|Year : 2013 | Volume
| Issue : 4 | Page : 225-228
Child friendly colors in a pediatric dental practice
N Umamaheshwari1, Sharath Asokan2, Thanga S Kumaran3
1 Department of Pediatric Dentistry, J. K. K. Nataraja Dental College and Hospital. Komarapalayam, India
2 Department of Pediatric Dentistry, K S R Institute of Dental Science and Research. Tiruchengode, Tamil Nadu, India
3 Department of Periodontology and Oral Implantology, J. K. K. Nataraja Dental College and Hospital. Komarapalayam, India
|Date of Web Publication||21-Nov-2013|
Department of Pediatric Dentistry, J. K. K. Nataraja Dental College and Hospital, P.B.No:151, Natarajapuram, NH-47 (Salem to Coimbatore), Komarapalyam, Namakkal Dist - 638 183, Tamilnadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The child's perception of the dental environment is a significant factor causing dental anxiety. If the color of the dental environment can have a positive impact on the child's behavior, it is possible that those colors may add to the comfort of a child, thus reducing dental anxiety. Aim: To evaluate the association between color and emotions of children in a pediatric dental set-up. Design: A total of 300 children aged 6-12 years were divided into 2 groups: Younger children (6-9 years, n = 156) and older children (9-12 years, n = 144). All the children were asked to shade two cartoon faces representing happiness and fear with their most preferred color. Results: For the positive emotion, 44% (n = 132) of the children preferred yellow, followed by blue 32.67% (n = 98). For negative emotion, 56.67% (n = 170) of the children preferred black and 42.67% (n = 128) preferred red. Association between color and emotion was highly significant (P < 0.001). Conclusion: This study has attempted to advance the area of color research to dental anxiety in children visiting a dental clinic. The use of child friendly colors like yellow and blue in the dental work place could enhance a positive dental attitude in the child's mind.
Keywords: Anxiety of children, color, emotions in a dental clinic
|How to cite this article:|
Umamaheshwari N, Asokan S, Kumaran TS. Child friendly colors in a pediatric dental practice. J Indian Soc Pedod Prev Dent 2013;31:225-8
|How to cite this URL:|
Umamaheshwari N, Asokan S, Kumaran TS. Child friendly colors in a pediatric dental practice. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2017 Jun 22];31:225-8. Available from: http://www.jisppd.com/text.asp?2013/31/4/225/121817
| Introduction|| |
The child's dental anxiety has been of concern for many years  and it is still a barrier to dental care.  There are many factors that cause the dental anxiety in children. They develop anxiety directly (by conditioning) or via indirect learning (by modeling or from information). The child's perception of the dental environment is also a significant factor causing the anxiety. The changing expectations of children encourage pediatric dentists to develop a more child-friendly atmosphere in their dental clinics. Environmental elements that produce positive feelings can reduce anxiety.  If the color of the dental environment can have a positive impact on the child's behavior, it is possible that those colors may add to the comfort of a child, thus reducing dental anxiety.
Color is one of the most instantaneous method of conveying messages and meanings. Our very survival depends on the ability to identify necessary objects and/or warning signals and color is an integral part of that identification process. Among other uses, color stimulates and works synergistically with all of the senses, symbolizes abstract concepts and thoughts, expresses fantasy or wish fulfillment, recalls another time or place and produces an aesthetic or emotional response.  Color has been studied from philosophical, biological, anthropological and psychological perspectives over the course of time.  Children were able to categorize colors according to several dimensions, most basic being whether or not a color perceived had a positive or negative effect on their emotions or whether or not they found the colors to be agreeable or not agreeable. In addition, they could link colors and emotions.  The discovery of the correlation between color and emotions and their effect on performance and productivity has recently been adopted in the work settings. Most of the exiting research on environmental design has been focused for healthy adults and those findings cannot be extrapolated for children. Park (2009) conducted a study to investigate the value of color as a component of a healing environment for pediatric patient room.  Although previous color studies are suggestive, none was focused on a pediatric dental environment. In a pediatric dental practice, some children react positive, while others are anxious. The use of child friendly colors in the dental office could create a positive environment for all of them. Thus the present study, first of its kind was carried out to evaluate the color-emotion association in relation to children's anxiety level.
| Materials and Methods|| |
A cross-sectional study was planned in the Department of Pediatric Dentistry, JKK Nataraja Dental College and Hospital, Tamil Nadu, India. The study protocol was analyzed and approved by the Institutional Review Board of JKK Nataraja institution. Written consent was obtained from the parents of all the participating children. A total of 300 children between ages 6-12 years participated in the study. They were divided into 2 groups: Younger children (6-9 years, n = 156) and older children (9-12 years, n = 144). A specially prepared pro forma was used to record personal information, Corah's dental anxiety scale and two cartoon line-drawing of faces. The face drawings included two different emotions: Happiness (positive emotion) and fear (negative emotion). Corah's dental anxiety scale was recorded by a calibrated examiner A in the waiting room. Each question was scored from 1 (not anxious) to 5 (extremely anxious) and hence the total score ranged from 5 to 20. A score of 9 or more was considered anxious. Children were divided into anxious and non-anxious groups based on their Corah's dental anxiety score. All the 300 children were given six crayon pencils (blue, green, pink, yellow, red and black) by examiner B and were asked the following "When you are happy, which color would you prefer to shade the happy face?" They were allowed to shade with their most preferred color for the positive emotion. Then the drawing representing fear was shown and asked, "If you are fearful, which color will you choose to shade this face?" and they were allowed to shade with the cartoon drawing with their preferred color. A probable association between the preference of color and their emotions were evaluated. Chi-square test (SPSS version 15) was used to evaluate the association between the variables and P ≤ 0.05 was considered statistically significant.
| Results|| |
The mean Corah's dental anxiety score for all the 300 children was 8.62. A total of 104 children (66.67%) of the younger age group were graded as anxious and 52 children (33.33%) were graded as non-anxious. 56 children (38.89%) of the older age group were anxious and 88 children (61.11%) were non-anxious. Dental anxiety was more in younger children than the older children and the difference was found to be highly statistically significant (P < 0.001) as shown in [Figure 1]. For positive emotion, 44% (n = 132) of the children preferred yellow, followed by blue 32.67% (n = 98), green 11.67% (n = 35), pink 11% (n = 33), red and black 0.33% (n = 1) respectively. [Figure 2] shows that for negative emotion, 56.67% (n = 170) of the children preferred black, 42.67% (n = 128) preferred red and 0.33% (n = 1) preferred blue, 0.33% (n=1) preferred blue and 0.33% (n=1) preferred yellow respectively. Association between the color and emotion was highly significant (P < 0.001). The color preference for positive and negative emotion was compared based on their anxiety level and age group. Both anxious and non-anxious children preferred yellow followed by blue for positive emotion. However, in comparison by age, the younger anxious children preferred yellow significantly more (65.38%) and older non-anxious children preferred blue significantly more (54.55%) (P < 0.001) as shown in [Figure 3]. On the other hand, [Figure 4] shows that both anxious and non-anxious children preferred black and red for negative emotion. The color preference for negative emotion among anxious and non-anxious (P = 0.44) children in relation with their age group was not statistically significant (P = 0.43 and 0.44 respectively).
|Figure 2: Prevalence of choice of color for the emotions and their association|
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|Figure 3: Color preference for positive emotion among anxious and non-anxious children|
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|Figure 4: Color preference for negative emotion among anxious and non-anxious children|
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| Discussion|| |
Color is a salient feature in a child's life. A child's environment including his/her clothes, toys, and home accessories convey many psychological messages through colors.  Goldstein claimed that specific color elicits specific emotional responses.  Clinicians have asserted that children's use of color in art, for example, is a manifestation of their underlying emotional status. , In this study it was decided to include six easily identifiable color groups: Blue, green, pink, yellow, red, and black. The colors chosen correspond to the four principle colors (blue, green, yellow, red) of the Munsell system; pink as it might be related to bodily tissues and finally black, an achromatic color.  To avoid specific hues and printer problem in reproducing the exact shade that could have a dramatic impact on the study, crayon color pencils were used rather than printing the shades in the paper.
Six emotions as defined by Ekman and Friesen include happiness, surprise, anger, sadness, aversion, and fear.  In this study, the two well experienced emotions of children, happiness and fear, were included. Terwogt and Hoeksma have shown that children and adults ranked their emotions differently.  Both groups ranked happiness and surprise the highest followed by the four negative emotions. Children seemed to relatively accept fear, as they experience fear on a daily basis at the younger ages whereas they ranked anger lower. It was found that surprise and sadness become less preferential with age.
The results of the study showed that both anxious and non-anxious children preferred yellow as their color choice for positive emotion followed by blue. But anxious children preferred yellow significantly more and non-anxious children preferred blue significantly more. It has been found that the associations of some mood tones with particular colors are more apparent and precise than others.  The color yellow is associated with happiness, cheerfulness and a positive emotional state; ,, the color blue is associated with secure, calm, comforting; green with quietness; red with anger, aggression, excitation; black with depression or anxiety. , Cimbalo et al., concluded that children viewing happy scenes used yellow, blue, green and orange to color, whereas when viewing sad scenes, they tend to use red, black and brown. Lawler and Lawler found that preschoolers colored with yellow crayon after hearing a happy story and with a black crayon after hearing sad story.  Odom et al., conducted a study to examine the color hue effects on mood tones. The results of the study supported that yellow was found to be both cheerful and exciting whereas blue was associated with being calm.  Park investigated the color preferences for the pediatric patient rooms among the inpatients, outpatients, and healthy children. All the three groups showed similar color preference patterns, except for yellow. Both pediatric outpatients and inpatients preferred yellow less than healthy children. Regardless of gender effects, healthy children and pediatric patients preferred blue and green the most and white the least. 
Terwogt et al.,  found that the link between color and emotion preferences varied between age groups. The younger age groups had a better correlation between colors and emotions involved, whereas the older age groups had a lower correlation. This is consistent with the theory that as the individual gets older his/her preferences change based on their experiences. Overall older groups preferred blue followed by green and yellow; younger children preferred yellow. In the present study younger children preferred yellow and older children preferred blue significantly more than the other colors for positive emotion.
Specific colors do usually elicit particular emotions, but the particular emotions involved are in no way the same for each individual.  The emotion triggered by a color depends on nationality, past experiences, and sometimes personal preferences. In our study, one child in contrary to the typical association of positive emotion with color blue, associated it with negative emotion of fear. Her reasoning was that her mother told blue sea is scary and dangerous. One child associated black with positive emotion because he loves watching black fish in aquarium. Another child remarked yellow made her fearful because her mom used to compel her to have yellow portion of the egg which she hates the most. These comments revealed that their color-emotion associations aroused from a single and concrete experience with a color. In few children, individual responses to color vary but the average reaction of groups of children is justification enough to reach a conclusion. 
The study has been attempted to understand better, the value of color in the dental environment and the appropriate colors for the pediatric dental population. The results showed that children do have preferential colors and can match these colors to emotions. Specific colors and combinations can psychologically affect the vast majority of people regardless of their culture or past. The color yellow preferred by the anxious and younger children for positive emotion provides the most cheerful and positive environment. ,,,, The color blue preferred by the non-anxious and older children provide a calm environment.  Goethe (1840)  created a color wheel showing the psychological effect of each color. He noticed that blue gives a feeling of coolness and yellow has a warming effect. He divided all the colors into two groups - the plus side (from red through orange to yellow) and the minus side (from green through violet to blue). Colors of the plus side produce excitement and cheerfulness. Colors of the minus side are associated with weakness and unsettled feelings. The complementary color scheme consists of two colors that are opposite to each other on the color wheel. This scheme looks best when you place a warm color against a cool color. This suggests that yellow can be the primary color and color blue can be an adjunct to it in the dental environment. Colors like black and red can be avoided. This study has attempted to advance the area of color research to dental environment. It has also attempted to correlate the preference of color to the emotions of children in a dental set-up. The use of the "child friendly" colors like yellow (warm color) and blue (cool color) in the dental work place could create a positive dental attitude in the child's mind. Future research with larger sample size, larger range of color samples and varying saturation could establish a strong association between different colors and emotions of children.
| Acknowledgments|| |
The authors wish to thank Dr. M.S. Muthu MDS, PhD for his valuable suggestions in writing this work and Dr. Shymala BDS, MSc (Epidemiology) for helping us with the statistical analysis.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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