الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Attention-deficit/ hyperactivity disorder is one of the most common neurobehavioral disorders of childhood, thus pediatric dentists are more likely to deal with it. Children with ADHD present more disruptive behavior and behavior management problems than healthy children. Thus, pediatric dentists may struggle to perform even the simplest procedures. Distraction is a commonly used behavior management technique to withdraw the patient’s attention from unpleasant stimuli. Audiovisual distraction could be more effective than traditional distraction techniques as it blocks visual and auditory stimuli. Virtual Reality (VR) is one of the most recent audiovisual distraction techniques. It has proved to be effective in reducing dental anxiety and improving the behavior of healthy children and children with autism. However, its effectiveness has not been studied on children with ADHD yet. Audio distraction has proven to be effective in reducing dental anxiety and improving behavior in healthy children and children with special health care needs. It can be done by listening to familiar songs, cartoon sounds, calm sounds, upbeat sounds, and white noise. There is a growing body of evidence that listening to white noise has many benefits for children with ADHD including better cognitive and attentional performance.
This study was designed to evaluate and compare the effectiveness of VR glasses and white noise distraction to the basic behavior management techniques on dental anxiety and behavior of children with ADHD aged 7-10 years during preventive dental procedures. The study was a three-armed parallel randomized controlled clinical trial. It was set up and recorded according to the CONSORT guidelines. Participants were recruited from patients attending the Pediatric Neurology Outpatient Clinic at Smouha Specialized Hospital for Children, Faculty of Medicine, Alexandria University. The study was carried out at the dental clinics of the same hospital. Ethical approval was obtained from the Research Ethics Committee of Alexandria University, Faculty of Dentistry (IRB NO: 0646-03/2023-IORG 0008839) and Faculty of Medicine (Serial NO: 0107698-IRB NO:00012098-FWA NO: 00018699) Alexandria University, Egypt. The parents of the children signed informed consent after full explanation of the objectives as well as benefits and the risks of the study. Forty-eight children diagnosed with ADHD were included in the current study. The children were on stimulant medication (Methylphenidate) with Frankl Behavior Rating Scale scores 2 and 3 during the preoperative assessments. Dentally, the children had no previous dental experience with at least one erupted first permanent molar indicated for fissure sealant. Children with comorbid physical disabilities or psychiatric disorders were excluded from the study. The participants were randomly divided into 3 groups according to the distraction technique where, in group I: 16 children were managed by VR, group II: 16 children were managed by white noise, and group III (control): 16 children were managed by basic behavior management techniques. The treatment was split into two visits with one-week interval. The first visit included examination and charting and the second visit included prophylaxis and fissure sealant. In the present study two methods were used to assess dental anxiety was assessed subjectively using the Facial Image Scale (FIS) and objectively using Pulse Rate (PR) and Blood Oxygen Saturation (SpO2). The child’s behavior was assessed using Venham’s Behavior rating scale. The length of the procedure was recorded from the moment the child was seated on the dental chair until the end of the dental procedure in both visits.
The results of FIS showed a statistically significant reduction of dental anxiety across the visits in VR, white noise, and control groups (P= <0.001, 0.001,0.005 respectively). However, no significant difference was found between the three groups at the baseline, first, and second visits (P= 0.67, 0.52, and 0.77 respectively). The results of the PR showed a statistically significant difference in the mean PR of the children in the white noise group and the control group during the first visit (P=0.003). Whereas in the second visit, a statistically significant difference was found in the mean PR of children in the white noise group in comparison to the VR group and control group where (P= 0.02 and 0.005 respectively). A statistically significant difference was found in mean PR values across the visits in the white noise group (P=<0.001). However, no statistically significant difference was found between the three groups in the mean SpO2 values at the baseline and during the first and second visits (P= 0.64,0.68, and 0.46 respectively). The results of VBRS showed a statistically significant improvement in children’s behavior across the visits in VR, white noise, and control groups (P=0.003, 0.04, and 0.003 respectively). However, no significant difference was found between the three groups at the baseline, first, and second visits (P=0.61,0.13, and 0.43 respectively). No significant difference was found in the procedure time between the three groups at the first and second visits (P=0.08 and 0.95).