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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 65-69

Dental anxiety among 4-7-year-old children measured by hand gestures: A new modified visual analog scale (Dave's hand gesture scale)


1 Department of Pediatrics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumadeep Vidyapeeth, Deemed to be University, Vadodara, Gujarat, India
2 Private Practitioner, KM Shah Dental College and Hospital Sumandeep Vidhyapeeth an Institution Deemed to be University, Ahmedabad, Gujarat, India

Date of Submission13-Oct-2021
Date of Decision06-Dec-2021
Date of Acceptance23-Dec-2021
Date of Web Publication15-Mar-2022

Correspondence Address:
Dr. Bhavana Inderchand
Department of Pediatrics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumadeep Vidyapeeth, Deemed to be University, Vadodara - 391 760, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jihs.jihs_26_21

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  Abstract 


Introduction: Dental Anxiety (DA) can have a serious impact on daily life and is a significant barrier for seeking and receiving dental care. Hence, our aim is to develop new scale for the assessment of DA in children between 4 and 7 years. Methodology: Visual analouge scale(VAS) and Dave's hand gesture scales were laminated on A2 size paper, which was shown to 60 participants before the procedure, immediately after the procedure and ½ h postprocedure and the participants were asked to show the score on the laminated sheet without the presence of any of the parent/guardian. Result: Descriptive analysis of all the explanatory and outcome parameters was performed. Friedman's test was used to compare the mean anxiety rating scores of both rating scales. Pearson correlation test was accustomed to correlate the anxiety rating scores. Chi-square test was used to compare the preference/liking of the different anxiety rating scales. The level of significance was set at P < 0.05. The results were statistically significant the new scale was in accordance with VAS. Conclusion: Dave's hand gesture scale is a reliable and valid measure of child's DA.

Keywords: Anxiety assessment, anxiety scales, dental anxiety, hand gesture, pediatric dentistry, visual analog scale


How to cite this article:
Dave BH, Thaker BA, Inderchand B. Dental anxiety among 4-7-year-old children measured by hand gestures: A new modified visual analog scale (Dave's hand gesture scale). J Integr Health Sci 2021;9:65-9

How to cite this URL:
Dave BH, Thaker BA, Inderchand B. Dental anxiety among 4-7-year-old children measured by hand gestures: A new modified visual analog scale (Dave's hand gesture scale). J Integr Health Sci [serial online] 2021 [cited 2022 Aug 12];9:65-9. Available from: https://www.jihs.in/text.asp?2021/9/2/65/339653




  Introduction Top


Dental anxiety (DA) is a multi-system response that is believed to threat or danger general well-being. DA is a widespread phenomenon which ranks fifth among the most commonly feared situations for individuals.[1] It can have a serious impact on daily life and is a significant barrier for seeking dental care. It has been estimated that the anxious patient requires approximately 20% more chair time than the nonanxious patient, so many general dental practitioners are not willing to provide care for preschool children who display disruptive behavior.[1]

DA in children affects child's behavior and is recognized as a source of problem in patient management. DA is seen in both children and adults, with child anxiety often manifesting as inappropriate or disruptive behavior with different etiological factors. The measurement of DA in children is vital not only for delivery of prime quality clinical care but also for understanding the extent of anxiety before treatment which will permit the dental practitioner to spot the anxious patents for appropriate anxiety management.[1]

It is been observed that Anticipatory anxiety may lead to avoidance of dental treatment, whereas the dental fear may make treatment stressful for the dentist.[2],[3] Understanding and measuring DA and fear is a necessary prerequisite for treatment, management, and its consequences.[4] Dental fear is also to a greater or lesser extent dependent upon the scale which is used, based on different questions/answers, lengthy descriptions of treatment and its consequences make the patients more anxious.[5]

Gestures are powerful means of communication among people. In fact, gesturing is so deeply rooted in our communication that people often continue gesturing when speaking on the telephone. Hand gestures provide a separate complementary modality to speech for expressing one's idea. Information associated with hand gestures is natural interaction between humans. Hearing-impaired children also use a hand gesture to communicate with other individuals. In today's life even computing devices are using hand gestures for communication, for example, various emojis and hand gestures added in applications.[6],[7]

People who are physically handicapped will also find this system very useful.[8] Thus, we have selected hand gestures in our study as a modified visual analog scale (VAS) which is used for the measurement of anxiety.

This study was designed with an aim to develop a new scale for the assessment of DA in children between 4 and 7 years of age.


  Methodology Top


The comparative experimental study was conducted amongst 4–7 years of children in the Department of Peadiatric and Preventive dentistry, K. M. Shah dental college, Vadodara. A sample size of 60 achieves 80% power to detect a race of 0.80 using a two-sided binomial test. The study was initiated after approval from institutional ethics committee. Two types of validation was carried out-content validation and concurrent validation Total 60 children between the age group 4 and 7 years and on their first dental visit who fell under behavior rating “3” according to Frankl's scale were included in the study. Children whose parents refused to give informed consent and those with special health care needs were excluded from the study.

The clinical examination of selected children was done by single investigator. Investigator received training before conducting survey, at the department of Pediatric and Preventive Dentistry, K. M. Shah Dental College and Hospital, Vadodara under the guidance of a Professor to limit examiner variability.

Dave's hand gesture scale [Table 1] were laminated on A2 size paper, which was shown to the participants before the procedure (P1) (oral prophylaxis) and immediately after the procedure (P2) and ½ h postprocedure (P3) and the participants were asked to show the score on the laminated sheet without the presence of any of the parent/guardian [Figure 1] and [Figure 2]. To check for the reliability of the scale the participants were asked to show the score after half an hour of procedure. This was marked by the examiner on individual's examination sheet. The VAS scale was noted in the similar manner on individual's examination sheet. Dave's hand gesture scale had 6 scores in comparison to VAS scale [Figure 3].
Table 1: Scores of New Scale and Visual Analog Scale

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Figure 1: Patient showing the anxiety score

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Figure 2: Patient pointing the anxiety score

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Figure 3: Shows the new hand gesture anxiety scale

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  Results Top


The data collected from the study were entered into the Microsoft Excel sheet and were forwarded for statistical analysis. The data collected were tabulated and subjected to statistical analyses using statistical analyses using Statistical Product and Service Solutions(SPSS) statistical software package, version 22.0. Descriptive analysis of all the explanatory and outcome parameters was performed, Friedman's test was used to compare the mean anxiety rating scores of different rating scales. Pearson correlation test was accustomed to correlate the anxiety rating scores between different rating scales. Chi-square test was used to compare the preference/liking of the different anxiety rating scales. The level of significance was set at P < 0.05.

The mean anxiety scores measured each of the scales demonstrate differences in the distribution of response scores. [Table 2] shows the results of anxiety pre procedure (P1), immediately postprocedure (P2) and ½ h postprocedure (P3) scores for the Dave's hand gesture scale(DHG).
Table 2: Anxiety scores of Dave's Hand Gesture Scale

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The mean score for the VAS P1 with no anxiety was 26.7% and DHG scale was 21.7%. The mean score for the VAS P2 with mild anxiety was 25.0% and DHG scale was 23.3%. The mean score for the VAS P3 with moderate anxiety was 51.7% and DHG scale was 51.7%. [Graph 1], [Graph 2], [Graph 3] shows comparison P1, P2, P3 of VAS and DHG Scale.



Pearson correlation test was performed to evaluate the correlation and validity VAS and DHG scale. A very strong correlation (r = 0.726, P < 0.001) was found between VAS and DHG scale, which indicated that DHG scale measured anxiety similar to VAS which is the gold standard, determined similarity between the scales. [Table 3] shows the results of P1, P2, P3 scores for visual analog scale.
Table 3: Anxiety scores of Visual Analog Scale

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  Discussion Top


DA is a highly frequent condition in children,[9],[10] this study has covered 4–7 years of age as these children cannot communicate. Various interactive elements, both personal and environmental, contribute to DA and fear.[11],[12] Previous studies found major psychological characteristics such as shyness and general fearfulness and immaturity to cause DA which is prevalent in this age group.[13] The mechanisms of DA acquisition[13] are cognitive ability and the transmission of negative attitudes by parents or others. Several studies showed that parental and child DA are interrelated.[14],[15] Dais also highly influenced most frequently by culture.[15] A study in the Stockholm has shown that DA in 7-year-old children is more common among foreign children compared with Swedish-born children.[16] A study by Raadal et al. indicated that 68% of high DA children suffered more than 5 carious lesion at age 5. About half of children express a low to moderate dental fear, whereas at this age 10% to 20% report a high level DA.[17],[18],[19],[20],[21] Anxiety-related behaviors have been recognized as the most difficult part of behavior guidance and so it is necessary classify and quantify anxiety.

According to Buchanan et al.,[22] an ideal anxiety assessment scale should be short in length to maximize response from children and minimize cognitive load, the scale used should hold the child's attention and be easy to interpret. Furthermore, the scale should be simple to use in younger children with limited psychological and linguistic skills.

In this study, we compared VAS with Dave's Hand gesture scale, Dave's hand gesture scale uses simple gestures for measuring anxiety in young children and it was found simpler and easier. Visual analog scales (VASs) are utilized in psychological assessment since the twentieth century and have afterward been utilized with success within the assessment of a large kind of health-related constructs including pain,[23],[24],[25] quality-of-life,[26],[27] and mood.[28],[29],[30] VASs are transient and straightforward to administer and negligible in terms of respondent burden. Hence, they are considered as gold standard. A study by Buchanan et al.[22] provided reliability and validity data on a computerized DA scale (the smiley faces program [SFP]) for children using faces as a response set suggested that the SFP is a valid and reliable measure for assessing children's trait DA and may help encourage dentists to formally assess DA.

The validity of the Dave's hand gesture scale was supported by its high degree of agreement with VAS. DA measurements with Dave's hand gesture scale showed a very strong correlation with VAS, and children preferred the former as there was no confusion with showing gestures with hand. Furthermore, the current generation children are exposed to expressing their feelings using gestures rather than talking much, so this makes new scale highly attractive to young children as it comprises motion emoticons. VAS had a linear line with numbers and faces below which children might find it difficult to correlate them with their anxiety, whereas asking them to show gesture in accordance to how much anxiety they had during the appointment is easier.

In younger children with limited linguistic and cognitive abilities, Dave's hand Gesture scale offers many advantages. It is very attractive, easy for children to relate with feelings, less time consuming, universal (no languages or questionnaires are used), common to both sexes, and offers immediate scoring of DA which serves the dental team to use acceptable behavior management modalities in establishing a trustworthy relationship and sensible rapport between the child, parent, and pediatric dental practitioner. Dave's Hand gesture scale is a novel and child-friendly alternative for the assessment of anxiety in children.

Dave's Hand Gesture scale is a useful and valid method for measuring preoperative anxiety and compares well with the visual analog scale for anxiety. The main objectives of this study were to define, develop and provide initial construct validation for an updated and more refined measure of anxiety in children. Dave's Hand gesture scale for anxiety measurement appears to hold promise as a reliable and potentially valid measure for use in children of all age groups. The limitation of the study is the smaller sample size further research on a bigger sample is required.


  Conclusion Top


DA and phobia can have a negative impact on a person's quality of life and so it is crucial that these important barriers be identified and alleviated so as to pave the way for greater dental health and general well-being. The results from our study provide a reliable and valid measure of DA among children using Dave's hand gesture scale when compared to visual analog scale.

Recommendations

  • It only includes items relevant to most children's dental experience
  • The modernization of the scale helps engage the child thereby increasing the likelihood of maximum response
  • The overall anxiety score can be interpreted quickly and easily
  • Children with special healthcare needs (CHCN) will also find this system very useful if used for day-to-day activities.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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