The use of imagery suggestions during administration of local anesthetic in pediatric patients.

Resident: Adam J. Bottrill
Date: 18SEP09 Region: Providence
Article title: The use of imagery suggestions during administration of local anesthetic in pediatric patients.
Author(s): Peretz B., Bimstein E.
Journal: Journal of Dentistry for Children
Volume #; Number; Page #s: July-August pp: 263-267
Year: 2000
Major topic: Behavior management
Minor topic(s): Hypnotism
Type of Article: Experimental study.

Main Purpose: To evaluate the effect of suggestion in a group of children before and during the receiving of a local anesthesia injection. Also, efforts were made to correlate these reactions with social and dental treatment variables.
Overview of method of research: Controlled study of effect of behavior management technique.
Findings: Not telling

Key points in the article discussion:

A. General: It is generally agreed upon that the most stressful time of a dental visit, for both patient and dentist is the administration of anesthesia (to a child).
1. “suggestion” is the main component in hypnosis
2. Found that the pulse rates of hypnotized children decreased and observed levels of crying were less intense.
3. Hypnosis is found, in general, to be more effective on younger children. It has been suggested though, that it not be used on those younger than 7 y.o.
4. Suceptability to suggestion:
a. females more than males
b. younger more than older
c. children of lenient parents more than children of strict parents.

B. Materials and Methods:
1. 80 children, age 3-16
2. All required anesthesia administration
3. Treated by one of two dentists:
4. Pre-data collected:
a. general behavior (relaxed, tense, highly tensed)
b. previous behavior (cooperative, uncooperative but allowing tx, uncooperative and didn’t allow tx)
c. mode of previous behavior management (non-pharmacological, nitrous, premed with nitrous, GA)
d. previous traumatic medical or dental treatment.
5. Behavior measured at current appt using previous measurements
6. Younger children told tooth was “going to sleep”, older children told the tooth would be “anesthetized”.
7. Before administration, all children was asked to think of their favorite pleasant image. Those who could not think of one were asked their favorite game/pet etc…
8. Throughout injection procedure, operator provided comments reinforcing the pleasant image.
9. Data collected:
a. whether they used the same image throughout, facial expressions, eye movement, body tonus.
10. Chi-square used for variable comparison, t-test used for boys vs. girls.

C. Results:
1. Mean ages: 5.3 boys, 7.2 girls
2. Nearly a third of the patients had previous dental/medical traumatic experiences.
3. 60% maxillary
4. 53% demonstrated facial pleasure, 31% indifferent, 16% dislike
5. 81% were “relaxed”
6. No gender difference found WRT eye movement, facial expression or body tonus.
7. Most children were able to maintain the images throughout procedure and most kept their eyes closed.
8. Those treated with nitrous or oral sedation were more able to maintain images.

D. Discussion:
1. Most children could conjure up images.
2. Boys (pets) were different than girls (nature) at what type of image they selected.
3. Present study agreed with previous studies that suggested younger patients are more susceptible to suggestion.
4. The request to “fantasize is a relaxation tool. The child is allowed to go into a light “trance.”
5. Good rapport is essential to this process.
6. Though many dentists use the power of suggestion intuitively, the findings of this study should encourage the routine and deliberate use of this technique.

E. Conclusions:
1. Visualization suggestions may be effective in children from the age of three.
2. The utilization of the child’s imagination is a baluable behavior management adjuvant during dental treatment.
3. Nitrous oxide enhances the children’s capacity to accept and retain images..

Assessment of article: Don’t we all sort of do this already? Seemed like a first year pedo resident project, but better organized. Shenanigans?