ORIGINAL SCIENTIFIC ARTICLE Behavioural and physiological outcomes of biofeedback therapy on dental anxiety of children undergoing restorations: a randomised controlled trial P. Dedeepya • S. Nuvvula • R. Kamatham • S. V. S. G. Nirmala Received: 9 March 2013 / Accepted: 13 July 2013 Ó European Academy of Paediatric Dentistry 2013 Abstract Aim To explore the efficacy of biofeedback as possible alternative means of psychological behaviour guidance in children receiving dental restorations. Study design Randomised clinical trial with a cross over design carried out on 40 children (19 boys and 21 girls) to determine the efficacy of biofeedback in reducing the dental anxiety through subjective and objective measures during restorative treatments under cotton roll isolation without administration of local analgesia. Method Highly anxious children with a minimum of five carious lesions were trained to lower their anxiety using biofeedback in five sessions within a 4-week interval, each session lasting for 45 min. After initial training, children were randomly divided into two groups and restorations were placed in four sequential therapeutic sessions with a 1-week interval and a follow-up visit 3 months later. First group received biofeedback in the second and third ses- sions; whereas the second group received biofeedback in the first and third sessions. Results Biofeedback therapy in children led to lower levels of anxiety in the initial appointments when assessed objectively, however the subjective methods of evaluation could not depict any statistically significant difference. Conclusion Biofeedback can be used in the initial visits for dentally anxious children and the usage of simpler biofeedback machines for these appointments in dental setup is suggested. Keywords Biofeedback Á Behaviour guidance Á Children’s dental anxiety Introduction Children fail to seek dental treatment for numerous reasons and one of the most significant among them is anxiety (Kleiman 1982). This anxiety on certain occasions leads to complete avoidance of dental care or for those who inter- mittently seek dental care, can cause unnecessary high levels of stress during dental visits. Contemporary paedi- atric dental literature reflects a growing concern with the problem of childhood dental anxiety (Wigen et al. 2009; Jones and Buchanan 2010; Sharma and Tyagi 2011). Technologic improvements and advances in pain control have reduced many of the dental fears children once felt, which are being further diluted by the attitudinal changes in the profession. Dentists can guide most of the children by using communicative means, but, some might need phar- macological help. Earlier research suggests that direct conditioning is the primary pathway for acquisition of dental fear in childhood (Locker et al. 1999). Varieties of behavioural guidance techniques have been applied to control and/or eliminate these anxious reactions to dental procedures both in adults and children (Roberts et al. 2010). An alternative therapy, regarded as a behavioural, psychological, social and spiritual approach to medicine focused on relation between brain, mind and body is bio- feedback training, which originated from the field of P. Dedeepya Á S. Nuvvula Á R. Kamatham (&) Á S. V. S. G. Nirmala Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh 524003, India e-mail: rekhanagmds@yahoo.co.in S. Nuvvula e-mail: dentist4kids@gmail.com 123 Eur Arch Paediatr Dent DOI 10.1007/s40368-013-0070-3