Anxiety in Children during Occlusal ART Restorations in Primary Molars Placed in School Environment and Hospital Dental Setup

To evaluate the anxiety in children during occlusal atraumatic restorative treatment (ART) in the primary molars of children; and compare the anxiety for ART procedure performed in school environment and in hospital dental setup. Study design: A randomized controlled trial where One dentist placed 120 ART restorations in 60 five- to seven year-olds who had bilateral matched pairs of occlusal carious primary molars. A split-mouth design was used to place restorations in school and in hospital dental setup, which were assigned randomly to contralateral sides. Anxiety was evaluated by Modified Venhem score and the heart rate of the children at five fixed moments during dental treatment. Results: At the entrance of the children into the treatment room, statistically significant difference between treatment in school environment and treatment in hospital dental setup for venham score and heart rate could be found (P=0.023 and P=0.037 respectively). At the start of the treatment procedure higher venham score and heart rate was observed in children treated in hospital dental setup in comparison with the children treated in school environment , finding was statistically significant (P=0.011 and P=0.029 respectively). During all other three points of treatment, the Venham scores of the children treated in school were lower than those of the children treated in hospital dental setup but statistically not significant (P>0.05). Positive co-relation between Venham scores and Heart rate was established. No statistically significant relation could be established between boys and girls. Conclusions: Overall anxiety in children for ART treatment was found to be less and the procedure was well accepted irrespective of environment where treatment was performed. Hospital dental setup by itself made children anxious during entrance and starting of the treatment when compared to children treated in school environment.

Atraumatic restorative treatment, Dental Caries, Primary Molars, Anxiety.

1. Smales RJ, Yip HK. The atraumatic restorative treatment (ART) approach for primary teeth: review of literature. Pediatr Dent, 22: 294–8, 2000.

2. Frencken JE, Pilot T, Songpaisan Y, Phantumvanit P. Atraumatic restorative treatment (ART): rationale, technique, and development. J Public Health Dent, 56: 135–40, 1996.

3. Carvalho TS, Ribeiro TR, Bönecker M, Pinheiro ECM, Colares V. The atraumatic restorative treatment approach: An “atraumatic” alternative. Med Oral Patol Oral Cir Bucal, 14: 668–73, 2009.

4. Schriks MC, van Amerongen WE. Atraumatic perspectives of ART: pychological and physiological aspects of treatment with and without rotary instruments. Community Dent Oral Epidemiol, 31: 15–20, 2003.

5. Mjör IA, Gordan VV. A review of atraumatic restorative treatment (ART). Int Dent J, 49: 127–31, 1999.

6. Honkala S, Honkala E. Atraumatic dental treatment among Finnish elderly persons. J Oral Rehabil, 29: 435–40, 2002.

7. Honkala E, Behbehani J, Ibricevic H, Kerosuo E, Al-Jame G. The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Int J Paediatr Dent, 13: 172–9, 2003.

8. Tyas MJ, Anusavice KJ, Frenken JE, Mount GJ. Minimal intervention dentistry – a review.FDI Commission Project 1-97 Int Dent J, 50: 1–12, 2000.

9. Croll TP, Nicholson JW. Glass ionomer cements in pediatric dentistry: review of the literature. Pediatr Dent, 24: 423–9, 2002.

10. Hume WR, Mount GJ. In vitro studies on the potential for pulpal cytotoxicity of glass ionomer cements. J Dent Res, 67: 915–8, 1988.

11. Forsten L. Fluoride release and uptake by glass ionomers and related materials and its clinical effect. Biomaterials, 19: 503–8, 1998.

12. Duque C, Negrini Tde C, Hebling J, Spolidorio DM. Inhibitory activity of glass ionomer cements on cariogenic bacteria. Oper Dent, 30: 636–40, 2005.

13. Smales RJ, Gao W. In vitro caries inhibition at the enamel margins of glass ionomer restoratives developed for the ART approach. J Dent, 28: 249–56, 2000.

14. Donly KJ, Nelson JJ. Fluoride release of restorative materials exposed to a fluoridated dentifrice. J Dent Child, 64: 249–50, 1997.

15. Marinelli CB, Donly KJ, Wefel JS, Jakobsen JR, Denehy GE. An in vitro comparison of three fluoride regimens on enamel remineralization. Caries Res, 31: 418–22, 1997.

16. Frencken JE, Taifour D, van´t Hof MA. Survival of ART and amalgam restorations in permanent teeth of children after 6.3 years. J Dent Res, 85: 622–6, 2006.

17. Frencken JE, van´t Hof MA, Taifour D, Al-Zaher I. Effectiveness of ART and traditional amalgam approach in restoring single-surface cavities in posterior teeth of permanent dentitions in school children after 6.3 years. Community Dent Oral Epidemiol, 35: 207–14, 2007.

18. Phantumvanit P, Songpaisan Y, Pilot T, Frencken JE. Atraumatic restorative treatment (ART): A three-year community field trial in Thailand survival of one-surface restorations in the permanent dentition. J Public Health Dent, 56: 141–5, 1996.

19. Frencken JE, Makoni F, Sithole WD, Hackenitz E. Three-year survival of one-surface ART restorations and glass-ionomer sealants in a school oral health programme in Zimbabwe. Caries Res, 32: 119–26, 1998.

20. Frencken JE, Makoni F, Sithole WD. ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years. Community Dent Oral Epidemiol, 26: 372–81, 1998.

21. 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, 67: 123–7, 2000.

22. Blount LB, Davis N, Powers SW, Roberts MC. The influence of environmental factors and coping style on children’s coping and distress. Clin Psychol Rev, 11: 93–116, 1991.

23. Eli I, Uziel N, Bath R, Kleinhauz M. Antecedents of dental anxiety: learned responses versus personality traits. Community Dent Oral Epidemiol, 25: 233–7, 1997.

24. Freeman RE. Dental anxiety: a multifactorial aetiology. Br Dent J, 159: 406–8, 1985.

25. Aartman I, van Everdingen T, Hoogstraten J, Schuurs A. Self report measurements of dental anxiety and fear in children: a critical assessment. J Dent Child, 252–8, 1998.

26. Amerongen WE, Rahimtoola S. Is ART really atraumatic? Community Dent Oral Epidemiol, 27: 431–5, 1999.

27. Berge M, Hoogstraten J, Veerkamo JSJ, Prins P. The dental subscale of the children’s fear survey schedule: a factor analytic study in the Netherlands. Community Dent Oral Epidemiol, 26: 340–3, 1998.

28. Gatchel RJ. Managing anxiety and pain during dental treatment. J Am Dent Assoc, 123: 37–41, 1992.

29. Veerkamp JSJ, Gruythuysen RJM, van Amerongen WE, Hoogstraten J. Dental treatment of fearful children using nitrous oxide. Part 3. Anxiety during sequential visits. J Dent Child, 60: 175–82, 1999.

30. Nathan JE, Venham LL, Steward West M, Werboff J. The effect of nitrous oxide on anxious young pediatric patients across sequential visits: a double blind study. J Dent Child, 55: 20–30, 1998.

31. de Horst G, de Wit CA. Review of behavioural research in dentistry 1987-92: dental anxiety, dentist-patient relationship, compliance and dental attendance. Int Dent J, 43: 265–78, 1993.

32. Liddell A, Locker D. Gender and age difference in attitudes to dental pain and dental control. Community Dent Oral Epidemiol, 25: 314–8, 1997.