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Dental AnxietyNCT06779448

The Effect of Rubber Dam on Objective and Subjective Parameters of Stress During Dental Treatment in Children

A study testing Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments, Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments and Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist in people with Dental Anxiety and Dental Fear, run by Izmir Katip Celebi University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Although rubber dam application provides many advantages, several pediatric dentists avoid using it, arguing that it may increase stress for young patients. The purpose of this clinical study was to evaluate the effect of rubber dam on the subjective and objective stress in children and the effects of preferred… Read more about this study

Who is it for?
Ages 6 to 12 yearsHealthy volunteers can take part
Conditions the study is for
Dental Anxiety, Dental Fear, Rubberdam
What is being tested?
Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments, Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments and Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Jul 2024to 1 Nov 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 to 12 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • 6-12 years child,
  • classified as ASA I (american assossiation of anesthesiologist)
  • cooperative children
  • child with bilateral fully erupted mandibular first permanent molars requiring pit and fissure sealant procedures.

Who cannot join

  • patients/guardians who do not meet the inclusion criteria
  • patients/guardians who do not agree to participate in the study.
  • child with chronic systemic disease
  • non-cooperative children

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • İzmir Katip Celebi University

    Izmir, 35640

Other trials in Turkey (Türkiye)

About this study

Although rubber dam application provides many advantages, several pediatric dentists avoid using it, arguing that it may increase stress for young patients.

The purpose of this clinical study was to evaluate the effect of rubber dam on the subjective and objective stress in children and the effects of preferred anesthesia methods during use of the rubber dam on the same parameters.

A total of 100 children, aged 6-12 years old participated in this study. The selected site of the patients divided cotton roll and rubber dam application group, and the rubber dam group divided also two subgroups as topical and infiltration anesthesia application. Objective parameters of stress of the patients and pulse rate of the operator were measured at three different time points. Pain perception was also evaluated subjectively. The data were statistically analyzed (p<0.05).

Read the detailed description

This randomized, controlled, single-blinded study included 100 healthy, cooperative children (Frankl Scale, Rating 3-4) aged 6-12 years, classified as ASA I (american assossiation of anesthesiologist), with bilateral fully erupted mandibular first permanent molars requiring pit and fissure sealant procedures. The inclusion criteria were based on the International Caries Detection and Assessment System II, including deep and retentive pits and fissures, no restorations, and no evidence of carious lesions.

The study was planned as split mouth design: For each patient, one tooth was selected for rubber dam isolation, while the corresponding tooth from the opposite quadrant was chosen for cotton roll isolation. The Rubber dam application group divided also into two groups as topical EMLA application, and infiltration anesthesia application. Randomization was performed using manually generated sealed envelopes containing information about which isolation method and anesthesia technique would be used on which side of the jaw (right or left). Random numbers were written on separate papers, folded, and placed in opaque sealed envelopes. Each participant chose an envelope and was assigned the printed participant number. Each number identified the teeth included in the study, the isolation technique specified for each tooth, and the anesthesia method to be used during the rubber dam application. Objective stress parameters (pulse rate, systolic blood pressure and diastolic blood pressure) for the children and the pulse rate of the operator were recorded at three different points: immediately after sitting in the treatment chair and prior to the beginning of the treatment (T1), after light curing of the fissure sealant with cotton roll isolation (T2), and following the completion of treatment and removal of the cotton rolls. Systolic and diastolic blood pressure were measured using an automatic blood pressure monitor (OMRON M2, Omron Healthcare Co., Kyoto, Japan). Pulse rate was evaluated with a fingertip pulse oximeter (LYG88 Pulse Oximeter, China). The operator's pulse rate was also recorded. Pain perception was assessed subjectively post-procedure using the Wong-Baker FACES Pain Rating Scale (WBFPRS) and Visual Analogue Scale (VAS). One week later, the patient was invited to a second appointment for the treatment of the corresponding tooth from the opposite side. At this stage, the teeth were cleaned like in cotton roll group, and the patients were divided into two groups according to the randomization procedure: topical anesthesia and infiltrative anesthesia before the placement of the clamp. The topical anesthetic agent (EMLA, AstraZeneca, Cotia, São Paulo, Brazil) was applied using a disposable dental Q-tip for 10-20 seconds and infiltration anesthesia (Maxicaine Forte, Artikain, VEM Drug, Turkey) was performed with a 20-gauge needle. Following the administration of anesthetics, an appropriate size rubber dam and metal clamp was placed in the mandibular arch, and pit and fissure sealant was applied to the opposite arch. The stress parameters of the subjects were recorded at three measurement points. At the conclusion of the treatment, pain perception was evaluated subjectively using the WBFPRS and VAS.

Being tested
Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments, Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments, Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist, Evaluation of the objective and subjective stress parameters caused by the application of cotton rolls during treatments in the patient and dentist
Keywords
dental anxiety, local anesthesia, topical anesthesia, rubber dam, cotton roll, dental stress, stress parameters
Medical subject headings
Toothache

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Evaluation of objective and subjective stress parameters caused by local anesthesia during treatmentsOther

    Patients were divided according to the randomization procedure. infiltration anesthesia (Maxicaine Forte, Artikain, VEM Drug, Turkey) was performed with a 20-gauge needle. Following the administration of anesthetic, an appropriate size rubber dam and metal clamp was placed i and pit and fissure sealant was applied. The stress parameters of the subjects were recorded at three measurement points. At the conclusion of the treatment, pain perception was evaluated subjectively using the WBFPRS and VAS.

  • Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatmentsOther

    Patients were divided i according to the randomization procedure. The topical anesthetic agent (EMLA, AstraZeneca, Cotia, São Paulo, Brazil) was applied using a disposable dental Q-tip for 10-20 seconds. Following the administration of anesthetic, an appropriate size rubber dam and metal clamp was placed i and pit and fissure sealant was applied. The stress parameters of the subjects were recorded at three measurement points. At the conclusion of the treatment, pain perception was evaluated subjectively using the WBFPRS and VAS.

  • Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentistOther

    Patients were divided into 4 subgroups according to the randomization procedure: topical anesthesia and infiltrative anesthesia before the placement of the clamp and also cotton roll application other side of the arch. The topical anesthetic agent (EMLA, AstraZeneca, Cotia, São Paulo, Brazil) was applied using a disposable dental Q-tip for 10-20 seconds and infiltration anesthesia (Maxicaine Forte, Artikain, VEM Drug, Turkey) was performed with a 20-gauge needle. Following the administration of anesthetics, an appropriate size rubber dam and metal clamp was placed in the mandibular arch, and pit and fissure sealant was applied to the opposite arch. The stress parameters of the subjects and dentist were recorded at three measurement points. At the conclusion of the treatment, pain perception was evaluated subjectively using the WBFPRS and VAS.

  • Evaluation of the objective and subjective stress parameters caused by the application of cotton rolls during treatments in the patient and dentistOther

    Patients were divided into 4 subgroups according to the randomization procedure: topical anesthesia and infiltrative anesthesia before the placement of the clamp and also cotton roll application other side of the arch. The topical anesthetic agent (EMLA, AstraZeneca, Cotia, São Paulo, Brazil) was applied using a disposable dental Q-tip for 10-20 seconds and infiltration anesthesia (Maxicaine Forte, Artikain, VEM Drug, Turkey) was performed with a 20-gauge needle. Following the administration of anesthetics, an appropriate size rubber dam and metal clamp was placed in the mandibular arch, and pit and fissure sealant was applied to the opposite arch. The stress parameters of the subjects and dentist were recorded at three measurement points. At the conclusion of the treatment, pain perception was evaluated subjectively using the WBFPRS and VAS.

Study groups in NCT06779448
Study groupRoleWhat they receive
local anesthesiaActive comparatorlocal anesthesia application before rubber dam isolation
Receives: Other: Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist; Other: Evaluation of the objective and subjective stress parameters caused by the application of cotton rolls during treatments in the patient and dentist
topical anesthesiaActive comparatortopical anesthesia application before rubber dam isolation
Receives: Other: Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist; Other: Evaluation of the objective and subjective stress parameters caused by the application of cotton rolls during treatments in the patient and dentist
rubber damActive comparatorRubber dam isolation and evaluation of the associated objective and subjective stress parameters
Receives: Other: Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist; Other: Evaluation of the objective and subjective stress parameters caused by the application of cotton rolls during treatments in the patient and dentist
cotton rollActive comparatorcotton roll insulation and evaluation of the associated objective and subjective stress parameters
Receives: Other: Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments; Other: Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist; Other: Evaluation of the objective and subjective stress parameters caused by the application of cotton rolls during treatments in the patient and dentist

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. blood pressure

    systolic blood pressure and diastolic blood pressure for the children recorded. Systolic and diastolic blood pressure were measured using an automatic blood pressure monitor (mmHg). (min 20 mmHg- max 320 mmHg) The mean values and standard deviations of these measured values be taken into account.

    Measured: one week intervals about observation/treatment sessions (total time is 2 weeks)

  2. pulse rate

    pulse rate for the children and the operator recorded. Pulse rate was evaluated with a fingertip pulse oximeter (unit per minute) (min 60- max 160). The mean values and standard deviations of these measured values be taken into account.

    Measured: one week intervals about observation/treatment sessions (total time is 2 weeks)

Secondary outcomes (2)
  1. pain perception

    Pain perception assessed subjectively post-procedure using the Wong-Baker FACES Pain Rating Scale (WBFPRS). The aforementioned assessments conducted through the assignment of scores. Wong-baker (WBFPRS) is realised as scoring from facial expressions. The lowest score selected from 6 different and graded facial expressions gives the lowest anxiety value (min 0- max 6).

    Measured: one week intervals about observation/treatment sessions (total time is 2 weeks)

  2. pain perception

    Pain perception is going to assess subjectively post-procedure using the Visual Analogue Scale (VAS). The aforementioned assessments conducted through the assignment of scores. VAS takes values ranging from 0-10 and higher values indicate an increase in patients pain perception. 0 is indicated no pain and 10 is indicated worst possible pain.

    Measured: one week intervals about observation/treatment sessions (total time is 2 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Jan 2025
  2. Study start1 Jul 2024
  3. Primary completion1 Sep 2024
  4. Study completion1 Nov 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
randomized, controlled, single-blinded, split mouth clinical study
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
100 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06779448
Sponsor's protocol ID
2024/0242
Status last verified
Jul 2025
First submitted
4 Dec 2024
Last updated
11 Jul 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: due to concerns about the security of unpublished data

Publications

  • Ammann P, Kolb A, Lussi A, Seemann R. Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents - a randomized controlled clinical pilot study. Int J Paediatr Dent. 2013 Mar;23(2):110-5. doi: 10.1111/j.1365-263X.2012.01232.x. Epub 2012 Mar 8.

    PubMed 22404253
  • Afshari E, Sabbagh S, Khorakian F, Sarraf Shirazi A, Akbarzadeh Baghban A. Reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents: a systematic review and meta-analysis of effectiveness. BMC Oral Health. 2023 Jun 16;23(1):398. doi: 10.1186/s12903-023-03115-7.

    PubMed 37328861
  • Wang Y, Li C, Yuan H, Wong MC, Zou J, Shi Z, Zhou X. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev. 2016 Sep 20;9(9):CD009858. doi: 10.1002/14651858.CD009858.pub2.

    PubMed 27648846
  • Kucukyilmaz E, Ozdemir T, Savas S. The effect of rubber dam on objective and subjective parameters of stress during dental treatment in children: a randomized clinical trial. BMC Oral Health. 2025 May 30;25(1):855. doi: 10.1186/s12903-025-06250-5.

    PubMed 40448060

Questions about this trial

What is this clinical trial studying?

A study testing Evaluation of objective and subjective stress parameters caused by local anesthesia during treatments, Evaluation of objective and subjective stress parameters caused by topical anesthesia during treatments and Evaluation of objective and subjective stress parameters caused by the application of rubber dam during treatments in the patient and dentist in people with Dental Anxiety and Dental Fear, run by Izmir Katip Celebi University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

blood pressure (time frame: one week intervals about observation/treatment sessions (total time is 2 weeks)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06779448, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jul 2025.

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