A form of ‘parental presence/absence’ (PPA) technique for the child patient with dental behaviour management problems

  • N. KotsanosEmail author
  • T. Coolidge
  • D. Velonis
  • K. N. Arapostathis
Short Communication


AIM: This paper reports on the use of early introduction of a specific parental presence/absence (PPA) behavioural technique to manage the initially uncooperative child. METHODS: Using a prospective design, 440 healthy children aged 3 to 10 years visited a paediatric dental practice within 33 months. Children exhibiting initially Frankl ‘negative’ and ‘definitely negative’ behaviour were empathically offered parental presence only if they were cooperative. Otherwise, the parent stepped out until behaviour improvement. Statistics: t-tests and Chi-square tests were used to compare characteristics of initially cooperative and uncooperative children, as well as proportions of parents who were asked to leave the surgery. The technique’s success was assessed by a one sample binomial test. RESULTS: 75 of the children presented as Frankl either ‘negative’ (30) or ‘definitely negative’ (45) at theirfirst visit; 70 (93.3%, p< 0.001) responded to the PPA technique by displaying positive behaviour as their first visit progressed. 38 responded without the need to ask the parent to exit the practice room, while the other 32 responded only after their parent exited. 52 children had additional appointments, and 8 required an application of PPA at a second appointment; all children cooperated in all subsequent appointments. CONCLUSION: Early and empathic application of the PPA technique appears very successful in managing initially uncooperative child patients, suggesting that a randomised controlled trial of the technique is warranted

Key words

Behaviour management negative behaviour uncooperative child dental patient parental presence 


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Copyright information

© European Academy of Paediatric Dentistry 2009

Authors and Affiliations

  • N. Kotsanos
    • 1
    Email author
  • T. Coolidge
    • 2
  • D. Velonis
    • 1
  • K. N. Arapostathis
    • 1
  1. 1.Dept. of Paediatric Dentistry, Dental SchoolAristotle University of ThessalonicaGreece
  2. 2.Dept. of Dental Public Health SciencesUniversity of WashingtonUSA

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