Comparison and evaluation of two play therapy breathing exercises to reduce anxiety in children receiving local anaesthesia: A randomized clinical study

Background: Children are anxious about dental procedures and the anaesthetic needle’s sight and feeling have been identified as the most fear-eliciting stimuli. Psychologists have used ‘play therapy’ to modify child behaviour to alleviate pain and anxiety during elective surgery in children. The pinwheel and bubble blower have been used in play therapy for children to bring about deep breathing which in turn brings about relaxation and anxiety reduction. Objectives: To evaluate and compare the use of two relaxation breathing exercises for anxiety reduction before and after administration of local anaesthesia for 6–12-year-old children undergoing dental treatment. Method: Forty-five children were divided into 3 groups as control, pinwheel breathing exercise and bubble blowing breathing exercise. The children were given a demonstration of the breathing exercise before local anaesthesia administration and asked to perform the exercise for 3 to 5 minutes. Anxiety was measured before and after administration of local anaesthesia with pulse rate and Venham’s picture scale score.  Results: Post-operative rise in pulse rate was seen in all groups but was statistically significant in the control group and the bubble blowing breathing exercise group (p<0.05). The least rise was seen in the pinwheel breathing exercise group. The post-injection Venham’s picture test score was the same as the pre-injection score in the pinwheel exercise group but had increased for the other two groups which was statistically not significant. Conclusions: The play therapy relaxation breathing exercises can be successfully used for anxiety reduction in children receiving local anaesthesia.