Evaluating the Use of Audiovisual Distraction in Reducing Stress during Dental Treatment in Children using Salivary Chromogranin A: A Quasi-experimental Study

Abstract

Introduction: Audiovisual Distraction (AVD), as a behaviour management technique, has gained significant importance in aiding patient cooperation during routine dental procedures. However, the scale at which it makes a difference needs to be evaluated. Objective approaches like measuring heart rate and pulse rates are unreliable methods. The quantification can be done using salivary Chromogranin A (CgA), a stress marker. Aim: To evaluate the use of AVD for reducing stress in children aged 4-7 years during dental treatment using salivary CgA. Materials and Methods: The present quasi-experimental study was conducted within the Department of Paediatric and Preventive Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India, from January 2022 to March 2022 after obtaining ethical clearance from the Institute and consent from parents. Six uncooperative children who required two Class-I restorative treatments for occlusal caries involving enamel and dentin were included in the study. The sample size was estimated using G*Power software v3.1.9.2 and calculated using t-tests. The treatment plan was divided into two appointments. In the first appointment, the cavity was prepared without the use of AVD. In the second appointment, AVD was incorporated during the dental procedure using the patient’s favourite cartoon. Unstimulated salivary samples were collected during both appointments, before and immediately after the procedure, which were sent to the laboratory for evaluation of CgA levels to gauge the stress levels during each appointment and the effect AVD has on the same. Results: Within the group without AV aids used, the mean salivary CgA levels showed a significant increase from 0.23 pmol/mg pretreatment to 1.26 pmol/mg protein after treatment. Within the group with AV aids, salivary CgA levels showed a significant reduction (p≤0.05) from 1.08 pmol/mg before treatment to 0.43 pmol/mg protein after treatment. There was also a significant difference in the change in salivary CgA levels from pre- to post-treatment between the two study groups. Conclusion: The study shows quantitatively that AVD reduced stress levels during dental treatment and therefore can be used as an adjunct for behaviour management. It can also be seen that Salivary CgA is a reliable short-term stress marker and can be used objectively to evaluate and quantify stress levels in children.

Keywords

• behaviour management
• distraction technique
• salivary cortisol
• uncooperative children