Assessment of Children’s Pain Expression and Behavior Using Audio-visual Distraction: A Randomized Controlled Study

Aim: The study evaluates the effects of an audio-visual distraction on children’s behaviors and pain expressions during dental treatment.

Background: Dental anxiety distresses children and their families with consequent poor oral health and costly pediatric dental services. Children’s behaviors could be modified using a distraction technique for improved dental treatment. Among the non–invasive distractive behavior guidance, audiovisual distraction (AVD) is being utilized for children who watch and listen to movies during a stressful procedure. Therefore, Numerous studies demonstrated the efficacy of AVD using devices in managing distress and reducing fear and anxiety in children during dental treatments.

Methods: One hundred healthy children, between 4 to 6 years of age, were randomly assigned to one of two groups: audio-visual distraction (AVD, N=61) group and control (CTR, N=39) group. The pre and post pain expression was collected using a faces pain rating scale from the participated children. Children’s behavior was evaluated using the Frankl behavior rating scale by the assigned dentist. Data was analyzed using chi-squared tests and analysis of variance.

Results: The AVD group demonstrated more “definitely positive” behavior (91.8%) compared to the CTR group (35.9%) based on the Frankl scale evaluation from pre- and post-treatment (P< .0001). The pain rating scale did not demonstrate a significant difference in post-treatment pain scales (P = 0.2073) or changes in pain (P = 0.1532) between the AVD group and the CTR group. The results suggested that the AVD was not associated with children’s perception based on the pain scale but was significantly associated with dentist assessment indicated by the Frankl behavior scales. The results are supported by other studies using other AVDs leading to less anxiety.

Conclusions: The AVD is an effective distraction tool for young children during dental treatment regardless of the child’s subjective pain expression.