the self-doll on the dental chair exhibited positive behavior during the dental treatment, while children who did not place the self-doll on the dental chair exhibited negative behavior.[5] On the evaluation of association of behavior and age of the child, it was seen that children up to the age of 6 years mostly showed negative-positive behavior, children ≥6 years showed a positive behavior. This was in contrast to the study done by Suresh et al., where they found no significant association between age of the child and the behavior displayed.[5] The age range of 3–9 years was chosen because of the fact that they could effectively comprehend the placement patterns and could reply to the questions asked and also the separation anxiety has been seen to wear off by the age of 3 years. Another finding of our research was that there was a significant difference in the type of behavior observed depending on the patient's gender, with boys behaving more favorably than girls during their first dental visit. Bedi et al. in their research also discovered that high dental anxiety was associated to gender, with girls having higher levels of anxiety than boys.[12]

Separation anxiety disorder is one of the most prevalent anxiety disorders among children, characterized by an extreme fear of being separated from a caregiver or family.[13] A questionnaire was also created based on the child's behavior to determine the child's separation anxiety levels in a location other than the dental office.[5]

For several years, clinical dentistry has recognized dental anxiety and dental fear in both adults and children as a roadblock to delivering effective dental treatment.[9] Children are often subjected to psychological stress during dental treatment. The effect of the dental environment and the dentist's behavior plays a very crucial role in child's cooperation.[14] Uncooperative children are considerably more prone than cooperative children to be afraid of the dentist.[15]

Limitations of the study

  1. The sample size could have been increased to improve the correlation between behavior and anxiety when using the miniature pediatric dental office model
  2. Separation anxiety was less in the age group ≥6 years, and they could easily understand the instructions, which could have been the reason for the display of positive behavior.



  Conclusion Top


The placement of the doll in the miniature pediatric office helped us to understand the anxiety and the child was experiencing during their first dental visit. In contrast, their behavior was also observed according to a modified Frankl's rating scale. Thus, our doll placement technique can be said to be a valuable predictor of anxiety and behavior. The study found that mothers should be present in the dental operatory to remove many behavior-related problems and to gain emotional support and reduce the impact of traumatic separation, especially in younger children.

Ethical clearance

Ref. No. SRCDSR/ACAD/2021/10457.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Carter AE, Carter G, Boschen M, AlShwaimi E, George R. Pathways of fear and anxiety in dentistry: A review. World J Clin Cases 2014;2:642-53.  Back to cited text no. 1
    
2.
Shim YS, Kim AH, Jeon EY, An SY. Dental fear & anxiety and dental pain in children and adolescents; a systemic review. J Dent Anesth Pain Med 2015;15:53-61.  Back to cited text no. 2
    
3.
Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: A review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007;17:391-406.  Back to cited text no. 3
    
4.
Messmer K. “Art and Play Therapy for Children with Anxiety”. Undergraduate Honors College Theses; 2019.  Back to cited text no. 4
    
5.
Suresh A, Karuna YM, Natarajan S, Maimoona TM, Shenoy S, Nayak AP, et al. Assessing the behavior management problems during the first dental visit of preschool children using a doll placement test. J Indian Soc Pedod Prev Dent 2020;38:41-7.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Riba H, Al- Zahrani S, Al-Buqmi N, Al-Jundi A. A review of behavior evaluation scales in pediatric dentistry and suggested modification to the Frankl scale. EC Dent Sci 2017;16:269-75.  Back to cited text no. 6
    
7.
Rajwar AS, Goswami M. Prevalence of dental fear and its causes using three measurement scales among children in New Delhi. J Indian Soc Pedod Prev Dent 2017;35:128-33.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Britton JC, Lissek S, Grillon C, Norcross MA, Pine DS. Development of anxiety: The role of threat appraisal and fear learning. Depress Anxiety 2011;28:5-17.  Back to cited text no. 8
    
9.
Ahuja S, Gandhi K, Malhotra R, Kapoor R, Maywad S, Datta G. Assessment of the effect of parental presence in dental operatory on the behavior of children aged 4-7 years. J Indian Soc Pedod Prev Dent 2018;36:167-72.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Bhardwaj SS, Almulhim B, Alghamdi S, Assaf AA, Bhardwaj A. Effect of age, gender and socioeconomic status on perceived dental anxiety. Rev Argent Clín Psicológica 2021;XXX: 525-30.  Back to cited text no. 10
    
11.
Vasiliki B, Konstantinos A, Vassilis K, Nikolaos K, van Loveren C, Jaap V. The effect of parental presence on the child's perception and co-operation during dental treatment. Eur Arch Paediatr Dent 2016;17:381-6.  Back to cited text no. 11
    
12.
Bedi R, Sutcliffe P, Donnan PT, McConnachie J. The prevalence of dental anxiety in a group of 13- and 14-year-old Scottish children. Int J Paediatr Dent 1992;2:17-24.  Back to cited text no. 12
    
13.
Mychailyszyn MP, Kendall PC, Domingues J, Treadwell K. Separation Anxiety Encyclopedia of Human Behavior. 2nd ed. Academic Press; 2012.  Back to cited text no. 13
    
14.
Arnrup K, Broberg AG, Berggren U, Bodin L. Lack of cooperation in pediatric dentistry – The role of child personality characteristics. Pediatr Dent 2002;24:119-28.  Back to cited text no. 14
    
15.
Welly A, Lang H, Welly D, Kropp P. Impact of dental atmosphere and behaviour of the dentist on children's cooperation. Appl Psychophysiol Biofeedback 2012;37:195-204.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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