Approximately 10% to 20% of the adult population in the western industrialized world report high dental anxiety; moreover, most report this reaction as having developed in childhood. Despite the recognition of children's dental anxiety as a worldwide public health dilemma, to date there is a lack of availability of cost-effective procedures to reduce this problem and the uncooperative and disruptive behaviours associated with it. Indeed, children's dental anxiety strongly interferes with the capacity to provide an effective dental treatment. The overall objective of the present proposal is to study the feasibility of the implementation of a brief abdominal breathing training to reduce children's anxiety during a dental procedure. To this aim, age and sex-matched children will be randomly allocated to two conditions: diaphragmatic breathing (n = 25) or treatment as usual (i.e., distraction by the use of a cartoon video) (n = 25). Subjective (visual analog scales) and physiological (i.e., corrugator electromyography and respiration) measures of anxiety and pain will be obtained during 5-minute baseline, dental treatment, and 5-minute recovery periods. Children's facial expressions will be videotaped for the entire experimental protocol to obtain more objective indicators of momentary pain feelings. We hypothesise that diaphragmatic breathing would be more effective than treatment as usual in decreasing both subjective and objective measures of pain and anxiety, and that this will be also confirmed by facial expression coding. Moreover, we expect that this would impact the duration of the dental appointments, with visits of shorter average duration in the experimental compared to the control group. The present proposal is anticipated to yield fruitful results, on one side by advancing our knowledge on the correlates of pain and anxiety in children and on the other by improving daily dental practice.
In spite of the tremendous burden placed by children¿s dental anxiety on both children's future dental health and dentists' time and performance, to date no studies have tried to implement cost-effective and easy to implement procedures to reduce such burden. The study has the objective to go substantially beyond the current state of the art by studying whether a simple abdominal breathing procedure during the dental visit can be more effective than distraction in reducing child's anxiety. In case of positive results, the present proposal is anticipated to yield fruitful results, with an impact on both applied research and daily dentists' clinical practice. As to the first, the project will advance our knowledge of the subjective and physiological concomitants of pain, anxiety, and abdominal breathing in children. Surprisingly, whereas the topic of dental anxiety has been broadly investigated in adults, there is a lack of research in paediatric populations. As to the second, understanding how to turn off dental anxiety in children has an important bearing on health costs ultimately improving children¿s dental care (therefore reducing the need of future and more invasive dental treatments) and diminishing the average duration of the visits.