Dentist’s reassuring touch: effects on children’s behavior 9/11/09

Resident: Murphy
Date: 9/11/09
Article title: Dentist’s reassuring touch: effects on children’s behavior
Author(s): Greenbaum, Paul. Mark Lumley, et al.
Journal: Pediatric Dentistry 1993, Vol. 15, #1, pg 20-24
Major topic: How a dentist’s touch can affect a child before and during treatment
Type of Article: Clinical Behavioral Study

Findings:
When seeing any type of doctor, some sort of anxiety experienced by most children, especially when making a trip to the “dreaded” dentist. This anxiety, or actual fear is a definite obstacle to adequate care, resulting in patient management problems and possible avoidance of necessary treatment. Many different types of behavior guidance strategies have been published and used by pediatric dentists all over the world. On strategy not mentioned is the use of reassuring touch, which may be an easy way to reduce fear and stress in the anxious child.
Numerous studies have proven that a doctor’s touch can improve patients reactions to treatment. Patients who were touched before and/or during treatment reported feeling more comfortable with their doctors and nurses, and having less pain and anxiety (up to this study, none were done in the dental setting, and none were done on preschool children).
In this study, 38 children were treated by two dentists a male and a female. For the purpose of the study, a reassuring touch was considered a gentle patting or rubbing on the shoulder or upper arm. Children were also separated by age, splitting up children younger than 7 and older than 7. Half of the children seen by each dentist were treat with reassuring touch and words, and the other half with only reassuring words. The children’s anxiety and fear was observed and calculated before, during, and after treatment using the Dental Fear Scale(DFS) and the Self Assessment Manikin(SAM). The DFS represents a more stable, trait like index, where SAM situational fluctuations. Also, the Behavior Profile Rating Scale BPRS was used to measure fear related behavior i.e. fidgeting, squirming, and constant closing of the mouth.
The dentist were instructed that with the touch group, they should pat the upper arm or shoulder for 10 seconds at two separate times during the appointment while giving reassuring comments.

Conclusions:
Essentially, the children who were treated with reassuring touch and words showed less fearful behavior, and reported the experience as being better than the no touch group (see chart in article for review/breakdown). However, this was only the case for the children in the >7 group. The younger children in the touch group still showed fidgeting, mouth closing, etc. This could simply be age appropriate behavior. Studies show that fidgeting and other repetitive behaviors increase a person’s psychological anxiety, and therefore increase stress. Basically they’re saying fidgeting is a manifestation of fear.
While the findings in the study are encouraging, there are many things to keep in mind. There are numerous factors that cold have affected how each child reacted to their respective treatment. These factors include how the child reacted to each dentist, past dental experience of the child, what kind of procedure was being performed, other types of behavior guidance that was used, etc.

Assessment of article:
Overall I thought it was good article. My major problem with the study was that while they tried to keep everything uniform, there were still so many variables that could have affected the children’s reactions. As we all know, some times you just can’t connect with a child while someone else can. The main thing I tool away was that a gentle touch of the shoulder, or pat on the arm can’t hurt.