Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study

Table 1 Distribution of Child drawing: Hospital scale and facial pain scale-revised scores based on age, gender and accompanying person

Variables		CD: H						FPS-R (local anaesthetic administration)					FPS-R (extractions)
		Mean ± SD	Classification
			≤43	44-83	84-129	130-167	>168	Mode	0	2-4	6-8	10	Mode	0	2-4	6-8	10
Age	4-6	76.43 ± 16.08	0	4	3	-	-	8	1	2	2	2	0	2	0	3	2
				3.73%	2.80%				0.93%	1.86%	1.86%	1.86%		1.86%		2.8%	1.86%
	> 6-9	76.06 ± 15.36	0	21	12	-	-	10	5	11	7	10	0	8	8	10	7
				19.6%	11.20%				4.67%	10.28%	6.54%	9.34%		7.47%	7.47%	9.34%	6.54%
	> 9-13	72.87 ± 16.75	3	43	21	-	-	2	6	38	17	6	0	17	24	18	8
			2.80%	40.18%	19.60%				5.60%	35.51%	15.88%	5.60%		15.88%	22.42%	16.82%	7.47%
	Significance		0.70NS					0.10NS					0.44NS
Gender	Boys	78.03 ± 15.29	0	35	23	-	-	2	7	22	17	12	0	14	17	17	10
				32.71%	21.49%				6.54%	20.56%	15.88%	11.2%		13.08%	15.88%	15.88%	9.34%
	Girls	69.41 ± 16.18	3	33	13	-	-	2	5	29	9	6	0	13	15	14	7
			2.80%	30.8%	12.14%				4.67%	27.10%	8.41%	5.60%		12.14%	14.01%	13.08%	6.54%
	Significance		0.08NS					0.17NS					0.97NS
Accom-panying person	Mother	72.55 ± 15.61	1	39	15	-	-	2	5	27	14	9	0	13	14	15	13
			0.93%	36.4%	14.01%				4.67%	25.23%	13.08%	8.41%		12.14%	13.08%	14.01%	12.14%
	Father	77.61 ± 17.15	1	16	14	-	-	2	5	14	8	4	2	10	15	6	3
			0.93%	14.95%	13.08%				4.67%	13.08%	7.47%	3.73%		9.34%	14.01%	5.60%	2.80%
	Guardian	72.90 ± 16.36	1	13	7	-	-	2	2	10	4	5	8	4	13	10	1
			0.93%	12.14%	6.54%				1.86%	9.34%	3.73%	4.67%		3.73%	12.14%	9.34%	0.93%
	Significance		0.47NS					0.90NS					0.12NS

CD: H: Children drawing: Hospital scale; FPS-R: Facial pain scale-revised; NS: Not significant, SD: Standard deviation.

Table 2 Distribution of faces, leg, activity, cry, consolability scale and frankl scores based on age, gender and accompanying person

Variables		FLACC (local anaesthetic administration)					FLACC (extractions)					Frankl (total score)
		Mode	0	1-3	4-6	7-10	Mode	0	1-3	4-6	7-10	Mode	2	3	4
Age	4-6	4	0	2	5	0	3	1	3	1	2	3	0	4	3
				1.86%	4.67%			0.93%	2.80%	0.93%	1.86%			3.73%	2.80%
	> 6-9	4	0	16	14	3	4	4	14	12	3	4	4	5	24
				14.95%	13.08%	2.80%		3.73%	13.08%	11.20%	2.80%		3.73%	4.67%	22.42%
	> 9-13	2	4	52	11	0	2	19	41	7	0	4	7	9	51
			3.73%	48.59%	10.28%			17.75%	38.31%	6.54%			6.54%	8.41%	47.66%
	Significance		< 0.011				< 0.011					0.06NS
Gender	Boys	2	2	37	17	2	2	14	29	12	3	4	3	11	44
			1.86%	34.57%	15.88%	1.86%		13.08%	27.10%	11.20%	2.80%		2.80%	10.28%	41.12%
	Girls	2	2	33	13	1	2	10	29	8	2	4	8	7	34
			1.86%	30.80%	12.14%	0.93%		9.34%	27.10%	7.47%	1.86%		7.47%	6.54%	31.77%
	Significance		0.95NS				0.82NS					0.16NS
Accompanying person	Mother	2	1	34	19	1	2	9	32	11	3	4	7	9	39
			0.93%	31.77%	17.75%	0.93%		8.41%	29.99%	10.28%	2.80%		6.54%	8.41%	36.44%
	Father	2	3	21	6	1	0	13	14	4	0	4	2	2	27
			2.80%	19.6%	5.60%	0.93%		12.14%	13.08%	3.73%			1.86%	1.86%	25.23%
	Guardian	2	0	15	5	1	2	2	12	5	2	4	2	7	12
				14.01%	4.67%	0.93%		1.86%	11.20%	4.67%	1.86%		1.86%	6.54%	11.20%
	Significance		0.34NS				0.07NS					0.10NS

¹Significant at 0.01 level. FLACC: Faces, leg, activity, cry, consolability scale; NS: Not significant.

Table 3 Differences between/among scores (Child drawing: Hospital scale and facial pain scale-revised) in groups divided based on age, gender and accompanying person

Variables	Groups	Mean ± SD	One way ANOVA P valve	Post hoc comparisons	Post hoc P valve
CD: H	Age groups (4-6, > 6-9, > 9-13)	4-6: 76.4 ± 16.1	0.61NS	4-6 vs > 6-9	1.00NS
		> 6-9: 76.1 ± 15.4		> 6-9 vs > 9-13	0.66NS
		> 9-13: 72.9 ± 16.7		4-6 vs > 9-13	0.86NS
	Gender (boys and girls)	Boys: 78.0 ± 15.3	0.011	--	--
		Girls: 69.4 ± 16.2
	Accompanying person (mother, father, guardian)	Mother: 72.6 ± 15.6	0.36NS	Mother vs father	0.38NS
		Father: 77.6 ± 17		Mother vs guardian	1.00NS
		Guardian: 72.9 ± 16.4		Father vs guardian	0.59NS
FPS-R (LA)	Age groups (4-6, > 6-9, > 9-13)	4-6: 6.0 ± 4.0	0.07NS	4-6 vs > 6-9	0.92NS
		> 6-9: 5.5 ± 3.8		> 6-9 vs > 9-13	0.14NS
		> 9-13: 4.1 ± 2.9		4-6 vs > 9-13	0.33NS
	Gender (boys and girls)	Boys: 5.0 ± 3.5	0.24NS	--	--
		Girls: 4.2 ± 3.1
	Accompanying person (mother, father, guardian)	Mother: 4.8 ± 3.9	0.63NS	Mother vs father	0.64NS
		Father: 4.1 ± 3.3		Mother vs guardian	1.00NS
		Guardian: 4.8 ± 3.6		Father vs guardian	0.80NS
FPS-R (Ext)	Age groups (4-6, > 6-9, > 9-13)	4-6: 6.0 ± 4.3	0.28NS	4-6 vs > 6-9	0.78NS
		> 6-9: 4.9 ± 3.9		> 6-9 vs > 9-13	0.54NS
		> 9-13: 4.0 ± 3.5		4-6 vs > 9-13	0.41NS
	Gender (boys and girls)	Boys: 4.7 ± 3.8	0.50NS	--	--
		Girls: 4.2 ± 3.6
	Accompanying person (mother, father, guardian)	Mother: 5.0 ± 3.9	0.06NS	Mother vs father	0.08NS
		Father: 3.1 ± 3.3		Mother vs guardian	1.00NS
		Guardian: 5.0 ± 3.4		Father vs guardian	0.70NS

¹Significant at 0.01 level. CD: H: Children drawing: Hospital scale; FPS-R: Facial pain scale-revised; L.A: Local anaesthetic administration; Ext: Extractions; NS: Not significant.

Table 4 Differences between/among scores (faces, leg, activity, cry, consolability dcale and frankl) in groups divided based on age, gender and accompanying person

Variables	Groups	Mean ± SD	One way ANOVA P valve	Post hoc comparisons	Post hoc P valve
FLACC (LA)	Age groups (4-6, > 6-9, > 9-13)	4-6: 3.9 ± 1.9	< 0.012	4-6 vs > 6-9	0.97NS
		> 6-9: 3.7 ± 2.2		> 6-9 vs > 9-13	< 0.012
		> 9-13: 2.3 ± 1.2		4-6 vs > 9-13	0.06NS
	Gender (boys and girls)	Boys: 2.9 ± 1.8	0.61NS	--	--
		Girls: 2.8 ± 1.6
	Accompanying person (mother, father, guardian)	Mother: 3.0 ± 1.6	0.60NS	Mother vs father	0.62NS
		Father: 2.6 ± 1.8		Mother vs guardian	1.00NS
		Guardian: 3.0 ± 1.9		Father vs guardian	0.75NS
FLACC (Ext)	Age groups (4-6, > 6-9, > 9-13)	4-6: 3.9 ± 2.8	< 0.012	4-6 vs > 6-9	0.67NS
		> 6-9: 3.2 ± 2.4		> 6-9 vs > 9-13	< 0.012
		> 9-13: 1.6 ± 1.5		4-6 vs > 9-13	0.012
	Gender (boys and girls)	Boys: 2.3 ± 2.2	0.93NS	--	--
		Girls: 2.2 ± 1.9
	Accompanying person (mother, father, guardian)	Mother: 2.5 ± 1.9	< 0.012	Mother vs father	0.021
		Father: 1.3 ± 1.5		Mother vs guardian	0.62NS
		Guardian: 3.0 ± 2.4		Father vs guardian	0.012
Frankl (total)	Age groups (4-6, > 6-9, > 9-13)	4-6: 3.4 ± 0.5	0.68NS	4-6 vs > 6-9	0.86NS
		> 6-9: 3.6 ± 0.7		> 6-9 vs > 9-13	0.69NS
		> 9-13: 3.7 ± 0.7		4-6 vs > 9-13	0.94NS
	Gender (boys and girls)	Boys: 3.7 ± 0.6	0.17NS	--	--
		Girls: 3.5± 0.8
	Accompanying person (mother, father, guardian)	Mother: 3.6 ± 0.7	0.17NS	Mother vs father	0.32NS
		Father: 3.8 ± 0.5		Mother vs guardian	0.82NS
		Guardian: 3.5 ± 0.7		Father vs guardian	0.22NS

¹Significant at 0.05 level;

²Significant at 0.01 level. FLACC: Faces, leg, activity, cry, consolability scale; LA: Local anaesthetic administration; Ext: Extractions; NS: Not significant.

Table 5 Correlation of Children drawing: Hospital Scale with facial pain scale-revised, faces, leg, activity, cry, consolability scale and frankl

Variables	Groups		CD:H	FPS-R (LA)	FPS-R (Ext)	FLACC (LA)	FLACC (Ext)	Frankl (Total)
Age	4-6	Correlation	1	0.87	-0.17	0.84	0.71	-0.14
		Significance	-	0.012	0.72NS	0.021	0.07NS	0.76NS
	> 6-9	Correlation	1	-0.09	-0.24	0.20	-0.12	0.27
		Significance	-	0.63NS	0.19NS	0.26NS	0.50NS	0.63NS
	> 9-13	Correlation	1	0.21	0.17	-0.08	0.05	0.07
		Significance	-	0.09NS	0.17NS	0.53NS	0.67NS	0.56NS
Gender	Boys	Correlation	1	0.11	-0.12	0.12	0.09	0.01
		Significance	-	0.40NS	0.37NS	0.38NS	0.52NS	0.94NS
	Girls	Correlation	1	0.18	0.18	0.11	0.07	0.15
		Significance	-	0.22NS	0.21NS	0.46NS	0.65NS	0.32NS
Accompanying person	Mother	Correlation	1	0.18	0.10	0.19	0.28	0.01
		Significance	-	0.20NS	0.47NS	0.17NS	0.041	0.98NS
	Father	Correlation	1	-0.06	-0.01	0.02	0.08	0.1
		Significance	-	0.74NS	0.97NS	0.91NS	0.68NS	0.60NS
	Guardian	Correlation	1	0.55	0.11	0.20	-0.12	0.33
		Significance	-	0.012	0.65NS	0.38NS	0.61NS	0.14NS
Total		Correlation	1	0.17	0.04	0.12	0.08	0.12
		Significance	-	0.09NS	0.72NS	0.21NS	0.44NS	0.24NS

¹Significant at 0.05 level;

²Significant at 0.01 level. NS: Not significant; CD: H: Children drawing: Hospital Scale; FPS-R: Facial pain scale-revised; FLACC: Faces, leg, activity, cry, consolability scale; L.A: Local anaesthetic administration; Ext: Extractions.