The long-term goal of this research is to develop and assess the effectiveness of intervention strategies designed to reduce the pain and distress associated with aversive aspects of dental treatment for children which lead to the development of fear and avoidance of dental care. Previous research by this investigator has demonstrated that two-thirds of adults in Seattle with clinically significant dental fears had this fear originate in childhood. Moreover, one-in-five Seattle school children from low income families demonstrate clinically significant levels of dental fear. The proposed study targets childhood as an appropriate time to intervene to reduce the development of dental fear and thus is directly related to the aims of the planned comprehensive center. We propose to conduct a randomized clinical trial in 168 children 8 toll years old to evaluate the effectiveness of cessation signaling for reducing pain and anxiety reports and increase the children's willingness to return for subsequent treatment; 2) to assess whether the effectiveness of providing cessation signals to reduce the pain and anxiety caused by dental injections varies as a function of the child's coping style. We have chosen this intervention because it is easily adaptable to clinical practice in a single appointment and does not require psychologist intervention. From a theoretical perspective the study is important because the intervention does not change the physical attributes of the infection nor does it allow the child to avoid the infection, but rather it manipulates the psychological construct of predictability by providing information about the duration of the injection. In a considerable amount of pilot work, we have provided justification for the proposed intervention and dependent measures. We have demonstrated that cessation signaling is effective in the laboratory setting with 8 to 11 year-old children. The animal literature suggests that this effect is primarily on anxiety. We now wish to extend our laboratory findings to the clinic.
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