New grant may help pediatric patients after negative dental experiences

Two HSC-Baylor College of Dentistry faculty members are using a $25,000 grant to explore whether a behavior management technique called “child life” could help previously uncooperative pediatric dental patients.

Drs. Carolyn Kerins and Kavitha Viswanathan, assistant professors in pediatric dentistry, received the grant in July from the North and Central Texas Clinical and Translational Science Initiative. They have already begun their research in the pediatric dentistry clinic with children ages 5 to 10.

Child life uses play, guided imagery and verbal explanations to develop coping strategies, emotional stability and decreased anxiety in young patients. As part of child life therapy, children are shown either model or real medical instruments and are allowed to explore and manipulate them using dolls.

Child life has been used for decades in the medical setting as a method to desensitize children to unfamiliar, stressful medical situations and procedures. Its effectiveness is well-documented and has been shown to improve health care experiences for hospitalized children. However, no quantitative research or literature exists about its application in dentistry.

“We wanted to explore child life therapy as a behavior management tool for frightened, uncooperative young patients in pediatric dentistry,” Viswanathan says. “Our research will evaluate the effectiveness of child life intervention to help dental-phobic children cope with dental procedures. We’re particularly interested to see if it could alleviate the need for pharmacologic intervention to modify behavior.”

In the HSC-BCD study, Kerins and Viswanathan partner with child life specialist Cinda McDonald, with whom they have worked at Texas Scottish Rite Hospital for Children. McDonald’s previous experience as a registered dental hygienist, coupled with her child life expertise, especially suits her for counseling children who have experienced a traumatic dental procedure.

The team has created a dental version of child life intervention to cater to HSC-BCD’s patient population. A book that McDonald developed introduces HSC-BCD dentists and treatments in child-friendly language. McDonald also introduces the children to Mac, a pastel-colored fuzzy alien puppet, or Sammie, a large soft doll, who have full sets of teeth to examine and brush.

As the children play with Mac and Sammie, they typically project their own feelings and experiences onto the dolls. What seems like simple playtime for children is actually a therapeutic way to express themselves and comfortably tell the specialist why they are afraid. Kerins and Viswanathan want to learn if this therapy produces positive behavioral changes when the children return to the dentist for restorative appointments.

“As pediatric dentists, we often encounter defiant and fearful older children who are too old to be treated under general anesthesia but too anxious to get treatment under a wakeful state,” Viswanathan says. “Treatment for these children is difficult even for pediatric dentists.

“Often they must undergo multiple oral sedation appointments with limited success, and they’re not given an opportunity to develop better dental coping skills for their lifetime,” Viswanathan says.

Kerins says previous techniques for nonpharmacologic behavior management have been explored by the American Academy of Pediatric Dentistry. She anticipates child life could be “a logical, novel approach to a recurring problem” and teamed with Viswanathan because both are looking to conduct more clinical research.

They are recruiting patients for the study from the college’s pediatric clinic, community dental clinics and pediatric dentists in the DFW area. They will provide child life therapy to 25 children who need dental procedures that require at least two appointments. The study concludes in summer 2009.

Those interested in the study or who would like to refer patients for it can contact Kerins at ckerins@bcd.tamhsc.edu or Viswanathan at kviswanathan@bcd.tamhsc.edu.