ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERATION
1 / NAME OF THECANDIDATE AND
ADRESSS / DR. SUGANDH MITTAL
POST GRADUATE STUDENT DEPARTMENT OF PEDODONTICS & PREVENTIVE DENTISTRY,
V.S.DENTALCOLLEGEHOSPITAL K.R. ROAD
V.V.PURAM. BANGALORE-560004
2 / NAME OF THE INSTITUTION / V.S.DENTALCOLLEGEAND HOSPITAL, K.R ROAD, V.V.PURAM. BANGALORE-560004
3 / COURSE AND STUDY OF SUBJECT / M.D.S PEDODONTICS AND PREVENTIVE DENTISTRY
4 / DATE OF ADMISSION TO THE COURSE / JUNE 2011
5 / TITLE OF THE TOPIC / Assessing Dental Anxiety and salivary pH changes of Children visiting dental hospital - A correlational study.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY-
Dental anxiety of children should be detected as early as possible since it can persist into adulthood and lead to dental avoidance which can result in deterioration of oral health. Though there are various fears assessment tools like Venham Picture Test [VPT], Facial Image Scale [FIS] for children, but they have certain limitations.
Cortisol hormonerelease , Na, K levels during stress are often measured in studies despite their cost and lab procedure, hence Salivary pH can be an cheaper significant alternative, chair side predictor of stress and dental caries. It can also serve as a mean for patient education.
Here is an attempt to make the tool appealing and easy, since anxiety provoking environment of the dental situation may regress and experience a lowering of child’s cognitive ability, and co relate it with psyco-physiological, i.e. PH change in saliva.
6. 2. Review of literature
Dentally induced stress and relaxation-induced anxiety reduction recently have been correlated with salivary changes in private patients treated by a solo endodontist. There were significant anxiety-reduction changes by the conclusion of the visits, as measured by increased salivary volume, increased salivary translucency, reduced salivary protein, increased salivary pH and reduced questionnaire-determined anxiety level. It can be concluded that saliva is an easily obtained fluid that can be used to determine levels of stress and relaxation.[1]
100 children (aged 3–18 years) completed the Facial Image Scale (FIS) and the Venham Picture Test (VPT) in the dental hospital waiting room andConcludedthat the FIS is a valid means of assessing child dentalanxiety status in a clinical context. [3]
A Computerised ‘Smiley Faces Program’ was devloped and was found to have good reliability and validity with children from 6-15 years, with the added advantages in that the interactive animation provides children with a straightforward and comprehensible task, while at the same time producing a numerical measure for use by the investigator.[5]
A new version of the Modified Child Dental Anxiety Scale was formed by adding faces rating scale to the original numeric form, and found it to be a reliable and valid measure of dental anxiety in children aged 8-12 yrs. [7]
A study hypothesized a relationship between academic year, coping mechanisms, stress, short-term memory and salivary pH.
Upperclassmen andlowerclassmen undergraduate students completed a
Life-stress scale, self-ratings of strategies used and effectiveness for handling stress.
Participant pH levels were measured in the saliva twice to ensure accuracy, and concluded that it provides some promising "early" data to suggest that pH might be a very cost efficient way of looking at the physiological effect of stress.[4]
6.3 OBJECTIVE OF THIS STUDY:
1)To assessanxiety level of children in Dental setup.
2)To examine the validity of modified Facial image scale, using series of 5 colored faces as an indicator of children’s dental anxiety.
3)Tomeasure salivary pH as a psycho-physiological indicator of Dental anxiety.
4)To find the correlation between Anxiety level and pH .
7. MATERIALSAND METHODS:
7.1 SOURCE OF DATA:
1) Children reporting to the Dept. of Pedodontics and preventive dentistry
VSDC, Bangalore,will be included in the study.
2) Written informed consent will be taken from the parents.
INCLUSION CRITERIA:
1)All Healthy communicative children (3-16yrs of age).
2)Those who are willing to participate in the study.
EXCLUSION CRITERIA:
1) Patients with Handicapping conditions.
7.2 METHODS AND COLLECTION OF DATA:
SAMPLE SIZE:
A total of 100 Children, who fulfill the above mentioned criteria’s, will be included for the study.
STUDY DESIGN:
Correlation Study
STUDY DURATION:
One and half year
SAMPLING DESIGN:
Purpose Sampling
METHODOLOGY-
Patient reporting to the dept. of Pedodontics and Preventive dentistry, VSDC, Bangalore fulfilling the above mentioned inclusion and exclusion criteria will be included in the study.
The MFIS (Fig. 1) comprises arow of five coloredsmiley ranging from very happy to very unhappy. The children will be asked the question ‘HOW DO YOU FEEL RIGHT NOW?’ The child then point at theface, they felt most like at that moment. The scale isscored by giving a value of one to the most positiveaffect face and five to the most negative affect face.
Facial image scale [fig. 2] comprises of 5 uncolored faces. Parents shall be asked not to contribute to theirChild’schoice. It is reportedthat validity (whether the instrument measures what it intends to), can be assessed by correlating thescale with another scale designed tomeasure the same phenomenon. The FIS is selected for this study as, with the MFIS, it is a picturescale that is intended for young children, it measuresstate anxiety, and it will be administered before and after treatment starts.
Following Assessment of anxiety level,salivary samples will be taken, to examine salivary variable (pH).
For the saliva test: - Children will be asked not to eat, drink, or brush there teeth for 2 hrs prior to the test. They will be asked to swallow a couple of times to clear the mouth and stimulate new saliva - Then discharge some saliva into a PLASTIC spoon (it is recommended NOT to touch the pH paper to the tongue due to the chemicals in the paper).
pH strip is then dipped into saliva and compare the color of immersed pH strip with the color chart provided. The lower pH value below 7.0, the higher is the degree of acid stress. Testing and recording of pH shall be done pre and posttreatment.
Statistical Analysis
Statistical analysis will be carried out to correlate Dental anxiety and pH changes in saliva using‘t’ test
Fig 1 -Modified Facial Image Scale with image scores
1 1 1 2 3 4 5
Fig 2- Facial Image Scale with image scores [Buchanan – 2002]
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS IF SO, PLEASE DESCRIBE BRIEFLY.
YES
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
YES
8. LIST OF REFERENCES
1) Morse DR, Schacterle GR, Esposito JV, Furst ML, Bose K; Stress, relaxation and saliva: a follow-up study involving clinical endodontic patients. J Human Stress.1981 Sep; 7(3):19-26.
2) Morse DR, Schacterle GR, Esposito JV, Furst ML, Bose K; Stress, relaxation, and saliva: a pilot study involving endodontic patients.
Oral Surg Oral Med Oral Pathol1981 Sep; 52(3):308-13.
3) H. Buchanan & N. Niven. Validation of a Facial Image Scale to assess child dental anxiety. Int J Pediatr Dent.2002; 12:47-52.
4) Bira Lindsay; "Stress, pH, & Coping: Does Experience Make a Difference?" 2008, University Honours Program. Paper69
5) H Buchanan; Development of a computerised dental anxiety scale for children: validation and reliability, BritishDentalJournal .2005; 199,359-362.
6)Arun Rathnam, Nidhi Madan, Neeti Madan; The language of pain: A short study Year:Contemporary clinical dentistry.2010; 1(3):142-145.
7) Karen E. Howard, Ruth freeman; Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. International Journal of Paediatric Dentistry,2007;17(4):281-288.
9. SIGNATURE OF THE CANDIDATE10. REMARKS OF THE GUIDE
11.NAME AND DESIGNATION OF GUIDE (IN BLOCK LETTERS) / DR. VIVEK DHRUV KUMAR
PROFESSOR ,
DEPARTMENT OF PEDODONTICS &
PREVENTIVE DENTISTRY,
V.SDENTALCOLLEGE & HOSPITAL
K.R. ROAD V.V.PURAM,
BANGALORE-560004.
11.1 SIGNATURE
11.2 CO-GUIDE IF ANY
11.3 SIGNATURE
11.4 HEAD OF THE DEPARTMENT / DR. VENKATESH BABU
PROFESSOR & HOD DEPARTMENT OF PEDODONTICS &
PREVENTIVE DENTISTRY,
V.SDENTALCOLLEGE & HOSPITAL
K.R. ROAD V.V.PURAM,
BANGALORE-560004.
11.5 SIGNATURE
12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
Consent Form
Department of Pedodontics and Preventive Dentistry
Vokkalingara Sangha Dental college and Hospital
V.V Puram, K.R Road,
Bangalore-40
I ------residing in ------, have been informed about involvement of my child ------, age ------, by Dr. Sugandh Mittal in the study "Assessing dental anxiety and salivary pH changes in children visiting dental hospital" in the language I can understand.
I agree to give my child's personal details and will cooperate and follow the instructions given by the dentist during the study.
I permit the operator to utilize the information given and the results obtained from this study for presentation and publication.
I’m allowing my child to participate in this study. If for any reason my child is unable to participate in the study, for reasons unknown, I can withdraw from the study.
Place:Parent Signature:
Date:
Dentist Signature:
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