Effectiveness of audiovisual distraction with computerized delivery of anesthesia during the placement of stainless steel crowns in children with Down syndrome

ABSTRACT

Objective: Assessing effectiveness of audiovisual (AV) distraction with/without video eyewear and computerized delivery system-intrasulcular (CDS-IS) for local anesthesia during placement of stainless steel crowns for the management of pathological tooth grinding in children with Down syndrome. Materials and Methods: This clinical study includes 22 children (13 boys and 9 girls), with mean age being 7.1 years. The study involved three sessions 1-week apart. During Session I, dental prophylaxis to the upper jaw was done while watching a movie projected on the ceiling without video eyewear whereas prophylaxis for the lower jaw and impressions of both jaws were taken while watching another movie using eyewear projection. After 1 week, during Session II/III, children had their upper and lower second primary molars which were prepared and steel crowns inserted, respectively, while watching movies which were projected using video eyewear under the effect of CDS-IS local anesthesia. Changes in pulse oximeter and heart rate were recorded every 5 min. Independent sample t-test was used to assess significance of changes during each visit. Results: A statistically significant difference (P < 0.03) was observed in mean pulse rate between dental prophylaxis without video eyewear and during dental prophylaxis and dental impression taken while children were distracted using AV distracter with video eyewear. We observed an increase in mean pulse rate during tooth preparation use dental drills, but this does not lead to disruptive behavior as children were being distracted by AV distracter with video eyewear. Conclusion: Routine psychological (Tell-Show-Do) intervention along with visual distraction using video eyewear and use of CDS-IS system for anesthetic delivery is recommended as an effective behavior management technique for children with Down syndrome during invasive dental treatment.

Key words:

Computerized delivery system-intrasulcular - Down syndrome - pathological tooth grinding - stainless steel crowns - visual distraction video eyewear

• REFERENCES

• 1 Bell EJ, Kaidonis J, Townsend GC. Tooth wear in children with Down syndrome. Aust Dent J 2002; 47: 30-5
• 2 Lindqvist B, Heijbel J. Bruxism in children with brain damage. Acta Odontol Scand 1974; 32: 313-9
• 3 Richmond G, Rugh JD, Dolfi R, Wasilewsky JW. Survey of bruxism in an institutionalized mentally retarded population. Am J Ment Defic 1984; 88: 418-21
• 4 Weijerman ME, de Winter JP. Clinical practice.The care of children with Down syndrome. Eur J Pediatr 2010; 169: 1445-52
• 5 Carranza FA, Newman MG, Takei HH, Klokkevold PR. Carranza's Clinical Periodontology. 10th ed.. Philadelphia: W.B. Saunders Co; 2006: p. 299-397, 409, 623
• 6 Dean JA, McDonald RE, Avery DR. Dentistry for the Child and Adolescent. 8th ed.. St. Louis, MO: Mosby; p. 164-8-190-4, 474
• 7 Nishigawa K, Bando E, Nakano M. Quantitative study of bite force during sleep associated bruxism. J Oral Rehabil 2001; 28: 485-91
• 8 Pinkham JR, Casamassimo PS, McTigue DJ, Fields Jr HW, Nowak AJ. Infancy through Adolescence, Pediatric Dentistry. 4th ed.. Philadelphia, PA: Elsevier Saunders; 2005
• 9 Cameron AC, Widmer RP. Handbook of Pediatric Dentistry. 2nd ed.. Mosby: Australasian Academy of Pediatric Dentistry; 2003
• 10 Fakhruddin KS, El Batawi H, Gorduysus MO. Effectiveness of audiovisual distraction eyewear and computerized delivery of anesthesia during pulp therapy of primary molars in phobic child patients. Eur J Dent 2015; 9: 470-5
• 11 Bellieni CV, Cordelli DM, Raffaelli M, Ricci B, Morgese G, Buonocore G. Analgesic effect of watching TV during venipuncture. Arch Dis Child 2006; 91: 1015-7
• 12 Hoffman HG, Doctor JN, Patterson DR, Carrougher GJ, Furness 3rd TA. Virtual reality as an adjunctive pain control during burn wound care in adolescent patients. Pain 2000; 85: 305-9
• 13 Cassidy KL, Reid GJ, McGrath PJ, Finley GA, Smith DJ, Morley C. et al. Watch needle, watch TV: Audiovisual distraction in preschool immunization. Pain Med 2002; 3: 108-18
• 14 Sparks L. Taking the “ouch” out of injections for children. Using distraction to decrease pain. MCN Am J Matern Child Nurs 2001; 26: 72-8
• 15 Dowling JS. Humor: A coping strategy for pediatric patients. Pediatr Nurs 2002; 28: 123-31
• 16 Berggren U, Meynert G. Dental fear and avoidance: Causes, symptoms, and consequences. J Am Dent Assoc 1984; 109: 247-51
• 17 Jones CM, Heidmann J, Gerrish AC. Children's ratings of dental injection and treatment pain, and the influence of the time taken to administer the injection. Int J Paediatr Dent 1995; 5: 81-5
• 18 Schleder JR, Reader A, Beck M, Meyers WJ. The periodontal ligament injection: A comparison of 2% lidocaine, 3% mepivacaine, and 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine in human mandibular premolars. J Endod 1988; 14: 397-404
• 19 Oztas N, Ulusu T, Bodur H, Dogan C. The wand in pulp therapy: An alternative to inferior alveolar nerve block. Quintessence Int 2005; 36: 559-64
• 20 Malamed SF. Sedation: A Guide to Patient Management. 4th ed.. St. Louis, MO: CV Mosby Co; 2003: 337
• 21 Ran D, Peretz B. Assessing the pain reaction of children receiving periodontal ligament anesthesia using a computerized device (wand). J Clin Pediatr Dent 2003; 27: 247-50
• 22 Ashkenazi M, Blumer S, Eli I. Effectiveness of computerized delivery of intrasulcular anesthetic in primary molars. J Am Dent Assoc 2005; 136: 1418-25
• 23 Aitken JC, Wilson S, Coury D, Moursi AM. The effect of music distraction on pain, anxiety and behavior in pediatric dental patients. Pediatr Dent 2002; 24: 114-8