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Title Behavioral Therapy and Nitrous Oxide are Both Effective in Dental Treatment for Children with Dental Anxiety
Clinical Question In a child with dental anxiety, how effective is behavioral therapy in comparison to nitrous oxide in undergoing dental treatment?
Clinical Bottom Line For children with dental anxiety, cognitive behavioral therapy (CBT) and nitrous oxide are both effective in minimizing dental anxiety to achieve successful dental treatment. This is supported by a randomized controlled trial in which cognitive behavioral therapy as well as nitrous oxide were both found to be clinically significant when compared to a control group, with no significant differences. Both are within the capability of the average general dental practice and likely to be accepted by the average patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25523492Kebriaee/201545 preschoolers (ages 3-6.5) with moderate to severe dental anxiety needing pulp treatment of a primary mandibular molar.Randomized Controlled Trial
Key resultsThe study included 3 treatment groups: control group, conscious sedation group, cognitive behavior technique group. Cognitive techniques included unrelated play, Benson’s breathing, and positive self-talk and modelling. The anxiety levels were measured after injection, rubber dam placement, and use of a high-speed handpiece, using the Children’s Fear Survey Schedule Dental Subscale, Venham Clinical Anxiety and Cooperation Scales (VCAS and VCCS), and Venham Picture Test (VPT). According to these tests, the “mean of baseline anxiety and cooperation did not show any significant differences between the treatment groups.” The mean differences between the VPT scores at the second visit and between the two sessions were -0.42 ± 2.21 (control group), -1.40 ± 2.10 (N20), and -2.60 ± 3.18 (CBT), with P=0.08. They did not show any significant difference between the groups. In conclusion, although there was no significant difference between sedation and cognitive behavior therapy, both experimental groups had an overall significant decrease in anxiety levels and higher cooperation using the VCCS and VCAS tests.
Evidence Search "child"[MeSH Terms] AND "dental anxiety"[MeSH Terms] AND "behavior therapy"[MeSH Terms] AND "nitrous oxide"[MeSH Terms]
Comments on
The Evidence
This study included three groups of 15 children each that were similar from the start, noting no significant differences in age, gender, and initial cooperation. The P values were all >0.05. There were 45 children that participated in the study with adequate follow up through two dental visits, and no mention of children who did not complete the procedure. Each of the 3 groups were treated the same and included groups for normal behavior management techniques, nitrous oxide and oxygen, and controlled behavioral therapy. The study was not double blinded. Perspective: Based on the study, the patient’s parents can decide which treatment supplement their child should receive since nitrous oxide and cognitive behavioral therapy are both equally effective. However, since the study was limited two dental sessions, I believe additional appointments would show more reliable results.
Applicability The children selected are representative of an accessible population. Although the study stated there was no significant difference between the use of nitrous oxide and cognitive behavioral therapy (CBT), it favored the use of cognitive therapy due to possible side effects of nitrous and the requirement of trained personnel and specialized equipment. While CBT is presented as a better alternative it is important to mention that the technique requires the dentist to spend approximately 16 minutes with each child developing a rapport and desensitizing the patient in a separate area before the operative appointment.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Dental anxiety, children, behavioral therapy, nitrous oxide
ID# 3228
Date of submission: 04/26/2017spacer
E-mail chowdhry@livemail.uthscsa.edu
Author Tanawush Chowdhry
Co-author(s) e-mail
Faculty mentor/Co-author Maria Jose Cervantes, DDS
Faculty mentor/Co-author e-mail CervantesMen@uthscsa.edu
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