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^st 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 (I²) 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, et al. 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.