The Role of Temperament in Cooperation and Level of Anxiety in Preschool and Elementary School Children in the Dental Office

BACKGROUND Dental fear and anxiety (DFA) refers to the fear of and anxiety towards going to the dentist. It exists in a considerable proportion of children and adolescents and is a major dilemma in paediatric dental practice. However, temperament has been suggested to be a predictive factor for the child’s reaction to dental treatment especially in young ages. This study was done to assess the role of temperament in the levels of anxiety and cooperation in preschool and elementary school children in the dental office. METHODS This descriptive, cross-sectional study evaluated 70 preschools (4 - 6 years of age) and elementary school (7 - 10 years of age) children presenting to the paediatric dental clinic of TUMS School of Dentistry. The children were generally healthy and had at least one carious primary molar requiring pulp therapy or restorative treatment under local anaesthesia. The temperament trait of children was determined using the Persian version of Malhotra’s Temperament Schedule that measures the nine temperament traits identified by Thomas and Chess. Next, the cooperation and level of anxiety in children were determined during anaesthetic injection and cavity preparation using the Venham Clinical Cooperation Scale (VCCS) and Venham Clinical Anxiety Scale (VCAS). Data was analyzed using a regression model. RESULTS The temperament trait of children had a significant correlation with their parent’s education level (P = 0.038). Lower sociability scores were significantly correlated with higher level of anxiety and uncooperative behaviour of children during anaesthetic injection and cavity preparation (P < 0.05). Rhythmicity was significantly correlated with anxiety during anaesthetic injection, and higher intensity of response/energy was significantly correlated with poor cooperation of children during injection and higher anxiety during cavity preparation (P < 0.05). CONCLUSIONS Within the limitations of this study, the results of temperament trait can predict the behaviour of children and their level of anxiety and cooperation in the dental office setting. KEY WORDS Anxiety; Cooperation; Child, Preschool; Temperament; Paediatric Dentistry.

89 Do Corticosteroid and Local Anaesthetic Hip Injections Administered Proximal or Distal to The Zona Orbicularis Have an Effect on Patient Satisfaction?

Aim Pubofemoral and ischiofemoral ligaments blend to make zona orbicularis. Zonaorbicularis has been suggested to force fluid from peripheral compartment to central compartment in unidirectional flow. This study aims to assess whether injection of corticosteroid with local anaesthetic injected either proximal or distal to the zona orbicularis has effect on patient satisfaction. Method This retrospective study investigated consecutive patients undergoing ultrasound guided hip injections at a single centre in the UK between November 2018 and March 2019. Patients were identified using IMPAX© picture archiving and communications system. Radiographs were assessed to see if radiopaque dye and therefore corticosteroid and local anaesthetic had been injected proximal or distal to the zona orbicularis. Clinic letters were accessed on the electronic patient record and we recorded whether patients had pain relief at 24 hours and 2 weeks following hip injection. Results 133 Patients were identified during the study period, of which 40 were included. At 24 hours post-injection 72% of patients were satisfied and 28% were unsatisfied, for which there was 76% and 70% satisfaction for proximal and distal injections respectively (p = 0.63). At 2 weeks post-injection 45% of patients were satisfied and 55% of patients unsatisfied, for which there was 47% and 44% satisfaction for proximal and distal injections respectively (p = 0.9). Conclusions Overall patient satisfaction is high following hip corticosteroid and local anaesthetic injection. No difference was found between injections proximal and distal to the zona orbicularis. Further research is needed to quantify the association between proximal and distal injections.

Outpatient Neuromodulation May Avert the Need for Surgery in Patients with Painful Cutaneous Neuromas

Background: Traumatic neuromas are a result of abnormal neural regeneration after nerve injury. Neuropathic pain arising from neuroma can be debilitating. Methods: This was a retrospective review of a consecutive series of patients who presented with a painful cutaneous neuroma secondary to direct trauma or surgery. The diagnosis was made by the presence of neuropathic symptoms in the dermatome of a cutaneous nerve and a positive Tinel sign. Local anaesthetic injection was performed for confirmation of diagnosis. Each patient was offered optimisation of medical therapy and physiotherapy for desensitisation. Outpatient neuromodulation was offered as an alternative to neuroma surgery. The primary aim of treatment was symptom reduction such that neuroma surgery was no longer required. Results: This study included 50 patients with painful cutaneous neuromas. Surgery was the commonest cause. The most frequently injured nerves were superficial radial nerve, digital nerve and dorsal ulnar cutaneous nerve, together comprising over 60% of cases. After receiving neuromodulation, 18 (36%) patients experienced sufficient symptom relief and did not wish to pursue neuroma surgery. Conclusions: Surgery is the commonest cause of a painful cutaneous neuroma. Following optimisation of pharmacotherapy and physiotherapy, neuromodulation may offer symptom relief such that neuroma surgery may be avoided in approximately one third of cases.

Results of repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection for recurrence of frozen shoulder

Background This study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC. Methods A consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter. Results The initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group. Conclusions A repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient’s informed consent. Trial registration Retrospectively registered

Topical anaesthesia as an adjuvant to local anaesthetic injection in open trigger digit release: a randomized controlled trial

We conducted a randomized controlled trial to compare pain scores and patient satisfaction between topical anaesthetic cream (5% lidocaine-prilocaine cream) versus placebo cream, applied approximately 90 minutes before local anaesthetic injection for open trigger digit release. One hundred participants were enrolled and randomly allocated into the two groups between May 2019 and February 2020. The visual analogue pain scores and satisfaction scores were measured. Most participants were female with Quinnell Grade 2–3 trigger digits. The pain scores during needle injection, local anaesthetic infiltration, the overall pain and satisfaction scores had no statistically significant differences between groups. There was no correlation between duration of topical anaesthetic drug application and pain scores. Subgroup analysis did not show significant differences in pain scores between genders. No complications were found during the study period. The topical anaesthetic drug was ineffective to use on the palmar skin during open trigger digit release surgery. Level of evidence: II