An interesting article titled “Breathing out dental fear: A feasibility crossover study on the effectiveness of diaphragmatic breathing in children sitting on the dentist’s chair” written by Martina Levi and et al. appears in the International Journal of Paediatric Dentistry (Feb. 13, 2022). The article sought to explore if diaphragmatic breathing by children can help to reduce fear and anxiety in dental setting.
In the study the authors evaulated 20 children who had two dental procedures done on different days who were between the ages of 7 and 13. The children were assigned two groups in one group the children were taught diaphragmatic breathing to be used prior to dental treatment and in the other group they were instructed to start their dental treatment normally. The children in the diaphramatic breathing group only had their dental treatment begin when they were able to use the techniqe correctly. Diaphragmatic breathing also known as belly breathing reduces respiration frequency and maximizes the amount of blood gasses through contraction of the diaphragm. This type of breathing reduces stress and anxiety and can reduce blood pressure and increase oxygenation. This breathing technique has been shown to reduce dental anxiety and fear in adults but very few studies in children in dental settings have been conducted. The authors state
“Diaphragmatic breathing is low-cost and easy to teach to most children; it can be taught through verbal instructions, role modelling and imitation.”
Once the children in the study were laying down on the dental chair, three electrocardiogram electrodes were attached and the respiration belt was put around their abdomen to establish a baseline physiological assessment. A visual analog scale was used to obtain a baseline of the childs emotions. After the 1st dental procedure the children were ased to remain for three minutes to again assess thier visual analog scale. After several months, the 20 children came back for another dental appointment. Those who had the breathing technique used in the 1st dental procedure did not use it in the 2nd procedure, and those who did not use the breathing technique were taught it to use for the 2nd procedure.
The authors found that fear increased from before the dental visit to after the vist for the children who did not have the breathing technique. For children who did use the breathing technique, their sadness was significantly reduced after the dental visit. Children who did not use the breathing technique not experience any reduction in sadness and saw a significant increase from the start of the visit to after treatment for pain experienced. The authors felt that this increase in pain showed that abdominal breathing was effective in dampening pain from the dental care. The authors said that children who underwent dental treatment using diaphragmatic breathing had improved moods, less pain, and physiological activation. The authors also found that the breathing techinque reduced the amount of time of dental visits by several minutes which was likely due to more cooperative behavior. The authors state
“Diaphragmatic breathing represents a promising tool for reducing psychological and physiological distress in children with dental anxiety.”
In the future the authors would like to use randomized clinical trials in a larger number of children with more controlled conditions to better assess breathing techniques on dental fear. They also recommend using a mixed effects model.