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Published in: BMC Oral Health 1/2020

Open Access 01-12-2020 | Anxiety | Research article

Experiential learning for children’s dental anxiety: a cluster randomized trial

Authors: Minmin Zhu, Hongbing Yu, Bo Xie, Hongwen Li, Qian He, Huimin Li, Jing Su, Xueqi Li

Published in: BMC Oral Health | Issue 1/2020

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Abstract

Background

Dental anxiety (DA) has an impact on the quality of dental treatment and may have long-lasting implications for children. A recent study introducing experiential learning (EL) into children’s oral health promotion resulted in better oral hygiene. The purpose of the study is to evaluate whether EL can reduce children’s DA.

Methods

In September 2018, we recruited 988 children aged 7–8 years from 24 classes to participate in a cluster-randomized trial. Classes were randomly assigned to EL (in which children received a lively presentation on oral health and participated in a role play in a simulated dental clinic in the classroom) or the Tell-Show-Do (TSD) group (in which children received a conventional TSD behavior management). The primary outcome was the prevalence of high DA after the procedure of pit and fissure sealant (PFS), assessed by a modified Children’s Fear Survey Schedule-Dental Subscale. Secondary outcomes were changes in blood pressures (BP) and pulse rates (PR) before and after the PFS procedure. The intervention effects were estimated by means of mixed effect models, which included covariates of gender and school (and baseline value for BP and PR only), and a random cluster effect.

Results

In 396 children of the EL group who received the PFS treatment, the prevalence of high DA (score ≥ 38) was 18.5%, compared with 24.3% in 391 children of the TSD group (OR = 0.65; 95% confidence interval, 0.46–0.93; P = 0.019). The increases in BP and PR after the PFS were also significantly less in the EL group.

Conclusion

School-based experiential learning intervention before a dental visit is feasible and effective in reducing children’s dental anxiety during PFS.

Trial registration

The trial was registered in Chinese Clinical Trial Registry on 5 January 2020 (No.: ChiCTR2000028878​, retrospectively registered).
Literature
1.
go back to reference Seligman LD, Hovey JD, Chacon K, Ollendick TH. Dental anxiety: an understudied problem in youth. Clin Psychol Rev. 2017;55:25–40.PubMedCrossRef Seligman LD, Hovey JD, Chacon K, Ollendick TH. Dental anxiety: an understudied problem in youth. Clin Psychol Rev. 2017;55:25–40.PubMedCrossRef
2.
go back to reference Cianetti S, Lombardo G, Lupatelli E, Pagano S, Abraha I, Montedori A, et al. Dental fear/anxiety among children and adolescents. A systematic review. Eur J Paediatr Dent. 2017;18(2):121–30.PubMed Cianetti S, Lombardo G, Lupatelli E, Pagano S, Abraha I, Montedori A, et al. Dental fear/anxiety among children and adolescents. A systematic review. Eur J Paediatr Dent. 2017;18(2):121–30.PubMed
3.
go back to reference 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(6):391–406.PubMedCrossRef 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(6):391–406.PubMedCrossRef
4.
go back to reference Lin CS, Wu SY, Yi CA. Association between anxiety and pain in dental treatment: a systematic review and meta-analysis. J Dent Res. 2017;96(2):153–62.PubMedCrossRef Lin CS, Wu SY, Yi CA. Association between anxiety and pain in dental treatment: a systematic review and meta-analysis. J Dent Res. 2017;96(2):153–62.PubMedCrossRef
5.
go back to reference Stenebrand A, Hakeberg M, Helkimo AN, Koch G, Boman UW. Dental anxiety and oral health in 15-year-olds: a repeated cross-sectional study over 30 years. Community Dent Health. 2015;32(4):221–5.PubMed Stenebrand A, Hakeberg M, Helkimo AN, Koch G, Boman UW. Dental anxiety and oral health in 15-year-olds: a repeated cross-sectional study over 30 years. Community Dent Health. 2015;32(4):221–5.PubMed
6.
go back to reference Torriani DD, Ferro RL, Bonow ML, Santos IS, Matijasevich A, Barros AJ, et al. Dental caries is associated with dental fear in childhood: findings from a birth cohort study. Caries Res. 2014;48(4):263–70.PubMedCrossRef Torriani DD, Ferro RL, Bonow ML, Santos IS, Matijasevich A, Barros AJ, et al. Dental caries is associated with dental fear in childhood: findings from a birth cohort study. Caries Res. 2014;48(4):263–70.PubMedCrossRef
8.
go back to reference Alsadat FA, El-Housseiny AA, Alamoudi NM, Elderwi DA, Ainosa AM, Dardeer FM. Dental fear in primary school children and its relation to dental caries. Niger J Clin Pract. 2018;21(11):1454–60.PubMed Alsadat FA, El-Housseiny AA, Alamoudi NM, Elderwi DA, Ainosa AM, Dardeer FM. Dental fear in primary school children and its relation to dental caries. Niger J Clin Pract. 2018;21(11):1454–60.PubMed
9.
go back to reference Armfield JM. What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance. Community Dent Oral Epidemiol. 2013;41(3):279–87.PubMedCrossRef Armfield JM. What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance. Community Dent Oral Epidemiol. 2013;41(3):279–87.PubMedCrossRef
10.
go back to reference Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: time for a sense of proportion? Br Dent J. 2012;213(6):271–4.PubMedCrossRef Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: time for a sense of proportion? Br Dent J. 2012;213(6):271–4.PubMedCrossRef
11.
go back to reference Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J. 2013;58(4):390–407.PubMedCrossRef Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J. 2013;58(4):390–407.PubMedCrossRef
12.
go back to reference Ashley PF, Chaudhary M, Lourenco-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018;2018(12):CD003877.PubMedCentral Ashley PF, Chaudhary M, Lourenco-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018;2018(12):CD003877.PubMedCentral
13.
go back to reference Goettems ML, Zborowski EJ, Costa FD, Costa VP, Torriani DD. Nonpharmacologic intervention on the prevention of pain and anxiety during pediatric dental care: a systematic review. Acad Pediatr. 2017;17(2):110–9.PubMedCrossRef Goettems ML, Zborowski EJ, Costa FD, Costa VP, Torriani DD. Nonpharmacologic intervention on the prevention of pain and anxiety during pediatric dental care: a systematic review. Acad Pediatr. 2017;17(2):110–9.PubMedCrossRef
14.
go back to reference Anthonappa RP, Ashley PF, Bonetti DL, Lombardo G, Riley P. Non-pharmacological interventions for managing dental anxiety in children. Cochrane Database Syst Rev. 2017;2017(6):CD012676.PubMedCentral Anthonappa RP, Ashley PF, Bonetti DL, Lombardo G, Riley P. Non-pharmacological interventions for managing dental anxiety in children. Cochrane Database Syst Rev. 2017;2017(6):CD012676.PubMedCentral
15.
go back to reference Strom K, Ronneberg A, Skaare AB, Espelid I, Willumsen T. Dentists’ use of behavioural management techniques and their attitudes towards treating paediatric patients with dental anxiety. Eur Arch Paediatr Dent. 2015;16(4):349–55.PubMedCrossRef Strom K, Ronneberg A, Skaare AB, Espelid I, Willumsen T. Dentists’ use of behavioural management techniques and their attitudes towards treating paediatric patients with dental anxiety. Eur Arch Paediatr Dent. 2015;16(4):349–55.PubMedCrossRef
16.
go back to reference Kantaputra PN, Chiewcharnvalijkit K, Wairatpanich K, Malikaew P, Aramrattana A. Children's attitudes toward behavior management techniques used by dentists. J Dent Child (Chic). 2007;74(1):4–9. Kantaputra PN, Chiewcharnvalijkit K, Wairatpanich K, Malikaew P, Aramrattana A. Children's attitudes toward behavior management techniques used by dentists. J Dent Child (Chic). 2007;74(1):4–9.
17.
go back to reference Peretz B, Kharouba J, Blumer S. Pattern of parental acceptance of management techniques used in pediatric dentistry. J Clin Pediatr Dent. 2013;38(1):27–30.PubMedCrossRef Peretz B, Kharouba J, Blumer S. Pattern of parental acceptance of management techniques used in pediatric dentistry. J Clin Pediatr Dent. 2013;38(1):27–30.PubMedCrossRef
18.
go back to reference Boka V, Arapostathis K, Vretos N, Kotsanos N. Parental acceptance of behaviour-management techniques used in paediatric dentistry and its relation to parental dental anxiety and experience. Eur Arch Paediatr Dent. 2014;15(5):333–9.PubMedCrossRef Boka V, Arapostathis K, Vretos N, Kotsanos N. Parental acceptance of behaviour-management techniques used in paediatric dentistry and its relation to parental dental anxiety and experience. Eur Arch Paediatr Dent. 2014;15(5):333–9.PubMedCrossRef
19.
go back to reference Farhat-McHayleh N, Harfouche A, Souaid P. Techniques for managing behaviour in pediatric dentistry: comparative study of live modelling and tell-show-do based on children's heart rates during treatment. J Can Dent Assoc. 2009;75(4):283.PubMed Farhat-McHayleh N, Harfouche A, Souaid P. Techniques for managing behaviour in pediatric dentistry: comparative study of live modelling and tell-show-do based on children's heart rates during treatment. J Can Dent Assoc. 2009;75(4):283.PubMed
20.
go back to reference Karekar P, Bijle MN, Walimbe H. Effect of three behavior guidance techniques on anxiety indicators of children undergoing diagnosis and preventive dental care. J Clin Pediatr Dent. 2019;43(3):167–72.PubMedCrossRef Karekar P, Bijle MN, Walimbe H. Effect of three behavior guidance techniques on anxiety indicators of children undergoing diagnosis and preventive dental care. J Clin Pediatr Dent. 2019;43(3):167–72.PubMedCrossRef
21.
go back to reference Kolb DA. Experiential learning: experience as the source of learning and development. 2nd ed. USA: Pearson FT Press; 2014. Kolb DA. Experiential learning: experience as the source of learning and development. 2nd ed. USA: Pearson FT Press; 2014.
22.
go back to reference Dyck RA, Kleinman NJ, Funk DR, Yeung RO, Senior P, Yardley JE. We can work (it) out together: type 1 diabetes boot camp for adult patients and providers improves exercise self-efficacy. Can J Diabetes. 2018;42(6):619–25.PubMedCrossRef Dyck RA, Kleinman NJ, Funk DR, Yeung RO, Senior P, Yardley JE. We can work (it) out together: type 1 diabetes boot camp for adult patients and providers improves exercise self-efficacy. Can J Diabetes. 2018;42(6):619–25.PubMedCrossRef
23.
go back to reference Battjes-Fries MCE, Haveman-Nies A, Zeinstra GG, van Dongen EJI, Meester HJ, van den Top-Pullen R, et al. Effectiveness of taste lessons with and without additional experiential learning activities on children's willingness to taste vegetables. Appetite. 2017;109:201–8.PubMedCrossRef Battjes-Fries MCE, Haveman-Nies A, Zeinstra GG, van Dongen EJI, Meester HJ, van den Top-Pullen R, et al. Effectiveness of taste lessons with and without additional experiential learning activities on children's willingness to taste vegetables. Appetite. 2017;109:201–8.PubMedCrossRef
24.
go back to reference Matthews JI, Zok AV, Quenneville EP, Dworatzek PD. Development and implementation of FRESH--a post-secondary nutrition education program incorporating population strategies, experiential learning and intersectoral partnerships. Can J Public Health. 2014;105(4):e306–11.PubMedPubMedCentralCrossRef Matthews JI, Zok AV, Quenneville EP, Dworatzek PD. Development and implementation of FRESH--a post-secondary nutrition education program incorporating population strategies, experiential learning and intersectoral partnerships. Can J Public Health. 2014;105(4):e306–11.PubMedPubMedCentralCrossRef
25.
go back to reference Angelopoulou MV, Kavvadia K, Taoufik K, Oulis CJ. Comparative clinical study testing the effectiveness of school based oral health education using experiential learning or traditional lecturing in 10 year-old children. BMC Oral Health. 2015;15:51.PubMedPubMedCentralCrossRef Angelopoulou MV, Kavvadia K, Taoufik K, Oulis CJ. Comparative clinical study testing the effectiveness of school based oral health education using experiential learning or traditional lecturing in 10 year-old children. BMC Oral Health. 2015;15:51.PubMedPubMedCentralCrossRef
26.
go back to reference Alnamankany A. Video modelling and dental anxiety in children. A randomised clinical trial. Eur J Paediatr Dent. 2019;20(3):242–6.PubMed Alnamankany A. Video modelling and dental anxiety in children. A randomised clinical trial. Eur J Paediatr Dent. 2019;20(3):242–6.PubMed
27.
go back to reference Lu JX, Yu DS, Luo W, Xiao XF, Zhao W. Development of Chinese version of children's fear survey schedule-dental subscale. Zhonghua Kou Qiang Yi Xue Za Zhi. 2011;46(4):218–21.PubMed Lu JX, Yu DS, Luo W, Xiao XF, Zhao W. Development of Chinese version of children's fear survey schedule-dental subscale. Zhonghua Kou Qiang Yi Xue Za Zhi. 2011;46(4):218–21.PubMed
28.
go back to reference Buchanan H, Niven N. Validation of a facial image scale to assess child dental anxiety. Int J Paediatr Dent. 2002;12(1):47–52.PubMed Buchanan H, Niven N. Validation of a facial image scale to assess child dental anxiety. Int J Paediatr Dent. 2002;12(1):47–52.PubMed
29.
go back to reference Townend E, Dimigen G, Fung D. A clinical study of child dental anxiety. Behav Res Ther. 2000;38(1):31–46.PubMedCrossRef Townend E, Dimigen G, Fung D. A clinical study of child dental anxiety. Behav Res Ther. 2000;38(1):31–46.PubMedCrossRef
30.
go back to reference Oliveira MA, Vale MP, Bendo CB, Paiva SM, Serra-Negra JM. Influence of negative dental experiences in childhood on the development of dental fear in adulthood: a case-control study. J Oral Rehabil. 2017;44(6):434–41.PubMedCrossRef Oliveira MA, Vale MP, Bendo CB, Paiva SM, Serra-Negra JM. Influence of negative dental experiences in childhood on the development of dental fear in adulthood: a case-control study. J Oral Rehabil. 2017;44(6):434–41.PubMedCrossRef
31.
go back to reference Gomes HS, Viana KA, Batista AC, Costa LR, Hosey MT, Newton T. Cognitive behaviour therapy for anxious paediatric dental patients: a systematic review. Int J Paediatr Dent. 2018;28:422–31.CrossRef Gomes HS, Viana KA, Batista AC, Costa LR, Hosey MT, Newton T. Cognitive behaviour therapy for anxious paediatric dental patients: a systematic review. Int J Paediatr Dent. 2018;28:422–31.CrossRef
32.
go back to reference Radhakrishna S, Srinivasan I, Setty JV, MK DR, Melwani A, Hegde KM. Comparison of three behavior modification techniques for management of anxious children aged 4-8 years. J Dent Anesth Pain Med. 2019;19(1):29–36.PubMedPubMedCentralCrossRef Radhakrishna S, Srinivasan I, Setty JV, MK DR, Melwani A, Hegde KM. Comparison of three behavior modification techniques for management of anxious children aged 4-8 years. J Dent Anesth Pain Med. 2019;19(1):29–36.PubMedPubMedCentralCrossRef
33.
go back to reference Liu Y, Gu Z, Wang Y, Wu Q, Chen V, Xu X, et al. Effect of audiovisual distraction on the management of dental anxiety in children: a systematic review. Int J Paediatr Dent. 2019;29(1):14–21.PubMedCrossRef Liu Y, Gu Z, Wang Y, Wu Q, Chen V, Xu X, et al. Effect of audiovisual distraction on the management of dental anxiety in children: a systematic review. Int J Paediatr Dent. 2019;29(1):14–21.PubMedCrossRef
34.
go back to reference Brand HS. Cardiovascular responses in patients and dentists during dental treatment. Int Dent J. 1999;49(1):60–6.PubMedCrossRef Brand HS. Cardiovascular responses in patients and dentists during dental treatment. Int Dent J. 1999;49(1):60–6.PubMedCrossRef
35.
go back to reference Samra-Quintero PA, Bernardoni-Socorro C, Borjas AM, Fuenmayor NR, Estevez J, Arteaga-Vizcaino M. Changes in blood pressure in children undergoing psychological treatment before dental procedures. Acta Odontol Latinoam. 2006;19(1):9–12.PubMed Samra-Quintero PA, Bernardoni-Socorro C, Borjas AM, Fuenmayor NR, Estevez J, Arteaga-Vizcaino M. Changes in blood pressure in children undergoing psychological treatment before dental procedures. Acta Odontol Latinoam. 2006;19(1):9–12.PubMed
Metadata
Title
Experiential learning for children’s dental anxiety: a cluster randomized trial
Authors
Minmin Zhu
Hongbing Yu
Bo Xie
Hongwen Li
Qian He
Huimin Li
Jing Su
Xueqi Li
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Anxiety
Published in
BMC Oral Health / Issue 1/2020
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-020-01204-5

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