The Effect of Waiting Room's Environment on the Levels of Anxiety Experienced by Children Prior Dental Treatment
Phase: NA
Conditions: Dental Anxiety
Sponsor: Hadassah Medical Organization

The effect of waiting room's environment on the levels of anxiety 
experienced by children prior dental treatment 
 
 
NCT03197129 
 
Protocol  23.3.17 
 

Introduction 
It has been estimated that about 11% of children and adolescents suffer from dental 
anxiety1. The level of the subject's dental anxiety is affected by environmental factors 
and by personality traits2.  
Several dental stimuli can cause anxiety; one of them is the waiting in the waiting 
area3. The amount of time the patient has spent awaiting treatment and the nature of 
the waiting room environment influence the anxiety level prior treatment4. 
Waiting room environment and atmosphere was the focus of several studies. Among 
the different methods to reduce anxiety in the waiting room were: exposure to positive 
images of dentistry5,6, aromatherapy7,8, and music9. 
The Snoezelen environment consists of a multisensory adapted environment coupled 
with client-centered therapy. The original idea was to use the multisensory 
environment to function as leisure and relaxation to calm the patient with cognitive 
impairment10. A sensory adapted dental environment (SADE) has been developed, 
based upon the Snoezelen environment, and found to be suitable in reducing dental 
anxiety and maladaptive behaviors and facilitating a calming effect in the dental clinic 
among children during routine dental prophylactic cleaning11-13. 
 
Objective  
The objective of the present study is to compare the effect of waiting room's 
environment on the levels of anxiety experienced by children, in SADE and 
traditional waiting rooms. 
 
Materials and methods 
 
 Participants- boys and girls, ages: 3-10 years waiting to dental examination or 
dental treatment with/without conscious sedation. The participants will be 
recruited from the pediatric dental clinic in Hadassah Ein Kerem. Exclusion 
criteria: mentally unable to understand and answer the Venham Picture Test 
(VPT) to assess anxiety before treatment, accepted immediately without waiting.   
 Waiting room- The SADE waiting room: a small waiting room (2.5mx2.5m) 
inside the clinic with 6 seats. All ceiling fluorescent lighting is removed. The 
adapted lighting consisted of slow-moving, repetitive visual color effects created 
by a projector, and a lighting column that children can touch and climb on. 
Auditory stimuli include rhythmic music, which is heard via loudspeakers. The 
traditional waiting room: a waiting area outside the clinic with ten seats in one 
row faces the reception desk in an area of 15 square meters. The area is air-
conditioned, moderately well-lit, without posters or paintings on the walls, and 
no reading material.   
 Dental anxiety scale- Venham Picture Test (VPT) is widely used and easily 
administered14. In this test, children are presented with eight cards, with two 
figures on each card, one ‘anxious’ figure and one ‘nonanxious’ figure. They are 

asked to choose the figure from each pair that describes how they feel at that 
particular time. All cards are shown in their numbered order. If an anxious figure 
is chosen, a score of one is recorded. If a nonanxious cartoon is chosen, a score 
of zero is recorded. A measure of anxiety is obtained by totaling the number of 
times the child picks the cartoons depicting the anxious state (minimum score, 0; 
maximum score, 8). The participants will be asked to answer while waiting in 
the waiting room just before entering the clinic. 
 Study design- The study is a parallel randomized trial. The participants will be 
randomly assigned to one type of waiting room.  
 Additional data- gender, age, the lengths of waiting, the purpose of the visit 
(examination or treatment with/without sedation), dental experience, type of 
waiting room, child escort.  
 Safety- there are no reports of adverse effect or risks using SADE. Cermak et al. 
reported that more than 95% of children accepted all components of SADE; 1 
child stated that he did not like the music and requested that we turn it off, and 1 
child reported that she did not like having the lights dimmed because she was 
afraid of the dark. Parents provided positive comments about the intervention as 
well15. 
 
Statistical analysis plan 
Descriptive statistics – tabulate for the demographic and clinical characteristics.  
Chi-squared and Fisher's Exact tests - utilize to test the association between the 
categorical variables and waiting room type.  
A T test with unequal variance - to test the association between VPT score and 
waiting room type.  
Estimated unadjusted and adjusted slopes from linear regression to examine the 
association between VPT score and waiting time; as well as, waiting room type.  
 
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