Use of the Lüscher Color Test in Pediatric Dentistry: A Prospective Study in Behaviorally Challenging Pediatric Dental Patients Undergoing Conscious Sedation

TL;DR

This study explores the Lüscher Color Test as a non-verbal tool to measure anxiety in children undergoing dental sedation, finding it shows some correlation with heart rate changes.

Contribution

The study introduces the Lüscher Color Test as a potential non-verbal anxiety measure for pediatric dental patients.

Findings

Anxiety scores measured by the Lüscher Color Test and VFAS decreased significantly after treatment.

Changes in Lüscher scores were strongly correlated with heart rate reduction.

Nitrous oxide sedation showed a non-significant trend toward greater anxiety reduction.

Abstract

Background: Dental anxiety is common in pediatric dentistry and may hinder care, particularly in behaviorally challenging children. Most anxiety measures rely on verbal report, which can be unreliable in young patients. This study explored whether the Lüscher Color Test, a non-verbal psychological instrument, shows associations with established anxiety proxies in a pediatric dental sedation setting. Methods: In this single-center prospective observational study, 100 children aged 4–12 years referred for dental treatment in a conscious sedation unit were recruited; 80 completed the protocol (exclusion rate 20%). N2O/O2 inhalation sedation was not randomized and was selected by the clinician based on clinical judgement. Anxiety was assessed pre- and post-operative using the Lüscher Color Test, heart rate (HR) monitoring, and the Visual Facial Anxiety Scale (VFAS). The primary outcome was the pre–post change in the Lüscher anxiety index calculated as the pre-operative score minus the post-operative score (Δ = pre − post). Associations between changes in anxiety measures and demographic/clinical variables were examined. Results: Anxiety scores decreased after treatment for both the Lüscher Color Test and VFAS (both p < 0.001). Change in Lüscher scores was positively associated with HR reduction (Spearman r = 0.68; p < 0.01), whereas VFAS change showed a weaker association (r = 0.28; p < 0.05). In regression analyses, treatment-related variables were explored; however, given the observational design and subgroup imbalance, these findings should be interpreted cautiously. Conclusions: Although pre–post scores suggested a reduction in anxiety, the Lüscher Color Test should be considered an exploratory, complementary non-verbal measure rather than a validated diagnostic instrument. In the multivariable logistic regression, nitrous oxide sedation showed only a non-significant trend toward greater anxiety reduction (p = 0.07). Further studies with appropriate validation frameworks and stronger designs are needed before clinical implementation can be recommended.

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