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

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