Comparing inhaled nitrous oxide gas with cognitive behavioral therapy to reduce anxiety in children undergoing dental treatment

INTERVENTION: Patients who accepted the invitation were randomly allocated to the intervention A or control group B using a closed envelope technique and a block assignment of two patients. Group A received dental treatment under pharmacological sedation with a mixture of nitrous oxide in oxygen delivered by mask inhalation. Gas concentrations ranged from 30% to 70%, accordingly to patients needs. Group B received dental treatment under cognitive behavioral therapy. The cognitive behavioral therapy was a verbal 'tell–show–do' explanation of dental procedures provided before and during treatment. This is a non‐pharmacological technique that allows a link to be established between the child and the dentist. All communication was constructed in phrases appropriate to the development level of the patient. Each treatment session was performed in 30‐40 minutes. The total number was defined depending on their needs and according to the DMFT (decayed missing and filled teeth) caries index. All efforts were made to obtain a 1‐ to 2‐week follow‐up. CONDITION: Anxiety associated with dental treatment ; Mental and Behavioural Disorders PRIMARY OUTCOME: Completion of planned treatment SECONDARY OUTCOME: ; 1. Anxiety levels assessed using a facial image scale (FIS) immediately before the start of dental treatment and after the end of procedure; 2. Stress assessed by measuring saliva cortisol levels immediately before the start of dental treatment and after the end of procedure; INCLUSION CRITERIA: 1. Aged 5 to 12 years 2. Moderate to severe dental anxiety 3. Parents' consent to participate in sampling process and two sessions of dental treatment 4. At least one mandibular primary molar needing pulp treatment 5. Previous history of dental treatment