Document Type : Original Article
Authors
1 Dept. of Pediatric Dentistry, Oral and Dental Diseases Research Center, Dental School, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Dentist, Zahedan University of Medical Sciences, Zahedan, Iran.
3 Dept. of Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran.
Abstract
Background: Pain and anxiety during inferior alveolar nerve block injections are com-mon challenges in pediatric dentistry; therefore, effective behavioral interventions such as medical clowning may help reduce children’s distress during dental procedures.
Purpose: This study aimed to evaluate the effect of medical clowns on pain and anxiety during inferior alveolar nerve block injections in children aged 6–12 years in a private pediatric dental clinic in Iran.
Materials and Method: In this prospective, randomized controlled trial, 66 healthy children requiring bilateral mandibular pulpotomy were enrolled. Each child attended two sessions: a baseline session (standard care) and an intervention session. In the second session, children were randomly assigned to either a control group (standard care) or an intervention group (standard care + medical clown). Anxiety was assessed subjectively using the Venham picture test (VPT) and objectively via HR measurement. Pain was assessed using the visual analogue scale (VAS). Data were analyzed using SPSS ver. 24 with paired and independent t-tests, Mann-Whitney U test, and calculation of effect sizes (Cohen's d) with 95% confidence intervals.
Results: The findings indicated that the mean pain scores (VAS) increased significantly from baseline in both groups (p Value=0.001) but did not differ significantly between groups post-intervention (p=0.13, d=0.37, 95% CI: -0.15 to 0.88). In contrast, anxiety scores (VPT) were significantly lower in the clown therapy group compared to controls after the intervention (p= 0.04, d= 0.40, 95% CI: 0.02 to 0.87). Furthermore, the mean heart rate increased significantly within both groups (p= 0.001) but showed no substantial between-group difference post-intervention (p= 0.90, d= 0.03).
Conclusion: The use of medical clowns significantly reduced self-reported anxiety in children during IANB injections but did not significantly affect perceived pain levels. Medical clowning presents a viable, non-pharmacological strategy for anxiety management in pediatric dental settings, particularly in cultural contexts where such interventions are novel.
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