Comparison of Preferences between Children and their Parents based on the Characteristics of the Dental Operator and the Clinical ScenarioABSTRACT
Objective: To compare the preferences of children and their parents regarding the characteristics of the dental operator and the clinical environment for dental care.
Material and Methods: This cross-sectional study was conducted from August 2022 to July 2023. A questionnaire was developed in English and then translated into Spanish, before being subjected to a trial and a pilot study. After obtaining informed consent, 152 parents and their children, selected by convenience sampling, participated in the survey. Bivariate statistical analysis was performed using Fisher's exact and chi-square tests.
Results: Statistically significant differences (p<0.05) were determined when comparing the preferences of children and parents for the variables gender, age, clothing, mask, floor, door, lighting, curtains, dental chair, play area, waiting area, and consulting room. Based on participants’ gender, it was determined that the highest percentage of boys (71.76%) and girls (86.57%) prefer to be seen by an operator of the same gender (p=0.001). Significant differences were identified among children regarding clothing preferences (p=0.001). Additionally, differences were observed in parents’ preferences for curtains and walls in the clinical scenario (p<0.05). Children showed varying preferences for the play area, waiting area, and office, whereas both parents and children had varying preferences for the reception area.
Conclusion: Differences were observed when comparing the preferences of children and their parents concerning the dental operator and the clinical scenario.
Keywords:
Clothing; Child; Parents; Dentists; Dental Clinics
Introduction
Visiting the dentist is not a pleasant experience for many people, especially children, as the vast majority have some fear due to past experiences or a fear of the office's equipment sounds. Therefore, they are usually noncooperative when receiving treatment [1-4]. Various factors are considered by children and their parents when deciding on dental care and selecting the ideal professional [5]. Thus, the clinical environment, presentation, and appearance of the dental operator are crucial to the child's dental experience [6]. Standards have changed over time, as have people's preferences. Therefore, this may be attributed to the significant influence of digital platforms and media, which have a visual impact on individuals and thus affect their decisions when choosing their dental experience [7,8].
The dentist's wardrobe has undergone significant evolution over time. The popular white coat, commonly worn by healthcare providers, has been perceived as a barrier to establishing the doctor–patient relationship in pediatric dentistry [9,10]. Nowadays, a diverse array of designs, colors, and presentations of clothing is available, providing greater comfort and making a better impression on patients [11-13]. This is particularly important for pediatric patients, as children form an impression of the dentist based on their appearance and both verbal and nonverbal communication [14,15]. Thus, for children, the visual impression is decisive in the dentist–patient relationship [11,14]. Furthermore, the dentist's characteristics are relevant for both parents and children [16-18]. In most cases, some children feel more comfortable with a specialist of the same gender [19].
Many studies have evaluated the preferences of children and their parents regarding the characteristics of the pediatric dentist and the clinical scenario [11,15]. According to studies conducted in Brazil by Volpato et al. [11] and Kastelic et al. [15], children prefer professionals wearing white coats, while parents prefer a different outfit. In India, Gedam and Katre [7] identified various factors, including demographic details (gender and age), external and internal characteristics of the clinical environment, and the pediatric dentist and their team. They concluded that children and their parents preferred colorful features in the clinical environment and the clothing of professionals. Similarly, children demonstrated a greater preference for female staff, whereas this factor was not significant for parents [7].
Given these factors, creating a clinical environment that aligns with the preferences of both the children and their parents is crucial for the proper development of practice and patient behavior [20-23]. However, this is a complex task, as selecting the characteristics of a dental clinic is not an everyday event because a child does not make the decision independently. If we consider the infant’s preferences, they can behave positively and safely during any dental treatment. Thus, parents perceive a greater benefit for their children’s oral health [7,9-12,14-23].
The literature includes several studies that demonstrate the preferences of children and parents regarding the clothing and gender of pediatric dentists [7, 11, 15]. However, few determine the choice for the clinical environment. Therefore, by evaluating all the characteristics, different preferences can be identified and subsequently compared to achieve a higher degree of patient satisfaction. This study aimed to compare the preferences of children and their parents regarding the characteristics of the dental operator and the clinical scenario.
Material and Methods
Study Design and Ethical Clearance
This was a cross-sectional study. The consent and informed assent of the parents and their children, respectively, were obtained in accordance with the ethical principles. Furthermore, a request was submitted to the Research Ethics Subcommittee of the Department of Health Sciences of the Peruvian University of Applied Sciences, which was approved (FCS-CTA/004-08-23).
Population and Sample
The study population consisted of children aged 8-12 years and their parents who resided in Metropolitan Lima in 2022. A pilot test was conducted to recalculate the sample size (p1 = 75% and p2 = 60%). Two samples were obtained: the first comprised 152 children, and the second comprised 152 parents (either fathers or mothers) of these children. The statistical program Stata®, version 17.0, was used in both cases, with a 95% confidence level and 80% power. The sampling type was non-probabilistic, based on convenience.
The Selection criteria were Children aged 8-12 years and their parents residing in Metropolitan Lima who accepted assent and informed consent, respectively, were included. Children without prior dental experience and those who did not complete the questionnaires correctly were excluded from the study.
The questionnaire was developed using Google Forms. Tablets and laptops were used for the children and their parents to complete the questionnaires. The authors personally supervised the questionnaires to ensure that participants completed the appropriate questionnaire.
Techniques and/or Procedures
The evaluation instrument, a questionnaire from a previous investigation conducted in Saudi Arabia [6], was applied. The questionnaire consisted of 24 multiple-choice questions, applicable to both children and parents, and included images to facilitate the choices. To respect the copyright of the images used, photographs for three questions related to "clothing," "hat," and "masks" were replaced; the remaining pictures were of free authorship. This process required the consent of the photographed models.
Validity and Reliability of the Instrument
Expert Judgment and Content Validity
The Spanish-language questionnaires were reviewed by a group of experts comprising five pediatric dentists and two dental management specialists with a minimum of 8 years of clinical experience. Aiken's V statistic was used to determine content validity, yielding a value of 0.85, which was considered acceptable.
The pilot test was approved by the expert committee and conducted with 20 participants. Internal consistency was assessed using Cronbach's alpha, which yielded a value of 0.95, indicating near-perfect reliability.
Instrument Reliability
The “rest-retest” method was conducted with a 2-week interval, and the kappa statistic was calculated at 0.86, indicating an almost perfect level of agreement.
Analysis Plan
Descriptive statistical measures were employed in the univariate analysis plan, including absolute and relative frequencies for the qualitative variables. For the age variable, the mean was used as a measure of central tendency, and the standard deviation was used as a measure of dispersion. For the bivariate analysis plan, Fisher's exact test was used to compare the preferences of boys and girls for the variables "lights" and "doors," as well as the preferences of fathers and mothers for the "play area" variable, and for both groups for the "reception area" variable. The chi-square test was used to compare the remaining variables. Furthermore, Fisher's exact test was used to compare the preferences of parents and their children based on the characteristics of the dental operator and the clinical scenario for variables “gender,” “floor,” and “reception area.” A confidence level of 95% was used, and a p-value of 0.05 indicated statistical significance. The results were analyzed using the statistical program Stata®, version 17.0 (StataCorp LLC, College Station, TX, USA).
Results
A total of 304 individuals (152 parents and 152 children) were evaluated. Table 1 shows that the children's ages ranged from 8 to 12 years, with the average age of the parents being 38 years (±13.22). Most parents were male (54.60%), as were children (55.92%). The most prevalent age among the children was 11 years (23.68%). According to previous dental experience, 51.30% of the children were treated by a specialist in pediatric dentistry (Table 1).
Table 2 compares the preferences of children and their parents, by gender, regarding the characteristics of the operator and the clinical environment. Most mothers (82.93%) and fathers (68.93%) preferred a female operator, whereas most girls (86.57%) and boys (71.76%) preferred to be treated by a specialist of the same gender. Regarding the operator's age group, fathers and mothers show greater preference for the older adult group (60–70 years), i.e., 56.63% and 49.28%, respectively. However, boys (69.41%) and girls (55.22%) show a greater preference for being seen by a young operator (aged 18–29 years). About the operator's clothing, most fathers and mothers prefer a solid-color scrub, with 40.96% and 53.62%, respectively. However, girls prefer scrubs with a design (58.21%), while boys prefer formal clothing with a robe (31.76%), followed by full-color scrubs with a design (23.53%). Concerning the operator's cap, fathers prefer a solid color (49.99%), and mothers prefer it with a design (63.77%). Both boys and girls prefer caps with a design. Statistically significant differences were found (p<0.05) in the clinical environment preferences. For the parents, it was curtains and walls; for the children, it was the play area, waiting area, and office; and for both groups, it was the reception area.
Determination and comparison of the preferences of children and their parents by gender, operator, and clinical scenario characteristics.
Table 3 shows significant differences in the preferences of children and their parents for the characteristics of the dental operator in terms of “gender”, “age,” “clothing,” and “mask” (p < 0.05). Regarding the characteristics of the clinical scenario, significant statistical differences were only found (p < 0.05) for the variables “main entrance,” “floors,” “doors,” “lights,” “curtains,” “dental chair,” “games area,” “waiting area,” and “dental office”.
Comparison of the preferences of children and their parents regarding dental operators and the clinical environment characteristics.
Discussion
This study aimed to compare the preferences between children and their parents based on the characteristics of the dental operator and the clinical environment. To assess the factors influencing the choice of dental operator and clinical environment, a self-reported and individualized survey was conducted. This approach was similar to that proposed by Gedam and Katre [7], who determined preferences for pediatric dentists and clinical environments. Self-reported surveys are easier to distribute and respond to because they are sent via virtual platforms. They also benefit investigators as the data are collected virtually, thus reducing research expenses and increasing productivity [24].
Regarding the findings on the characteristics of the dental operator, it was found that boys preferred male operators (71.76%), girls preferred female operators (86.57%), and both fathers and mothers preferred female operators. This finding is similar to those reported by Volpato et al. [11], Hermida et al. [18], and Mohebbi et al. [10], who found that children prefer to be seen by a pediatric dentist of the same gender, and their parents prefer a female pediatric dentist. These results may be related to the perception that females are kinder and more empathetic, with more pleasant communication and a greater affinity for children [9]. Furthermore, children may consider the maternal figure as welcoming and kind, thus transferring that feeling to their pediatric dentists [13].
On the contrary, regarding the age of the dental operator, children also preferred to be treated by a younger dental operator (18–21 years old), but both fathers and mothers preferred an older operator (50–60 years old) for their children’s dental care. According to Devi [25], healthcare professionals classified as older adults have a greater experience and trajectory that can only be reflected after years of practice and professional development [24, 25]. However, it is believed that young health professionals bring innovation and vitality, have a greater chance of gaining the trust of children, and possess more up-to-date knowledge and professional practices that benefit patients [26].
Regarding the scrubs, masks, and caps, it was found that parents (46.71%) preferred them in solid colors, whereas children preferred designs with patterns. This finding aligns with the results of Mohebbi et al. [10], who reported that 32.4% of children preferred their dentist to wear outfits featuring cartoons. This preference may be associated with the influence and impact of colors, as each color conveys a distinct meaning: orange provides confidence, green brings calm, and turquoise stimulates tranquility. Thus, the operator's appearance is crucial for ensuring positive outcomes in dental care [6, 7, 13, 16]. Conversely, white scrubs were the least preferred by children. This finding is consistent with the results obtained by Hermida et al. [18], who found that only 6% of children chose white scrubs. This preference can be attributed to the well-known "white robe syndrome," a phenomenon where patients experience increased stress and anxiety in response to the white clothing worn by healthcare professionals [16].
Significant statistical differences were observed for the following variables when comparing the preferences of children and parents regarding the clinical scenario: “main entrance,” “floors,” “doors,” “lights,” “curtains,” “dental chair,” “play area,” “waiting area,” “dental office,” and “waiting area amenities.” This result is similar to that obtained by Gedam and Katre [7], where the majority of parents and children preferred dental environments and fixtures (such as dental units, chairs, and tables) with different shades and animated designs. Quesada et al. [28] stated that the space where children are located should allow them to experience entertainment while receiving care. Furthermore, they pointed out that all the components of the infrastructure reflect their own identity through various educational materials, such as posters and/or panels, that make the organization of each detail visible to children and parents [27]. This generates a desire to return the next day [28].
This research is necessary because it is essential to understand the preferences of the participants identified in this study and how these preferences influence the choice of a dentist and a clinical environment by parents and their children, ensuring quality care.
One limitation of this study is the lack of information on the participants' socioeconomic backgrounds. Factors such as income level, access to health services, and type of dental care (public or private) can significantly influence the preferences of both parents and children. This limits the ability to generalize the results to broader and more diverse populations. Furthermore, psychological variables (dental anxiety, negative previous experiences) that can have a direct impact on decisions related to dental care are not considered. These emotional and behavioral variables can influence the perception of the clinical environment and the dental practitioner, especially in the pediatric population. It is recommended that future research incorporate these dimensions to gain a more comprehensive understanding of the factors influencing the choice of professionals and spaces in pediatric dental care.
Conclusion
Differences were found when comparing preferences between children and their parents regarding some characteristics of the dental provider (gender, age, clothing, and face mask). It was determined that both boys and girls prefer to be treated by a dental provider of the same gender and from a younger age group, while parents prefer a dental provider from an older age group. Currently, there are more resources available for dental care to improve the environment for children. Therefore, the preferences of children and their parents play a crucial role, as they distinguish one service from another and provide a better experience for patients. This highlights the growing relevance of pediatric dental care as a specialty in recent years.
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Financial Support
None.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
References
-
[1] Celine G, Cho V, Kogan A, Anthonappa R, King N. Eye-tracking in dentistry: What do children notice in the dentist? J Dent 2018; 78:72-75. https://doi.org/10.1016/j.jdent.2018.08.006
» https://doi.org/10.1016/j.jdent.2018.08.006 -
[2] López J. Fear of the dentist among children under 5 years of age. Rev Eug Esp 2020; 14(2):51-60. https://doi.org/10.37135/ee.04.09.07
» https://doi.org/10.37135/ee.04.09.07 - [3] Ramos K, Alfaro M, Madera V, González F. Anxiety and fear among children treated in a dental office at the University of Cartagena. Rev Odont Mex 2018; 22(1):8-14.
-
[4] Buldur B, Armfield JM. Development of the Turkish version of the Index of Dental Anxiety and Fear (IDAF-4C+): Dental anxiety and concomitant factors in pediatric dental patients. J Clin Pediatr Dent 2018; 42(4):279-286. https://doi.org/10.17796/1053-4628-42.4.7
» https://doi.org/10.17796/1053-4628-42.4.7 -
[5] Benavente P, Álcantara B, López G, Munive A. Factors that influence parents when choosing a pediatric dentist based on their children’s dental consultation experience in Metropolitan Lima. Rev Odontopediatr Latinam 2023; 13: e-222547. https://doi.org/10.47990/alop.v13i.547
» https://doi.org/10.47990/alop.v13i.547 -
[6] Bahammam S. Children’s preferences toward dentist attire in Al Madinah Al Munawarah. Patient Prefer Adherence 2019; 13:601-607. https://doi.org/10.2147/PPA.S196373
» https://doi.org/10.2147/PPA.S196373 - [7] Gedam K, Katre A. Scenario-based assessment of children and parents preferences towards a pediatric dental setup -An observational study. IOSR JDMS 2018; 17:32-42.
-
[8] Asociación Latinoamericana de Odontopediatría. Estrategias Psicoconductuales e información para Odontólogos y pacientes que requieran procedimientos de Odontología Pediátrica durante la etapa de la pandemia COVID-19. Rev Odontopediatr Latinam 2020; 10(2):e-620511. https://doi.org/10.47990/alop.v10i2.194 [In Spanish].
» https://doi.org/10.47990/alop.v10i2.194 -
[9] Mohebbi S, Razeghi S, Mizanian F, Kharazifard M. Perspectives and preferences of preschoolers and their parents regarding dentist’s attire and gender. Front Dent 2022; 19:4. https://doi.org/https://doi.org/10.18502/fid.v19i4.8512
» https://doi.org/https://doi.org/10.18502/fid.v19i4.8512 -
[10] Volpato L, Dos Santos L, Gialain I, De Campos Neves A, Aranha A. The preference of children and their parents about the pediatric dentist’s appearance. Pesqui Bras Odontopediatria Clín Integr 2021, 21:e268. https://doi.org/10.1590/pboci.2021.125
» https://doi.org/10.1590/pboci.2021.125 -
[11] De Amorim C, Coqueiro R, De Menezes B, Aguiar S, Maia L, Pithon M. Perception regarding pediatric dentist’s appearance and factors influencing the child’s responses. J Clin Pediatr Dent 2021; 45(2):90-97. https://doi.org/10.17796/1053-4625-45.2.4
» https://doi.org/10.17796/1053-4625-45.2.4 -
[12] Sujatha P, Nara A, Avanti A, Shetty P, Anandakrishna L, Patil K. Child dental patient's anxiety and preference for dentist's attire: A cross-sectional study. Int J Clin Pediatr Dent 2021; 14(Suppl 2):S107-S110. https://doi.org/10.5005/jp-journals-10005-1940
» https://doi.org/10.5005/jp-journals-10005-1940 -
[13] Valenzuela A, Valenzuela M, Valenzuela R. Experiencias de los estudiantes de estomatologia en el control de la conducta de niños. Analisis cualitativo. Av Odontostomatol 2019; 35(1):11-17. https://doi.org/10.4321/s0213-12852019000100002 [In Spanish].
» https://doi.org/10.4321/s0213-12852019000100002 -
[14] Kastelic DR, Volpato LE, de Campos Neves AT, Aranha AM, Martins CC. Do children and adolescents prefer pediatric attire over white attire during dental appointments? A meta-analysis of prevalence data. Int J Clin Pediatr Dent 2021; 14(1):14-29. https://doi.org/10.5005/jp-journals-10005-1861
» https://doi.org/10.5005/jp-journals-10005-1861 -
[15] Ganesh G, Peedikayil F, Kottayi S, Chandru T. Child preferences for the dentist’s attire and dental healthcare setting: A cross-sectional study. Sci Dent J 2021; 5(1):28-32. https://doi.org/10.4103/SDJ.SDJ_16_20
» https://doi.org/10.4103/SDJ.SDJ_16_20 - [16] Westphal J, Berry E, Carrico C, Shroff B, Brickhouse T. Provider appearance: A survey of guardian and patient preference. J Dent Child 2017; 84(3):139-144.
-
[17] Hermida L, Puig F, Braun A, Ram D, Volfovikz R. Preference of child patients and their parents regarding the clothing and sex of the pediatric dentist. Odontol Acts 2017; 14(1):33-42. https://doi.org/10.22235/ao.v14i1.1400
» https://doi.org/10.22235/ao.v14i1.1400 -
[18] Kamavaram Ellore VP, Mohammed M, Taranath M, Ramagoni N, Kumar V, Gunjalli G. Children and parent’s attitude and preferences of dentist’s attire in pediatric dental practice. Int J Clin Pediatr Dent 2015; 8(2):102-107. https://doi.org/10.5005/jp-journals-10005-1293
» https://doi.org/10.5005/jp-journals-10005-1293 -
[19] Shindova M, Belcheva A, Raycheva J. Dental fear of 6-12-year-old children - Role of parents, gender and age. Fol Med 2019; 61(3):444-450. https://doi.org/10.3897/folmed.61.e39353
» https://doi.org/10.3897/folmed.61.e39353 -
[20] Sanguida A, Suwetha R, Dharani M, Kathir R, Ezhumalai G. Children’s choice of dentist’s attire, color, and type of mouth mask: A cross-sectional study in Puducherry, India. J Sci Den 2019; 9(2):36-40. https://doi.org/10.5005/jp-journals-10083-0906
» https://doi.org/10.5005/jp-journals-10083-0906 - [21] Babaji P, Chauhan P, Rampratap V, Tamanpreet K, Singh S, Augustine M. A cross-sectional evaluation of children preference for dentist attire and syringe type in reduction of dental anxiety. Dent Res J 2018; 15(6):391-396.
-
[22] Oliveira L, Massignan C, De Carvalho R, Savi M, Bolan M, Porporatti A, et al. Children’s perceptions of dentist’s attire and environment: A systematic review and meta-analysis. Int J Clin Pediatr Dent 2020; 13(6):700-716. https://doi.org/10.5005/jp-journals-10005-1839
» https://doi.org/10.5005/jp-journals-10005-1839 - [23] Munayco E. Factores asociados con la colaboración de los niños peruanos durante el tratamiento odontológico. Odontología Vital 2021; (34):31-38. [In Spanish].
-
[24] Sánchez M, Fernández M, Diaz J. Técnicas e instrumentos de recolección de información: Análisis y procesamiento realizado por el investigador cualitativo. Rev Cient UISRAEL 2018; 8(1):107-121. https://doi.org/10.35290/rcui.v8n1.2021.400 [In Spanish].
» https://doi.org/10.35290/rcui.v8n1.2021.400 -
[25] Devi G. Alzheimer's disease in physicians - Assessing professional competence and tempering stigma. N Engl J Med 2018; 378(12):1073-1075. https://doi.org/10.1056/NEJMp1716381
» https://doi.org/10.1056/NEJMp1716381 -
[26] Ajmi S, Aase K. Physicians' clinical experience and its association with healthcare quality: A systematised review. BMJ Open Qual 2021; (4):e001545. https://doi.org/10.1136/bmjoq-2021-001545
» https://doi.org/10.1136/bmjoq-2021-001545 -
[27] Quesada J. Condiciones de la infraestructura educativa en la Región Pacífico Central: Los espacios escolares que promueven el aprendizaje en las aulas. Rev Educación 2019; 43(1):293-311. https://doi.org/10.15517/revedu.v43i1.28179 [In Spanish].
» https://doi.org/10.15517/revedu.v43i1.28179 -
[28] Fux-Noy A, Zohar M, Herzog K, Shmueli A, Halperson E, Moskovitz M, et al. The effect of the waiting room environment on the level of anxiety experienced by children before dental treatment: A case control study. BMC Oral Health 2019; 19(1):294. https://doi.org/10.1186/s12903-019-0995-y
» https://doi.org/10.1186/s12903-019-0995-y
Edited by
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Academic Editor:
Catarina Ribeiro Barros de Alencar
