The aim of this study is to compare the effect of multisensory and traditional waiting
room environments on the level of dental anxiety experienced by children prior to
Participants were recruited from the pediatric dental clinic at Hadassah Ein Kerem.
Inclusion criteria: males and females between 3-10 years of age, who were waiting for a dental examination or dental treatment.
Exclusion criteria: patients who were unable to understand or answer the Venham Picture
Test (VPT)14 that assesses anxiety before treatment; as well as, patients accepted immediately
for their dental visit.
This is a case control study. The test group was waiting for dental treatment in the
multisensory waiting room: a small room (2.5mx2.5m) located inside the dental clinic with 6 seats. The multisensory environment consisted of a lighting column that children could touch
and climb on. Auditory stimuli included rhythmic music, played on loudspeakers. The
control group was waiting for dental treatment in the traditional waiting room, located
outside the dental clinic with ten seats in one row facing the reception desk. The
area was air-conditioned, well-lit, without posters or paintings on the walls, and
no reading material. Participants were randomly assigned to test or control group.
Participants were asked to answer the VPT, a dental anxiety scale, while waiting in
the waiting room just before entering the treatment room. VPT is widely used and easily administered. In this test, children are presented with
eight cards, with two figures on each card: one anxious figure and one non-anxious
figure. They are asked to choose the figure from each pair that describes how they
feel at that particular time. All cards are shown in their numbered order. If an anxious
figure is chosen, a score of one is recorded. If a non-anxious figure is chosen, a
score of zero is recorded. A measure of anxiety is obtained by totaling the number
of times the child picks the figure depicting the anxious state (minimum score 0;
maximum score 8).
Additional data including gender, age, waiting time, purpose of visit, parent/guardian
accompanying child, child’s dental history and experience was collected.
Sample size and power calculation
A power analysis was completed to determine an appropriate sample size. To achieve
a significance level at the 95th percentile confidence level and a power of 80%, with a 0.5 estimated effect size,
the sample size was calculated to be 51 subjects.
Study protocol was approved by the Institutional Human Subjects Ethics Committee of
Hadassah Medical Organization IRB, Jerusalem, Israel. All procedures performed were
in accordance with the ethical standards of the institutional and national research
committee. The study protocol was also enrolled, and the full trial protocol can be
accessed at clinicaltrials.gov (NCT03197129). Detailed information in simple non-technical language was provided in advance and
parents/guardians of all patients included in the study were requested to sign an
informed consent. No compensation was provided for participating patients.
Data analysis was performed using statistical software (Stata version 12.1, StataCorp).
Descriptive statistics were tabulated for the demographic and clinical characteristics.
Chi-squared and Fisher's Exact tests were utilized to test the association between
the categorical variables and waiting room type. T tests with unequal variance was
used to test the association between VPT score and waiting room type. We estimated
unadjusted and adjusted slopes from linear regression to examine the association between
VPT score and weight time; as well as, waiting room type. For this analysis, a p-value less than 0.05 was considered statistically significant.