Children Anxiety and Pain while Performing Interim Therapeutic Restorations with Hand Instruments compared to Rotary Instruments: A Randomised Clinical Trial

Abstract

Introduction: Children with dental anxiety may avoid visiting the dentist until a more serious and painful condition develops. Dentists could use less stressful techniques, like Interim Therapeutic Restorations (ITR), to treat dental cavities in difficult or young patients. ITR performed with hand tools may be preferred due to the absence of handpiece vibration, sound, or smell. Aim: To assess the anxiety and pain levels experienced by children during ITR procedures performed with hand instruments compared to rotary instruments. Materials and Methods: The present randomised clinical trial was conducted in the Department of Pediatric Dentistry at King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. The inclusion criteria consisted of children aged 3-12 years visiting the dental clinic for the first time and having a carious primary anterior (incisor or canine) tooth. Patients were recruited from the paediatric screening clinic and randomly assigned to either the “Hand instrument group” or the “Rotary instrument group.” Caries excavation was performed using a hand instrument in the former group, while a low-speed handpiece was used in the latter group. Anxiety levels were assessed using Venham’s anxiety rating scale before and after the procedure. Heart rate was measured using pulse oximetry every two minutes. Pain levels were evaluated using the Wong-Baker Faces Pain Rating Scale after completing the procedure. Results: The study included 60 patients, with a mean age of 5.87±2.09 years. The anxiety score after the procedure was significantly lower in the hand instrument group compared to the rotary instrument group (p=0.007). Although the heart rate was lower in the hand instrument group compared to the rotary instrument group, the difference was not statistically significant. The subjects in the hand instrument group reported lower pain levels compared to those in the rotary instrument group (p=0.029). Conclusion: Performing ITR using hand instruments resulted in reduced anxiety and pain levels among young children compared to ITR performed using rotary handpieces.

Keywords

• dental anxiety
• dental atraumatic restorative treatment
• randomised controlled trials
• toothache