Is audio a mandatory component of multimedia distraction for reduction of pain and anxiety of pediatric dental patients? A split‑mouth crossover randomized controlled clinical trial

Abstract

Background: Control of pain, fear, and anxiety of pediatric dental patients is a common concern
for the parents and dental clinicians. This study aimed to compare the efficacy of audiovisual
distraction (AVD) and mute‑video distraction (MVD) for reduction of pain and anxiety of pediatric
dental patients.
Materials and Methods: This randomized split‑mouth crossover clinical trial evaluated
60 systemically healthy children between 4 and 7 years requiring bilateral pulpotomy of primary
maxillary first molars. The samples were randomly divided into 6 groups based on the distraction
technique and sequence of its receipt: (I) control‑AVD, (II) AVD‑control, (III) control‑MVD, (IV)
MVD‑control, (V) AVD‑MVD, and (VI) MVD‑AVD and were treated. The severity of pain and anxiety
of patients during anesthetic injection was measured using physiological (pulse rate [PR]), sound,
eyes, and motor (SEM) and faces pain rating (FPR) scales. Data were compared between Groups 1
and 2, 3 and 4, and 5 and 6 using crossover clinical trial analysis (P = 0.05).
Results: The increase in PR and the mean FPR and SEM scales during anesthetic injection was
significantly smaller in AVD than MVD (P < 0.05). No significant difference was noted between
MVD and control technique regarding PR and mean FPR or SEM (P = 1.00).
Conclusion: It appears that MVD has no significant efficacy for reduction of pain and anxiety of
pediatric dental patients. AVD, however, can effectively decrease the pain and anxiety of pediatric
dental patients during anesthetic injection.
Key Words: Audiovisual media, behavior control, dental anxiety, distraction, pain perception,
pediatric dentistry