Child preferences for the dentist attire and dental health-care setting: A cross-sectional study

Greeshma Ganesh; Faizal C Peedikayil; Soni Kottayi; TP Chandru

doi:10.4103/SDJ.SDJ_16_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 5 | Issue : 1 | Page : 28-32

Child preferences for the dentist attire and dental health-care setting: A cross-sectional study

Greeshma Ganesh, Faizal C Peedikayil, Soni Kottayi, TP Chandru
Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India

Date of Submission	30-May-2020
Date of Decision	03-Jan-2021
Date of Acceptance	15-Jan-2021
Date of Web Publication	16-Feb-2021

Correspondence Address:
Greeshma Ganesh
Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur - 670 612, Kerala
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_16_20

Abstract

Background: Color plays an important role in a child's life and can elicit emotions such as anxiety and fear. Clothes worn by a dental surgeon may increase anxiety and fear in children because of the children's previous experiences. Furthermore, a dental clinic environment can significantly contribute to dental anxiety and fear. Objectives: The present study was undertaken to evaluate children's preferences for dentist attire and the color of the pediatric dental clinic environment. Methods: A cross-sectional study was conducted among 132 female schoolchildren aged 6–10 years. Using a questionnaire with a pictorial demonstration, each child was interviewed to gather information regarding their preferences for the dentist attire and the color of the dental clinic. First, the children were asked to prioritize five photographs of a single anonymous dentist wearing five different aprons (white coat, casual attire, pediatric scrub, surgical scrub, jeans, and T-shirt). Then, a set of five pictures of a dental clinic painted in blue, yellow, green, and black and one clinic with cartoon images were shown to the children. The data were subjected to statistical analysis using the Statistical Package for the Social Sciences software. Results: The majority of the children preferred that pediatric dentists wear traditional white coats (n = 62), while the most preferred interior for the dental clinic was the one with cartoon images (n = 88). Statistical analysis indicated that preference for the white coat and preference for the clinic with cartoon images were significant when compared with others (P < 0.0224). Conclusion: The study concludes that children likes to see dentists in white coat and also prefer pictures of cartoon characters in the dental clinic settings.

Keywords: Apron, dental clinics, dentist attire

How to cite this article:
Ganesh G, Peedikayil FC, Kottayi S, Chandru T P. Child preferences for the dentist attire and dental health-care setting: A cross-sectional study. Sci Dent J 2021;5:28-32

How to cite this URL:
Ganesh G, Peedikayil FC, Kottayi S, Chandru T P. Child preferences for the dentist attire and dental health-care setting: A cross-sectional study. Sci Dent J [serial online] 2021 [cited 2023 Jun 4];5:28-32. Available from: https://www.scidentj.com/text.asp?2021/5/1/28/309540

Background

A successful pediatric dental practice is dependent on not only the technical knowledge and skills of the dental surgeon but also the patients' attitudes and behavior in the operatory.^[1] Dental fear and dental anxiety are considered to be the main reasons for behavior problems – which, in turn, lead to avoiding dental treatment. Most children perceive the dental environment as a threat, and this is a significant factor that causes dental anxiety.^[2] The attire, expressions, and gestures of the dental practitioner can greatly affect the anxiety level of a child. Other factors that may be controlled by the dentist and can affect the child's attitude are the appearance and color of the dental clinic.^[3]

Visual supports may facilitate successful dental treatment outcomes. Previous episodes of pain caused during dental treatment can influence anxiety in children. This may be due to fears that may arise, especially as a result of the professional clothing worn by the dental team.^[2] Various studies have associated medical staff attire with the behavior of children and adults.^[1] While some studies^[4] have demonstrated that there is no association between the impact of professional attire and behavior among adults, studies among pediatric patients (4–8 years old) have shown that physicians' attires appear to impact the behavior of children in health-care settings.

The white coat has long been accepted as the uniform of medical professionals. However, the white coat has been seen as a barrier to communication between patients and doctors.^[3],[4] In recent years, physicians have begun to see patients without a white coat to establish better communication with their patients.^[5] Therefore, the use of a white coat is limited among certain professionals to bridge the gap between them and their patients and facilitate closer provider–patient relationships.

Color has a salient presence in everyone's life, especially in children. The clothes, toys, sports kits, home furniture, and other children's environments convey several psychological messages through color.^[1] There have been some assumptions by psychologists about the emotional significance of color. Various colors can motivate, enthuse, pacify, heal, and even disturb and agitate, which can lead to mood changes.^[3] Children are extra sensitive to the impact of color in their surroundings.^[6] Various studies have reported that the color yellow is associated with gladness, joyfulness, and a positive emotional state; the color blue with safety, peace, and comfort; the color green with tranquility; the color red with anger, aggression, and excitation; and the color black with depression and nervousness.^[7]

Positive environmental elements can reduce anxiety; therefore, children's perception of the dental environment is also a significant factor in managing their fear and anxiety.^[2],[3] Therefore, the expectations and perceptions of children are significant factors that encourage pediatric dentists to develop a more child-friendly environment in their dental clinics.^[8] The dental environment should have a positive impact on the child's behavior; hence, the importance of picking the right color, according to the positive color preferences for a pediatric dental clinic, should not be underestimated.^[9]

Therefore, the present study was conducted among schoolchildren to evaluate their preferences regarding the dentist attire and the color used in the pediatric dental clinic.

Materials and Methods

This cross-sectional study was conducted by the pediatric dentistry department of a dental college in Kerala, India. The convenience sampling method was used to select eligible respondents. A total of 132 female schoolchildren between the ages of 6 and 10 years were recruited for this study. The sample size was derived based on previous studies with a confidence interval of 95% using the Open Source Epidemiologic Statistics for Public Health version 3.01 software. (Available online from https://www.openepi.com/Menu/OE_Menu.htm). Ethical clearance was obtained from the Institutional Ethical Committee of Kannur Dental College (KDC/17/DEC 121). Informed consent forms were made available in both English and the local language of the participants' guardians, and permission was obtained from the school authorities.

Students who have had at least a visit to the dental clinic as part of school dental health checkup were included in this study. Students with known color vision deficiency were excluded from the study. This study was done using questionnaires with pictorial demonstrations, which were distributed in the school auditorium and filled out by each student. The students were interviewed individually to gather information regarding their preferences for the dentist attire and the color of the dental clinic.

First, they were given the option to prioritize five photographs of a single anonymous dentist wearing five different aprons. The pictures depicted the dentist in different attires (white coat, casual attire, pediatric scrub, surgical scrub, jeans, and T-shirt). Then, a set of five pictures of a dental clinic painted in blue, yellow, green, and black and one clinic with cartoon images was shown to the students. The students were interviewed individually and asked to choose their preferences, and these were recorded. The Statistical Package for the Social Sciences for Windows, SPSS 16 (IBM Corporation, Chicago, US) was used to analyze the data collected. The data were tabulated and expressed in numbers and percentages. Chi-square was used to find the statistical significance between the groups, and P < 0.05 (P < 0.05) was considered statistically significant at a 95% confidence interval.

Results

[Table 1] shows the demographic details of the participants. The traditional white coat attire (n = 62, 47%) was the most preferred dentist attire among the 132 female students who participated in the study, followed by the formal attire (26%, n = 34), the casual attire (16%, n = 20), and the child-friendly attire (8%, n = 10). The least preferred attire among the children was the professional attire (5%, n = 6). [Table 2] shows the order of preference of the children regarding the dentist attire in clinics. On Pearson's Chi-squared test, preference for the white coat was found to be significant compared with others (P < 0.0224).

Table 1: Demographic details of the participants

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Table 2: The distribution of the participants' preferences for the dentist attire

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[Figure 1] shows that the most preferred interior of dental clinics was the one with cartoon images (67%, n = 88). The second most preferred was an interior painted with the color blue (21%, n = 28), followed by green (6%, n = 8) and then yellow (4.5%, n = 6). The least preferred color was black (2%, n = 2). Preference for a dental clinic with cartoon images was found to be statistically significant when compared with the other options (P < 0.0481). [Table 3] shows the order of preference for dental clinic appearance.

Figure 1: The preferences of the participants regarding the interior of the dental clinic

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Table 3: The distribution of the participants based on preferences for dental clinic color

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Discussion

Children's dental anxiety has been of concern for dental professionals, and it is still a barrier to dental care.^[1] Children may develop anxiety directly by conditioning or indirectly by modeling or from observation. A child's perception of the dental environment is also a significant factor that can cause anxiety.^[10] Therefore, an affirmative and fear-free setting in the dental operatory is of paramount importance for a pediatric dental clinic. An interaction between pediatric dentists and children in a positive environment is very important to improve work efficiency, motivation, and work satisfaction.^[11]

This study was conducted to determine the preferences of children regarding pediatric dentist attire and the color of the dental clinic. The results of this study reveal that the majority of the children preferred traditional white coat attire to other attires. Mistry and Tahmassebi^[12] studied the attitudes of children and parents toward dental attire and found that parents are in favor of the white coat dress, as it denotes professionalism. Al Sarheed^[13] indicated that children prefer their dentist to wear formal attire with a white apron, as they see it as a symbol of healing. Some studies have also noted that children are not afraid of the doctors who wear the white coat, as they consider these physicians to be more competent and concerned about the needs of the patients.^[11] However, certain researchers have stated that the white coat may be a reason for fear in children with previous negative experiences, as it can cause anxiety; therefore, child-friendly aprons might be appropriate for anxious children.^{[10],[11],[14]}

Most participants in this study opted for the dental clinic with cartoon images, which may be because colorful prints reduce the anxiety of the child and also build up excitement in the child for the dental visit. The results also showed that the most preferred color of the dental clinic was blue, while the least preferred color was black. Goethe^[15] in 1840 observed that blue color has a sense of coolness, while yellow produces a feeling of warmth. The blue color was found to produce effects such as muscle relaxation, lowering of blood pressure, and calming of restlessness in children.^[14] Annamary et al.^[16] stated that black and red could develop a negative outlook in their mind, while colors such as blue and pink have been found to instill a positive dental attitude in children. Umamaheshwari et al.,^[17] in their study, observed high significance of color with emotions – the anxious and nonanxious children preferred yellow color for positive emotion, followed by blue color. Whereas, black or red colors were preferred for negative emotions. Boyatzis and Varghese^[7] observed that light colors such as yellow and blue are associated with positive emotions, while dark colors such as black and gray are associated with negative emotions. Hemphill,^[18] in his study, substantiated the fact that light colors elicit positive emotions, while dark colors produce negative emotions. Cimbalo et al.,^[19] in a study on color selection among children and college students for emotional drawings, reported that the students used yellow, blue, green, and orange to color happy scenes and red, black, and brown for sad scenes.

Viewing positive images of surroundings has the benefit of short-term reductions in anticipatory anxiety in children.^[20],[21] Various studies have shown that children favored a decorated clinic with cartoons over a plain clinic because the cartoons can distract the child during dental treatment.^[22] Therefore, the use of child-friendly colors with cartoons in the dental office, especially yellow, blue, green, or orange, could create an extremely positive effect, which can lead to a happier and more relaxed environment.^[7],[23]

The preferences given by the children are nondescriptive and may vary slightly in actual settings. The students who participated in this study were few and of female gender only. The preferences of a child regarding “attire” and “clinic environment” may also be influenced by other factors that were not considered in this study such as socioeconomic background, cultural diversity, and their experience with previous dental treatment. Future studies with a larger sample size and participants of different age groups and gender, as well as family and socioeconomic and cultural backgrounds, can help in better understanding the preferences of children regarding the dentist attire and the color of the dental clinic setting.

Conclusion

The results obtained from this study demonstrate that, contrary to what is widely believed, most children prefer that dentists wear a white coat compared to other attires. The children in this study preferred dental clinic settings with cartoons. Cartoon image walls and child-friendly colors help in relieving dental anxiety and aid improved communication, which in turn will produce a better treatment outcome. The information gathered by this study is important, as the study highlights the preferences of a girl child regarding the dental office and the overall appearance of the pediatric dentist.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Asokan A, Kambalimath HV, Patil RU, Maran S, Bharath KP. A survey of the dentist attire and gender preferences in dentally anxious children. J Indian Soc Pedod Prev Dent 2016;34:30-5. [PUBMED] [Full text]
2.	Assuncão CM, Losso EM, Andreatini R, de Menezes JV. The relationship between dental anxiety in children, adolescents and their parents at dental environment. J Indian Soc Pedod Prev Dent 2013;31:175-9.
3.	Ram D, Hermida ML, Jerozolimsky AB, Slav OY, Wang HY, Abbate FP, et al. Children's Preferences for Pediatric Dentist Attire: A Multicenter Study. J Clin Pediatr Dent 2018;42:195-202.
4.	Zeren AE, Öktem ZB, Can İ, Bezgin T, Özalp N. What to wear when practicing on pediatric dental patients? J Pediatr Dent 2016;4:37-41. [Full text]
5.	Patır Münevveroğlu A, Ballı Akgöl B, Erol T. Assessment of the feelings and attitudes of children towards their dentist and their association with oral health. ISRN Dent 2014;2014:867234.
6.	Meeti C, Hind PB, Shveta S, Naresh S, Akshara S. Predilections for attitude and gender of the dentist and the clinic environment by children. Mod Res Dent 2018;2:533.
7.	Boyatzis CJ, Varghese R. Children's emotional associations with colors. J Genet Psychol 1994;155:77-85.
8.	Bubna K, Hegde S, Rao D. Role of colors in pediatric dental practices. J Clin Pediatr Dent 2017;41:193-8.
9.	Phillip Park JG, Park C. Color Perception in pediatric patient room design: American versus Korean pediatric patients. HERD 2013;6:10-26.
10.	Porritt J, Marshman Z, Rodd HD. Understanding children's dental anxiety and psychological approaches to its reduction. Int J Paediatr Dent 2012;22:397-405.
11.	Dunn JJ, Lee TH, Percelay JM, Fitz JG, Goldman L. Patient and house officer attitudes on physician attire and etiquette. JAMA 1987;257:65-8.
12.	Mistry D, Tahmassebi JF. Children's and parents' attitudes towards dentists' attire. Eur Arch Paediatr Dent 2009;10:237-40.
13.	Alsarheed M. Children's perception of their dentists. Eur J Dent 2011;5:186-90.
14.	Tibdewal H, Sharma S, Tadakamadla J, Duraiswamy P, Kulkarni S. Should dentist wear white coat? A cross-sectional study. J Oral Health Res 2010;1:76-81.
15.	Goethe JW. Effect of colours with reference to moral association. In: Eastlake CL, editor. Theory of Colours. 2^nd ed. Cambridge (MA): MIT Press; 1840. p. 321-23.
16.	Annamary K, Prathima GS, Sajeev R, Kayalvizhi G, Ramesh V, Ezhumalai G. Colour preference to emotions in relation to the anxiety level among school children in Puducherry-A cross-sectional study. J Clin Diagn Res 2016;10:ZC26-30.
17.	Umamaheshwari N, Asokan S, Kumaran TS. Child friendly colors in a pediatric dental practice. J Indian Soc Pedod Prev Dent 2013;31:225-8. [PUBMED] [Full text]
18.	Hemphill M. A note on adults' color-emotion associations. J Genet Psychol 1996;157:275-80.
19.	Cimbalo RS, Beck KL, Sendziak DS. Emotional toned pictures and color selection for children and college students. J Gen Psychol 2014;133:303-4.
20.	Jayakaran TG, Rekha CV, Annamalai S, Baghkomeh PN, Sharmin DD. Preferences and choices of a child concerning the environment in a pediatric dental operatory. Dent Res J (Isfahan) 2017;14:183-7.
21.	Fox C, Newton JT. A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children. Community Dent Oral Epidemiol 2006;34:455-9.
22.	Biddiss E, Knibbe TJ, McPherson A. The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces: A systematic review of randomized and nonrandomized trials. Anesth Analg 2014;119:433-48.
23.	Carruthers HR, Morris J, Tarrier N, Whorwell PJ. The Manchester Color Wheel: Development of a novel way of identifying color choice and its validation in healthy, anxious and depressed individuals. BMC Med Res Methodol 2010;10:12.