Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Feb 8, 2016; 5(1): 102-111
Published online Feb 8, 2016. doi: 10.5409/wjcp.v5.i1.102
Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study
Sai Priya Pala, Sivakumar Nuvvula, Rekhalakshmi Kamatham
Sai Priya Pala, Sivakumar Nuvvula, Rekhalakshmi Kamatham, Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore 524003, India
Author contributions: Pala SP, Nuvvula S and Kamatham R substantially contributed to the conception and design of the study, acquisition, analysis and interpretation of data; all authors drafted the article, made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the institutional ethical committee, Narayana Dental College, India.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to the study enrollment.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Rekhalakshmi Kamatham, MD, Reader, Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore 524003, India. rekhanagmds@yahoo.co.in
Telephone: +91-949-0426052 Fax: +91-861-2305092
Received: May 20, 2015
Peer-review started: May 21, 2015
First decision: September 17, 2015
Revised: October 16, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: February 8, 2016
Abstract

AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions.

METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral, faces, legs, activity, cry and consolability (FLACC) scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright’s modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test.

RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study.

CONCLUSION: Drawings could not act as surrogate measure of child’s pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium.

Keywords: Anxiety, Child, Distress, Drawings, Pain

Core tip: Assessing the effect of an invasive dental treatment, like extractions, on children is very important. To achieve this, drawings can be addressed as a method for working with children. They act as narrative of children’s painful experience and emotions.