Are Behavior Rating Scales Able to Identify Behavioral Changes in Preschool Children Undergoing a Dental Intervention? A Systematic Review

Silva, Jéssica Aparecida da; Paiva, Saul Martins; Pereira, Daniele Masterson Tavares; Maia, Lucianne Cople; Primo, Laura Guimarães; Fonseca-Gonçalves, Andréa

doi:10.1590/pboci.2020.097

Jéssica Aparecida da Silva

Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

http://orcid.org/0000-0003-4497-1952

Saul Martins Paiva

Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-3968-1638

Daniele Masterson Tavares Pereira

Health Science Center, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

http://orcid.org/0000-0001-7108-1117

Lucianne Cople Maia

Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

http://orcid.org/0000-0003-1026-9401

Laura Guimarães Primo

Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

http://orcid.org/0000-0003-3718-693X

Andréa Fonseca-Gonçalves Author to whom correspondence should be addressed: Professor Andréa Fonseca-Gonçalves, Rua Rodolpho Paulo Rocco 325, Faculdade de Odontologia, Cidade Universitária, Rio de Janeiro, RJ, Brazil. 21941-913. Phone: +55 21 39382098. E-mail: andrea.goncalves@odonto.ufrj.br.

Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

http://orcid.org/0000-0001-6467-7078

Author to whom correspondence should be addressed: Professor Andréa Fonseca-Gonçalves, Rua Rodolpho Paulo Rocco 325, Faculdade de Odontologia, Cidade Universitária, Rio de Janeiro, RJ, Brazil. 21941-913. Phone: +55 21 39382098. E-mail: andrea.goncalves@odonto.ufrj.br.

Academic Editors: Alessandro Leite Cavalcanti and Wilton Wilney Nascimento Padilha

Authors’ Contributions

JAS Investigation, Formal Analysis, Validation and Writing - Original Draft Preparation.

SMP Supervision and Writing - Review and Editing.

DMTP Methodology and Investigation.

LCM Supervision, Writing - Original Draft Preparation and Writing - Review and Editing.

LGP Investigation, Supervision and Writing - Original Draft Preparation.

AFG Conceptualization, Investigation, Formal Analysis, Writing - Original Draft Preparation and Writing - Review and Editing.

All authors declare that they contributed to critical review of intellectual content and approval of the final version to be published.

Conflict of Interest

The authors declare no conflicts of interest.

Database	Search Strategy
PubMed	#1 ((((Behavior Rating Scale[Mesh] OR Rating Scales Behavior[tiab] OR evaluation scaleS[tiab] OR Scale Behavioral Rating[tiab] OR Tests Behavior[tiab] OR Test Behavioral[tiab] OR Behavior scale[tiab] OR Behaviour scale[tiab] OR Frankl Scale[tiab] OR Frankl's Behavior Rating Scale[tiab] OR Frankl behavior Rating Scale[tiab] OR Frankl scores[tiab] OR Frankl Rating Scale[tiab] OR Frankl Behavioral Scale[tiab] OR FBRS[tiab] OR Global Rating[tiab] OR Houpt[tiab] OR Wright Classification[tiab] OR Behavior Profile Rating Scale[tiab] OR Venham Behaviour Rating Scale[tiab] OR Venham Behavior Scale[tiab] OR Venham Scale[tiab] OR Venham's Scale[tiab] OR Kurosu Behaviour Evaluation Scale[tiab] OR Ohio State University Behavior Rating Scale[tiab] OR OSUBRS[tiab] OR North Carolina Behavior Rating scale[tiab] OR NCBRS[tiab] OR Visual Analog Scale[Mesh] OR Visual Analog Scales[tiab] OR VAS[tiab] OR Visual Analogue[tiab]))) #2 ((Dentistry[Mesh] OR dentist*[tiab] OR Tooth[Mesh] OR Teeth[tiab] OR Relations Dentist-Patient[tiab] OR Pediatric Dentistry[Mesh] OR Pedodontics[tiab] OR Dentistry Pediatric[tiab])))
	# 1 and # 2
Scopus	#1 (TITLE-ABS-KEY("Behavior Rating Scale" OR "Evaluation scales" OR "Scale Behavioral Rating" OR "Tests Behavior" OR "Behavior scale" OR "Frankl Scale" OR "Frankl behavior Rating Scale" OR "Frankl scores" OR "Frankl Behavioral Scale" OR fbrs OR "Global Rating" OR houpt OR "Wright Classification" OR "Behavior Profile Rating Scale" OR "Venham Behaviour Rating Scale" OR "Venham Scale" OR "Kurosu Behaviour Evaluation Scale" OR "Ohio State University Behavior Rating Scale" OR osubrs OR "North Carolina Behavior Rating scale" OR ncbrs OR "Visual Analog Scale" OR vas OR "Visual Analogue")) #2 (TITLE-ABS-KEY(dentistry OR dentist OR tooth OR teeth OR "Dentist-Patient Relations" OR "Relation Dentist-Patient" OR "Relations Dentist-Patient" OR "Pediatric Dentistry" OR pedodontics OR "Dentistry Pediatric")) #3 (TITLE-ABS-KEY(child OR "child preschool"))
	# 1 and # 2 and # 3
Web of Science	#1 (((("Behavior Rating Scale" OR "Evaluation scales" OR "Scale Behavioral Rating" OR "Tests Behavior" OR "Behavior scale" OR "Frankl Scale" OR "Frankl behavior Rating Scale" OR "Frankl scores" OR "Frankl Behavioral Scale" OR FBRS OR "Global Rating" OR Houpt OR "Wright Classification" OR "Behavior Profile Rating Scale" OR "Venham Behaviour Rating Scale" OR "Venham Scale" OR "Kurosu Behaviour Evaluation Scale" OR "Ohio State University Behavior Rating Scale" OR OSUBRS OR "North Carolina Behavior Rating scale" OR NCBRS OR "Visual Analog Scale" OR VAS OR "Visual Analogue")) #2 ((Dentistry OR dentist OR Tooth OR Teeth OR "Relations Dentist-Patient" OR "Pediatric Dentistry" OR Pedodontics OR "Dentistry Pediatric")) #3 ((child OR "child preschool"))))
	# 1 and # 2 and # 3
Cochrane	#1MeSH descriptor: [Behavior Rating Scale] explode all trees #2("Behavior Rating Scale" or "Evaluation scales" or "Test Behavioral" or "Behavior scale") #3#1 or #2 #4("Frankl Scale" or "Frankl behavior Rating Scale" or "FBRS") #5("Global Rating") #6("Houpt") #7("Venham Scale") #8("Ohio State University Behavior Rating Scale") #9#4 or #5 or #6 or #7 or #8 #10MeSH descriptor: [Visual Analog Scale] explode all trees #11("Visual Analog Scales") #12#10 or #11 #13#3 or #9 or #12 #14MeSH descriptor: [Dentistry] explode all trees #15(dentist) #16#14 or #15 #17MeSH descriptor: [Tooth] explode all trees #18("tooth" or "Teeth" or "dental") #19#17 or #18 #20MeSH descriptor: [Dentist-Patient Relations] explode all trees #21("Dentist-Patient Relations") #22#20 or #21 #23MeSH descriptor: [Pediatric Dentistry] explode all trees #24("Pediatric Dentistry" or "pedodontics") #25*#23 or #24
	#16 or #19 or #22 or #25
BVS	#1 (tw:((tw:(((mh:("Behavior Rating Scale")) OR (tw:("Rating Scales Behavior")))) OR (tw:("Escala de classificação do comportamento")) OR (tw:("Tests Behavior")) OR (tw:("teste de comportamento")) OR (tw:("Behavior scale")) OR (tw:("escala de comportamento")) OR (tw:("Frankl Scale")) OR (tw:("Escala de Frankl")) OR (tw:("Frankl's Behavior Rating Scale")) OR (tw:("Escala de classificação comportamental de Frankl")) OR (tw:("Global Rating")) OR (tw:("Escala Global")) OR (tw:("Houpt")) OR (tw:("Wright Classification")) OR (tw:("Classificação de Wright")) OR (tw:("Behavior Profile Rating Scale")) OR (tw:("Escala avaliação perfil comportamento")) OR (tw:("Venham Behaviour Rating Scale")) OR (tw:("Kurosu Behaviour Evaluation Scale")) OR (tw:("Ohio State University Behavior Rating Scale")) OR (tw:("North Carolina Behavior Rating scale")) OR (tw:("Visual Analog Scale")) OR (tw:("Escala visual analógica"))) #2 (tw:(("Dentistry)) OR (tw:("dentist")) OR (tw:("dentista")) OR (mh:("Tooth")) OR (tw:("dente")) OR (mh:("Dentist-Patient Relations")) OR (tw:("Relação dentista-paciente")) OR (mh:("Pediatric Dentistry")) OR (tw:("Odontopediatria")))))
	# 1 and # 2
OpenGrey	#1 Behavior rating scale OR Rating scale OR Behavior classification OR Tests behavior #2 Pediatric dentistry OR Dentistry OR Dentistry for children
	# 1 and # 2

Questions	Kamel et al. (2017)	Chambers et al. (1981)	Frankl et al. (1962)
1. Was the study question or objective clearly stated?	Yes	Yes	No
2. Were eligibility/ selection criteria for the study population prespecified and clearly described?	No	No	No
3. Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?	Yes	No	No
4. Were all eligible participants that met the prespecified entry criteria enrolled?	Yes	No	Yes
5. Was the test/service/intervention clearly described and/or delivered consistently across the study population?	Yes	No	NA
6. Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants?	Yes	Yes	Yes
7. Were the people assessing the outcomes blinded to the participants' exposures/interventions?	No	No	No
8. Did the statistical methods examine changes in outcome measures from before and after the intervention? Were statistical tests done that provided p values for the pré-to-post changes?	Yes	Yes	Yes
9. Was the outcome measure evaluated by a calibrated examiner?	No	Yes	No

Author/Year	Country	Study Design	Sample	Age Range	Baseline/ First Visit/ Before Treatment	Dental Intervention	Behavior Rating Scale	Children Behavior at Baseline N (%)	Children Behavior After Dental Intervention	Outcome
Kamel et al. [2017]	Egypt	RCT	N= 30	4-6 years	Seating in dental chair	A) Administration of local anethesia B) Treatment procedure	Frankl	[- -] 01 (3.3) [-] 04 (13.3) [+] 14 (46.7) [++] 11 (36.7)	Intervention A [- -] 02 (6.7) [ - ] 05 (16.6) [+] 20 (66.6) [++] 03 (10.0) Intervention B [- -] 02 (6.7) [ - ] 03 (10.0) [+] 09 (30.0) [++] 16 (53.3)	The behavioral changing was noted with the use of Frankl scale
Chambers et al. [1981]	USA	CS	N=40	3-5 years	First visit (exam, prophylaxis and topical fluoride)	A1) First day of treatment (class I restoration under local anesthesia and rubber dam) A2) Second day of treatment (class I restoration under local anesthesia and rubber dam)	North Carolina behavior rating scale	[H H] 36 (90.0) [L M] 10 (25.5) [C P] 10 (25.5) [O P R] 04 (10.0)	Intervention A [H H] 31 (77.5) [L M] 14 (35.0) [C P] 19 (47.5) [O P R] 03 (7.5) Intervention B [H H] 32 (80.0) [L M] 36 (90.0) [C P] 19 (47.5) [O P R] 04 (10.0)	The North Carolina scale was able to identify behavioral changes in the studied population
Frankl et al. [1962]	USA	CS	N=56	3.5-5.5 years	Entering the dental office	A) Administration of local anesthesia B) During cavity preparation C) Insertion of restorative material D) On departure	Frankl	[- -] 0(0.0) [-] 2 (3.57) [+] 53 (94.6) [++] 1 (1.7)	Intervention A [- -] 0 (0.0) [-] 12 (21.4) [+] 43 (76.7) [++] 1 (1.7) Intervention B [- -] 0 (0.0) [-] 5 (8.9) [+] 49 (87.5) [++] 2 (3.57) Intervention C [- -] 0 (0.0) [-] 1 (1.7) [+] 51 (80.9) [++] 4 (7.14) Intervention D [- -] 0 (0.0) [-] 1 (1.7) [+] 51 (80.9) [++] 4 (7.14)	The Frankl scale was able to detect behavioral changing after treatments

Certainty Assessment							Certainty
No. of Studies	Study Design	Risk of Bias	Inconsistency	Indirectness	Imprecision	Other Considerations
03 [11,13,18]	Observational / Before and after evaluation	Serious^a a Two included studies [11,13] were classified as having high risk of bias, while one [18] was qualified as having low risk of bias. Thus, the proportion of information from studies at high risk of bias is enough to affect the interpretation of results. As summary, there is crucial risk of bias for one criterion, or multiple criteria, that likely to seriously alter the results.	Not Serious	Serious^b b The evidence summarized in the review comes from studies that partially address the question of interest to the review, and therefore the conclusions may not be directly answering the review question with respect to PICO. So, the evidence that was found is more restrictive than the review question and some indirectness exist.	Very Serious^c c The number of children analyzed (N=126) is not enough to detect a precise estimate of the effect.	All plausible residual confounding would reduce the demonstrated effect	⨁ VERY LOW

[1] Author to whom correspondence should be addressed: Professor Andréa Fonseca-Gonçalves, Rua Rodolpho Paulo Rocco 325, Faculdade de Odontologia, Cidade Universitária, Rio de Janeiro, RJ, Brazil. 21941-913. Phone: +55 21 39382098. E-mail: andrea.goncalves@odonto.ufrj.br.

Brasil

Brasil

Are Behavior Rating Scales Able to Identify Behavioral Changes in Preschool Children Undergoing a Dental Intervention? A Systematic Review

Abstract

Objective:

Material and Methods:

Results:

Conclusion: