Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial

Background: The aim of this study was to establish the efficacy of two different preparation packages, a paper-based cartoon and an interactive computer, at facilitating coping behavior in children undergoing dental general anesthetic (DGA) tooth extraction. Method: A total of 198 children were allocated randomly to computer, cartoon or control groups. A Visual Analog Scale (VAS) and Modified Child Dental Anxiety Scale (MCDAS) were used to compare preoperative anxiety levels between the three study groups. Blinded observers then scored behavior at both anesthesia induction and upon recovery using a VAS for each (0 = coped/no distress and 10 = no coping/high distress). Results: The children's median age was 5 (range 3-10) years, 57% were boys, a median of seven teeth were extracted (range 1-20). Preoperative anxiety was similar for all preparation groups; with 24% of all children categorized 'phobic' using MCDAS. The median induction (coping) VAS level for both the computer and the cartoon groups was '1' (range 0-10), compared with the control group level of '3' (range 0-10). The median recovery (coping) VAS levels were: computer group: 0 (range 0-10), cartoon group: 4 (range 0-10) and control group: 2.5 (range 0-10). The Mann-Whitney U-test showed that the computer group coped significantly better than the control group at induction (P = 0.014) and significantly better than the cartoon group upon recovery (P = 0.016). The statistical power for detecting differences between groups (computer/ cartoon versus control) was calculated to be 90%, based on pilot study data. Conclusions: The computer preparation package facilitated coping behavior in children undergoing DGA induction.