Sequential Changes in Response to Dental Procedures

Journal of Dental Research http://jdr.sagepub.com/

Sequential Changes in Response to Dental Procedures J.W. Howitt and G. Stricker J DENT RES 1970 49: 1074 DOI: 10.1177/00220345700490051201 The online version of this article can be found at: http://jdr.sagepub.com/content/49/5/1074

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Sequential Changes in Response to Dental Procedures J. W. HOWITT and G. STRICKER Department of Pedodontics, Eastman Dental Center, Rochester, New York, USA 14603 and Department of Psychology, Adelphi University, Garden City, New York, USA 11530 This portion of a study that involved children 8, 10, 12, and 14 years of age, was concerned with cardiac rate as a function of age, type of dental procedure and repetitive exposure to the dental treatment situation. It was consistently found that as children become more experienced with dental procedures and the dental treatment environment, their arousal level is reduced. Similarly, as a child becomes older, he becomes less autonomically responsive to dental treatment, as he does to many other stimuli. Our interest in cardiac rate as an index of physiologic activity dates back many years.l'3 We have not been as concerned in obtaining a measure of autonomic activity for its own sake, as with obtaining a responsive and relatively artifact-free index of the patient's psychological responsiveness to his environment. Findings in both the dental' and the psychological4 literature suggest the use of cardiac rate as an index of arousal. In previous studies, we found significant differences in the cardiac rate of patients who were rated as clinically apprehensive and clinically nonapprehensive.1 We have also found differences in the cardiac rate of patients who respond differently to paper-and-pencil tests of anxiety,2 although this relationship was beset by some of the same complications that psychologists are now experiencing in their study of personality inventories.5 Given the substantial evidence that indicates one's autonomic response to a situation contains a significant psychosomatic component, it then becomes important to investigate more closely some of the parameters of this response. This paper describes a project that studied, among other things, Received for publication August 29, 1969.

cardiac rate as a function of age, type of dental procedure, and repetitive exposure to the dental treatment situation. Materials and Methods The subjects for this study were 167 children chosen from the new applicants for treatment at the Eastman Dental Center. The group included 21 8-year-olds, 54 10year-olds, 49 12-year-olds, and 43 14-yearolds. Some of the children were not available for each of the procedures and so the number participating will be indicated when less than 167. Before the physiological recording began, the children were given an extensive interview about their dental attitudes, and a number of measures of their oral health were obtained, but these data are not relevant to this presentation. When the patient was seated in the dental chair a small, unobtrusive, finger-tip photoelectric plethysmograph was attached to his index finger. The plethysmograph recorded the cardiac rate on a modified Stoelting polygraph placed in an adjacent room, out of sight of the patient. The patient was allowed to rest for three minutes to accustom himself to the apparatus and environment, and then a ten-minute, basallevel cardiac recording was made. At the end of this time, a standardized examination, prophylaxis, and flouride application ensued, with cardiac rate measured continuously. During this standardized procedure, separate cardiac rate indexes were obtained to indicate the subject's response to mirror and explorer examination, rubber cup prophylaxis, the use of water and air syringes, and the application of cotton holders for isolation of the teeth during fluoride application. A toothbrush instruction period followed the fluoride application. Thus, this initial visit produced a basal

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Vol 49 No. 5

SEQUENTIAL CHANGES IN PROCEDURAL RESPONSE

1075

TABLE 1 recording, four separate procedure recordMEANS AND ANALYSIS OF VARIANCE: ings, and an overall average for cardiac BASE RATES AND OVERALL MEANS rate during the session. After this initial Source F df ms visit, each patient received complete dental treatment according to his needs, with com- Treatments (T) 5 492.09 13.13* 124 ... 576.68 plete physiologic recording obtained during Subjects (S) 620 37.48 each treatment visit. The treatment visits T X S Total 749 ... ... yielded a three-minute basal score, an overall average, and nine separate measures Measure Cardiac Rate of response to some particular dental pro- Initial basal rate 85.9at cedure. Each of the 11 scores represents Examination overall mean 83.8c Prophylaxis overall mean 86.0a a composite derived from averaging the Follow-up basal rate 82.1b response to the procedure throughout the overall mean 81.5b entire set of treatment visits. The specific Follow-up * P