Sensory Adapted Dental Environments to Enhance Oral Care for Children with and without Dental Fear and Anxiety

项目摘要/摘要 牙科恐惧和焦虑(DFA)表现出高达42%的儿科人群的特征，并预示着负面的 在牙科诊所的行为，不规律的预约就诊，需要全身麻醉，以及口腔不良 健康。感觉过度反应性(SOR)，发生在33%的儿科人群中，很可能是 DFA的贡献者，也可以独立于DFA发生。在牙科诊所，患有SOR的儿童可能 表现出对光、声音、触摸和其他感官刺激的行为过度反应，导致破坏性 行为类似于与DFA关联的行为。该项目将测试感官适应的牙科环境 (SADE)，一种新型的干预措施，提供舒缓的视觉、听觉和触觉输入，以减少儿童的 牙科治疗期间的焦虑或恐惧。在我们之前的NIDCR资助的R34研究中，Sade降低了生理性 自闭症儿童和发育中儿童的焦虑和行为障碍。因为萨德 利用感官修饰作为其关键活性成分，它补充-并可以与- 减少焦虑的策略，如建模，一种基于社会观察和模仿的策略。 研究参与者将是312名6-12岁的不同种族儿童、156名患有DFA的儿童和156名 没有。采用随机平衡研究设计，每个儿童将接受两次牙齿清洁4-6次 四种情况中的两种情况相隔数月：SADE结合基于视频的建模(SADE-VBM)、SADE 单独(SADE)、单独基于视频的建模(VBM)和常规牙科环境(RDE)。 由于SADE干预措施的可接受性和可行性已在我们的 在试点工作中，我们将在UG3规划阶段只评估拟议研究的三个新要素： VBM视频的内容和交付、加权毯子的使用以及新环境下的招聘技术。 在UH3阶段，具体目标是进行随机临床试验：测试Sade-VBM， SADE、VBM和RDE对牙科生理性焦虑和行为困扰的影响 清洁以及次要结果(目标1)；评估生理焦虑是否影响每种结果 干预对行为困扰的影响，以及DFA和SOR是否适度干预对生理压力的影响 焦虑和行为困扰(目标2)；并进行探索性分析，以检查DFA和SOR的独特 以及交互作用对门诊生理焦虑和行为困扰的总体水平的影响， 干预所涉费用问题，以及其他方法学问题，如治疗顺序效应(目标3)。 这一项目意义重大，因为它是第一个全面调整感官干预的随机对照试验 典型发育儿童的牙科环境。完成研究目标将有助于完善 基于SADE的方法提供简单、廉价且高度可扩展的治疗模型，我们将 随后在多点有效性试验中进行测试。长期项目成果将具有极大的受益潜力。 在美国，无数儿童在牙科诊所表现出破坏性的焦虑反应。

PROJECT SUMMARY/ABSTRACT Dental fear and anxiety (DFA) characterizes up to 42% of the pediatric population and predicts negative behaviors in the dental clinic, irregular appointment attendance, need for general anesthesia, and poor oral health. Sensory over-responsivity (SOR), which occurs in up to 33% of the pediatric population, is a likely contributor to DFA and may also occur independently from DFA. In the dental clinic, children with SOR may exhibit behavioral overreactions to lights, sounds, touch, and other sensory stimuli, leading to disruptive behaviors akin to those associated with DFA. This project will test the Sensory Adapted Dental Environment (SADE), a novel intervention which provides soothing visual, auditory, and tactile input to reduce children’s anxiety or fear during dental treatment. In our previous NIDCR-funded R34 study, SADE reduced physiological anxiety and behavioral distress in both children with autism and typically developing children. Because SADE utilizes sensory modifications as its key active ingredient, it complements – and could be combined with – anxiety-reducing strategies such as modeling, a strategy based on social observation and imitation. Research participants will be 312 ethnically diverse children aged 6-12 years, 156 with DFA and 156 without. Using a randomized counterbalanced study design, each child will undergo two dental cleanings 4-6 months apart in two of four conditions: SADE in conjunction with video-based modeling (SADE-VBM), SADE alone (SADE), video-based modeling alone (VBM), and a regular dental environment (RDE). As acceptability and feasibility of the SADE intervention and procedures have been established in our pilot work, in our UG3 planning phase we will assess only the three new elements of the proposed study – content and delivery of VBM videos, use of a weighted blanket, and recruitment techniques in new settings. In the UH3 phase, the specific aims are to conduct a randomized clinical trial to: test SADE-VBM, SADE, VBM, and RDE’s relative effects on physiological anxiety and behavioral distress during dental cleaning, as well as on secondary outcomes (Aim 1); assess whether physiological anxiety mediates each interventions’ effect on behavioral distress, and if DFA and SOR moderate intervention effects on physiological anxiety and behavioral distress (Aim 2); and conduct exploratory analyses to examine DFA and SOR’s unique and interactive contributions to overall levels of in-clinic physiological anxiety and behavioral distress, the intervention’s cost implications, and other methodological issues such as treatment sequencing effects (Aim 3). This project is significant because it is the first full-scale RCT of a sensory adapted intervention to modify the dental environment for typically developing children. Completion of the study aims will enable refinement of the SADE-based approach to provide a simple, inexpensive, and highly scalable treatment model that we will later test in a multi-site effectiveness trial. Long-term project outcomes will have excellent potential to benefit countless children in the US who manifest disruptive anxiety reactions in the dental clinic.