Comparison of effectiveness of three distraction techniques to allay dental anxiety during inferior alveolar nerve block in children: A randomized controlled clinical trial

Abstract

Background: Among the numerous methods used to control anxiety, distraction is the most popular method for controlling behavior during dental procedures in children. The present study aimed to use a fidget spinner, kaleidoscope, and virtual reality as distraction techniques individually and observe the effects on the anxiety levels of children subjected to inferior alveolar nerve block (IANB). Methods: In this parallel-group randomized clinical trial, 102 children aged 6-9 years requiring IANB for various dental treatments were screened and 60 children who met the inclusion criteria were enrolled and randomly assigned into four groups of 15 each; Group 1 fidget spinner (FS), Group 2 kaleidoscope, Group 3 virtual reality (VR) and Group 4 no distraction (Control). The child's self-reported anxiety levels using Venham's picture test (VPT); the pulse oximeter was used to measure physiological signs of oxygen saturation and pulse rate at three intervals i.e. before, during, and after the IANB procedure. The collected data were statistically analyzed with SPSS 21 software. Paired t-test and One way ANOVA were used to compare the VPT, oxygen saturation, and pulse rate values. Findings: Groups 1, 2, and 3 showed significantly lower mean VPT scores compared to Group 4. Groups 1 & 3 showed lower mean pulse rates and Group 2 showed comparable mean pulse rates to Group 4 respectively during the IANB procedure. Oxygen saturation levels remained non-significant between all the Groups (p > 0.05). Interpretation: Fidget spinner, kaleidoscope, and virtual reality seem to be effective distraction methods and can be recommended as effective approaches to help alleviate children's dental anxiety during IANB procedures.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

“…Many of the interventions designed to address DFA in children, such as modeling or distraction techniques, have limited evidence to support their use [ 15 , 28 , 235 , 236 ]. Research findings examining distraction and modeling techniques are mixed, with some studies reporting a decrease in DFA, whereas others found either mixed results or no difference (e.g., [ 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 ]). Tell–show–do, one of the most popular techniques utilized by dentists, likewise has little evidence to support its efficacy; however, it is widely accepted by children and parents, and there are no contraindications for its use [ 28 ].…”

Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis

“…There were 3 studies published during or before the 1990s [ 57 , 58 , 59 ], 4 studies published in the 2000s [ 60 , 61 , 62 , 63 ], and the majority of the included studies were published in the 2010s ( n = 30) [ 31 , 35 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ] and 2020s ( n = 29) [ 50 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , ...…”

“…The age of the participants ranged from 3 to 12 years old. The investigated NPBIs included Tell–Show–Do ( n = 2) [ 75 , 92 ], distraction ( n = 6) [ 50 , 75 , 81 , 92 , 109 , 110 ], video modelling ( n = 4) [ 77 , 80 , 87 , 88 ], virtual reality (n = 9) [ 72 , 74 , 82 , 85 , 93 , 100 , 102 , 109 , 110 ], and visual pedagogy ( n = 3) [ 69 , 78 , 95 ].…”

“…When comparing VR versus traditional distraction techniques using self-rated scales, VR showed a significant reduction in child-reported DFA when measured with VPT [ 93 ] and WBFS [ 102 , 110 ]. No significant reduction in the child’s DFA was found when measured with FPS-R [ 85 ], FIS [ 100 ], and CFSS-DS [ 102 ].…”

“…It has gained popularity in both the medical and dental fields [ 128 ]. Nine studies reported reduced DFA, pain, and HR/PR with the use of VR [ 72 , 74 , 82 , 85 , 93 , 100 , 102 , 109 , 110 ]. VR provides an immersive visual experience through occlusive headsets, effectively blocking out real-world visual and auditory stimuli.…”