European Archives of Paediatric Dentistry

, Volume 17, Issue 5, pp 381–386 | Cite as

The effect of parental presence on the child’s perception and co-operation during dental treatment

  • B. VasilikiEmail author
  • A. Konstantinos
  • K. Vassilis
  • K. Nikolaos
  • C. van Loveren
  • V. Jaap
Original Scientific Article



This was to study the influence of parental presence during dental treatment on children’s behaviour and perception.


Parents of 100 patients (mean age 7 ± 2.2 years) who visited the Postgraduate Paediatric Dental Clinic were randomly divided into two equal groups during one familiarisation and two treatment sessions: (1) parent present in the surgery/operatory and (2) parent absent (with their child observed through a window). Both an independent paediatric dentist and the parent rated the child’s behaviour using the Venham scale. The child’s perception was measured using the Wong-Baker Faces Rating Scale (FPRS) at the end of every session. Statistical analysis was performed with the IBM Statistics SPSS 22.0 (p < 0.05). Comparisons between variables were performed with the Mann–Whitney U, Wilcoxon and Friedman’s tests.


According to the paediatric dentist’s rating, children’s behaviour was worse when the parent was absent, with a significant difference only for the second restorative treatment session (p = 0.011). There was no difference on parents’ rating child behaviour scores between the two groups. There was no difference of children’s own perception between the two groups, except for any increased discomfort found at the second treatment (p = 0.021) when the parent was present. In both groups, the dentist rated lower Venham scores (better child behaviour), than parents did (presence: p = 0.001, absence: p = 0.038). Children recorded worse scores than both parents and the paediatric dentist.


The only significant finding lay in the antithesis of how children perceived their last treatment session and how the dentist rated children’s behaviour regarding parental presence. Parents’ scores of their child’s behaviour were unrelated to parental presence.


Parental presence Behaviour management Child perception 


Compliance with ethical standards

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Aristotle University of Thessaloniki Ethics Committee and with the 1964 Helsinki declaration and its later ame.


  1. Aartman IH, van Everdingen T, Hoogstraten J, et al. Self-report measurements of dental anxiety and fear in children: a critical assessment. ASDC J Dent Child. 1998;65:252–8.PubMedGoogle Scholar
  2. American Academy of Pediatric Dentistry. Accessed at 10/11/2013.
  3. Arapostathis KN, Coolidge T, Emmanouil D, Kotsanos N. Reliability and validity of the Greek version of the Children’s Fear Survey Schedule-Dental Subscale. Int J Paediatr Dent. 2008;18(5):374–9.CrossRefPubMedGoogle Scholar
  4. Berggren U, Carlsson SG. Community psychometric measures of dental fear. Dent Oral Epidemiol. 1984;12(5):319–24.CrossRefGoogle Scholar
  5. ten Berge M, Veerkamp JS, Hoogstraten J. The etiology of childhood dental fear: the role of dental and conditioning experiences. J Anxiety Disord. 2002;16(3):321–9.CrossRefPubMedGoogle Scholar
  6. ten Berge M, Veerkamp JS, Hoogstraten J, Prins PJ. Childhood dental fear in relation to parental child-rearing attitudes. Psychol Rep. 2003;92(1):43–50.CrossRefPubMedGoogle Scholar
  7. Boka V, Arapostathis K, Karagiannis V, et al. Dental fear and dental caries in 6-12 year old children in Greece. Eur J Paediatr Dent. 2016.Google Scholar
  8. Chambers CT, Giesbrecht K, Craig KD, et al. A comparison of faces scales for the measurements of pediatric pain: children’s and parent’s ratings. Pain. 1999;83:25–35.CrossRefPubMedGoogle Scholar
  9. Coolidge T, Arapostathis KN, Emmanouil D, et al. Psychometric properties of Greek versions of the modified corah dental anxiety scale (MDAS) and the dental fear survey (DFS). BMC Oral Health. 2008;30:8–29.Google Scholar
  10. Coric A, Banozic A, Klaric M, Vukojevic K, Puljak L. Dental fear and anxiety in older children: an association with parental dental anxiety and effective pain coping strategies. J Pain Res. 2014;20(7):515–21.Google Scholar
  11. Cox IC, Krikken JB, Veerkamp JS. Influence of parental presence on the child’s perception of, and behaviour, during dental treatment. Eur Arch Paediatr Dent. 2011;12(4):200–4.CrossRefPubMedGoogle Scholar
  12. Fenlon WL, Dabbs AR, Curzon MEJ. Parental presence during treatment of the child patient: a study with British parents. Br Dent J. 1993;174:23–8.CrossRefPubMedGoogle Scholar
  13. Freeman R. The case for the mother in the surgery. Br Dent J. 1999;186:610–3.PubMedGoogle Scholar
  14. Gerull FC, Rapee RM. Mother knows best: effects of maternal modelling on the acquisition of fear and avoidance behaviour in toddlers. Beh Res Ther. 2002;40:279–87.CrossRefGoogle Scholar
  15. Kamp A. Parent child separation during dental care: a survey of parent`s preference. Pediatr Dent. 1992;14:231–4.PubMedGoogle Scholar
  16. Klaassen MA, Veerkamp JS, Aartman IH, Hoogstraten J. Stressful situations for toddlers: indications for dental fear? ASDC J Dent Child. 2002;69(3):306–9.PubMedGoogle Scholar
  17. Klingberg G, Berggren U, Carlsson SG, Noren JG. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci. 1995;103(6):405–12.CrossRefPubMedGoogle Scholar
  18. Klingberg G, Broberg AG. Temperament and child dental fear. Pediatr Dent. 1998;20(4):237–43.PubMedGoogle Scholar
  19. Kotsanos N, Coolidge T, Velonis D, Arapostathis KN. A form of ‘parental presence/absence’ (PPA) technique for the child patient with dental behaviour management problems. Eur Arch Paediatr Dent. 2009;10(2):90–2.CrossRefPubMedGoogle Scholar
  20. Locker D, Poulton R, Thomson WM. Psychological disorders and dental anxiety in a young adult population. Community Dent Oral Epidemiol. 2001;29:456–63.CrossRefPubMedGoogle Scholar
  21. Nuttall NM, Gilbert A, Morris J. Children’s dental anxiety in the United Kingdom in 2003. J Dent. 2008;36(11):857–60.CrossRefPubMedGoogle Scholar
  22. Peretz B, Zadik D. Attitudes of parents towards their presence in the operatory during dental treatments to their children. J Clin Pediatr Dent. 1998;23:27–30.PubMedGoogle Scholar
  23. Roberts JF, Curzon ME, Koch G, Martens LC. Review: behaviour management techniques in paediatric dentistry. Eur Arch Paediatr Dent. 2010;11(4):166–74.CrossRefPubMedGoogle Scholar
  24. Themessl-Huber M, Freeman R, Humphris G, Macgillivray S, Terzi N. Empirical evidence of the relationship between parental and child dental fear: a structured review and meta-analysis. Int J Paediatr Dent. 2010;20(2):83–101.CrossRefPubMedGoogle Scholar
  25. Thomson WM, Locker D, Poulton R. Incidence of dental anxiety in young adults in relation to dental treatment experience. Community Dent Oral Epidemiol. 2000;28:289–94.CrossRefPubMedGoogle Scholar
  26. Townend E, Dimigen G, Fung D. A clinical study of child dental anxiety. Behav Res Ther. 2000;38:31–46.CrossRefPubMedGoogle Scholar
  27. Veerkamp JS, Gruythuysen RJ, van Amerongen WE, Hoogstraten J. Treating fearful children: does a parent’s view of the child’s fear change? ASDC J Dent Child. 1994;61(2):105–8.PubMedGoogle Scholar
  28. Veerkamp JS, Gruythuysen RJ, van Amerongen WE, et al. Dentist’s ratings of child dental-patients’ anxiety. Community Dent Oral Epidemiol. 1995;23:356–9.CrossRefPubMedGoogle Scholar
  29. Venham LL, Gaulin-Kremer E, Munster E, Bengston-Audia D, Cohan J. Interval rating scales for children’s dental anxiety and uncooperative behaviour. Pediatr Dent. 1980;2(3):195–202.PubMedGoogle Scholar
  30. Versloot J, Veerkamp J. Dental fear and psychological functioning in children: its relationship with behaviour during treatment. Eur Arch Paediatr Dent. 2008;9(Suppl 1):36–40.CrossRefPubMedGoogle Scholar
  31. Winer GA. A review and analysis of children’s fearful behaviour in dental settings. Child Dev. 1982;53:1111–33.CrossRefPubMedGoogle Scholar
  32. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14:9–17.PubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2016

Authors and Affiliations

  • B. Vasiliki
    • 1
    • 2
    Email author
  • A. Konstantinos
    • 1
  • K. Vassilis
    • 3
  • K. Nikolaos
    • 1
  • C. van Loveren
    • 2
  • V. Jaap
    • 2
  1. 1.Department of Paediatric Dentistry, School of DentistryAristotle University of ThessalonikiThessalonikiGreece
  2. 2.Department of Cariology, Endodontology and PedodontologyACTAAmsterdamNetherlands
  3. 3.School of MathematicsAristotle University of ThessalonikiThessalonikiGreece

Personalised recommendations