Dental fear and anxiety in the dental office are very common and have been proven to be a barrier to dental care for children [17]. Authors have put some effort to study how the dentist’s attire would affect the child’s anxiety in the dental office [6,7,8, 18].
This randomized controlled trial was carried out to compare and test the effect of different PPE on children’s anxiety in dental settings, taking into consideration the recent recommendations introduced due to the COVID-19 pandemic.
In this study, we used the commonly used PPE as goggles and face shields (groups 1 and 2) as comparators to the “new norms” in some dental settings’ half-face and full-face reusable respirators. These elastomeric respirators offer higher assigned protection factors (APFs) than conventional disposable masks, partially due to the seal developed by the elastomeric mask, and partially due to the used filter/cartridge. The reusability of these elastomeric respirators was also an advantage during the times when PPE was short [19].
The results of our study showed no statistically significant difference in preoperative anxiety between all study groups, for each item and for total CFSS-DS scores, this came in agreement with Berwick et al., who found that the use of full PPE does not cause anxiety for children in a surgical setting their findings were reported by children and confirmed by their reaction to anaesthesia induction, Berwick et al. [9] study took part during the time of COVID-19 pandemic as well. These results may be justified by the fact that children at this age are aware of the changes happening during the COVID-19 times, it is now normal to see people wearing masks all the time; so, they easily accept the change in the appearance of their health care workers.
The examiner dentist reported that she did not feel discomfort or anxiety from the children’s side during the examination; however, she reported that the half-face and full-face reusable respirators did cause some change in her voice which could affect her communication with the children.
Although not the main outcome of the study, data were analysed to study the associations and correlations of dental anxiety with other factors such as gender, age and whether the child have to the dentist before. In the current study, boys were statistically significant more anxious than girls for the “Goggles and surgical mask” group and “overall”, but other study groups showed no correlation between gender and anxiety. Previously, Rank et al. [20] studied the motivational influence of awards at the end of a dental visit, in their study, girls were less anxious than boys after receiving awards in a previous visit. The study by Mendoza-Mendoza et al. [21] found no relation between anxiety scores and gender. Disagreeing with the findings in this study, Alshoraim et al. [22] Found that 12–15 year-old girls were statistically significant more fearful than boys, in Dahal et al. study, > 50% of 6–15 years-old girls had high fear in comparison to 34.5% of boys as assessed by their responses to the CFSS-DS [12], and Majstorovic et al. [13] evaluated the relationship between dental anxiety and some child and parental characteristics; they assessed dental anxiety using CFSS-DS and found that girls were more anxious than boys (32.5 vs. 26.3, p = 0.003).
In the current study, there was no correlation between age and anxiety score, this may be due to the small age range for the study population; however, this came in disagreement with Mendoza-Mendoza et al. [21] who found higher anxiety scores for 4 and 5 year-old children in their study, and concluded a negative correlation between age and anxiety scores.
For “Goggles and surgical mask”, “Face shield and surgical mask “groups and “overall”, children were statistically significant more anxious when this was their first dental visit, this came in agreement with Alshoraim et al. [22] who found that children are more fearful on their first dental visit. In Mendoza-Mendoza et al. [21] study there was a moderate positive correlation between elevated anxiety scores and the number of previous dental visits. For the intervention groups in our study “Half-face reusable respirator + filter” and “Full-face reusable respirator + filter”, there was no correlation between dental experience and anxiety score, this was the case with a previous study by Rojas et al. [23] who found no association between the previous dental visits and the anxiety level of 6 year-old children.
The current study is the first study to address the use of extra PPE in dental settings and its effect on a child’s preoperative anxiety; however, more trials involving a preventive or a treatment dental procedure may be more conclusive. Also, a longer procedure would emphasize the effect of altered voice and difficulty in communication reported by the examiner dentist. Dentists can feel confident that the protection delivered by reusable respirators, does not come with the price of increased anxiety in the dental office, children can generally be more anxious on their first dental visit, that is why dentists should do their best to make the first dental visit friendly, short and non-invasive, where the primary concern is communication with the child rather than an actual dental procedure or staying safe from infections.
