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Updated: Jun 23, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
A software-based observational coding approach for evaluating paediatric dental pain, anxiety, and fear
Clare Bocklage1,2, Raven Selden3, Olivia Tumsuden3
1Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
Background:
Dental practitioners desire non-pharmacological methods to alleviate anxiety, fear, and pain in children receiving dental care; high-quality evidence, however, is required to evaluate methods' efficacy.
Aim:
This study aimed to develop and validate an observation-based coding approach (paediatric dental pain, anxiety, and fear coding approach [PAFCA]) to evaluate non-pharmacological behavior management techniques for anxiety, fear, and pain.
Design:
Objective (video-based) and subjective (self-reported) anxiety, fear, and pain data were collected from a pilot clinical trial evaluating animal-assisted therapy (AAT) in paediatric dentistry, in which 37 children aged 7-14 were assigned to AAT or control before dental treatment (restorations or extractions). A coding approach utilizing a codebook, a gold standard calibration video, and a user training guide was developed. Trained examiners coded the gold standard video for inter-rater agreement, and masked, calibrated examiners analyzed videos using the Noldus Observer XT software.
Results:
A novel, software-based coding approach was developed, with moderately high inter-rater agreement. Using PAFCA, we found children reporting higher levels of pain, fear, and anxiety exhibited treatment-interfering behaviors, including crying/moaning, attempts to dislodge instruments, and more upper and lower body movements.
Conclusion:
PAFCA shows promise as a reliable tool for assessing anxiety, pain, and fear in behavioral research for paediatric dentistry.
