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ORIGINAL ARTICLE
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The effect of pediatric dental clinical environment on children's behaviors in Riyadh City


 Division of Pediatric Dentistry, Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia

Correspondence Address:
Haneen Alshukairi,
Division of Pediatric Dentistry, Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, P.O.Box 8963, Riyadh 11492
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjos.SJOralSci_66_19

  Abstract 


Background: Fear of dental treatment prevents children from cooperation in the dental clinic. Children's behavior can be improved if the environment of the dental practice is modified.
Aim: This study aims to assess the effect of the atmosphere of the dental clinic and the dentist's attitude on the patient's behaviors.
Materials and Methods: A 13 questions survey was developed to assess the various factors contributing to childhood fears in the dental clinic. One hundred and thirty children presenting to Riyadh Elm University who agreed to participate consented.
Results: Fifty percent of children prefer to have a female doctor, and 60% of them like to see a dentist in a white coat. Furthermore, 46% of children are happy watching a cartoon, and 44% enjoy listening to a story during treatment. The presence of parents during the procedure and getting a reward at the end show significant children satisfaction. In addition, having a play station in the waiting room and having a dental tour before starting treatment were useful tools to reduce the fear of children. Finally, the color and the smell of the clinic, as well as the time of the dental appointment, were not significant factors to improve children anxiety.
Conclusion: Improving the environment of the dental clinic and the attitude of the dentist are crucial elements to reduce children's fear during dental treatment.

Keywords: Anxiety, dental clinic, dental environment, fear



How to cite this URL:
Alshukairi H, Al Muhaidib D, Aleidan S. The effect of pediatric dental clinical environment on children's behaviors in Riyadh City. Saudi J Oral Sci [Epub ahead of print] [cited 2020 Aug 4]. Available from: http://www.saudijos.org/preprintarticle.asp?id=279063




  Introduction Top


Fear of dentist and dental treatment is still the main problem that prevents young children from cooperation in dental practice.[1] The age of patients plays an essential role in that fear.[2] By the period of 6–7 years, dental anxiety starts to decrease;[3] however, other factors may influence the child ability to minimize his/her own fear.[4]

In many cases, parents transmit their anxiety to their children in their first dental visit. Mothers as the closest person to the children may influence their children's behavior in dentistry.[5] Other factors like the clinic environment, the dentist's behavior also may affect the child reaction to dentistry.

A comfortable atmosphere during the child's first visit help to develop a strong relationship with the dentist and the child does not feel frightened.[6]

In the dental clinic, the receptionist is the first person to meet the child and greet him. The manner and the way the child introduced into the clinic for the first time is significant and plays an essential role in minimizing his anxiety.[7],[8] A beautiful and attractive reception area (e.g., age-appropriate toys and games) can distract the child and indicate how expert the staff is in dealing with young patients. The first impressions the child gets usually influences the future behaviors extremely.[9]

Warm colors in pediatric dentistry have a positive impact on their emotional status. Studies have shown that the color of the dental clinic helps in minimizing dental anxiety. Adding bright colors to the dental setup and introducing colorful equipment make the child feel better and more comfortable in the dental clinic.[10]

Usually, the child is also influenced by his dentist's appearance, expression, and motion.[6],[11] Dentist's outfit has been a topic of interest as there is a constant variation in the children's perception of their dentist's clothing. Various studies show that children have a preference for the white coat and formal outfit.[12],[13],[14] Most of these considerations may vary based on the age of the child.[15]

The perceptions of children regarding both the dentists and the dental environment need to assessment closely and carefully. As this information is essential and it can help dentists better shape their practices to meet the preferences of their patients. Therefore, this study aimed to evaluate school children's feelings and attitudes toward their dentist as well as their dental clinic.


  Materials and Methods Top


A cross-sectional study conducted at the dental clinic of Riyadh Elm University (REU). Healthy, children, aged between 6 and 12 years, who were attending the REU clinic between January and March 2018 included in the study. Informed consent obtained from their parents before collecting data. There were no exclusion criteria based on the reason for the clinic visit or lack of previous dental visits. A study questionnaire filled by two dental students who interrogated children in the waiting area. The responses presented as number and percentage. Significant differences in child preferences between those who had a good or bad experience with clinic visits were examined using Chi-square or Fisher's exact test, as appropriate. All P values were two-tailed. P < 0.05 was considered statistically significant. SPSS software (release 25.0, Armonk, NY, USA: IBM Corp, USA) used for statistical analysis.


  Results Top


A total of 132 children included in the current analysis. A total of 90 (68.2%) children had a previous visit to the dental clinic. Out of them, 62 (68.9%) children liked the stay while 28 (31.1%) did not like the visit. For all children, the majority preferred either morning (43.9%) or noon (41.7%) appointments, while only a few (14.4%) preferred afternoon appointments. More children preferred the walls of the dental clinic to be blue (31.1%), followed by cartoon-decorated (28.8%), pink (22.0%), and finally white (18.2%). The majority (57.6%) of children reported that flowers are the comfortable smell in the dental clinic. More children preferred to see games in the waiting area (31.1%), followed by playing with toys (28.8%), watching T. V. (24.2%), and finally reading books (15.9%). The majority of children preferred the dentist to wear a professional white laboratory coat (65.2%), to be funny (54.5%), and to be females (49.2%) rather than males (24.2%). The majority of children preferred taking a tour in the clinic before treatment (68.2%), to have their parents attending during treatment (65.9%), and to get a gift to encourage returning to the clinic (97.0%). For the activities during the procedure, the majority of children preferred either listening to their doctor telling a story (46.2%) or watching cartoon movies (43.9%) while only a few (9.8%) preferred listening to the music. Compared with children who either did not like their dental visit or those who never had one, children who liked their clinic visits were significantly preferring noon visit (P = 0.015), flowers clinic smell (P = 0.036), funny dentist (P = 0.001), female dentist (P = 0.021), and taking a tour in the clinic before treatment (P = 0.036), but not to have their parents attending during treatment (P = 0.036) [Table 1].
Table 1: Preferences of children by previous experience with dental clinic visit (n=132 children)

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  Discussion Top


Our study revealed that children have strong perceptions and preferences regarding dental visits and dentists. Sixty-eight percent of the examined children had a previous visit to the dental clinic; out of them, 69% liked the stay while 31 did not like the appointment. Our results are similar to the effects of other studies that have examined children's attitudes toward dental care.[16],[17] AlSarheed reported identical results. 63% of the children in her research liked their appointment to the dentist. However, 11% of children in that study reported that they disliked their stay, and another 12% said that they were afraid of the dentist.[12] Mittal and Sharma[2] showed that younger children had more negative opinions than older children because more youthful children could not comply with satisfactorily.[18]

Preference is more toward noon appointment in our study, only 14% preferred afternoon visit. This finding can explain that school-aged children avoid being absent from their school. In addition, the fatigue and tiredness kids usually suffer after a long day of activity disable them to coop with the dental treatment in the afternoon or evening time.

The children in our study preferred the wall of the dental clinic to be colorful or cartoon-decorated over the while plane color. McCarthy et al. also showed that the majority of the children favored the decorated clinic over a plane clinic. This finding attributed to the comfort and the distraction a colorful clinic can cause in patients during the treatment.[19] AlSarheed also reported similar results, which indicated that 63% of the children selected the decorated clinic.[12]

Interestingly, the smell of the clinic was another factor that may affect the child attitude and emotions toward the dental clinic. Fifty-seven percent of our sample would prefer to have comfortable flowers smell in the dental clinic. The different smell of dental materials can irritate children and increase their anxiety.

The majority of the children in our study preferred to play games (31%) or toys (29%), or at least T. V. (24%) in the waiting area. A pediatric dental clinic designed in such a way that children can feel comfortable as they wait for their appointment to minimize their stress. Furthermore, taking a tour at the clinic before the treatment is beneficial for the children to be familiar with the place and be less stressed. Forty-nine percent of children in our study prefer to be treated by a female dentist. Patır Münevveroǧlu et al. reported even a higher percentage, 84% of the children favored to be operated by a female dentist, regardless of the child's gender.[18] However, Mistry and Tahmassebi reported a significant difference in the preference of the patient for the gender of their dentist.[20] Similarly, AlSarheed indicated that children are more comfortable when treated by a dentist of the same gender.[12]

Our results indicated that children prefer their dentist to wear the traditional white coat in the dental clinic. This finding is similar to the results of McCarthy et al. found that contrary to what people believe, children are not afraid of the physician in a white coat.[19] Furthermore, Mistry and Tahmassebi assessed the attitudes of children and parents toward dental outfit and found that parents preferred traditional dress as it looks for professionalism.[20] Children may favor the white coat as they see it as a sign for healing. This result agrees with AlSarheed,[12] McKinstry and Wang[21] on the patient's attitude to the way the doctors' dress. However, this finding is different from other studies, which found that patients have less preference for the white coat.[22],[23] Münevveroglu et al. reported 76.5% of the children like their dentist to wear a colored coat instead of a white one.[18]

Another factor may minimize the anxiety of children during the dental visit. Fifty-four percent of the children in our study prefer to have a funny dentist that tell stories during the treatment. Forty-four percent find it less stressful if the procedure performed while watching cartoon movies. The presence of the parent is highly recommended in the young age group but not for the older age group, as the attachment to a parent is influential in the young patient.

Certain other factors may be the cause of the child's fear from the dental clinic, such as the stories mentioned by their siblings after a previous bad experience. Children who have negative impressions with a painful experience in the dental clinic are more likely to share these impressions with other children, which will be difficult to overcome.[24]


  Conclusion Top


We are reporting clear preferences of children attending a dental clinic in Saudi Arabia. Modifying dentist behavior, clinic environment, and prevailing practices can make the child visit to the dental clinic a pleasant experience. Such a situation can potentially alleviate traditional children stress and facilitate the dentist's work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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