Neoteric Desensitization Among Five-Seven Year Old Children- A Novel Behaviour Modification Technique

Introduction

Intelligence is the ability to adapt to the environment to mapping into physical, cognitive, social and emotional development.1 The recognition and understanding of these factors are important from the point of view of successful clinical pediatric practice. Fear and anxiety towards dentistry has been a major hurdle in the delivery of treatment. But by knowing the psychology of child helps to eliminate the fear of them by following development and clinically apply these features in behaviour modification, by which treating a child patient becomes a success when the child leaves the clinic with a smiling face.

Behaviour management refers to application of various techniques by which the dental team effectively and efficiently performs dental treatment thereby instills a positive attitude in the patient. To address these causative factors various behavior management strategies can be practiced which include verbal and non-verbal communication, tell show do, distraction, presence/absence of parents, modelling, audiovisual aids, desensitization, positive reinforcement, physical restraints, structuring,hand over mouth technique etc.

One of the most effective technique for structuring is tell show do popularized by Addleson which is especially useful during a child’s first dental visits. But one of the main disadvantage of this technique is lack of tactile interaction with the new dental environment. This method allows the child to just look and hear and it can’t provide a sense of control by touching and feeling which will be more effective in children. Moreover TELL SHOW DO is not practical in a crying child who closes his eyes & refuses to see what we are showing.

Behaviour therapists have propounded that desensitization also one of the most effective ways to reduce maladaptive anxiety,² so here we introduce a new behaviour management technique called neoteric desensitization which is a combination of structuring and desensitization and solves the drawbacks of tell show do.

The aim of this study was to compare the conventional tell show do technique with neoteric desensitization among 5-7 year old children.

Materials & Methods:

This randomized clinical trial study was conducted among 50 children aged 5–7 years, reporting to the department of Pedodontics and Preventive Dentistry of our tertiary care hospital. The study was initiated subsequent to approval of Ethical Committee of KVG Dental College and Hospital. Necessary permission was taken from parents of children before conducting the study.

50 children were selected based on the below mentioned criteria.

Inclusion criteria:

1. Child visiting the dentist for the first time.
2. Aged between 5-7 years.
3. fearful child.
4. Patient agreed for written informed consent.

Exclusion criteria:

1. Patient having no history of previous dental visit
2. Children suffering from a debilitating systemic illness, mental retardation, cerebral palsy, or any other systemic disease.

Anxiety level of each patient was assessed using Chotta – Bheem Chutki scale. (figure 1).

They were randomly allocated into 2 groups.

Group 1:

neoteric desensitization group in which the child is allowed to use handpiece, scaler, diagnostic instruments etc on a cartoon doll with mouth wide open. (figure 2,3).

Group 2:

Tell show do group. It consists of explaining and demonstrating the procedure and the instruments used during the procedure.

After behavioural modification in each subject the appropriate non-invasive dental treatments like oral prophylaxis and restorations were performed. During the procedural time anxiety was again measured using the same scale.

Results:

The data collected was entered into Microsoft excel spreadsheet and analyzed using statistical package for social sciences (SPSS) VERSION 20 (SPSS Inc. California, USA). Descriptive data were presented in the form of frequencies, percentages, mean and standard deviation. It is given below in tables (table 1,and 2)P value <0.001 was considered significant.

Discussion:

Children possess limited level of cognition and understanding to their age and perceiving this cognitive development, pedodontist can frame suitable behaviour management strategy according to their level of cognition and can help mold them in their own world of knowledge which can reduce the use of complex strategies in clinical setup.

Our study sample consisted of children under the category of preoperational stage of child psychology with the age range of 4-7 years.This is the age when the understanding level of child starts to grow through intricate stages and develop intellectual abilities3 and a better foundation formed at this stage can tailor make the child to build a strong positive dental attitude in them .It is also the period of time when first – time child comes to a dentist as their first appointment mostly due to the consequences of early childhood caries. Hence the management of the child in a better & positive way is mandatory to promote the child by proper behaviour management strategy by the Pediatric dentist thereby instills a positive dental attitude.

In our study the child was assessed using Chotta Bheem–Chutki scale.⁴ This is a newly designed scale developed in the Department of Pedodontics, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar. This scale comprises two separate cards; one for boys and the other for girls. For boys, ChottaBheem cartoon character was chosen to depict various emotions, and for girls, Chutki cartoon character was chosen to depict various emotions.Each card consists of a series of six figures depicting happy to unhappy and running emotion by the cartoon character. Children were asked to choose the face they identified with at that instant. To record on the scale, a score of one was assigned to a happy face and six to an unhappy face and running [Figure 1].

Study done by Sadana et al.,4showed that the CBC scale yielded comparable results to the Visual Pictorial Test and Facial Image Scale. Its simplicity and familiar figures put into limelight its establishment as a benchmark to assess the level of dental anxiety faced by young children. We used this scale because it is very colorful& attractive and takes only short time to understand. Moreover the cartoon doll was in the shape of ChottaBheem so that the patient can correlate easily.

The next step was to remove the fear and anxiety through desensitization and structuring. For this purpose, tell show do & neoteric desensitization approaches were adapted. In tell show do procedure the child was explained about the new situation showing him what will be done and then doing it while retelling him about it while carrying out simple interventions like oral prophylaxis and restorations. While performing treatment, anxiety rating was again done to evaluate whether there is reduction in fear or not.

After modification technique there were notable differences in fear level. The results are similar to studies done by  Carson and  Freeman5 in which they found that the children in the TSD group had lower observed anxiety and heart rate prior to treatment compared with the control children. However, tell-show-do was unable to reduce heart rate in children who had previous experience of general anaesthesia.

Neoteric desensitization is a combination of desensitization and structuring where the child is allowed to think- feel- do simple procedures on dental doll using dental equipments which can create fear on child like scaler, micromotor etc. Similar study was done by Vishwakarma, et al and they found that TPD technique is more efficient than live modeling technique to control 5–7-year-old children’s anxiety and achieve cooperative behavior during dental treatment.6

In this study we compared the effectiveness of neoteric desensitization and tell show do. In the neoteric desensitization group the anxiety score was reduced from 3.68 to 1.48 but  in tell show do group the reduction was from 3.48 to 2.12 which implies that  neoteric desensitization is better mode of  behavioural modification compared to tell show do. But further studies with large sample are needed to confirm this.

Conclusion:

According to the methodology and based on the results of the present study, we can conclude that Neoteric desensitization technique is more efficient than Tell Show Do technique to control five–seven-yearold children’s anxiety and achieve cooperative behavior during dental treatment. Neoteric desensitization technique may be an alternate method to Tell Show Do and Neoteric desensitization can be a technique worth practicing in pediatric dentistry.