Evolução do manejo comportamental em Odontopediatria e o impacto da técnica imagens positivas pré-visita na ansiedade, comportamento e dor Infantil.

Abstract

Dental fear/anxiety represents significant challenges in pediatric dental care, directly influencing children's behavior and cooperation during appointments. Various behavior management techniques are employed to ensure safe and effective treatment. Over time, these techniques have evolved to align with social changes and the approach to child care. This study aimed to analyze the evolution of behavior management techniques in the guidelines of the American Academy of Pediatric Dentistry (AAPD) over the years, relating them to social transformations. Additionally, it investigated the impact of using pre-visit videos with positive dental images on anxiety, behavior, and pain perception in children, comparing them with neutral videos. For the historical analysis, AAPD guidelines were examined from their first publication through searches in different databases. The results revealed that, over the past 35 years, the guidelines have undergone adaptations to keep pace with technological, cultural, and ethical changes. The focus of strategies has shifted from a control and containment-based model to a more respectful, collaborative, and childcentered approach, with greater parental involvement. The findings underscore the ongoing need to update clinical guidelines to promote more humane and effective pediatric dental care. Furthermore, a randomized, double-blind clinical trial was conducted with 20 children aged 4 to 10 years who sought treatment at the School of Dentistry of the Federal University of Pelotas and had never been treated before. After signing the Informed Consent Form, the guardians answered a sociodemographic questionnaire and a child anxiety assessment. The child's anxiety was measured before watching the video. Subsequently, the children were randomized into two groups: the Control Group, which watched a video with neutral images, and the Intervention Group, which watched a video with positive dental images. Anxiety was assessed again after the video was shown and also after the appointments (up to 3 visits). Behavior and pain (subjective and objective) were also recorded. Statistical analysis was performed using different tests, selected according to the nature of the outcomes and data distribution. Normality tests were applied to assess the distribution of variables, and non-parametric tests, such as Mann-Whitney, Wilcoxon Signed Ranks, and Fisher's Exact, were used for between-group comparisons. The proportion test was used to evaluate differences in categorical variables. A significance level of P<0.05 was adopted for all analyses. The results showed that both groups reduced anxiety, with no statistically significant difference between them, immediately after watching the video and after the first appointment compared to anxiety before the video. For the secondary outcomes, self-perceived pain, objective pain, and behavior showed no clinically significant differences between the groups. Although audiovisual materials temporarily reduced anxiety, they did not have a lasting impact on anxiety. Pre-visit positive imagery did not yield better outcomes (reduced anxiety, improved behavior, and less pain) when compared to the control group with neutral images.