Creation and evaluation of a cognitive pamphlet designed to help children needing nitrous oxide inhalation sedation

Busuttil Naudi, Antoniella (2009) Creation and evaluation of a cognitive pamphlet designed to help children needing nitrous oxide inhalation sedation. MSc(R) thesis, University of Glasgow.

Abstract

A number of paediatric dental patients are highly anxious about dental treatment and this prevents them from accepting dental treatment in the conventional manner. There are a number of techniques available to help subjects deal better with treatment and one of the more commonly used techniques is nitrous oxide inhalation sedation. This technique involves the administration of a titrated mixture of nitrous oxide and oxygen through a nose-piece with the aim of sedating a patient to a point where s/he can cope with dental treatment. This technique is highly successful but it still requires a certain amount of cooperation on the part of the patient. Some patients find it hard to accept the nose-piece while others accept it initially but then still do not manage to relax enough for dental treatment to be carried out. Children‟s coping strategies vary and are dependent on factors such as age, personal characteristics and cultural influences. Research shows that cognitively oriented coping strategies are more constructive in the dental setting and it is possible to teach children how to use such strategies. Preparation for surgery and anaesthesia is clearly important and many children consider the dental visit a stressful situation. Cognitive behaviour therapy has been used to help subjects cope with various medical conditions and also in preparation for surgery.
The aim of this project was to develop and evaluate a cognitive pamphlet to help facilitate inhalation sedation treatment for anxious paediatric dental patients. The project was carried out in three parts.
The first study, a retrospective case note review of the patients undergoing inhalation sedation at Glasgow Dental Hospital and School, ascertained the population sample.
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The case notes of all the patients who attended for dental treatment with inhalation sedation at the Glasgow Dental Hospital in the year 2005 were pulled and demographic details of the patients were recorded from them. The results showed that the mean age of the patients attending was 10.8years with a range of 5 to 16 years and about 53% of patients were female. Therefore, it was concluded that the pamphlet should target children aged between 7 and 16 years and it should be equally appealing to both genders.
In the second study a cognitive pamphlet was designed, evaluated qualitatively and modified. The pamphlet was designed by the main researcher with the help of a psychologist. It consisted of a three-panel brochure with bold colourful images and text. It presented the subject with three sets of cognitive exercises to practice at home and perform during treatment. The pamphlet was qualitatively evaluated by a focus group of paediatric dentists using a structured interview questionnaire. The pamphlet was then amended according to the suggestions of the interviewees.
The third study was a single blind randomised controlled clinical evaluation of this modified pamphlet.
Subjects were assessed and recruited to the study from the sedation assessment clinics in the Glasgow Dental Hospital and the Community Dental Services. The subjects were randomly allocated to either a control or a study group. The subjects in the study group received a previously developed pamphlet consisting of cognitive behavioural therapy exercise. The children were instructed to read the pamphlet and practice the exercises at home and then use them at their first treatment visit. The preoperative anxiety levels of the subjects were assessed prior to assignment into the
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respective groups. The blinded operators were asked to assess the overall behaviour of the subjects on a Global Rating Scale and a Visual Analog Scale. All the subjects had their first treatment visit videotaped and all the tapes were watched by two blinded observers at the end of the study and the subjects‟ acceptance of the nose-piece as well as their overall behaviour was scored. The scales used by the blinded observers were the Houpt Scale, the Visual Analog Scale and the Global Rating Scale. These scales were applied at specific time-points, namely: 1. introduction to the nose-piece, 2. fitting of the nose-piece, 3. breathing in and out of the nose-piece and 4. start of the operative procedure.
The final number of subjects participating in the study was 35, of which 11 (31.5%) were recruited from the Community Dental Services. Eighteen (51.4%) were male and the mean age was 10.2 years (7-14). Thirteen (34.2%) were in the highest level of social deprivation. The preoperative anxiety scores were very similar for both groups and the mean values (24.6 and 24.9) were higher than the normative value.
The primary outcome measure of the study was whether the pamphlet improved subject acceptance of the nose-piece. Only one subject from the control group refused to wear the nose-piece while all the subjects in the study group accepted the nose-piece. The difference was not statistically significant (Chi square test, p= 0.324). The secondary outcome measure was the overall behaviour of the subjects during treatment. Although, there was poor agreement between the observers, the individual results from each observer as well as the result at the time of best agreement show that there was no statistically significant difference between the two groups (Mann-Whitney and Fisher‟s Exact test). The results show that the pamphlet was not
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successful to either help subjects accept the nose-piece or improve their behaviour during treatment.
There could be various reasons for the failure of the pamphlet to improve patient co-operation. These include an already highly successful technique (inhalation sedation), a small study sample, failure to comply with instructions to read the pamphlet, difficulty in processing cognitive exercises without the help of a psychologist and the Hawthorne effect. Although it is not possible to recommend the use a cognitive pamphlet prior to inhalation sedation at this stage, it may be possible to further investigate this idea in a future study taking into consideration the shortcomings of the present study and improving them.

• Item Type: Thesis (MSc(R))
• Qualification Level: Masters
• Keywords: paediatric dentistry, inhalation sedation, cognitive behaviour therapy, pamphlet, coping skills
• Subjects: R Medicine > RK Dentistry; R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Supervisor's Name: Hosey, Prof. Marie-Therese
• Date of Award: 2009
• Depositing User: Mrs Antoniella Busuttil Naudi
• Unique ID: glathesis:2009-1328
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 09 Dec 2009
• Last Modified: 10 Dec 2012 13:37
• URI: https://theses.gla.ac.uk/id/eprint/1328