Manal Abushal and Joseph O. Adenubi
Al Yamamah Hosptial, Ministry of Health, Saudi Arabia
College of Dentistry, King Saud University, Riyadh, Saudi Arabia

Objective

The purpose of this study was to investigate the attitudes of Saudi parents to being separated or not separated from their children in the dental office and to assess the factors affecting such attitudes.

Method

Five hundred and five parents participated in the study by completing a questionnaire which included questions related to their sex, marital status, job, family income and reasons for seeking dental treatment for the child. Questions were also designed to determine the responses and attitudes of the parents regarding their presence in the dental clinic.

Results

Ninety-seven percent of the respondents preferred to stay with their children during dental treatment of their children. The main reason given by 83% of the parents was that the child would feel safe. More than 72% of the parents reported that they would reduce their child’s fear and comfort him/her during the dental treatment.

Conclusions

From the parent’s point of view, the most threatening dental procedure undergone by their children was dental anesthesia (87.7%) followed by the use of dental drills (55.4%). It can be concluded from the results that majority of Saudi parents studied preferred to stay with their children during treatment. Dentists should consider this when treating children.

The various behavior guidance techniques used in pediatric dentistry must be tailored to the individual patient and practitioner. Promoting a positive dental attitude, safety and quality care are of utmost importance ( American Academy of Pediatric Dentistry, 2007–2008). Clinical observations as well as research findings suggest that home environment plays a major role in the dental attitudes of children ( Shaw, 1975).

An unfavorable parental attitude toward dentistry is significantly associated with dental anxiety of the child ( Shaw, 1975). The influence of parents’ manner and reactions on the child’s dental behavior has been demonstrated in several studies ( [Bailey et al., 1973], [Johnson and Baldwin, 1968], [Wright et al., 1973] and [Holst et al., 1988]).

The issue of whether a parent should be present in the dental operatory during a child’s dental appointment has inspired divergent opinions among practitioners of dentistry for children ( Casamasimo et al., 2002).

In the study by Frankl et al. (1962) maintaining the mother–child pair intact yielded more positive response by the preschool child aged 41–49 months in the dental operatory. However, Johnson and Baldwin (1968) found that maternal anxiety appeared to be a major factor affecting the behavior of young children experiencing dental treatment.

Different studies have been carried out to assess the parental acceptance of BMT. Kamp, 1992 A.A. Kamp, Parent child separation during dental care: a survey of parents’ preference, Pediatr. Dent. 14 (1992), pp. 231–235. View Record in Scopus | Cited By in Scopus (5)Kamp (1992) used a closed-ended questionnaire which was answered by 79 parents prior to their children’s dental visit. Sixty-six percent of the parents wanted to be present with their child for care. Of the parents wishing to accompany their children, 85% responded that they would feel better and 92% believed the child would feel better.

In a study by Peretz and Zadik (1998) 104 parents completed a questionnaire regarding their presence in the operatory. Most of the parents (70.2%) expressed a wish to be present in the operatory.

Arathi and Ashwani (1999) used a questionnaire answered by 1350 parents, 78.3% of whom expressed their willingness to be present with the child during dental procedures.

Saudi parents identified parent’s separation (PS) among the least acceptable techniques which included physical restraints, hand-over-mouth, and voice control ( Abushal and Adenubi, 2003).

Crowley et al. (2005) studied the preference of parents of 8-year-old school children in Ireland in relation to accompanying their children during dental procedures and concluded that if given the choice, the majority of parents (67%) would prefer to accompany their child when receiving dental treatment. Parents in other societies may differ from Saudi parents in their responses towards presence with their children during dental treatment.

The purpose of this study was to investigate the attitudes of Saudi parents to separation from their children in the dental office and to assess the factors affecting such attitudes.

The study was a random sample survey. A questionnaire was designed to be answered by the participating Saudi parents. Pre-testing early draft of the questionnaire on a group of parents, who were not included in the study, was conducted and proper adjustments of some questions were made. The questionnaire was administered in the Arabic language. It contained questions related to their sex, marital status, job, family income and reasons for seeking dental treatment for the child. Then, questions were designed to determine the responses of the parents regarding their presence in the dental clinic. Also, questions were designed regarding parents’ dental experience and the most threatening factors in the dental situation from the parents’ view.

The sample consisted of Saudi parents who were able to answer the questionnaire independently and who accompanied their children for dental treatment in different hospitals (College of Dentistry, King Saud University and Yamamah Hospital, Ministry of Health) in Riyadh, Saudi Arabia. Only parents with normal and healthy children were included in the study.

The data collected were analyzed using SPSS Program version 10. The Chi-square test was used to detect differences between various distributions and the P-value was set at <0.05 for significance throughout the study.

Responses were analyzed for all the demographic data namely gender, age groups, marital status, educational level, work status and income groups.

Five hundred and twenty Saudi parents participated in the study of which 505 responses were suitable for tabulation. Fathers constituted 47.5%, while mothers were 52.5%. Mean age range was between 30 and 39 years.

Most of the respondents (84.2%) reported that they had three or more children. The educational level was mainly high school or diploma as reported by 37.4% of the respondents. The job situation varied between joblessness (36.6%) and jobs related to teaching or engineering (24.4%). Ninety-four percent of the parents reported that they have had good dental experience and 97% reported that they preferred to stay in the dental clinic during the treatment of their children.

Table 1 shows the situations where parents would prefer to be present during the dental treatment of their children. The highest response was the preference of parents to accompany their child if they were afraid prior to dental visit. There was a highly significant difference between fathers and mothers on the question on extraction-related dental treatment (P-value = 0.0001), followed by when the child was in pain or was on emergency visit (P-value = 0.005).

Table 2 indicates the parents’ reasons to stay with their child during the dental treatment. Safety of the child was chosen by 83% of the respondents. However, fathers showed significant difference from mothers that they were more likely to motivate the child (P-value = 0.0001).

Table 3 shows parents’ attitudes in the dental clinic during the treatment of their children. Reducing the child’s fear, comforting the child by talking and touching the hands and feet during the dental treatment was reported by 72.3% of the respondents.

Table 4 indicates the parents’ preferences regarding their attendance during the dental treatment of their children. Preference to stay throughout the whole treatment session was indicated by 78% of the respondents.

The most threatening dental procedure were dental anesthesia as reported by 87.7% of the respondents (Mean = 0.90, SD = 0.52), followed by the use of dental drill as reported by 55.4% of the respondents (Mean = 0.58, SD = 0.68). Regarding parents’ responses to the request by the treating dentist that parents should leave the clinic, 37.2% reported their agreement to leave immediately and discuss it with the dentist later.

The main finding of the present study was that Saudi parents preferred to be present during dental treatment of their children. Most of the Saudi parents preferred to stay during the whole treatment session. This finding is comparable to figures reported by American parents in studies by Venham et al. (1978) and more recently by Kamp (1992) Israeli parents by Peretz and Zadik (1998) Indian parents by Arathi and Ashwani (1999) and Irish parents by Crowley et al. (2005).

More than 72% of the parents indicated that they preferred to stay during the dental treatment if their children were afraid prior to the dental visit. There was significant difference between fathers’ and mothers’ response in their preference to stay if dental treatment would include extractions (P-value = 0.0001). Such differences could be due to the more protective nature a father always provides particularly when physical trauma is likely to occur.

The main reason of the parents to stay with their children was the safety of the child (83%) which is comparable to parents in Kamp’s study (1992). However, 52% of the parents in this study reported that they would be comfortable if they attended while 85% of the parents in Kamp’s study Holst et al. (1988) responded that they would feel better. This is higher than that of the Saudi parents. More than 35% of the parents reported that they would prefer to stay during their child’s treatment even if the dentist was known to them and to the child. This is comparable to the 50% reported by Venham et al. (1978). More than 59% of Saudi parents reported that they were likely to assist the dentist in controlling the child and this is comparable to 58% reported by Israeli parents in Peretz and Zadik study (1998).

According to parents, they would help the dentist in controlling children’s behavior by reducing their fear and comforting them by talking and touching. More than 78% of the parents indicated that they preferred to stay during the entire visit. However, in Venham et al. (1978) study, nearly half of the parents and children continued to prefer to remain together through the last visit.

Dental anesthesia and the use of hand pieces were the most threatening procedures from parents’ point of view. This is comparable to the findings of Kleinknecht et al. (1973) who studied college students and high school students. The sight of the anesthetic needle and the sight, sound and sensation of the drill were rated the most fear eliciting stimuli. Furthermore, previous study (West et al., 1983 G.A. West, K.H. Reid and A.E. Bastawi, Autonomic responses to dental procedures in pedodontic patients during a standard restoration session, J. Dent. Res. 62 (1983), pp. 728–732. View Record in Scopus | Cited By in Scopus (4)West et al., 1983) indicated that the injection procedure was the most stressful of all the procedures during dental restoration visit. However, when anesthesia was inadequate, painful high-speed drilling resulted in exaggerated responses. West et al. (1983) used pulse rate, pulse amplitude, absolute skin conductance and skin conductance responses to measure stress and anxiety in pedodontic patients.

Most Saudi parents preferred to be present in the clinic during dental treatment of their children. The main reason given by parents to stay during treatment was that the child would feel safe. Dentists should consider this when treating children. Parents observed that the administration of dental anesthesia and the use of dental drill were the most threatening procedures to the children.