Acceptance of Parents toward Hand-over-mouth Exercise and Other Behavior Management Techniques for Pediatric Dental Care in the 21st Century: A Systematic Review and Meta-analysis of Observational Studies.

BACKGROUND

Hand-over-mouth exercise (HOME) is an aversive technique for child behavior management in a dental office. HOME has been omitted from various guidelines and certain teaching curricula due to legal and ethical issues. This systematic review meta-analysis (SRMA) was undertaken to understand the acceptance of parents toward HOME in comparison with that of other behavior management techniques (BMTs).

OBJECTIVES

This SRMA compared parental acceptance for HOME and other BMTs from observational studies reported in the literature from 1 January 2000, to date.

METHODOLOGY

Two authors independently searched data from the Cochrane Library, PubMed, Google Scholar, Semantic Scholar, and others. Twenty-one studies remained in the systematic review, of which eleven could be included in the meta-analysis. Based on the summary findings of 1,034 participants from 10 studies, we compared parents' acceptance for HOME vs other BMTs [voice control (VC), tell-show-do (TSD), physical restraint-active (PR-A), physical restraint-passive (PR-P), parental separation (PS), conscious sedation (CS), general anesthesia (GA), oral premedication (OP), and positive reinforcement (PR)]. Data analyses were carried out using RevMan 5.3. The Joanna Briggs Risk of Bias (JB-ROB) tool for cross-sectional analytical studies was used for bias assessment. A funnel plot was used to detect publication bias.

RESULTS

Of 20 studies, nine studies reported higher acceptance for GA than HOME; seven reported higher acceptance for HOME than GA, and the remaining four appeared inconclusive. The meta-analysis results (eleven studies) based on forest plots with fixed effects models in terms of OR (CI) indicated no statistically significant difference in the acceptance for HOME vs GA [1.03 (0.84, 1.25)], CS [0.77 (0.60, 1.00)], and PR-P [1.21 (0.92, 1.59)]. In comparison with the acceptance for HOME, CS (NO) [0.65 (0.51, 0.84)], VC [0.48 (0.39, 0.59)], TSD [0.04 (0.03, 0.05)], PR-A [0.65 (0.50, 0.84)], PS [0.28 (0.22, 0.36)], OP [0.55 (0.39, 0.78)], distraction [0.11 (0.09, 0.15)], and PR [0.06 (0.04, 0.08)] were preferred; these being statistically significant. Heterogeneity values (I) for all comparisons were high (above 80%), with the exception of one (comparison of HOME vs OP) having 50%. ROB across studies was judged to be moderate. The publication bias using the funnel plot analysis for all studies on the basis of SE [Log (OR)] showed marked and fairly equal dispersion on either side of the central line.

CONCLUSION

No statistically significant difference was seen in the acceptance for HOME vs GA, CS, and PR-P. BMTs such as TSD, VC, PR-A, PS, CS (NO), OP, distraction, and PR were preferred to HOME; the difference in acceptance being statistically significant. The differences in acceptance between HOME vs CS (NO) and PR-A did not remain statistically significant when random effects models were used. The heterogeneity was high, the ROB was moderate, and the publication bias was minimal.

HOW TO CITE THIS ARTICLE

Jawdekar A, Tafti F, Deolikar S, Acceptance of Parents toward Hand-over-mouth Exercise and Other Behavior Management Techniques for Pediatric Dental Care in the 21st Century: A Systematic Review and Meta-analysis of Observational Studies. Int J Clin Pediatr Dent 2024;17(11):1302-1319.