Evaluation the Effect of Multi-Coloured Versus Traditional Restorative Materials on the Childrens Dental Anxiety
Background: Restorative dental care may be an unpleasant procedure for children which seems to be contributing to the development of dental anxiety. The placement of colored restorative material was termed to anticipate the child's positive attitude toward treatment.
Aim: The aim of this study is to evaluate the effect of multicolored restorative materials on the children's dental anxiety level.
Material and Methods: A total of 80 children were selected for this study, aged 8-9 years old from primary schools in Iraq. The children were divided randomly and equally into two groups, the control group (group A) who were received traditional composite material, and the experimental group (group B) who were received colored restorative material. The restorative treatment for both groups was class I for primary lower molars. Dental anxiety was measured for all participants using the Abeer Children Dental Anxiety Scale (ACDAS) before the dental procedure as a baseline score and after the dental procedure.
Result: There was a highly significant decrease in the in ACDAS scours after dental procedure between control and experimental groups. Most children in the present study selected the pink colored restorative material. Conclusion: The use of multicolored restorative materials might aid in the reduction of children's dental anxiety during the dental procedure.
Dental anxiety, Children, Colored restorative material, Composite restoration, Colors
Anxiety can be described as an unpleasant state with an associated fear of dangers from within or an acquired from one's environment. It varies depending on the capacity to imagine . Dental anxiety is one of the most prevalent problems faced in the dental procedure and is a source of complication for the pediatric dentist, avoiding dental visits and reject dental treatment for children . Restorative dental care may be an unpleasant procedure for children because it involves several potentially stressful stimuli, each contributing to the development of dental anxiety .
The colored restorative material had been created for children and can be regarded as an active motivating technique in which children considered their dental appointment as engaging experiences in their restoration with different colors . Furthermore, giving the child the chance to select the restoration form or color that would be put into his teeth might be another successful approach . Color affects a child's life in forms we cannot identify. We can allow children who are anxious and refuse treatment to choose his/her multi-colored restorative materials that could improve child behavior in the dental clinic, especially in younger age groups . Furthermore, colored restoration could be used as an alternative for composite restoration due to clinical rate of success .
The aim of this study is to evaluate the effect of placement multicolored restorative materials compared with traditional restorative materials on the dental anxiety level of Iraqi children.
Materials and Methods
The present study had been started after gaining the approval from the ethical and the scientific committee at College of Dentistry/University of Baghdad. The sample was selected among children aged 8-9 years old from primary school who have no previous dental experience and require restorative dental treatment (class I for primary lower molars with absence of pain, fistula, and, pulpal exposure for selected tooth.
A statistically calculated sample size of 80 children were divided randomly and equally into two groups, the control group (group A) and experimental group (group B), with 40 samples in each group. A random allocation list was generated using a Microsoft excel (Random number generation RNG) program. Details of the procedures and aims of the study were explained to the parents, verbal and signed consent was obtained to approve their acceptance about the participation of their children in the study.
The study steps were done by one dentist who used euphemisms and the tell-show do technique to encourage patients for treatment. The caries lesion was removed using a rotatory high-speed hand piece and the cavity was prepared, a standard dental procedure was followed with all participants in both groups. Group A received traditional composite material (restorative kit, CAVEX, Holland BV), and group B received colored flowable composite filling (RAINBOW flow, PPH CERKAMED Wojciech Pawlowski, Poland), after asking the child to choose his/her color preference of restorative material (Figure 1).
Figure 1. Selected restorative materials colors.
Dental anxiety was measured for all participants using the Abeer Children Dental Anxiety Scale (ACDAS)  before dental procedure as a baseline score and after the dental procedure by the same examiner to overcome operator bias.
The collected data were subjected to statistical analysis using the Statistical Package for Social Science (SPSS version 22), at a level of significance set at P<0.05.
The changes in ACDAS scores in both groups before and after the dental procedure were shown in the Table 1. There were lower ACDAS scores after the dental procedure than the baseline readings before the dental procedure.
|ACDAS (anxiety score)|
|Groups||Statistics||Before dental procedure||After dental procedure|
Table 1: Statistical description of ACDAS scores between two groups.
The intra comparison of ACDAS among control and experimental group revealed that there was a highly significant difference (P value<0.01) in the change in ACDAS score from before to after dental procedure as shown in Table 2.
|(Intra comparison) Pairwise Comparisons|
|Groups||(I) Time||(J) Time||Mean Difference (I-J)||P Value|
|A||Before dental Procedure||After dental procedure||1.75||0.008|
|B||Before dental procedure||After dental procedure||4.525||0|
Table 2: Comparisons of ACDAS between times by groups.
The inter-group comparison of ACDAS by times were shown in Table 3. The mean difference was nonsignificant (P value>0.05) before dental procedure, while highly significant differences (P value<0.01) were found after dental procedure.
|(Inter Comparison) Pairwise Comparisons|
|Time||(I) Groups||(J) Groups||Mean Difference (I-J)||P Value|
|Before dental procedure||A||B||0.65||0.484|
|After dental procedure||A||B||3.425||0|
Table 3: Comparisons of ACDAS between groups.
The distribution of children ’ s color preference for restorative materials is shown in Figure 1. The highest percentage of preference was found for the pink color (30%) and the lowest percentage for orange and yellow (7.5).
Dental anxiety is popular among children in the dental clinic. Younger children have a greater tendency to prefer multicolored restoration over traditional restorative material, thereby making it a useful tool to treat young children in pediatric dentistry . The results of this study showed a highly significant reduction (P value <0.01) in anxiety scores after the completion of the procedure relative to the baseline before the dental procedure for both groups as shown in table (1) and table (2). This is in accordance with de Menezes Abreu et al. and Rayen et al. [10,11]. Low ACDAS scores in both groups at the end of the procedure indicated that children are afraid of unknown dental procedures before treatment and that dental anxiety decrease after dental procedures has been completed . However, there was a highly significant difference in anxiety scores between control and experimental groups after the dental procedure as shown in table (3) which agrees with the findings of [4,6]. This result may be explained by allowing children to select their preferred dental restorative color increase their enthusiasm and cooperation and the child becomes more likely to accept the treatment . Thus, fear will decrease, and dental care will be approved . Furthermore, the colors may have a positive effect on the behaviors of the child, these colors can contribute to the child's comfort and minimize dental anxiety .
The multicolored restorative materials have been available in the market for the restoration of primary teeth with different colors ranged from orange, blue, pink, yellow, green, to purple colors. Most children in the present study selected the pink color as shown in Figure 2. Clinicians have explained experientially how a child's emotional status influences their choice of color [16,17]. Color preferences are related to whether a color causes positive or negative feelings . This may probably be attributed to that the pink color is associated with happy and positive emotion [19,20], as well as having calming effects on the child . Contrary to the findings of this study, Raj and Ganapathy, found from their research, that most children have chosen green color followed by pink color as their favorite colored restorative materials , which may be due to a difference in the gender distribution, and colors of restorative material compared to this study.
Figure 2. Preference of children for colour of restorative materials.
The use of multicolored restorative materials might aid in the reduction of children's dental anxiety during dental procedures especially when child allowed selecting their preferred dental restorative color.
- Viswanath D, Kumar RM, Prabhuji M. Dental anxiety, fear and phobia in children. Int J Dent Res Develop 2014; 4:2250-2386.
- Chapman HR, Kirby-Turner N. Psychological intrusion–An overlooked aspect of dental fear. Frontiers Psychol 2018; 9:501.
- Krikken J, Cate T, Veerkamp J. Child dental fear and general emotional problems: A pilot study. Eur Archives Paediat Dent 2010; 11:283-286.
- Juliet S, Gurunathan D. Behavior assessment of children after placing colored restorative material: A randomized controlled trial. Int J Pedodont Rehabilitation 2017; 2:66.
- Sharma A and Tyagi R. Behavior assessment of children in dental settings: A retrospective study. Int J Clin Pediatr Dent 2011; 4:35.
- Hugar SM, Kohli D, Badakar CM, et al. An In vivo comparative evaluation of dental anxiety level and clinical success rate of composite and multicolored compomers in 6 to 12 years of children. Int J Clin Pediatr Dent 2018; 11:483-489.
- Nicholson JW. Polyacid-modified composite resins (“compomers”) and their use in clinical dentistry. Dent Materials 2007; 23:615-622.
- Al-Namankany A, Ashley P, Petrie A. The development of a dental anxiety scale with a cognitive component for children and adolescents. Pediatr Dent 2012; 34:219-224.
- Gungör ÖE, Erdoğan Y, Yalcın-Gungör A, et al. Comparative evaluation of shear bond strength of three flowable compomers on enamel of primary teeth: An in-vitro study. J Clin Exp Dent 2016; 8:e322-326.
- De Menezes Abreu D, Leal S, Mulder J, et al. Patterns of dental anxiety in children after sequential dental visits. Eur Archives Paediatr Dent 2011; 12:298-302.
- Rayen R, Muthu M, Rao CR, et al. Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children. Indian J Dent Res 2006; 17:27.
- Caltabiano ML, Croker F, Page L, et al. Dental anxiety in patients attending a student dental clinic. BMC Oral Health 2018; 18:48.
- Raj D, Ganapathy D. Childrens preference toward color of compomer fillings. Drug Invention Today 2019; 12. .
- Arora V, Arora P, Srivastava N, Togoo RA. Multicoloured restorations for pediatric dental patients. Bri J Appl Sci Tech 2014; 4:4014.
- Bubna K, Hegde S, Rao D. Role of colors in pediatric dental practices. J Clin Pediatr Dent 2017; 41:193-198.
- Boyatzis CJ, Varghese R. Children's emotional associations with colors. J Genetic Psychol 1994; 155:77-85.
- Rathod H. Color-emotion association and its affective interpretation. IJSR 2014; 3:275-279.
- Pope DJ, Butler H, Qualter P. Emotional understanding and color-emotion associations in children aged 7-8 years. Child Development Res 2012; 2012:9.
- Park JG. Color perception in pediatric patient room design: Healthy children vs. pediatric patients. HERD: Health Environments Res Design J 2009; 2:6-28.
- Umamaheshwari N, Asokan S, Kumaran TS. Child friendly colors in a pediatric dental practice. J Indian Society Pedodont Preventive Dent 2013; 31:225.
- Annamary K, Prathima GS, Sajeev R, et al. Colour preference to emotions in relation to the anxiety level among school children in Puducherry–A cross-sectional study. J Clin Diagnostic Res 2016; 10:ZC26.