The Use of a Respiratory Biofeedback Device to Reduce Dental Anxiety in Children: A Randomized Controlled Clinical Trial | ||||
Alexandria Dental Journal | ||||
Article 7, Volume 46, Issue 1, April 2021, Page 179-184 PDF (329 K) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/adjalexu.2020.25911.1054 | ||||
View on SCiNiTO | ||||
Authors | ||||
Sarah Zeitoun 1; Amani Khalil2; Nadia Wahba2; Mohammed Sayed3 | ||||
1Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Egypt | ||||
2Professor, Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Egypt | ||||
3Professor, Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Egypt | ||||
Abstract | ||||
Introduction: Dental anxiety occurs when the patient presents to the dentist with the anticipation of dental treatment. Many children react to dental stressful situations through uncooperative behaviors. Objectives: Investigate the effect of a respiratory biofeedback device (RESPeRATETM) in reduction of preoperative anxiety in children undergoing dental procedures under local anesthesia. Materials and methods: A randomized controlled clinical trial comprising 110 healthy children, of age range 7-12 years, were selected. Their scores were 19 or more according to the Faces version of Modified Child Dental Anxiety Scale. Participants were randomly allocated into two groups: Study and Control group. For both groups, heart rate was recorded prior to local anesthesia administration and a salivary sample was collected to measure the salivary amylase. The study group was submitted to a session of respiratory biofeedback “RESPeRATETM”. The control group was managed by a routine behavioral management technique “Tell, Show and Do”. Infiltration or block local anesthesia injections were administered, after which heart rate measurement and salivary sample was repeated. T and paired T tests were used for statistical analysis. Results: Heart rate decreased significantly in the study group (P=0.001), and increased significantly in the control group (P=0.002). There were non-significant changes among both groups regarding salivary amylase. A weak correlation was found between heart rate and salivary amylase. Conclusions: “RESPeRATETM” group showed a decrease in dental anxiety, as evidenced by decreased heart rate. “RESPeRATETM” can be used effectively before dental procedures for anxious children. Salivary alpha amylase was a poor stress biomarker. | ||||
Keywords | ||||
Dental anxiety; RESPeRATETM; Salivary Alpha Amylase; Respiratory biofeedback | ||||
References | ||||
Mendoza-Mendoza A, Perea MB, Yañez-Vico RM, Iglesias-Linares A. Dental fear in children: the role of previous negative dental experiences. Clin Oral Investig. 2015;19(3):745–51.
Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: A review. Aust Dent J. 2013;58:390–407.
Weiner AA. The Fearful Dental Patient: A Guide to Understanding and Managing. 1st ed. Boston: Blackwell Publishing Ltd.;
2011. 3–14 p.
Mustafa O, Parekh S, Ashley P, Anand P. Post-operative pain and anxiety related to dental procedures in children. Eur J Paediatr
Dent. 2013;14:289–94.
Paryab M, Hosseinbor M. Dental anxiety and behavioral problems: A study of prevalence and related factors among a group of
Iranian children aged 6-12. J Indian Soc Pedod Prev Dent. 2013;31:86.
Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: Literature review. Clin Cosmet Investig
Dent. 2016;8:35–50.
Al-Namankany A, De Souza M, Ashley P. Evidence-based dentistry: Analysis of dental anxiety scales for children. Br Dent J.
2012;212:219–22.
Howard KE, Freeman R. Reliability and validity of a faces version of the modified child dental anxiety scale. Int J Paediatr Dent.
2007;17:281–8.
Kreibig SD. Autonomic nervous system activity in emotion: A review. Biol Psychol. 2010;84:394–421.
Lilly L, Lee C, Williams G. Hypertension. In: Lilly L, editor. Pathophysiology of Heart Disease: A Collaborative Project of
Medical Students and Faculty. 5th ed. Philadelphia: Lippincott, Williams, and Wilkins; 2012. p. 301–23.
Najafian J, Hashemi S. A study of the effect of relaxation and biofeedbackassisted relaxation on patients with mild hypertension.
ARYA Atheroscler. 2010;1:12–8.
Mejía-Rubalcava C, Alanís-Tavira J, Mendieta-Zerón H, Sánchez-Pérez L. Changes induced by music therapy to physiologic
parameters in patients with dental anxiety. Complement Ther Clin Pract. 2015;21:282–6.
Furlan NFNF, Gavião MBD, Barbosa TSTS, Nicolau J, Castelo PMP, Gaviäo M, et al. Salivary Cortisol, Alpha-Amylase and
Heart Rate Variation in Response to Dental Treatment in Children. J Clin Pediatr Dent. 2012;37:83–7.
ThompsonLA,TrevathanWR.CortisolReactivity,MaternalSensitivity,andLearningInThree-Month-OldInfants.InfantBehav
Dev. 2008;31:92–106.
Gozansky WS, Lynn J, Laudenslager M, Kohrt W. Salivary cortisol determined by enzyme immunoassay is preferable to serum
total cortisol for assessment of dynamic hypothalamic-pituitary-adrenal axis activity. Clin Endocrinol (Oxf). 2005;63:336–41.
Bozovic D, Racic M, Ivkovic N. Salivary Cortisol Levels as a Biological Marker of Stress Reaction. Med Arch. 2013;67:371–4.
CamposMJdaS,RaposoNRB,FerreiraAP,VitralRWF.SalivaryAlpha-AmylaseActivity:APossibleIndicatorofPain-Induced
Stress in Orthodontic Patients. Pain Med. 2011;12:1162–6.
ArhakisA,MenexesMG,CoolidgeT,KalfasS.HeartRate,Salivaryα-amylaseActivity,andCooperativeBehaviorinPreviously
Naïve Children Receiving Dental Local Anesthesia. Pediatr Dent. 2012;34:40–3.
Van Stegeren AH, Wolf OT, Kindt M. Salivary alpha amylase and cortisol responses to different stress tasks: Impact of sex. Int J
Psychophysiol. 2008;69:33–40.
De Oliveira VN, Bessa A, Lamounier RPMS, De Santana MG, De Mello MT, Espindola FS. Changes in the salivary biomarkers
induced by an effort test. Int J Sports Med. 2010;31:377–81.
Jerath R, Crawford MW, Barnes VA, Harden K. Self-Regulation of Breathing as a Primary Treatment for Anxiety. Appl
Psychophysiol Biofeedback. 2015;40:107–15.
Siwiak D, Berger J, Yang Y. Catch Your Breath-Musical Biofeedback for Breathing Regulation. In: Audio Engineering Society
127 international convention. 2009.
Parati G, Glavina F, Guido O, Alberto M, Paolo C, Benjamin G, et al. P-418 Acute effects of device-guided breathing on
cardiovascular parameters and baroflex sensitivity in normal subjects. Am J Hypertens. 2002;15:182A-183A.
Morarend QA, Spector ML, Dawson D V, Clark SH, Holmes DC. The Use of a Respiratory Rate Biofeedback Device to Reduce
Dental Anxiety: An Exploratory Investigation. Appl Psychophsiol Biofeedback. 2011;36:63–70.
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials.
Int J Surg. 2011;9:672–7.
Research Randomizer [Internet]. [cited 2018 Sep 26]. Available from: https://www.randomizer.org/
Javadinejad S, Farajzadegan Z, Madahain M. Iranian version of a face version of the Modified Child Dental Anxiety Scale:
Transcultural adaptation and reliability analysis. J Res Med Sci. 2011;16:872–7.
Coolidge T, Hillstead MB, Farjo N, Weinstein P, Coldwell SE. Additional psychometric data for the Spanish Modified Dental
Anxiety Scale, and psychometric data for a Spanish version of the Revised Dental Beliefs Survey. BMC Oral Health. 2010;10.
https://doi.org/10.1186/1472-6831-10-12
Porritt J, Buchanan H, Hall M, Gilchrist F, Marshman Z. Assessing children’s dental anxiety: A systematic review of current measures. Community Dent Oral Epidemiol. 2013;41:130–42.
Zhang H, Xia B, Wang J, Xie P, Huang Q, Ge L. Chinese version of a face version of the modified child dental anxiety scale: transcultural adaptation and evaluation. Zhonghua kou qiang yi xue za zhi=Zhonghua kouqiang yixue zazhi=Chinese J Stomatol. 2013;48:403–8.
EsaR,HashimNA,AyobY,YusofZYM.PsychometricpropertiesofthefacesversionoftheMalay-modifiedchilddentalanxiety scale. BMC Oral Health. 2015;15. https://doi.org/10.1186/s12903-015-0013-y
Al-Nasser L, Yunus F, Ahmed A. Validation of Arabic Version of the Modified Dental Anxiety Scale and Assessment of Cut‐off Points for High Dental Anxiety in a Saudi Population. J Int Oral Heal. 2016;8:21–6.
DedeepyaP,NuvvulaS,KamathamR,NirmalaSVSG.Behaviouralandphysiologicaloutcomesofbiofeedbacktherapyondental anxiety of children undergoing restorations: a randomised controlled trial. Eur Arch Paediatr Dent. 2014;15:97–103.
Wojcicki JM, Geissler JD, Stokes CW, Heyman MB, Tran CT. The Use of the RESPeRATE Device to Lower Blood Pressure in Inner City Obese Adolescents and Children: A Pilot Feasibility Study. High Blood Press Cardiovasc Prev. 2013;20:89–92.
Kapitza KP, Passie T, Bernateck M, Karst M. First Non-Contingent Respiratory Biofeedback Placebo versus Contingent Biofeedback in Patients with Chronic Low Back Pain: A Randomized, Controlled, Double-Blind Trial. Appl Psychophysiol Biofeedback. 2010;35:207–17.
Nater UM, Rohleder N, Gaab J, Berger S, Jud A, Kirschbaum C, et al. Human salivary alpha-amylase reactivity in a psychosocial stress paradigm. Int J Psychophysiol. 2005;55:333–42.
Nater U, Rohleder N. Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: Current state of research. Psychoneuroendocrinology. 2009;34:486–96.
Rashkova MR, Ribagin LS, Toneva NG. Correlation between salivary α-amylase and stress-related anxiety. Folia Med (Plovdiv). 2012;54:46–51.
Almaummar M, Althabit HO, Pani S. The impact of dental treatment and age on salivary cortisol and alpha-amylase levels of patients with varying degrees of dental anxiety. BMC Oral Health. 2019;19:1–8.
Rosaura Polak A, Witteveen AB, Denys D, Olff M. Breathing Biofeedback as an Adjunct to Exposure in Cognitive Behavioral Therapy Hastens the Reduction of PTSD Symptoms: A Pilot Study. Appl Psychophsiol Biofeedback. 2015;40:25–31.
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