European Archives of Paediatric Dentistry

, Volume 15, Issue 2, pp 97–103 | Cite as

Behavioural and physiological outcomes of biofeedback therapy on dental anxiety of children undergoing restorations: a randomised controlled trial

  • P. Dedeepya
  • S. Nuvvula
  • R. KamathamEmail author
  • S. V. S. G. Nirmala
Original Scientific Article



To explore the efficacy of biofeedback as possible alternative means of psychological behaviour guidance in children receiving dental restorations.

Study design

Randomised clinical trial with a cross over design carried out on 40 children (19 boys and 21 girls) to determine the efficacy of biofeedback in reducing the dental anxiety through subjective and objective measures during restorative treatments under cotton roll isolation without administration of local analgesia.


Highly anxious children with a minimum of five carious lesions were trained to lower their anxiety using biofeedback in five sessions within a 4-week interval, each session lasting for 45 min. After initial training, children were randomly divided into two groups and restorations were placed in four sequential therapeutic sessions with a 1-week interval and a follow-up visit 3 months later. First group received biofeedback in the second and third sessions; whereas the second group received biofeedback in the first and third sessions.


Biofeedback therapy in children led to lower levels of anxiety in the initial appointments when assessed objectively, however the subjective methods of evaluation could not depict any statistically significant difference.


Biofeedback can be used in the initial visits for dentally anxious children and the usage of simpler biofeedback machines for these appointments in dental setup is suggested.


Biofeedback Behaviour guidance Children’s dental anxiety 



We would like to acknowledge the help of the Department of Psychiatry, Narayana Medical College, Nellore for their technical assistance.


  1. Barrio BA, Shigetomi CC. Coping-skills training for the management of anxiety: a critical review. Behav Ther. 1979;10:491–522.CrossRefGoogle Scholar
  2. Berggren U, Carlsson SG. A psychophysiological therapy for dental fear. Behav Res Ther. 1984;22:487–92.PubMedCrossRefGoogle Scholar
  3. Berggren U, Carlsson SG. Qualitative and quantitative effects of treatment for dental fear and avoidance. Anesth Prog. 1986;33:9–13.PubMedCentralPubMedGoogle Scholar
  4. Berggren U, Hakeberg M, Carlsson SG. Relaxation vs. cognitively oriented therapies for dental fear. J Dent Res. 2000;79:1645–51.PubMedCrossRefGoogle Scholar
  5. Berry DC, Singh BP. Effect of electromyographics biofeedback therapy on occlusal contacts. J Prosthet Dent. 1984;51:397–403.PubMedCrossRefGoogle Scholar
  6. Bodner S. Stress management in the difficult patient encounter. Dent Clin N Am. 2008;52:579–603.PubMedCrossRefGoogle Scholar
  7. Bowers D. Doing it right first time—designing a study. In: Medical statistics from scratch. 2nd ed. England: Wiley; 2008. p. 71–90.Google Scholar
  8. Buchanan H, Niven N. Validation of a Facial Image Scale to assess child dental anxiety. Int J Paediatr Dent. 2002;12:47–52.PubMedGoogle Scholar
  9. Chiarioni G, Heymen S, Whitehead WE. Biofeedback therapy for dyssynergic defecation. World J Gastroenterol. 2006;12:7069–74.PubMedGoogle Scholar
  10. Dohrmann RJ, Laskin DM. An evaluation of electromyographic biofeedback in the treatment of myofascial pain-disfunction. J Am Dent Assoc. 1978;96:656–62.PubMedGoogle Scholar
  11. Eversaul GA. Biofeedback and kinesiology: technologies for preventive dentistry. J Am Soc Prev Dent. 1976;6:19–23.PubMedGoogle Scholar
  12. Feehan M, Marsh N. The reduction of bruxism using contingent EMG audible biofeedback: a case study. J Behav Ther Exp Psychiatr. 1989;20:179–83.CrossRefGoogle Scholar
  13. Freedman R, Papsdorf JD. Biofeedback and progressive relaxation treatment of sleep-onset insomnia: a controlled, all-night investigation. Biofeedback Self Regul. 1976;1:253–71.PubMedCrossRefGoogle Scholar
  14. Gordon D, Heimberg RG, Tellez-Merchan M, Ismail AI. A critical review of approaches to the treatment of dental anxiety in adults. J Anxiet Disord. 2013. doi: 10.1016/j.janxdis.2013.04.002.
  15. Hussein I, Kershaw AE, Tahmassebbi JF, Fayle SA. The management of drooling in children and patients with mental and physical disabilities: a literature review. Int J Paediatr Dent. 1998;8:3–11.PubMedCrossRefGoogle Scholar
  16. Jones LM, Buchanan H. Assessing children’s dental anxiety in New Zealand. N Z Dent J. 2010;106:132–6.PubMedGoogle Scholar
  17. Kleiman MB. Fear of dentists as an inhibiting factor in children’s use of dental services. ASDC J Dent Child. 1982;49:209–13.PubMedGoogle Scholar
  18. Litt MD. A model of pain and anxiety associated with acute stressors: distress in dental procedures. Behav Res Ther. 1996;34:459–76.PubMedCrossRefGoogle Scholar
  19. Little JW. Complementary and alternative medicine: impact on dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:137–45.PubMedCrossRefGoogle Scholar
  20. Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res. 1999;78:790–6.PubMedCrossRefGoogle Scholar
  21. Messer JG. Stress in dental patients undergoing routine procedures. J Dent Res. 1977;56:362–7.PubMedCrossRefGoogle Scholar
  22. Morarend QA, Spector ML, Dawson DV, Clark SH, Holmes DC. The use of a respiratory rate biofeedback device to reduce dental anxiety: an exploratory investigation. Appl Psychophysiol Biofeedback. 2011;36:63–70.PubMedCrossRefGoogle Scholar
  23. Moravec CS. Biofeedback therapy in cardiovascular disease: rationale and research overview. Cleve Clin J Med. 2008;75:S35–8.PubMedCrossRefGoogle Scholar
  24. Moss RA, Hammer D, Adams HE et al. A more efficient biofeedback procedure for the treatment of nocturnal bruxism. J Oral Rehab. 1982;9:125–31.CrossRefGoogle Scholar
  25. Mount GJ, Hume WR. A new cavity classification. Aust Dent J. 1998;43:153–9.PubMedCrossRefGoogle Scholar
  26. Nishimura C, Wang L-Q, Nagase A et al. A learning model of autonomic function in biofeedback. Int Congr Ser. 2007;1301:119–22.CrossRefGoogle Scholar
  27. Nolan RP, Kamath MV, Floras JS et al. Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control. Am Heart J. 2005;149:1137.e 1–7.Google Scholar
  28. Peper E, Harvey R, Takabayashi N. Biofeedback an evidence based approach in clinical practice. Jpn J Biofeedback Res. 2009;36:3–10.Google Scholar
  29. Rayen R, Muthu MS, Chandrasekhar RR, Sivakumar N. Evaluation of physiological and behavioural measures in relation to dental anxiety during sequential dental visits in children. Ind J Dent Res. 2005;17:27–34.CrossRefGoogle Scholar
  30. Roberts JF, Curzon MEJ, Koch G, Martens LC. Review: behaviour management techniques in paediatric dentistry. Eur Arch Paediatr Dent. 2010;11:166–74.PubMedCrossRefGoogle Scholar
  31. Scheutz F. Electrodermal activity, dental anxiety, and fear of dentistry in a group of parenteral drug addicts. Scand J Dent Res. 1986;94:248–52.PubMedGoogle Scholar
  32. Scott DS, Gregg JM. Myofascial pain of the temporomandibular joint: a review of the behavioral-relaxation therapies. Pain. 1980;9:231–41.PubMedCrossRefGoogle Scholar
  33. Shapiro M, Melmed RN, Sgan-Cohen HD, Eli I, Parush S. Behavioural and physiological effect of dental environment sensory adaptation on children’s dental anxiety. Eur J Oral Sci. 2007;115:479–83.PubMedCrossRefGoogle Scholar
  34. Sharma A, Tyagi R. Behaviour assessment of children in dental settings: a retrospective study. Int J Clin Pediatr Dent. 2011;4:35–9.CrossRefGoogle Scholar
  35. Sowjanya V, Tandon S, Tharian E. Physiological response to dental anxiety in children. J Indian Soc Pedo Prev Dent. 1995;13:13–7.Google Scholar
  36. Stenn PG, Mothersill KJ, Brooke RI. Biofeedback and a cognitive behavioral approach to the treatment of myofascial pain dysfunction syndrome. Behav Ther. 1979;10:29–36.CrossRefGoogle Scholar
  37. Strickland BR, editor. Biofeedback: the gale encyclopedia of psychology. 2nd ed. Detroit: Gale; 2001. p. 77–8.Google Scholar
  38. Turk DC, Zaki HS, Rudy TE. Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. J Prosthet Dent. 1993;70:158–64.PubMedCrossRefGoogle Scholar
  39. van der Plas RN, Benninga MA, Redekop WK, Taminiau JA, Buller HA. Randomised trial of biofeedback training for encopresis. Arch Dis Child. 1996;75:367–74.PubMedCentralPubMedCrossRefGoogle Scholar
  40. Watkinson AC. Biofeedback and the mandibular rest position. J Dent. 1987;15:16–22.PubMedCrossRefGoogle Scholar
  41. Wepman BJ. Biofeedback in the treatment of chronic myofascial pain dysfunction. Psychosomatics. 1980;21:157–62.PubMedCrossRefGoogle Scholar
  42. West GA, Reid KH, Bastawi AE. Clinical science: autonomic responses to dental procedures in pedodontic patients during a standard restoration session. J Dent Res. 1983;62:728–32.PubMedCrossRefGoogle Scholar
  43. Whitehead WE. Biofeedback in the treatment of gastrointestinal disorders. Biofeedback Self Regul. 1978;3:375.PubMedCrossRefGoogle Scholar
  44. Wigen TI, Skaret E, Wang NJ. Dental avoidance behaviour in parent and child as risk indicators for caries in 5 year old children. Int J Paediatr Dent. 2009;19:431–7.PubMedCrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2013

Authors and Affiliations

  • P. Dedeepya
    • 1
  • S. Nuvvula
    • 1
  • R. Kamatham
    • 1
    Email author
  • S. V. S. G. Nirmala
    • 1
  1. 1.Department of Paedodontics and Preventive DentistryNarayana Dental College and HospitalNelloreIndia

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