Does atraumatic restorative treatment reduce dental anxiety in children? A systematic review and meta-analysis

ABSTRACT

Dental anxiety is one of the major problems affecting children, which impairs the rendering of dental care, leading to impaired quality of life. It often leads to occupational stress in dental personnel and conflict between parents/caregivers. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials done in children, to synthesize evidence of the effectiveness of atraumatic restorative treatment (ART) in reducing dental anxiety in children compared to conventional restorative treatments. The databases searched included PubMed, Google Scholar and The Cochrane Oral Health Group's Trials Register. Eligible studies reporting dental anxiety by a variety of psychometric scales were tabulated. The review was conducted and reported in accordance with the guidelines provided by the Cochrane Collaboration. Among 416 studies retrieved through literature search, six studies matched the inclusion criteria. Due to lack of data, only three studies were included for meta-analysis using RevMan software (Review Manager, Version 5.3;The Cochrane Collaboration, Copenhagen, 2014). The pooled meta-analysis data, (standardized mean difference − 2.12 [95% confidence interval: −4.52, 0.27]) failed to show any difference between ART group and the conventional treatment group. In conclusion, ART was not more beneficial in reducing dental anxiety among pediatric dental patients. The findings are relevant in the field of clinical practice in dentistry in the management of the anxious pediatric dental patient.

 

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Key words:

Child - dental restoration - oral health - panic - practice guideline - test-anxiety scale

 

 

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Conflict of Interest

None declared.

• REFERENCES

• 1 Folayan MO, Idehen EE, Ojo OO. The modulating effect of culture on the expression of dental anxiety in children: A literature review. Int J Paediatr Dent 2004; 14: 241-5
• 2 Skaret E, Soevdsnes EK. Behavioural science in dentistry. The role of the dental hygienist in prevention and treatment of the fearful dental patient. Int J Dent Hyg 2005; 3: 2-6
• 3 Coric A, Banozic A, Klaric M, Vukojevic K, Puljak L. Dental fear and anxiety in older children: An association with parental dental anxiety and effective pain coping strategies. J Pain Res 2014; 7: 515-21
• 4 Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999; 78: 790-6
• 5 Pine CM, Adair PM, Burnside G, Nicoll AD, Gillett A, Borges-Yáñez SA. et al. Barriers to the treatment of childhood caries perceived by dentists working in different countries. Community Dent Health 2004; 21: 112-20
• 6 Milgrom P, Mancl L, King B, Weinstein P, Wells N, Jeffcott E. An explanatory model of the dental care utilization of low-income children. Med Care 1998; 36: 554-66
• 7 Armfield JM, Slade GD, Spencer AJ. Dental fear and adult oral health in Australia. Community Dent Oral Epidemiol 2009; 37: 220-30
• 8 Nicolas E, Bessadet M, Collado V, Carrasco P, Rogerleroi V, Hennequin M. Factors affecting dental fear in French children aged 5-12 years. Int J Paediatr Dent 2010; 20: 366-73
• 9 Klingberg G, Berggren U, Carlsson SG, Noren JG. Child dental fear: Cause-related factors and clinical effects. Eur J Oral Sci 1995; 103: 405-12
• 10 Van Houtem CM, Aartman IH, Boomsma DI, Ligthart L, Visscher CM, de Jongh A. Is dental phobia a blood-injection-injury phobia?. Depress Anxiety 2014; 31: 1026-34
• 11 Beena JP. Dental subscale of children's fear survey schedule and dental caries prevalence. Eur J Dent 2013; 7: 181-5
• 12 Boyle CA, Newton T, Milgrom P. Who is referred for sedation for dentistry and why?. Br Dent J 2009; 206: E12
• 13 Mahesh R, Prasad V, Menon PA. A case of accidental aspiration of an endodontic instrument by a child treated under conscious sedation. Eur J Dent 2013; 7: 225-8
• 14 Kanegane K, Penha SS, Borsatti MA, Rocha RG. Dental anxiety in an emergency dental service. Rev Saude Publica 2003; 37: 786-92
• 15 Berggren U, Meynert G. Dental fear and avoidance: Causes, symptoms, and consequences. J Am Dent Assoc 1984; 109: 247-51
• 16 Banerjee A, Watson TF, Kidd EA. Dentine caries excavation: A review of current clinical techniques. Br Dent J 2000; 188: 476-82
• 17 Walsh LJ. Anxiety prevention: Implementing the 4 S principle in conservative dentistry. Auxilliary 2007; 17: 24-6
• 18 Frencken J, van Amerogen E, Phantumvanit P, Songpaisan Y, Pilot T. Manual for the Atraumatic Restaurative Treatment Approach to Control Dental Caries. 3rd ed.. Groningen: WHO Collaborating Centre for Oral Health Research; 1997
• 19 Smales RJ, Yip HK. The atraumatic restorative treatment (ART) approach for primary teeth: Review of literature. Pediatr Dent 2000; 22: 294-8
• 20 Smales RJ, Yip HK. The atraumatic restorative treatment (ART) approach for the management of dental caries. Quintessence Int 2002; 33: 427-32
• 21 Togoo RA, Blower C. Atraumatic Restorative Treatment (ART) in pediatric dentistry examination gloves. Int J Clin Dent Sci 2011; 2: 30-5
• 22 Mickenautsch S, Frencken JE, van't HM. Atraumatic restorative treatment and dental anxiety in outpatients attending public oral health clinics in South Africa. J Public Health Dent 2007; 67: 179-84
• 23 Higgins JP, Green S. editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 5. The Cochrane Collaboration; 2011. Available from: http://www.handbook.cochrane.org/ [Last accessed on 2014 Sep 05]
• 24 Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD. et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
• 25 Review Manager (RevMan) [Computer program]. Version 5.3 Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2014
• 26 Schriks MC, van Amerongen WE. Atraumatic perspectives of ART: Psychological and physiological aspects of treatment with and without rotary instruments. Community Dent Oral Epidemiol 2003; 31: 15-20
• 27 De Menezes AbreuDM, Leal SC, Mulder J, Frencken JE. Dental anxiety in 6-7-year-old children treated in accordance with conventional restorative treatment, ART and ultra-conservative treatment protocols. Acta Odontol Scand 2011; 69: 410-6
• 28 Topaloglu-Ak A, Eden E, Frencken JE. Perceived dental anxiety among schoolchildren treated through three caries removal approaches. J Appl Oral Sci 2007; 15: 235-40
• 29 Luz PB, Barata JS, Meller CR, de Slavutsky SM, de Araujo FB. ART acceptability in children: A randomized clinical trial. Rev Fac Odontol Porto Alegre 2012; 53: 27-31
• 30 Goud RS, Nagesh L, Shoba F, Raju HG. Assessment of discomfort experienced by school children while performing ‘ART’ and ‘MCP’-An experimental study. J Dent (Tehran) 2012; 9: 229-37
• 31 Kuscu OO, Akyuz S. Is it the injection device or the anxiety experienced that causes pain during dental local anaesthesia?. Int J Paediatr Dent 2008; 18: 139-45
• 32 De Menezes AbreuDM, Leal SC, Mulder J, Frencken JE. Pain experience after conventional, atraumatic, and ultraconservative restorative treatments in 6-to 7-yr-old children. Eur J Oral Sci 2011; 119: 163-8
• 33 Rahimtoola S, van Amerongen E, Maher R, Groen H. Pain related to different ways of minimal intervention in the treatment of small caries lesions. ASDC J Dent Child 2000; 67: 123-7 83
• 34 Frencken JE, Holmgren CJ. ART: A minimal intervention approach to manage dental caries. Dent Update 2004; 31: 295-8 301
• 35 Carvalho TS, Ribeiro TR, Bönecker M, Pinheiro EC, Colares V. The atraumatic restorative treatment approach: An “atraumatic” alternative. Med Oral Patol Oral Cir Bucal 2009; 14: e668-73
• 36 Wide BomanU, Carlsson V, Westin M, Hakeberg M. Psychological treatment of dental anxiety among adults: A systematic review. Eur J Oral Sci 2013; 121: 225-34
• 37 Dixon KE, Thorn BE, Ward LC. An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: A path analytic description. Pain 2004; 112: 188-96