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ORIGINAL ARTICLE
Year : 2016  |  Volume : 34  |  Issue : 1  |  Page : 30-35
 

A survey of the dentist attire and gender preferences in dentally anxious children


Department of Pedodontics and Preventive Dentistry, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India

Date of Web Publication2-Feb-2016

Correspondence Address:
Alexander Asokan
Department of Pedodontics and Preventive Dentistry, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.175507

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   Abstract 

Background: Anxiety about doctors among children is very common. White coat phobia which is a classical conditioning phenomenon is said to be prevalent among children. Objectives: To analyze the association between anxious states of children about dentists and their preference of dentist attire and gender in the dental office. Materials and Methods: The 9-12-year-old middle school children were selected for the study. Children were asked to fill a questionnaire containing children's fear survey schedule-dental subscale (CFSS-DS) and asked to prefer dental attire from four different pictures displaying the single anonymous dentist in four different attires in the same operator. The CFSS-DS gave the anxiety scale, and age, gender, and experience were also plotted against children preference in an apron, protective wear, and gender preference. Results were tabulated and statistically analyzed using Chi-square test. Results: About 718 (62%) were scored as anxious children. Of all anxious children, 502 (69.9%) had preference of colored attires of the dentist, and 408 (66.8%) anxious children preferred dentist with protective wear. Female dentists were preferred by 452 (66%) anxious children. Same gender preference was also prevalent.


Keywords: Children′s fear survey schedule-dental subscale, children preferences, dental attire, dentist gender


How to cite this article:
Asokan A, Kambalimath HV, Patil RU, Maran S, Bharath K P. A survey of the dentist attire and gender preferences in dentally anxious children. J Indian Soc Pedod Prev Dent 2016;34:30-5

How to cite this URL:
Asokan A, Kambalimath HV, Patil RU, Maran S, Bharath K P. A survey of the dentist attire and gender preferences in dentally anxious children. J Indian Soc Pedod Prev Dent [serial online] 2016 [cited 2019 Jul 17];34:30-5. Available from: http://www.jisppd.com/text.asp?2016/34/1/30/175507



   Introduction Top


In developing countries, the need for dental pediatric oral health care is increasing. The success of pediatric dentist practice is not only dependent on the technique applied or the technical skills of the pediatric dentist but also on their patients, their attitudes, and behavior in the operatory. The positive interaction between pediatric dentists and children is very important to improve work efficiency and for motivation. By establishing good communication with children, the pediatric dentist can provide reassurance and moral support which improves the chances their patients to take up proper treatment. An understanding of the child psychology will help pediatric dentist to modify and shape the patient's attitude toward dental care and dental caregivers.

A biggest hindrance in reaching out to the children is their anticipated trait anxiety. Dental anxiety has a very early onset in childhood in most of the population and is to be of exogenous origin. In young adolescent-onset anxiety, trait anxiety is most prevalent. [1] It is widely recognized that colors also have a strong impact on our emotions and feelings. [2] Children had categorized colors based on several dimensions. In addition, they could link colors and emotions such as pleasing effect or unpleasant effect. [3] There was evidence that distraction therapy by using clown doctors could significantly improve significantly the behavior of children, before surgical procedures. [4] In some early studies, colors such as red, blue, yellow, green, black, and white were hypothesized to be associated with anger, happiness, sadness, surprise, disgust, and fear, respectively. [3],[5] Therefore, to understand the children preferences in dentist and their attire and to find their relation to their dental anxiety, the present study has been conducted.


   Materials and Methods Top


The study was planned in Department of Pedodontics and Preventive Dentistry, Rishiraj College of Dental Sciences and Research Centre. Since there was no invasive procedures involved and no inception of unethical concepts in the children the Ethical Committee approved the study. A total of 1155 school children participated in this study. The study was conducted in three different schools at Bhopal By three undergraduates of Rishiraj college of dental sciences and research centre and tabulated data were given to the researcher within a period of 1 week. As suggested by previous studies, validity of parental ratings of their children dental fear should be questioned, particularly in high-fear populations and self-ratings can used be as far as possible; [6] therefore, a questionnaire was prepared in both English and (Hindi) native language of the children to facilitate better understanding for children. In the previous study, age of 4 years and less cooperativeness in the first dental visit, maternal dental fear, unbearable pain during the first dental visit, and visiting dentists in a regular dental clinic were the predictors of clinical anxiety and children fear survey schedule-dental subscale (CFSS-DS) score; therefore, an age group of 9-12-year-old were alone selected for the study considering their fear perception would be more validated without external influences. [7] The questionnaire consisted of CFSS-DS and questions related to their past dental or medical experience and their preferences toward dentist i.e., male dentist or female dentist. The CFSS-DS covers more aspects of the dental situation; it measures dental fear more precisely than the other scales normative data are available on this scale, and it has slightly superior psychometric properties. [8] The CFSS-DS consists of 15 items related to different aspects of dental treatment which were scored as follows: Not afraid: (1), a little afraid: (2), fairly afraid: (3), quite afraid: (4), and very afraid: (5). Total scores thus ranged from 15 to 75. Score 75 indicating maximum fear components. Children with CFSS-DS ≥38 were defined as dentally anxious. [8]

Final questions were designed to get the children preferences of dentist attire (i.e., dentist apron and protective wear; they use including glasses and masks), previous experiences in dental clinic or doctor including their own or indirect experiences from siblings and children's preference of dentist gender. The children were asked to complete the questionnaire in supervision of parents. After the children had completed the questionnaire, they were showed individually four photographs of a single anonymous dentist wearing four different aprons in a single clinical set up [Figure 1]. Two of the attires were formal doctor's/dentist attire (white colored) and other two were stylish colored attire (blue and green colored). However, children preference of colors was associated to the emotions by cognitive experiences; therefore, children's preference may vary with age also. [9] Therefore, in the present study, middle school children in 9-12 years were selected. They were asked to select any one of the four attires which they prefer most for their dentist. Then the completed questionnaires were used to collect data about children's anxiety. Children who scored above 38 were considered to be anxious. Children who had direct experience or visually experienced sibling treated by a physician or dentist were considered to be a child with past medical or dental experience. Children who accounted for at least one of the protective wear in the questionnaire were considered to prefer protective wear. The results were tabulated and statistically analyzed by Chi-square test.
Figure 1: Poster showing anonymous dentist in different attire which was used for the study

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   Results Top


Of total 1155 children, 718 (62%) were scored as anxious children and 437 (38%) as nonanxious. Of 718 anxious children, 610 (85%) were girls, and 108 (15%) were boys.

Of all anxious children, 502 (69.9%) had preference of colored attires of the dentist and 216 (30.1%) preferred conventional attire [Table 1]. Of all nonanxious children, 128 (29.2%) had preference of colored attires of the dentist and 309 (70.8%) preferred conventional attire. The P value was 0, and the result was significant at P < 0.05 [Table 2]. Four hundred and eight (66.8%) anxious children preferred dentist with protective wear, and 238 (33.2%) preferred dentist without protective wear. Of all nonanxious children, 252 (57.7%) children preferred dentist with protective wear and 185 (42.3%) preferred dentist without protective wear. The P value was 0.001673, and the result was significant at P < 0.05 [Table 3]. Male dentists were preferred by 246 (34%), and female dentists were preferred by 452 (66%) in anxious children group. Male dentists were preferred by 200 (46%), and female dentists were preferred by 237 (54%) in nonanxious children group. The P value was 0.000412, and the result was significant at P < 0.05.
Table 1: Children's preference of aprons and relation to anxiety

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Table 2: Children's preference of protective wear and relation to anxiety

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Table 3: Children's preference of dentist gender and relation to anxiety

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Of total 1155 children, 720 (62.3%) children had past dental/medical experience, and 435 (37.7%) children had no past dental/medical experience.

Of all children with past dental/medical experience, 497 (69%) had preference of colored attires of the dentist and 223 (31%) preferred conventional attire [Table 4]. Of all children without past dental/medical experience, 133 (30.5%) had preference of colored attires of the dentist and 305 (69.5%) preferred conventional attire. The P value was 0, and the result was significant at P < 0.05. Four hundred twenty-five (59%) [Table 5] children with past dental/medical experience preferred dentist with protective wear, and 305 (41%) preferred dentist without protective wear. Of all children without past dental/medical experience, 397 (91%) children preferred dentist with protective wear, and 38 (9%) preferred dentist without protective wear. P value was 0; the result was significant at P < 0.05 [Table 6]. Male dentists were preferred by 250 (34.7%) and female dentists were preferred by 470 (65.3%) in children with past dental/medical experience [Table 6]. Male dentists were preferred by 196 (45%), and female dentists were preferred by 239 (55%) in children without past dental/medical experience. P value was 0.000473; the result is significant at P < 0.05.
Table 4: Children's preference of aprons and relation to past dental/medical experience

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Table 5: Children's preference of protective wear and relation to past dental/medical experience

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Table 6: Children's preference of dentist gender and relation to past dental/medical experience

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Of total 1155 children participated in the study, there were 356 (31%) boys and (69%) 799 were girls.

A 220 (61.7%) boys preferred stylish colored attires and 136 (38.3%) preferred conventional attire [Table 7]. Four hundred and ten (51.3%) girls preferred stylish colored attires and 389 (48.7%) preferred conventional attire. P value was 0.000953, and the result was significant at P < 0.05 [Table 8]. One hundred eighty-one (50.9%) boys preferred dentist with protective wear and 175 (49.1%) dentist without protective wear. Five hundred fifty-one (69%) girls preferred dentist with protective wear and 248 (31%) dentist without protective wear. P value was 0, and the result was significant at P < 0.05 [Table 9]. Two hundred forty-four (68.5%) boys preferred male dentist and 112 (31.5%) preferred female dentists. Two hundred and two (25%) girls preferred male dentist and 597 (75%) preferred female dentists. P value was 0, and the result was significant at P < 0.05.
Table 7: Children's preference of aprons and relation to gender of children

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Table 8: Children's preference of protective wear and relation to gender of children

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Table 9: Children's preference of dentist gender and relation to gender of children

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   Discussion Top


Of 1155 children, 718 (62%) were scored as anxious children. This shows dental anxiety and fear of dentist procedures is common in children. [1] Of 718 anxious children, 610 were girls, i.e., 76% of the girls who participated in the study were anxious about the dentist and dental procedures, whereas only 108 boys, i.e., 30% who participated in the study were dentally anxious. This may be attributed to the fact that females are more anxious than males, and dental anxiety is more prevalent in females. [10]

Most of the anxious children 502 (69.9%) had preference of colored attires of the dentist and in nonanxious children 309 (70.8%) preferred conventional attire. This is in accordance with previous studies which found anxious children to prefer colored attires. [9] This result was contrary to the studies conducted on adults above 50 years of age where the patients tend to prefer more professionally dressed doctors (females) especially. [11] Increase in dentist fear may also occur due to past, painful experiences in the clinic, so past experiences were also evaluated with children's preferences. [12] Children with past dental/medical experience 497 (69%) had preference of colored attires of dentist whereas children without past dental/medical experience 133 (30.5%) had preference of colored attires of the dentist. These finding suggest children associate past experiences with the doctors/dentist identity which is represented by their attire and might also confirm to the fact that dental anxiety occurs in most children due to negative cognitive experience; [12] however, this also conforms dental anxiety is common among children. [13] This may be considered as evidence of classical conditioning theory and orienting reflex. [14] Both boys and girls showed higher preference of colored attires of the dentist. This can attribute to the fact children perceive colors as pleasing, and most studies with preschool children in the United States have also reported a preference for primary colors on the part of both boys and girls. [15] Children were more able to link color to positive rather than negative emotions. [16]

The study revealed 408 (66.8%) anxious children preferred dentist with protective wear and even nonanxious children 252 (57.7%) children preferred dentist with protective wear. Both boys and girls preferred dentist with protective wear, i.e., at 50.9% and 61%, respectively. This may be attributed to the fact that children had knowledge of use of protective wears in dental operatory and might felt that use of protective wears is necessary. This was in accordance with previous studies where children preferred face masks. [17]

In the present study, male dentists were preferred by 246 (34%) and female dentists were preferred by 452 (66%) in anxious children group. This may suggest that anxious children tend to prefer females in proximity. Male dentists were preferred by 200 (46%) and female dentists were preferred by 237 (54%) in nonanxious children group. The high preference of female dentists in the study may be attributed to high sample size of girls and also girls were more anxious than boys in the study. Male dentists were preferred by 250 (34.7%) and female dentists were preferred by 470 (65.3%) in children with past dental/medical experience. This co-relates with the fact most of the children who had experience been anxious. It was also in accordance with previous studies most of the children reported only the first visit as pleasing. [17] Male dentists were preferred by 196 (45%), and female dentists were preferred by 239 (55%) in children without past dental/medical experience. The high preference of female dentists in the study may be attributed to high sample size of girls. These lead to unconfirmed fact whether children were felt more comfortable with females; however, 244 (68.5%) boys preferred male dentist and 112 (31.5%) preferred female dentists. Two hundred and two (25%) girls preferred male dentist, and 597 (75%) preferred female dentists. Thus, same gender preference existed both in males and females. This may be due to the cultural component in the Indian population. This was in accordance with Mistry and Tahmassebi report of significant difference in the preference of same gender of their dental healthcare provider. [18] Number of studies previously investigated patients preference for male or female healthcare professionals, including doctors and nurses and concluded same gender preference among patients. [16],[19],[20] However, overall there was an inclination toward female dentist preference in all three groups considered, which was in accordance with some previous studies. [17],[21] Furthermore in previous studies, parents' preferred female dentists to treat their child, whereas children preferred a dentist of the same gender. [22]


   Conclusion Top


The present study suggests that before dental procedures information about the child's anxiety may help the pediatric dentist in assisting children to cope by distracting them with their own pleasant preferences. This is well obliging with the Guidelines for Behavior Management of the American Academy of Pediatric Dentistry. As a pedodontist, our role is to ease fear and anxiety. The use of child-friendly colors in attires may help in relieving dental anxiety and aid in better communication.

Anxious children (718) 62% and nonanxious children (437) 38%, of total children (1155) 100%. Children with past dental/medical experience 62.3% (720) and without past dental/medical experience 37.7% (435), of total children (1155) 100%. Boys 31% (356) and girls 69% (799), of 100% (1155) the total children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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