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Çocuk Diş Hekimliğinde Farmakolojik Olmayan Kaygı ve Ağrı Yönetimi Yaklaşımları

Yıl 2025, Cilt: 7 Sayı: 3, 133 - 144, 28.10.2025

Öz

Dental anksiyete, genellikle ağrı algısıyla ilişkilidir ve diş tedavilerinden kaçınmaya yol açabilir. Ağrı, hem fizyolojik hem de bilişsel bileşenlere sahip olduğundan, çocuk diş hekimliğinde nonfarmakolojik yaklaşımlar önemli bir rol oynamaktadır. Klinik hipnoz, ağrı ve dental anksiyete yönetiminde güvenli ve etkili bir psikolojik yöntemdir. Dental fobilerin azaltılması, öğürme refleksinin kontrolü ve dudak ile parmak emme gibi zararlı alışkanlıkların giderilmesinde başarılı bir şekilde kullanılmaktadır. Bu derleme, çocuk diş hekimliğinde nonfarmakolojik ağrı yönetimi tekniklerini ve hipnozun rolünü güncel literatür ışığında ele almaktadır.

Kaynakça

  • 1. Zisopoulou T, Varvogli L. Stress management methods in children and adolescents: past, present, and future. Horm Res Paediatr. 2023;96(1):97-107. doi:10.1159/000526946.
  • 2. Venkiteswaran A, Tandon S. Role of hypnosis in dental treatment: a narrative review. J Int Soc Prev Community Dent. 2021;11(2):115-124. doi:10.4103/jispcd.JISPCD_320_20.
  • 3. Thbeet HN, Shoq AH. Non-pharmacological pain management and its effect on pain of children postoperatively. Pak J Med Health Sci. 2022;16(6):497-499. doi:10.53350/pjmhs22166497.
  • 4. Santos SA, Gleiser R, Ardenghi TM. Hypnosis in the control of pain and anxiety in pediatric dentistry: a literature review. RGO Rev Gaucha Odontol. 2019;67. doi:10.1590/1981-86372019000333602.
  • 5. Burghardt S, Koranyi S, Magnucki G, Strauss B, Rosendahl J. Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: systematic review and meta-analysis. J Dent. 2018;69:22-31. doi:10.1016/j.jdent.2017.11.005.
  • 6. Hedén LE, Essen L, Ljungman G. Effect of morphine in needle procedures in children with cancer. Eur J Pain. 2011;15(10):1056-1060. doi:10.1016/j.ejpain.2011.05.010.
  • 7. Canbulat N, Turkmen AS. The effect of distraction cards on reducing pain and anxiety during intramuscular injection in children. Worldviews Evid Based Nurs. 2019;16(3):230-235. doi:10.1111/wvn.12359.
  • 8. Weiss KE, Dahlquist LM, Wohlheiter K. The effects of interactive and passive distraction on cold pressor pain in preschool-aged children. J Pediatr Psychol. 2011;36(7):816-826. doi:10.1093/jpepsy/jsq125.
  • 9. Ali S, McGrath T, Drendel AL. An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond. Pediatr Emerg Care. 2016;32(1):36-42. doi:10.1097/PEC.0000000000000669.
  • 10. Wohlheiter KA, Dahlquist LM. Interactive versus passive distraction for acute pain management in young children: the role of selective attention and development. J Pediatr Psychol. 2013;38(2):202-212. doi:10.1093/jpepsy/jss108.
  • 11. Duman E, Yildirim E, Saba T, Ozulku M, Gunday M, Coban G. The effect of laser wavelength on postoperative pain score in the endovenous ablation of saphenous vein insufficiency. Diagn Interv Radiol. 2013;19(4):326-329. doi:10.5152/dir.2013.023.
  • 12. Mutlu B, Balcı S. Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: a randomized controlled trial. J Spec Pediatr Nurs. 2015;20(3):178-186. doi:10.1111/jspn.12112.
  • 13. Balliel N. Effect of soap bubbles technique, coughing and distraction cards on reducing pain and anxiety during phlebotomy in children. Paediatr Neonatal Pain. 2022; Dec. doi:10.1002/pne2.12090.
  • 14. Lyons RA. Understanding basic behavioral support techniques as an alternative to sedation and anesthesia. Spec Care Dentist. 2009;29(1):39-50. doi:10.1111/j.1754-4505.2008.00061.x.
  • 15. Bukola IM, Paula D. The effectiveness of distraction as procedural pain management technique in pediatric oncology patients: a meta-analysis and systematic review. J Pain Symptom Manage. 2017;54(4):589-600.e1. doi:10.1016/j.jpainsymman.2017.07.006.
  • 16. Weydert JA, Shapiro DE, Acra SA, Monheim CJ, Chambers AS, Ball TM. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr. 2006;6:29. doi:10.1186/1471-2431-6-29.
  • 17. American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793-797. doi:10.1542/peds.108.3.793.
  • 18. Rusy LM, Weisman SJ. Complementary therapies for acute pediatric pain management. Pediatr Clin North Am. 2000;47(3):589-599. doi:10.1016/s0031-3955(05)70227-3.
  • 19. Nash MR, Barnier AJ. The Oxford Handbook of Hypnosis: Theory, Research and Practice. New York: Oxford University Press; 2012.
  • 20. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35-50. doi:10.2147/CCIDE.S63626.
  • 21. Hoffman HG, Chambers GT, Meyer WJ, Arceneaux LL, Russell WJ, Seibel EJ, et al. Immersive virtual reality as an adjunctive non-opioid analgesic for children with severe burn wounds during wound cleaning: a pilot study. Front Hum Neurosci. 2019;13:262. doi:10.3389/fnhum.2019.00262.
  • 22. Ang SP, Montuori M, Trimba Y, Maldari N, Patel D, Chen QC. Recent applications of virtual reality for the management of pain in burn and pediatric patients. Curr Pain Headache Rep. 2021;25(1):4. doi:10.1007/s11916-020-00917-0.
  • 23. D’Alessandro LN. Using virtual reality distraction during wound management: a brief case report in a patient with epidermolysis bullosa. Pediatr Pain Lett. 2022;24(1):1-7.
  • 24. Guinot F, Mercadé M, Oprysnyk L, Veloso A, Boj JR. Comparison of active versus passive audiovisual distraction tools on children’s behaviour, anxiety and pain in paediatric dentistry: a randomised crossover clinical trial. Eur J Paediatr Dent. 2021;22(3):230-236. doi:10.23804/ejpd.2021.22.03.10.
  • 25. Rao D, Khan S, Jasuja P. Passive distraction: a technique to maintain children’s behavior undergoing dental treatment. Indo Am J Pharm Sci. 2019;6(2):4043-4048.
  • 26. Ahn AC. Acupuncture. UpToDate. https://www.uptodate.com/contents/acupuncture. Accessed Mar 26, 2023.
  • 27. Plonski KS. Acupuncture for pain management in pediatric patients with sickle cell disease. Children. 2022;9(7):1076. doi:10.3390/children9071076.
  • 28. Tsai SL, Bombacie M, Licursi M, Qian Y, Stiles GM, Lee MT. Acupuncture for pediatric sickle cell pain management: a promising non-opioid therapy. Complement Ther Med. 2020;49:102314. doi:10.1016/j.ctim.2020.102314.
  • 29. Myrvik MP, Brandow AM, Drendel AL, Yan K, Hoffmann RG, Panepinto JA. Clinically meaningful measurement of pain in children with sickle cell disease. Pediatr Blood Cancer. 2013;60(10):1689-1695. doi:10.1002/pbc.24624.
  • 30. Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S. The safety of pediatric acupuncture: a systematic review. Pediatrics. 2011;128(6):e1575-e1587. doi:10.1542/peds.2011-1091.
  • 31. Aminabadi NA, Farahani RMZ, Balayi Gajan E. The efficacy of distraction and counterstimulation in the reduction of pain reaction to intraoral injection by pediatric patients. J Contemp Dent Pract. 2008;9(6):33-40.
  • 32. Nunna M, Dasaraju RK, Kamatham R, Mallineni SK, Nuvvula S. Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children. J Dent Anesth Pain Med. 2019;19(5):277-88. doi:10.17245/jdapm.2019.19.5.277.
  • 33. Patil SB, Thakur R, Paul ST, Sharma S, Jadhav J, et al. Comparative evaluation of different pain-alleviating methods before local anesthetic administration in children: a clinical study. Int J Clin Pediatr Dent. 2021;14(4):447-453. doi:10.5005/jp-journals-10005-1998.
  • 34. Kasat V, Gupta A, Ladda R, Kathariya M, Saluja H, Farooqui AA. Transcutaneous electric nerve stimulation (TENS) in dentistry: a review. J Clin Exp Dent. 2014;6(5):e562-e568. doi:10.4317/jced.51586.
  • 35. Wood C, Bioy A. Hypnosis and pain in children. J Pain Symptom Manage. 2008;35(4):437-446. doi:10.1016/j.jpainsymman.2007.05.009.
  • 36. Kohen DP, Olness K. Hypnosis and hypnotherapy with children. 4th ed. New York: Taylor & Francis Group; 2011.
  • 37. Al-Harasi S, Ashley PF, Moles DR, Parekh S, Walters V. Hypnosis for children undergoing dental treatment. Cochrane Database Syst Rev. 2010;(3):CD007154. doi:10.1002/14651858.CD007154.pub2.

Non-Pharmacological Approaches to Anxiety and Pain Management in Pediatric Dentistry

Yıl 2025, Cilt: 7 Sayı: 3, 133 - 144, 28.10.2025

Öz

Dental anxiety, often linked to pain perception, can lead to avoidance of dental treatments. Pain has both physiological and cognitive components, making non-pharmacological approaches essential in pediatric dentistry. Clinical hypnosis is a safe and effective psychological method for managing pain and dental anxiety. It has been successfully used to reduce dental phobias, control the gag reflex, and eliminate harmful oral habits like lip and finger sucking. This review explores non-pharmacological pain management techniques and the role of hypnosis in pediatric dentistry, highlighting its potential benefits based on current literature.

Teşekkür

14. Uluslararası Tıp ve Sağlık Bilimleri Araştırmaları Kongresi'nde sözlü bildiri olarak sunulmuştur.

Kaynakça

  • 1. Zisopoulou T, Varvogli L. Stress management methods in children and adolescents: past, present, and future. Horm Res Paediatr. 2023;96(1):97-107. doi:10.1159/000526946.
  • 2. Venkiteswaran A, Tandon S. Role of hypnosis in dental treatment: a narrative review. J Int Soc Prev Community Dent. 2021;11(2):115-124. doi:10.4103/jispcd.JISPCD_320_20.
  • 3. Thbeet HN, Shoq AH. Non-pharmacological pain management and its effect on pain of children postoperatively. Pak J Med Health Sci. 2022;16(6):497-499. doi:10.53350/pjmhs22166497.
  • 4. Santos SA, Gleiser R, Ardenghi TM. Hypnosis in the control of pain and anxiety in pediatric dentistry: a literature review. RGO Rev Gaucha Odontol. 2019;67. doi:10.1590/1981-86372019000333602.
  • 5. Burghardt S, Koranyi S, Magnucki G, Strauss B, Rosendahl J. Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: systematic review and meta-analysis. J Dent. 2018;69:22-31. doi:10.1016/j.jdent.2017.11.005.
  • 6. Hedén LE, Essen L, Ljungman G. Effect of morphine in needle procedures in children with cancer. Eur J Pain. 2011;15(10):1056-1060. doi:10.1016/j.ejpain.2011.05.010.
  • 7. Canbulat N, Turkmen AS. The effect of distraction cards on reducing pain and anxiety during intramuscular injection in children. Worldviews Evid Based Nurs. 2019;16(3):230-235. doi:10.1111/wvn.12359.
  • 8. Weiss KE, Dahlquist LM, Wohlheiter K. The effects of interactive and passive distraction on cold pressor pain in preschool-aged children. J Pediatr Psychol. 2011;36(7):816-826. doi:10.1093/jpepsy/jsq125.
  • 9. Ali S, McGrath T, Drendel AL. An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond. Pediatr Emerg Care. 2016;32(1):36-42. doi:10.1097/PEC.0000000000000669.
  • 10. Wohlheiter KA, Dahlquist LM. Interactive versus passive distraction for acute pain management in young children: the role of selective attention and development. J Pediatr Psychol. 2013;38(2):202-212. doi:10.1093/jpepsy/jss108.
  • 11. Duman E, Yildirim E, Saba T, Ozulku M, Gunday M, Coban G. The effect of laser wavelength on postoperative pain score in the endovenous ablation of saphenous vein insufficiency. Diagn Interv Radiol. 2013;19(4):326-329. doi:10.5152/dir.2013.023.
  • 12. Mutlu B, Balcı S. Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: a randomized controlled trial. J Spec Pediatr Nurs. 2015;20(3):178-186. doi:10.1111/jspn.12112.
  • 13. Balliel N. Effect of soap bubbles technique, coughing and distraction cards on reducing pain and anxiety during phlebotomy in children. Paediatr Neonatal Pain. 2022; Dec. doi:10.1002/pne2.12090.
  • 14. Lyons RA. Understanding basic behavioral support techniques as an alternative to sedation and anesthesia. Spec Care Dentist. 2009;29(1):39-50. doi:10.1111/j.1754-4505.2008.00061.x.
  • 15. Bukola IM, Paula D. The effectiveness of distraction as procedural pain management technique in pediatric oncology patients: a meta-analysis and systematic review. J Pain Symptom Manage. 2017;54(4):589-600.e1. doi:10.1016/j.jpainsymman.2017.07.006.
  • 16. Weydert JA, Shapiro DE, Acra SA, Monheim CJ, Chambers AS, Ball TM. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr. 2006;6:29. doi:10.1186/1471-2431-6-29.
  • 17. American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793-797. doi:10.1542/peds.108.3.793.
  • 18. Rusy LM, Weisman SJ. Complementary therapies for acute pediatric pain management. Pediatr Clin North Am. 2000;47(3):589-599. doi:10.1016/s0031-3955(05)70227-3.
  • 19. Nash MR, Barnier AJ. The Oxford Handbook of Hypnosis: Theory, Research and Practice. New York: Oxford University Press; 2012.
  • 20. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35-50. doi:10.2147/CCIDE.S63626.
  • 21. Hoffman HG, Chambers GT, Meyer WJ, Arceneaux LL, Russell WJ, Seibel EJ, et al. Immersive virtual reality as an adjunctive non-opioid analgesic for children with severe burn wounds during wound cleaning: a pilot study. Front Hum Neurosci. 2019;13:262. doi:10.3389/fnhum.2019.00262.
  • 22. Ang SP, Montuori M, Trimba Y, Maldari N, Patel D, Chen QC. Recent applications of virtual reality for the management of pain in burn and pediatric patients. Curr Pain Headache Rep. 2021;25(1):4. doi:10.1007/s11916-020-00917-0.
  • 23. D’Alessandro LN. Using virtual reality distraction during wound management: a brief case report in a patient with epidermolysis bullosa. Pediatr Pain Lett. 2022;24(1):1-7.
  • 24. Guinot F, Mercadé M, Oprysnyk L, Veloso A, Boj JR. Comparison of active versus passive audiovisual distraction tools on children’s behaviour, anxiety and pain in paediatric dentistry: a randomised crossover clinical trial. Eur J Paediatr Dent. 2021;22(3):230-236. doi:10.23804/ejpd.2021.22.03.10.
  • 25. Rao D, Khan S, Jasuja P. Passive distraction: a technique to maintain children’s behavior undergoing dental treatment. Indo Am J Pharm Sci. 2019;6(2):4043-4048.
  • 26. Ahn AC. Acupuncture. UpToDate. https://www.uptodate.com/contents/acupuncture. Accessed Mar 26, 2023.
  • 27. Plonski KS. Acupuncture for pain management in pediatric patients with sickle cell disease. Children. 2022;9(7):1076. doi:10.3390/children9071076.
  • 28. Tsai SL, Bombacie M, Licursi M, Qian Y, Stiles GM, Lee MT. Acupuncture for pediatric sickle cell pain management: a promising non-opioid therapy. Complement Ther Med. 2020;49:102314. doi:10.1016/j.ctim.2020.102314.
  • 29. Myrvik MP, Brandow AM, Drendel AL, Yan K, Hoffmann RG, Panepinto JA. Clinically meaningful measurement of pain in children with sickle cell disease. Pediatr Blood Cancer. 2013;60(10):1689-1695. doi:10.1002/pbc.24624.
  • 30. Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S. The safety of pediatric acupuncture: a systematic review. Pediatrics. 2011;128(6):e1575-e1587. doi:10.1542/peds.2011-1091.
  • 31. Aminabadi NA, Farahani RMZ, Balayi Gajan E. The efficacy of distraction and counterstimulation in the reduction of pain reaction to intraoral injection by pediatric patients. J Contemp Dent Pract. 2008;9(6):33-40.
  • 32. Nunna M, Dasaraju RK, Kamatham R, Mallineni SK, Nuvvula S. Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children. J Dent Anesth Pain Med. 2019;19(5):277-88. doi:10.17245/jdapm.2019.19.5.277.
  • 33. Patil SB, Thakur R, Paul ST, Sharma S, Jadhav J, et al. Comparative evaluation of different pain-alleviating methods before local anesthetic administration in children: a clinical study. Int J Clin Pediatr Dent. 2021;14(4):447-453. doi:10.5005/jp-journals-10005-1998.
  • 34. Kasat V, Gupta A, Ladda R, Kathariya M, Saluja H, Farooqui AA. Transcutaneous electric nerve stimulation (TENS) in dentistry: a review. J Clin Exp Dent. 2014;6(5):e562-e568. doi:10.4317/jced.51586.
  • 35. Wood C, Bioy A. Hypnosis and pain in children. J Pain Symptom Manage. 2008;35(4):437-446. doi:10.1016/j.jpainsymman.2007.05.009.
  • 36. Kohen DP, Olness K. Hypnosis and hypnotherapy with children. 4th ed. New York: Taylor & Francis Group; 2011.
  • 37. Al-Harasi S, Ashley PF, Moles DR, Parekh S, Walters V. Hypnosis for children undergoing dental treatment. Cochrane Database Syst Rev. 2010;(3):CD007154. doi:10.1002/14651858.CD007154.pub2.
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Diş Hekimliği
Bölüm Pediatric Dentistry
Yazarlar

Tuğçe Akçora 0009-0005-7104-323X

Ceren Kaplan 0000-0003-1779-1438

Özlem Martı Akgün 0000-0003-1180-1390

Yayımlanma Tarihi 28 Ekim 2025
Gönderilme Tarihi 24 Temmuz 2025
Kabul Tarihi 2 Ekim 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 7 Sayı: 3

Kaynak Göster

Vancouver Akçora T, Kaplan C, Akgün ÖM. Non-Pharmacological Approaches to Anxiety and Pain Management in Pediatric Dentistry. Dent & Med J - R. 2025;7(3):133-44.




"Dünyada herşey için, medeniyet için, hayat için, başarı için en gerçek yol gösterici ilimdir, fendir. İlim ve fennin dışında yol gösterici aramak gaflettir, cahilliktir, doğru yoldan sapmaktır. Yalnız ilmin ve fenin yaşadığımız her dakikadaki safhalarının gelişimini anlamak ve ilerlemeleri zamanında takip etmek şarttır. Bin, iki bin, binlerce yıl önceki ilim ve fen lisanının koyduğu kuralları, şu kadar bin yıl sonra bugün aynen uygulamaya kalkışmak elbette ilim ve fennin içinde bulunmak değildir."

M. Kemal ATATÜRK