Dental Anesthesia, Emotional Anxiety and Stress During Pediatric Dental Treatment
Conditions
Keywords
Pediatric dental anxiety, Aromatherapy, PediMelissa officinalis, Essential oils, Pediatric oral anesthesia
Brief summary
This clinical study will look at whether a plant-based essential oil called "Melissa officinalis" (lemon balm) can help reduce fear and stress in children during dental treatment. Children between 6 and 10 years old who need a mandibular injection for a pulpotomy or pulpectomy will be invited to participate. They will be randomly assigned to one of three groups: one group will receive aromatherapy with \*Melissa officinalis\* from brand A, another group will receive the same essential oil from brand B, and a third group will receive the usual behavioral management used in pediatric dentistry, but without aromatherapy. The essential oil will be diffused in the dental room so that the child can gently inhale the aroma starting a few minutes before the injection and throughout the procedure. The study team will measure the child's dental anxiety using a child-friendly questionnaire with drawings of faces, observe pain behaviors during the injection, and record the child's own rating of pain with a faces scale. Heart rate and oxygen saturation will also be monitored as objective signs of stress. The goal is to find out whether "Melissa officinalis" aromatherapy is a safe, simple, non-invasive way to make dental visits less stressful and more comfortable for children, and whether there are meaningful differences between the two commercial products.
Detailed description
This is a single center, three arm, parallel group, randomized controlled trial in pediatric dental patients. Participants will be randomized in equal proportions (1:1:1) to one of three groups using permuted blocks, with allocation concealed in sequentially numbered, opaque, sealed envelopes prepared by an independent investigator. Due to the olfactory nature of the intervention, blinding of operators is not feasible; however, outcome assessors who record anxiety, pain scores, and physiological measures will be distinct from the operator and will remain unaware of group allocation until data analysis. All clinical procedures will be performed by a single calibrated pediatric dentist using a standardized protocol that includes topical lidocaine 10% spray, inferior alveolar nerve block with lidocaine 2% with epinephrine 1:100,000, and subsequent pulpotomy or pulpectomy as indicated. Behavioral management techniques (tell-show-do, positive reinforcement, age appropriate language, and modeling when needed) will be applied in all groups, with the control group receiving only these non pharmacological strategies and no aromatherapy.
Interventions
OTHERAromatherapy with Melissa officinalis essential oil - Brand A
Melissa officinalis essential oil from Brand A (Young Living, Lehi, Utah, USA) will be placed in an electric nebulizer in the dental operatory at a standardized dilution in 10 mL of sterile distilled water. Diffusion will start 5 minutes before administration of topical anesthetic and inferior alveolar nerve block and will continue throughout the pulpotomy or pulpectomy procedure. Conventional behavioral management (tell-show-do, positive reinforcement, age appropriate communication) will also be used.
OTHERAromatherapy with Melissa officinalis essential oil - Brand B
Melissa officinalis essential oil from Brand B (doTERRA, Pleasant Grove, Utah, USA) will be administered with the same nebulizer model and under the same conditions and timing used in the Brand A arm (5 minutes before and during local anesthesia and treatment). Conventional behavioral management will be applied in all cases.
OTHERStandard behavioral management
Behavioral techniques including tell-show-do, positive reinforcement, euphemistic wording, and modeling when needed will be used to facilitate cooperation during local anesthesia and pulpotomy or pulpectomy, without the use of essential oils.
Sponsors
Universidad Autonoma de San Luis Potosí
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Due to the olfactory nature of the intervention, blinding of operators and participants is not feasible. Therefore, only the principal investigator and the outcome assessor will be blinded to group allocation. The operator performing the dental procedures and managing the aromatherapy device will be aware of the assigned intervention, due to the practical characteristics of the olfactory exposure. However, the individuals responsible for data analysis and for evaluating anxiety, pain, and physiological outcomes will not know which intervention each child received, in order to minimize assessment bias.
Eligibility
Sex/Gender
ALL
Age
6 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* Children aged 6 to 10 years at the time of enrollment. * Male or female pediatric patients in good general physical and mental health. * Require mandibular local anesthesia (inferior alveolar nerve block) for pulpotomy or pulpectomy of at least one primary molar. * No previous experience with dental local anesthesia. * Behavior classified as "positive" or "negative but accepting" (categories 2 or 3) according to the Frankl Behavior Rating Scale during the initial examination. * Ability of the child to understand simple verbal instructions appropriate for age. * Parent or legal guardian able and willing to sign written informed consent. * Child willing to provide verbal assent to participate in the study.
Exclusion criteria
* History of previous dental local anesthesia. * Presence of dental emergencies (e.g., acute infection, severe pain, or swelling) requiring urgent treatment. * Known diagnosis of neurological, psychiatric, developmental, or behavioral disorders that may interfere with cooperation or with the assessment of anxiety and pain. * Systemic diseases or medical conditions (American Society of Anesthesiologists \[ASA\] physical status III or higher) that increase procedural risk or preclude participation according to the investigator's judgment. * Current acute upper respiratory conditions, such as common cold, rhinitis, sinusitis, or nasal allergy that could alter the sense of smell or breathing comfort. * Known allergy, hypersensitivity, or adverse reaction to Melissa officinalis, other Lamiaceae plants, essential oils, or components of the products used in the study. * Use of anxiolytics, antidepressants, sedatives, or other psychotropic medications within the last 30 days. * Behavior rated as definitely negative (Frankl category 1) or definitely positive (Frankl category 4) at baseline. * Inability of parents or guardians to understand the study information or provide informed consent. * Participation in another clinical trial within the previous 30 days.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in dental anxiety (MCDASf score) | From baseline before the dental appointment to immediately after local anesthetic injection (approximately 15-20 minutes). | Dental anxiety will be assessed using the Modified Child Dental Anxiety Scale with faces (MCDASf). Scores will be recorded at baseline (before exposure to the operatory or aromatherapy) and after completion of local anesthetic injection. The outcome is the change in MCDASf score (post anesthesia minus baseline) and will be compared among the three study groups. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Observed pain during needle insertion (SEM scale) | During needle insertion and anesthetic injection (approximately 1-2 minutes). | Pain behavior during administration of the inferior alveolar nerve block will be evaluated using the Sound, Eye, Motor (SEM) scale by an independent, trained observer. Higher scores indicate more intense behavioral signs of pain. |
| Self reported pain after treatment (Wong-Baker Faces) | Immediately after completion of pulpotomy or pulpectomy (within 5-10 minutes). | After completion of the dental procedure, children will rate their pain using the Wong-Baker Faces Pain Rating Scale (0-10). Higher scores indicate greater perceived pain intensity. |
| Heart rate during dental treatment | Baseline, during injection, and post treatment (total monitoring period approximately 20-30 minutes). | Heart rate will be measured with a digital pulse oximeter at three time points: baseline (seated in the operatory), during the local anesthetic injection, and after completion of treatment. The outcome will be the mean heart rate and its change across time points within and between groups. |
| Oxygen saturation during dental treatment | Baseline, during injection, and post treatment (approximately 20-30 minutes). | Peripheral oxygen saturation (SpO₂) will be measured with the same pulse oximeter at baseline, during injection, and post treatment, as an objective indicator of physiological stress or instability during the dental visit. |
| Adverse events related to Melissa officinalis essential oil | From the start of aromatherapy (or entry into the operatory for the control group) to 30 minutes after the end of the dental procedure (single visit). | All adverse events possibly related to exposure to Melissa officinalis essential oil (e.g., nausea, vomiting, dizziness, headache, respiratory symptoms, skin irritation, or other unexpected reactions) will be recorded throughout the visit. Serious adverse events will be documented and reported according to institutional and regulatory requirements. o Time |
Contacts
CONTACTDhira Limón-Ramírez, DDS
CONTACTMiguel Rosales-Berber, M.Sc,
Outcome results
None listed