Fear and anxiety are the most commonly cited reasons for avoiding dental care. The stress of coping with dental treatment is most severe for the youngest dental patients, who often express their anxiety by uncooperative behavior. Since a high level of cooperation is necessary to accomplish most dental procedures, the management of anxiety is an important problem in pediatric dentistry. The substantial child development and psychological literature has led many hospital pediatric departments to recognize the supportive role that parents might play in helping their children to cope with medical treatment and illness. However, this possibility has been virtually unexplored in pedodontics. This proposal is a prospective, experimental study designed to explore the hypothesis that parents might be trained to play a facilitative role in helping their children cope with dentistry. To do this, 104 children ages three to five will undergo routine dental care consisting of an examination and a treatment visit with their parents present. Children and their parents will be assigned in a 2 X 2 experimental design to one of four groups testing the effectiveness of the presence or absence of two interventions: play desensitization and parent orientation. In the play desensitization groups, the parent is provided and trained in the use of materials for previsit play with the child. In the parent orientation groups, the parent is provided information and training prior to the child's visits to foster a supportive role during the actual delivery of care. Dependent measures include chair time, parent satisfaction, and behavioral assessment of child, parent and provider. This experiment is expected to provide insight into the complex parent-child interactions that occur in stressful situations and to point to practical applications that would be of interest to dentists as well as other clinicians treating patients on an outpatient basis.
