|Year : 2019 | Volume
| Issue : 2 | Page : 67-71
Parental acceptance of the advanced behavior management techniques in pediatric dentistry: A comparative study in North Indian population
Ayushi Jindal1, Parul Singhal1, Ritu Namdev1, Priyanka Grewal1, Gaurav Aggarwal2
1 Department of Pedodontics and Preventive Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
2 Endodontist, Dental Comfort, Yamuna Nagar, Haryana, India
|Date of Submission||28-Apr-2019|
|Date of Acceptance||20-May-2019|
|Date of Web Publication||13-Nov-2019|
Dr. Ayushi Jindal
536, Sector 17, HUDA, Jagadhri, Yamuna Nagar - 135 003, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: An integral aspect of pediatric dental care is to initially provide parents with the information of behavior management techniques (BMTs) and a mechanism by which parents can participate in treatment decisions of their child. The present study aims to assess the parental acceptance of the advanced BMTs in North Indian population and its association with several possible factors.
Materials and Methods: A study sample of 200 parents accompanying their children aged 3–9 years who were demonstrating Frankl's 1 and 2 behavior and could not be managed by basic BMTs were randomly selected. The parents were verbally explained, and then, a video was demonstrated about the two included techniques – protective stabilization (PS) and sedation/general anesthesia; and subsequently asked to mention their preference between the two techniques in the questionnaire.
Results: The parents of children in the age group of 3–6 years were more accepting to PS than sedation/general anesthesia as the preferred BMT with a statistically significant difference (P < 0.01). About 90% of the rural parents preferred PS oversedation (P < 0.001). Other variables such as gender, birth order, and general behavior of the child at home, educational and professional status of the parents were found to statistically insignificant.
Conclusion: Parents of younger children (3–6 years) and those belonging to rural areas showed more acceptance for PS oversedation/general anesthesia. It is hoped that the data presented here will be valuable to the dentist for planning treatment and allow its completion effectively and efficiently.
Keywords: Acceptance, advanced behavior management technique, negative children, parents
|How to cite this article:|
Jindal A, Singhal P, Namdev R, Grewal P, Aggarwal G. Parental acceptance of the advanced behavior management techniques in pediatric dentistry: A comparative study in North Indian population. Int J Oral Health Sci 2019;9:67-71
|How to cite this URL:|
Jindal A, Singhal P, Namdev R, Grewal P, Aggarwal G. Parental acceptance of the advanced behavior management techniques in pediatric dentistry: A comparative study in North Indian population. Int J Oral Health Sci [serial online] 2019 [cited 2020 Jul 6];9:67-71. Available from: http://www.ijohsjournal.org/text.asp?2019/9/2/67/270878
| Introduction|| |
Behavior management is a continuum of interaction targeted to build a relationship between the child, parent, and doctor. It enables the dentist to lower the dental anxiety of both the child and parents and forestall a positive attitude toward oral health and dental treatment. Thus, helping the dentist to build trust and perform treatment safely. For this, dental practitioners utilize a number of behavior management techniques (BMTs) to render quality dental care. Basic BMTs form the foundation and can be used efficiently to manage most of the children while rendering dental treatment. However, some children with psychological or emotional immaturity and/or mental, physical, or medical disability demonstrate behaviors that disrupt the practitioner and make the safe delivery of acceptable treatment very difficult. These children should be customized to the individual needs of the child and desires of the parents with the use of advanced BMTs which include protective stabilization (PS), sedation, and general anesthesia.
Since nineties, the American Academy of Pediatric Dentistry guidelines on behavior management has advocated the use of PS (previously addressed as medical immobilization or physical restraint). The uncooperative young child may harm himself while presenting an apprehensive behavior. Hence, it is recommended to use restraint to deliver effective oral health care while ensuring the highest grades of safety. The physical restraining force can be applied in two forms – active or passive. Active restraint is of human origin wherein the parents or dentist/dental assistant restrains the child. On the other hand, passive restraints are provided with the help of mechanical aids such as papoose board, Pedi-Wrap, or a combination. Before the use of any active or passive restraint, it is essential to obtain and document an informed consent of the parents in the patient's record file.
On the other hand, sedation is the production of a depressed state involving a lack of total consciousness but short of anesthetic sleep. In dentistry, the objective of sedative management is often to achieve mild-to-moderate levels of sedation. Pain relief is not a major goal; rather sedation is used as an adjunctive means of controlling the psychological component of discomfort and resistance to treatment. General anesthesia is a controlled state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command. In dental practice, the use of general anesthesia is sometimes required to render quality dental care for certain children.
An integral aspect of child dental care is to provide parents with information of BMTs before the commencement of treatment. This delivery of information provides a mechanism by which parents can participate in treatment decisions with full understanding of factors related to their child's proposed dental care and helps in reducing situational parental anxiety. Thus, insights into the factors which influence parental perceptions are very important. The present study was conducted to assess the parental acceptance of the advanced BMTs (PS and sedation/general anesthesia in North Indian population and its association with several possible factors.
| Materials and Methods|| |
The present study was conducted on 200 parents who accompanied their children to the Outpatient Department of Pedodontics and Preventive Dentistry, Post-Graduate Institute of Dental Sciences, Rohtak. Study individuals were randomly selected from the regular pool of patients reporting to the department using the following criterion: (1) parents of children aged 3–9 years with a first dental visit and no previous exposure to BMTs, (2) parents of children requiring emergency dental treatment, (3) parents of children not managed by basic BMTs and demonstrating Frankl's 1 and 2 behavior rating, (4) parents of children with noncontributory medical history, and (5) parents who showed willingness to participate in the study. The same dental practitioner observed the behavior of all the children during the dental treatment while they are managed with the basic BMTs and then, rated according to the Frankl's scale. Based on the inclusion criterion, an informed consent was obtained from the parents who showed a willingness to participate in the study and documented in the patient's record book.
The advanced BMTs included in the study were PS and sedation (oral/parenteral)/general anesthesia. A single examiner verbally explained the parents about the included techniques in Hindi as described in [Table 1]. Subsequently, a video demonstrating the same was also shown to the parents for a more clear understanding of the techniques. Then, the parents were asked to complete a questionnaire in Hindi about demographics (age, gender and birth order of the child, general behavior of the child at home, area of residence, and educational and professional status of the parents) and mention the technique they would prefer for their children in a situation of emergency dental treatment (when he/she cannot be managed by basic BMTs). The examiners were available throughout to make any required clarifications to the individuals.
The results were tabulated and expressed as both number and percentage. In addition, Chi-square test, where appropriate, was employed to evaluate the effect of various factors on acceptance of techniques described.
| Results|| |
A total of 200 parents accompanying their children participated in the study. Majority of the parents belonged to rural areas (66.5%) with 54.5% having a senior secondary level of qualification or below and 64% of the parents were nonworking. The detailed description of the demographic characteristics of the children and parents is listed in [Table 2].
|Table 2: Distribution of sociodemographic details of the child and the parents|
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[Table 3] summarizes the distribution and comparison of parental acceptance according to sociodemographic details of the child. Of 112 children in the age group of 3–6 years, 88.3% of parents chose PS while only 11.6% chose sedation/general anesthesia as the preferred BMT which was found to be statistically significant (P< 0.01).
|Table 3: Distribution and comparison of parental acceptance according to sociodemographic details of the child|
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[Table 4] summarizes the distribution and comparison of parental acceptance according to sociodemographic details of the parents. A significant difference (P< 0.001) was found in the acceptance of PS compared to sedation/general anesthesia technique among rural and urban parents. Rural parents (n = 120) preferred PS oversedation/general anesthesia (n = 13). Other variables such as gender, birth order, general behavior of the child at home, and educational and professional status of the parents were found to statistically insignificant [Table 3] and [Table 4].
|Table 4: Distribution and comparison of parental acceptance according to sociodemographic details of the parents|
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| Discussion|| |
A clinician often encounters a great challenge in the management and treatment of children with Frankl's 1 and 2 behavior rating. The treatment of such children usually requires management with advanced BMTs which includes PS, sedation (oral/parenteral), and general anesthesia. In the present study, the parental acceptance toward PS or sedation/general anesthesia as a preferred technique for managing their children during dental treatment was recorded.
Of the 200 parents, 162 preferred PS oversedation/general anesthesia for managing the behavior of their children irrespective of the sociodemographic characteristics of the child and parents. This parental response could be explained by the fact that most parents' described their own reactions toward their children's improper behavior at home as a firm. While staying with their children during treatment and witnessing, the behavioral problems encountered by the dentist trying to manage the child using basic BMTs also might have influenced parents to mention PS as the best alternative to the basic BMTS. These two factors suggest a basic high parental tolerance level regarding firm management of their children's behavior in our study population. Similar results were reported by Lawrence et al. who compared the effect of prior explanation on parental acceptance of eight BMTs employed in pediatric dentistry. Physical restraint by either dentist or assistant and papoose Board was viewed more favorable than oral premedication and general anesthesia. This consistent hierarchy is very similar to the one found by Murphy et al. in their study. Paryab et al. also reported that 82% of the parents in his study showed the highest acceptance rate for physical restraint by dental assistant or parent. On the contrary, Peretz and Zadik reported that more parents (35%) fully approved sedation while only 22% accepted restraints as the preferred BMT. Frankel assessed the attitude of mothers toward the use of papoose board and concluded that 90% of the mothers approved the use of it and 96% thought the papoose board was necessary to perform the dentistry. In a review of 487 emergency dental visits seen at a children's hospital during a 3-year period, Lombardi, Sheller, and Williams revealed that a modified restraining device was used most often for children of 4 years of age and younger who required extractions. Another study by McKnight-Hanes et al. reported that pediatric dental practitioners were significantly more likely to use restraint of some form (71%) compared to general practitioners, among whom only 3% reported that they would use restraint.
In the present study, age of the child and residential area came out to be a significant factor in influencing the parental preference of the BMT. Parents usually find it safe, easy, and comfortable for their younger children to be restrained by themselves or in their lap, accounting for 88% of the parents agreeing for the use of PS in comparison to sedation/general anesthesia in the age group of 3–6 years. These findings reflect their reluctance toward more invasive procedures and fear toward the risks associated with the medication and general anesthesia. Even the parents think that sedation may negatively affect the brain function and intelligence of the child. In addition, in the present study, there was an across the board shift toward PS than sedation/general anesthesia among rural parents (90.2%). This may reflect the mindset of rural parents of the study population of using sedation/general anesthesia only for the medical procedures rather than dental.
When the education level and professional status of parents were considered, the present study failed to receive greater approval toward any of the technique. Although illiterate parents were more inclined toward PS than parents with higher educational qualification, the results were not statistically significant. The previous study by Abushal and Adenubi also yielded similar results from parents with high educational qualification.
The behavior of children at home and his/her order of birth were also not found to be associated with parents' attitudes toward any of the BM techniques in the present study. The same pattern was observed by Peretz and Zadik. The parents of stubborn and complaining children reported that they generally react firmly when their child did not behave properly at home and so were relatively more likely to approve of aggressive behavior management strategies.
| Conclusion|| |
The results of the present study showed that demographic factors such as the age of the child and area of residence affected the parental acceptance of the advanced BMTs. It is hoped that the data presented here will be valuable to the dentist for planning treatment and allow its completion effectively and efficiently.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]