Download PDF
Open Access
CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0045-1813651
Original Article

Assessing Pediatric Dental Stress Through Wearable Technology: Influence of Procedure Type, Treatment Phase, and Age

Authors

  • Francesco Saverio Ludovichetti 

    1   Neurosciences Department, Dentistry Section, Università Degli Studi di Padova, Padova, Italy

  • Julia Gonçalves de Freitas

    1   Neurosciences Department, Dentistry Section, Università Degli Studi di Padova, Padova, Italy

  • Claudia Manera

    1   Neurosciences Department, Dentistry Section, Università Degli Studi di Padova, Padova, Italy

  • Patrizia Lucchi

    1   Neurosciences Department, Dentistry Section, Università Degli Studi di Padova, Padova, Italy

  • Federica I. Giordano

    1   Neurosciences Department, Dentistry Section, Università Degli Studi di Padova, Padova, Italy

  • Edoardo Stellini

    1   Neurosciences Department, Dentistry Section, Università Degli Studi di Padova, Padova, Italy

  • Sergio Mazzoleni

    1   Neurosciences Department, Dentistry Section, Università Degli Studi di Padova, Padova, Italy
Further Information
Also available at
  Permissions and Reprints

Abstract

Objective

Pediatric dental stress is a common barrier to effective treatment, often resulting in behavioral management challenges and long-term avoidance of dental care. Wearable technology, such as smart watches capable of measuring heart rate variability (HRV), may offer real-time, noninvasive tools to assess stress in clinical settings. This study aimed to evaluate physiological stress responses in children undergoing different dental procedures by analyzing HRV across treatment phases.

Materials and Methods

Eighty children aged 5 to 10 years (mean age = 7.2 ± 1.6 years) were randomly assigned to four treatment groups: dental hygiene, dental restorations with anesthesia, restorations without anesthesia, and sealant application. Stress levels were measured using Garmin smart watches that analyze HRV and convert the data into a stress score from 0 to 100. Stress was recorded at three time points—beginning, during, and end of the procedure—for a total of nine measurements per patient. A two-way repeated measures ANOVA was used to evaluate the effects of treatment type and phase, along with post hoc tests and linear regression to assess age-related stress variation.

Results

While the type of treatment alone did not significantly influence stress levels, stress varied significantly across treatment phases (p = 0.0249), with a strong interaction between treatment and phase (p = 0.0004). Post hoc analyses revealed that dental hygiene led to a significant reduction in stress over time (p < 0.05), whereas restorations with anesthesia caused a significant increase in stress during the procedure (p = 0.0011). No significant changes were observed for restorations without anesthesia and sealant application. Age was inversely correlated with stress (p = 0.0003), although it explained only a small proportion of variance (R 2 = 0.0527).

Conclusion

The study confirms that pediatric dental stress is influenced by both the procedure type and the treatment phase. Smart watches represent a practical tool for monitoring stress in real time. These findings highlight the importance of tailoring behavior management strategies to the procedure and the patient's age, promoting individualized and stress-reducing approaches in pediatric dental care. From a clinical perspective, wearable stress monitoring can assist pediatric dentists in real-time identification of anxiety peaks, allowing timely behavioral adjustments and potentially improving treatment outcomes and patient cooperation.

Keywords

pediatric dentistry - heart rate variability - stress assessment - behavioral management


Publication History

Article published online:
23 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India