Silent stress in children at the dentist

Children are very stressed by anesthetics injected into the mouth before tooth extraction, as part of orthodontic treatment. In a study from the University of Gothenburg, a technique was tested to monitor stress levels in 14- to 16-year-olds during dental care.

The results of the pilot study are being presented at the ongoing European Academy of Pediatric Dentistry (EAPD) Congress in Gothenburg. The objective of the study corresponds well to the objective of the expertise gathered in the field: to treat children with sensitivity.

The study was led by Larisa Krekmanova, a researcher in pediatric dentistry and pedodontics at the Sahlgrenska Academy of the University of Gothenburg and a pediatric dentist at the public dental service of the Västra Götaland region.

“Child and adolescent patients are not always able or confident enough to convey negative experiences during dental treatment. At the same time, we know that a significant number of them find dental exams and invasive treatments stressful, whether because of fear or pain,” she notes.

“We want to uncover this silent stress, a type of stress that is difficult to detect and can remain hidden. This research aims to increase the sensitivity of practitioners and make the voices of patients heard,” says Krekmanova.

Movements and sweating monitored

The study included 34 patients, aged 14 to 16, who were scheduled to undergo either a regular dental examination (20 patients) or an invasive treatment (14 patients) involving anesthetic injections and extraction of healthy molars, often over multiple appointments, in conjunction with orthodontic treatment.

During treatment, participants were fitted with a device on one of their hands to collect data on hand movements and hand sweating, measured via the electrical properties of the skin, known as electrodermal activity or galvanic response of the skin.

The results showed that participants who had regular dental checkups had scattered spikes in stress, while those who had invasive treatment were significantly more stressed for longer periods, all following a clear trend.

Anesthetic injection is the most stressful

Some stress was already registered when the patient had the dentist’s fingers in the mouth and was examined with a mirror. However, these stress levels skyrocketed when anesthesia was administered. To some extent when applying an anesthetic gel, but especially when injecting a local anesthetic. This is when hand movements and sweating peak. During the actual tooth extraction, hand movements subsided somewhat while profuse sweating persisted.

The technical devices used for this pilot study come from the world of sport. The leader of the technical application of the study is Christian Jonasson, a researcher specializing in sensor systems at the Swedish research institutes, RISE. Another key member of the research group is Claudia Jaldin, a dentist at the Kvillebäcken Public Dental Clinic in Gothenburg, who carried out the treatment.

“Children and adolescents are more afraid of invasive procedures, and we now have an idea of ​​the stress caused by these various interventions. In the future, the ability to use the device in real time would help practitioners monitor stress levels and perhaps take a break. for corrective action before continuing processing. In dental care, when it comes to fear and pain, it is important to work preventively with children and adolescents,” says Jaldin.