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Parents' Presence in the Operatory During Their Child's Dental Visit: A


Person-Environmental Fit Analysis of Parents' Responses.

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PEDIATRIC DENTISTRY V 34 / NO 5 SEP / OC T 12

Case Report
Parents’ Presence in the Operatory During Their Child’s Dental Visit: A Person-Environmental
Fit Analysis of Parents’ Responses
Jung Soo Kim, BS1 • James R. Boynton, DDS, MS2 • Marita Rohr Inglehart, Dr. phil. habil.3

Abstract: Purpose: The purpose of this study was to explore whether parents’ satisfaction with their child’s treatment and their attitudes concerning the
dental visit are affected by the fit between their desire to be present/absent during their child’s dental treatment and whether they were actually present/
absent. In addition, this study explored the effects of child variables (age, gender, ethnicity, and prior experiences with dental treatment) and parent
variables (age, gender, and prior own dental experiences) on parents’ desire to remain/not remain with their child. Methods: Survey data were collected
with paper-pencil surveys from 239 parents at the beginning and at the end of their child’s dental appointment. The survey contained questions
concerning the parents’ preferences for being with their child in the operatory and their evaluations of the dental visit. Results: Parents whose expe-
riences concerning being in the operatory matched their wishes were more satisfied and had more positive attitudes concerning the dental visit vs
parents whose experiences and wishes did not match. The older the parents were, the more they wanted to accompany the child into the operatory.
Conclusions: The fit between the parents’ desire to be present/absent during their child’s treatment and the actual situation they encountered was
significantly related with the parents’ satisfaction and attitudes related to their child’s dental visit. (Pediatr Dent 2012;34:407-13) Received January 29,
2011 | Last Revision April 12, 2011 | Accepted April 13, 2011

KEYWORDS: PARENTS, CHILD, PEDIATRIC DENTISTRY, PATIENT SATISFACTION, DENTAL CARE FOR CHILDREN

Parental presence during medical and dental procedures has practice settings showed that providers were only rarely nega-
long been a controversial topic. 1 The controversy focuses on tively affected by the parents’ presence2 and mostly found no
how the parents’ presence/absence affects children’s, providers,’ negative effects on the providers.3,5,14-16 Some providers even
and parents’ responses to the treatment. advocated for the parents’ presence, 17 especially during less
Concerning the child patients’ responses, research in med- invasive procedures.18,19 In dental settings, Marcum and col-
ical settings showed that parental presence during induction of leagues found that pediatric dentists who did not allow parents
anesthesia decreased children’s psychological trauma and helped into the operatory argued that their presence would waste
with a smoother induction2 and that children who were with time, disrupt the child, and make the dentist uncomfortable.20
their parents showed less distress than children whose parents When Adair and colleagues surveyed members of the AAPD
were not present during venipuncture.3 Two systematic reviews, in 2004, however, they found that 61% and 66% of the pro-
however, found mixed evidence concerning the effects of parents’ viders, respectively, allowed parents in the operatory during
presence/absence on children’s responses.4,5 In the dental set- emergency examinations and when the child was a patient with
ting, research on the effects of parents’ presence in the operatory special health care needs, and that 25% reported that they rou-
on their child had mixed results. While some authors showed tinely invited parents for sedation visits.21
that the parents’ presence was beneficial, 6 other authors pro- Concerning the effects of the parents’ presence/absence on
vided evidence that it is not helpful7 or that there was no sig- the parents themselves, most studies in the medical setting
nificant difference in the behavior of the children whose parents showed that parents had a more positive response to the treat-
were present vs absent. 8-11 The guidelines of the American ment when they were with their child during invasive proce-
Academy of Pediatric Dentistry (AAPD) include parental pres- dures,2,3,5,16, 17 while only a few researchers found no effect of
ence or absence as a method to help establish effective dentist- the parents’ presence/absence on their responses to the treat-
child communication during dental treatment.12 ment.4,14 Research on the parents’ desire to be present/absent
Research on the effects of parental presence/absence dur- during their child’s treatment showed that most parents wanted
ing children’s treatment on medical and dental care providers to be with their child when they were getting invasive proce-
in operating rooms,2 general hospital settings,13 and in private dures22 and thought they should be invited to be present.13 This
desire to remain with their child was also found in studies in
the dental setting where the percentages of parents who wanted
1Ms. Kim is a research assistant, Department of Periodontics and Oral Medicine, and to accompany their child ranged from 66%23 and approximate-
2Dr. Boynton is a clinical assistant professor of dentistry and director of pediatric den-
ly 70%24 to 78%25 and even to 97%.26 The reasons were that
tistry, Department of Orthodontics and Pediatric Dentistry, both at the School of Den- parents wanted to know what happened,8 they thought they
tistry; and 3Dr. Inglehart is an associate professor, Department of Periodontics and Oral
Medicine, School of Dentistry, and adjunct associate professor, Department of Psychol-
could actively support the dentist when their child had be-
ogy, College of Literature, Science and Arts, all at the University of Michigan, Ann Arbor, havioral problems24, and they felt their child benefited from
Mich., USA. their presence.26 In the survey of AAPD members, 78% of the
Correspond with Dr. Inglehart at mri@umich.edu

PARENTS’ RESPONSES TO ACCOMPANYING/NOT ACCOMPANYING CHILDREN TO THE OPERATORY 407


PEDIATRIC DENTISTRY V 34 / NO 5 SEP / OCT 12

respondents realized that parents prefer to be present and 58% relationship between a child’s previous dental experiences and
even responded that parents insisted on being present.21 parents’ desire to accompany their child.23,29
While most parents desire to be present with their child in In addition to child factors, parent factors were studied to
the operatory, it is still debated whether the parents’ presence explore whether they affected the parents’ desire to remain with
would have a positive effect on the parents.27 Knowing under their child. Research showed that parental age was not signifi-
which circumstances parents’ presence/absence can increase the cantly correlated with the parents’ desire to accompany their
parents’ satisfaction with their child’s dental visit and improve child,23,24 nor was their gender24 or the degree to which parents
their attitudes toward the dentist could be important to assure had previous dental experiences.23,24,29
future dental care for children, given that parents are the gate- In summary, the purpose of this study was to explore how
keepers who decide to bring their child for dental care. The fit/ a consistency/inconsistency between the parents’ desire to
misfit between the parents’ own wishes and what actually hap- remain/not remain with their child and the actual situation
pens in the situation might be one factor that determines encountered would affect the parents’ satisfaction with the ap-
whether the parents’ presence/absence during their child’s dental pointment and their attitudes toward the dentist and dental
treatment has a positive effect on their response to their child’s visit. It was predicted that parents who wanted to stay with
dental visit. their child and actually did so and parents who did not want to
Consistency theories predict that a consistency or fit be- stay with their child and did not stay (=consistent conditions)
tween a person’s expectations and wishes and actual events results would be more satisfied and have a more positive attitude to-
in a state of consistency, while an inconsistency or mismatch ward the dentist than parents in inconsistent conditions. In
between a person’s expectations and actual events leads to ten- addition, this study explored the effects of child and parent
sion.28 While parents differ in their desire to accompany their characteristics on the parents’ desire to remain with their child
child into the operatory, 23-26 providers may or may not ask and their satisfaction with their child’s treatment.
them to be present/absent during their child’s treatment. Parents
who wanted to remain with their child and actually did and
parents who didn’t want to accompany their child and actually Table 1. BACKGROUND CHARACTERISTICS OF CHILDREN AND PARENTS
didn’t experience a state of consistency. Experiencing consistency
Child characteristics Total Consistent† Inconsistent P-value
and no tension is likely to result in a more positive response to sample* n=185 n=38
the situation—specifically, a higher level of satisfaction with n=239
the appointment and a more positive attitude with the dentist
compared to experiencing inconsistency. Parents who desired to Gender
Boy 54% 55% 61% >.54
remain with their child in the operatory but did not actually do Girl 46% 45% 40%
so and parents who don’t desire to remain with their child but Age (ys)
actually did experience a state of inconsistency,28 which results Mean±(SD) 7.35/3.37 7.71/3.39 7.35/3.30 >.61
in tension that needs to be reduced. Being less satisfied with Range 1-15 1-15 1-13
the appointment and having less positive attitudes toward the Ethnicity/race
European American 60% 62% 47% >.40
dentist would be one way to reduce this tension. Non-European American 40% 38% 53%
The first objective of this study was, therefore, to test the Grade in school
hypothesis that parents in an inconsistent condition would be Mean±(SD) 2.61/2.72 2.57/2.74 2.34/2.42 >.63
less satisfied and have less positive attitudes toward the dentist Range 1-10 0-10 0-7
and the dental visit vs parents in a consistent condition. Visit characteristics according to clinical chart
If the findings support this hypothesis, it could ultimately Treatment provided
be important for providers to consider parents’ wishes concern- Examination 61% 59% 70% .21
ing their presence/absence during their child’s dental treatment. Cleaning 55% 53% 68% >.11
X-ray 32% 30% 43% >.12
It would, therefore, be helpful for dentists to know which parents Fluoride 40% 39% 49% >.28
were likely vs not likely to want to stay with their child and also Filling 19% 20% 19% <.87
which factors affected their satisfaction with the treatment. A Extraction 10% 10% 8% <.72
Orthodontic treatment 21% 23% 19% >.58
second objective therefore, was to explore which child and parent Sealant 16% 18% 11% >.30
factors would be related with the parents’ desire to remain with Local anesthesia 2% 2% 5% >.19
their child during the child’s dental treatment and their treat- Nature of visit
ment satisfaction. Concerning child factors, some previous New patient exam 50% 49% 54% >.54
studies showed that the child’s age was correlated with the Regular visit 50% 52% 46%
Nitrous oxide
parents’ desire to remain with their child in the operatory,23,25 Yes 20% 21% 16% <.54
while Peretz and Zadik,24 found that the child’s age did not signi-
ficantly influence the parents’ preference. Research concerning
whether parents of girls would be more likely to remain with * Parents were asked if they wanted to be present in the operatory during the child’s
dental visit. Some parents indicated they were not sure if they wanted to be present.
their child vs parents of boys showed that the child’s gender did These parents were excluded from the comparisons of the parent responses in the
not affect the parents’ preferences.24,29 In addition, the child’s conditions “consistent” vs “inconsistent” situation.
ethnic/racial background also did not affect the parents’ desire † Parents who indicated they wanted to be and were in the operatory as well as
to remain with their child.6,29 While Peretz and Zadik24 found parents who did not want to be and were not in the operatory were categorized as
having encountered a consistent situation during their child’s treatment. Parents
no significant relationship between the child’s previous dental whose desire to be or not be with their child did not match their actual situation
experience and parental preferences for being present in the during their child’s treatment were categorized as encountering an inconsistent
dental operatory, other findings suggest that there might be a situation.

408 PARENTS’ RESPONSES TO ACCOMPANYING/NOT ACCOMPANYING CHILDREN TO THE OPERATORY


PEDIATRIC DENTISTRY V 34 / NO 5 SEP / OC T 12

Methods indicated they had between $500 and $2,000 per month and
This study was approved by the Institutional Review Board of 16% that they had $3,000 or more as a monthly income. Data
the Health Sciences, University of Michigan, Ann Arbor, Mich. were also collected from the 14 providers at the pediatric dental
Respondents. Before collecting the data, a power analysis clinic who provided care for these pediatric patients. These pro-
with G* Power Program 3.1.2 software (available at: “http:// viders were all pediatric dentistry residents at this dental school.
www.psycho.uni-duesseldorf.de/aap/projects/gpower/”) had Procedure. The data were collected between July 2009 and
been conducted to determine the sample size needed to detect a May 2010. Parents/guardians who accompanied their children
.60 difference in the responses of the parents in the consistent vs to regularly scheduled appointments at a pediatric dental clinic
inconsistent conditions concerning their satisfaction with their were approached in the waiting area and invited to participate
child’s dental visit. This dependent variable “satisfaction with in the study. After they signed a consent and Health Insur-
the child’s visit,” was selected as the central variable because it is ance Portability and Accountability Act (HIPAA) form, they
the most relevant outcome in this study. A difference of .60 on participated by responding to a survey before and after their
the 5-point answer scale (12%) was considered a clinically rel- child’s appointment and agreed to have their child’s chart rev-
evant difference. When assuming a 1-sided test (expecting that iewed. They received free parking for their participation.
the parents in the inconsistent condition would be less satisfied Materials. The Parent Baseline Survey included questions
than the parents in the consistent condition) and an alpha of about the patient’s oral health and dental anxiety and the
.05 and the power of .80, a sample size of 36 respondents in parents’ oral health, dental fear, and preferences concerning ac-
each condition was determined. Data were collected from 239 companying their child into the operatory. The Parent Follow-
parents/guardians of regularly scheduled child patients at a pedi- up Survey consisted of 3 sections. First, the parents reflected
atric dental clinic at a Midwestern dental school; 185 of these on whether they wanted to be/not to be with their child in the
parents fell into the consistent condition (“wanted to be with operatory, whether they actually were with their child, and how
child and were with child” or “did not want to be with child and much they wished they had been with their child. The second
were not with child”) and 38 were in the inconsistent condition. set of 2 questions assessed the parents’ perceptions of the child’s
Table 1 shows that the children (54% boys/46% girls) were responses to the treatment. The final set of 6 questions measured
between 1 and 15 years old (average age=7.35±3.37 [SD] years the parents’ own responses to their child’s treatment, These 6
old) and were mostly from a European American background questions asked the parents to indicate: (1) how satisfied they
(60%). Most of the parents/guardians were mothers or step- had been with the visit; (2) how comfortable they had been;
mothers (69%); additionally, 21% were fathers/stepfathers and (3) how friendly the dentist had been; (4) how well the dentist
10% were guardians. The parents/guardians ranged in age from had explained what would be done during the visit; (5) how
16 to 78 years old (average age=36.21±9.97 years old) and had, much they had trusted the dentist; and (6) how much they had
on average, a high school diploma (mean=13.41 years of school- learned about making sure that the child would have healthy
ing starting with kindergarten). While 7% of the parents reported teeth. A factor analysis (extraction method: principal compo-
they had no income or an income below $500 per month, 55% nent analysis; Varimax Rotation) showed that all 6 items loaded

Table 2. PARENTS’ RESPONSES CONCERNING THEIR CHILD’S DENTAL VISIT


Parents’ responses concerning their situation during treatment Total sample Consistent Inconsistent P-value
n=239 n=185 n=38
Parent wanted to be in operatory: Yes 39% 34% 82% <.001
Parent was in operatory: Yes 26% 34% 18% <.05
Consistent/inconsistent—Total 83% 17%
Yes/yes 34%
No/no 66%
I wanted to be with my child during the dental visit* Mean±(SD)
2.84±1.71 2.73 3.44 >.02
How much do you wish you had accompanied your child?† 1.88±1.36 n=119 n=25 <.001
1.45 3.76
Parents’ perceptions of child’s response Total sample Consistent mean Inconsistent P-value
Mean±(SD) mean

Child wanted parent in room* 2.84±1.68 2.78 3.29 <.11


Child enjoyed the visit today* 3.68±1.30 3.77 3.23 <.04
Parents’ own responses to child’s visit (Cronbach’s alpha=.82)
Satisfaction with child’s dental care today‡ 4.54±0.90 4.74 3.76 <.001
I felt comfortable bringing my child to the visit today* 4.53±0.95 4.60 4.32 >.10
The dentist was friendly* 4.71±0.78 4.74 4.52 <.14
The dentists explained what would be done today* 4.55±1.00 4.64 4.06 <.02
I trusted the dentist to provide good treatment for my child* 4.64±0.85 4.71 4.22 .002
I learned more about how to make sure that my child has healthy teeth* 4.10±1.19 4.18 3.61 .009

* Answers were given on 5-point scales from: 1=strongly disagree to 5=strongly agree. † Answers were given on 5-point scales from: 1=not at all to 5=very much.
‡ Answers were given on 5-point scales from: 1=not at all satisfied to 5=very satisfied.

PARENTS’ RESPONSES TO ACCOMPANYING/NOT ACCOMPANYING CHILDREN TO THE OPERATORY 409


PEDIATRIC DENTISTRY V 34 / NO 5 SEP / OCT 12

on 1 factor. The reliability of these measures was determined 3.77 vs 3.23; P<.04). The parents’ own responses to their child’s
with a Cronbach’s alpha coefficient, which was alpha=.82. visit showed that the parents in the consistent condition were
Statistical analyses. The data were analyzed with SPSS 17 significantly more satisfied with the child’s dental care than
statistical software (SPSS Inc, Chicago, Ill).30 Descriptive statis- the parents in the inconsistent group (4.74 vs 3.76; P<.001).
tics (eg, percentages of responses, means, and standard devia- Concerning the relationship with their child’s provider, parents
tions) were used to describe the responses overall as well as the in the consistent condition agreed significantly more strongly
responses of parents who had experienced a consistent situation that the dentist had explained what would be done today (4.64
vs an inconsistent situation. The parents were in a consistent vs 4.06; P<.02) and that they trusted the dentist to provide
situation when they wanted to be with their child during the good treatment for their child (4.71 vs 4.22; P=.002) than the
treatment and actually were with the child (yes/yes) and when parents in the inconsistent condition. In general, parents in the
they did not want to be with their child and were not with the consistent condition agreed more strongly that they learned
child (no/no). They were in an inconsistent condition when more about how to make sure that their child has healthy
their desire to be with their child did not match their actual teeth than parents in the inconsistent condition (4.18 vs 3.61;
experienced situation (yes/no and no/yes). Independent sample P=.009).
t tests were conducted to compare the average responses of Figure 1 provides more detailed information concerning
parents in the consistent vs inconsistent conditions. Chi-square the differences between parents in the consistent condition who
tests were used to analyze whether the percentages of parents wanted to be with their child and were with their child vs the
with different characteristics in the consistent vs inconsistent parents who did not want to be with their child and were not
conditions differed. A P<.05 significance level was used. with their child, and also in the responses of the parents in the
inconsistent condition who either did not want to be with their
Results child and were with their child or who wanted to be with their
Before analyzing whether the parents in the consistent vs in- child and were not with their child. Figure 1 shows that there
consistent conditions differed in their responses to their child’s are significant interaction effects for the interaction between
dental visit, it is worthwhile to explore whether parents’ and the factors “I want to be with my child: yes/no” and “I was with
children’s background characteristics and dental visit character- my child: yes/no.” Concerning the responses to the question
istics are comparable in the consistent vs inconsistent condi- about how satisfied the parents were with their child’s dental
tions. Table 1 shows that the 2 groups did not differ significantly care today, this figure shows that a nearly perfect level of satis-
in any of these characteristics. Both groups had approximately faction was reported by parents who wanted to be with their
the same percentages of boys vs girls, and the average age of child and were with their child, and that the level of satisfaction
these children was between 7 and 8 years old. In addition, in the consistent condition in which parents did not want and
most respondents in both groups were mothers/stepmothers were not with their child was also higher than the 2 means in
(consistent condition=68%; inconsistent condition=74%; P>.77). the inconsistent condition. The lowest average response was
Fathers or stepfathers were the second most common group given by the parents who did not want to be with their child
of respondents (consistent condition=22%; inconsistent condi- and who were with their child during the dental treatment. The
tion=26%), with the average age in the mid 30s (consistent same pattern of responses also occurred concerning how much
condition=36.08 years old; inconsistent condition=35.22 years trust the parents had in their child’s dentist.
old; P=.62) and had on average graduated from high school The second objective was to explore whether child and
(consistent condition=13.41 years of education starting from parent background as well as dental care related characteristics
kindergarten; inconsistent group=13.22 years; P=.764). Table 1 would be correlated with the parents’ desire to accompany their
also shows that the children in the consistent and inconsistent
group did not differ significantly in the types of treatments they
had received before, in the nature of their visit, and concerning
whether they had received nitrous oxide during their treatment.
The central objective was to determine whether the parents’
responses to their child’s dental visit differed as a function of
whether they had encountered a consistent vs inconsistent situa-
tion concerning the fit between their own wishes and the actual
visit. A total of 16 parents were not sure if they wanted to be
with their child or not and could, therefore, not be assigned to
the consistent or inconsistent group. Table 2 shows that, over-
all, more parents experienced a consistent situation (n=185) vs
an inconsistent situation (n=38). In the consistent condition,
34% of the parents were in the operatory vs 18% of parents in
the inconsistent condition. Of the parents with a consistent ex-
perience, 34% had the experience that they wanted to be with
their child and actually were with their child, while 66% did
not want to be with their child and were not with their child.
Concerning the parents’ perceptions of their child’s response
to the appointment, Table 2 shows that the parents in the con-
sistent condition rated their child’s enjoyment of the visit higher Figure 1. Satisfaction, attitude, and knowledge of parents in the consistent and
than the parents in the inconsistent condition (on 5-point scale: inconsistent condition.

410 PARENTS’ RESPONSES TO ACCOMPANYING/NOT ACCOMPANYING CHILDREN TO THE OPERATORY


PEDIATRIC DENTISTRY V 34 / NO 5 SEP / OC T 12

Table 3. RELATIONSHIPS BETWEEN CHILD AND PARENT ported by the data in several ways. First, the parents in the 2
CHARACTERISTICS AND THE PARENTS’ conditions differed in their perceptions of their child’s response
RESPONSES TO THEIR CHILD’S DENTAL VISIT to the dental visit. The parents in the inconsistent condition
indicated that their child did not enjoy the dental visit as much
Child characteristics Parents’ Parents’ as the parents in the consistent condition. Given that these
desire to satisfaction
accompany with answers reflected the parents’ perceptions of their child’s feel-
child* treatment ings, it would be interesting to explore in future studies whether
the children’s own responses would mirror their parents’ per-
Age -.31 (P<.001) -.09 ceptions or whether the parents’ experiences had biased these
Gender† .19 (P<.02) .14 responses.
Ethnicity .12 .14 Secondly, concerning the parents’ own responses to their
Total no. of operative visits -.16 (P<.02) -.02 child’s visit, the findings showed that parents with consistent
No. of fillings in experiences: were more satisfied; trusted the dentist more; felt
Primary teeth -.16 (P<.02) -.03
Permanent teeth -.18 (P=.008) -.08
the dentist had explained better what would be done during
the visit; and indicated that they had learned more about how
No. of extractions of
Primary teeth .18 (P=.008) -.03
to keep their child’s teeth healthy vs parents in the inconsistent
Permanent teeth -.10 -.11 condition. When interpreting these findings, it is important to
Parent characteristics
remember that only 34% of the parents in the consistent con-
Age .13 (P<.05) .01 dition were actually with their child, while 66% were not in
Gender .08 .06 the operatory.
Parents’ oral health .13 .33 (P>.03) Despite not being in the operatory, these parents indicated
Did parent see dentist during .14 .16 that the dentist had explained the treatment well and that they
the last year?
had learned more about how to make sure that their child has
healthy teeth. This finding is interesting because it demonstrates
* Wanting to accompany the child=1; not wanting to accompany the child=0.
that even if parents are not in the operatory, they can neverthe-
† Boy=1; girl=2.
less perceive that they learn about good oral health promotion—
as long as they are in a situation that they themselves want to
child. Table 3 shows that the younger the children were, the be in.
more likely parents were to desire to accompany their child Concerning the relationships between child characteristics
(r=-.31; P<.001), and that parents of girls were more likely to and parents’ desire to remain with the child, the results concern-
want to accompany their child than parents of boys (r=.19; ing the role of the child’s age are consistent with previous find-
P<.02). In addition, the more prior operative visits a child had, ings7,23,25 showing that the younger their child was, the more
the less the parents desired to accompany their child (r=-.16; the parents wanted to be with their child. In addition, Adair et
P<.02) and the more dental treatments they had, the less the al.,21 found in their survey of members of AAPD that pediatric
parents desired to accompany their child (fillings in primary dentists preferred to have parents in the operatory when the
teeth: r=-.16; P<.02; in permanent teeth: r=-.18; P=.008; ex- child was younger. Concerning the relationship between the
tractions in primary teeth: r=.18; P=.008). The older the child’s gender and the parents’ desire to accompany their child,
parents were, the more they wanted to accompany their child the data showed that parents were more interested in accom-
(r=.13; P<.05). Concerning the relationships between child panying girls than boys. This finding is inconsistent with the
and parent characteristics and the parents’ satisfaction with the results of a previous study by Peretz and Zadik,24 who found
visit, Table 3 shows that not one of the child factors and only that the child’s gender did not affect the parental preference
the parents’ self perception of their own oral health was cor- for being present in the operatory. This finding suggests that
related with the parents’ satisfaction with their child’s treatment parents of girls were more protective of their child than parents
(r=.33; P>.03). of boys and, thus, might have a greater desire to accompany
their daughter into the operatory.
Discussion Finally, the data showed that the more previous dental visits
The respondents in the consistent vs inconsistent conditions did the child had (such as the total number of operative visits) and
not differ in the child, parent, or dental visit-related character- the more previous dental treatment the child had (such as the
istics. This finding is important because differences in those number of fillings in primary and permanent teeth and the
characteristics could potentially have had an effect on the out- number of extractions of primary teeth), the less the parents
come variables in this study, namely on the parents’ satisfaction wanted to accompany their child into the operatory. This find-
with their child’s treatment as well as their attitudes toward ing is inconsistent with the results by Peretz and Zadik,24 but
the dentist and the treatment. The fact that the respondents consistent with the findings by Kamp23 who showed that parents
in the 2 conditions did not differ in these characteristics offers who wanted to accompany their child had children with an
an excellent starting point for exploring the effects of having a initial dental visit. Kamp23 suggested that parents of children
person-environmental fit (consistent condition) vs not having who came for their first dental visit (eg, parents who were less
such a fit (inconsistent condition) on these outcomes. experienced) were more willing to accompany their child. This
It was predicted that parents in the consistent conditions result is consistent with the current findings. While the parents’
would have a more positive response toward the dental visit desire to accompany their child was related to a child’s previous
than parents who had encountered an inconsistency between dental experience, however, their satisfaction with the visit was
their desire and the actual situation. This hypothesis was sup- not significantly related to previous dental experiences.

PARENTS’ RESPONSES TO ACCOMPANYING/NOT ACCOMPANYING CHILDREN TO THE OPERATORY 411


PEDIATRIC DENTISTRY V 34 / NO 5 SEP / OCT 12

In addition to exploring whether child characteristics would The clinical charts reviewed only captured the information
affect the parents’ desire to be with their child during a den- collected during visits to this particular dental clinic, making
tal visit, the effects of parent characteristics such as the parent’s these chart review data less comprehensive. Finally, the parents
age, gender, self-perceived oral health, and whether they had described the children’s emotional responses to the visit and no
visited a dentist during the previous year were also explored. The child responses were assessed. It is quite likely that the parents’
only variable found to be significantly related to the parents’ perceptions of the visit biased their responses concerning their
desire to accompany their child was the parents’ age. The older child’s visit. Future research should, therefore, also collect
the parents were, the more likely they were to want to accom- data from the patients. These limitations could potentially have
pany their child during the dental visit. This finding is incon- affected this study’s results and should be considered in future
sistent with previous findings showing that the parents’ age was studies.
unrelated to the parents’ desire to accompany their child.23,24
In addition, the parents’ self perceived oral health was the only Conclusions
parental characteristic that was found to be significantly related Based on this study’s results, the following conclusions can be
to parents’ satisfaction with their child’s treatment. The better made:
the parents perceived their own oral health to be, the higher 1. Compared to parents whose desire was not matched
their satisfaction with the treatment. One possible explanation with the actual event, parents whose desire to be present/
for this finding could be that parents who had good oral health absent during their child’s dental visit matched the
regarded their child’s dental treatment as more important and actual event:
crucial; therefore, they were more satisfied with their child’s a. were more satisfied with their child’s dental
dental visit. appointment;
In this study, we only explored the parents’ responses con- b. had a more positive attitude toward the dentist
cerning their desire to remain with their child during the child’s and the dental visit; and
dental visit and their satisfaction with their child’s visit and how c. had a more positive perception of their child’s
a consistency or inconsistency between the parents’ desire and response to the appointment.
the situation they actually encountered would affect these out- 2. Concerning the effects of child and parent background
come variables. It would be interesting to explore how a consis- and dental treatment-related characteristics, the
tency or inconsistency of the provider or of the child’s desire to younger the child is, the older the parents are, and the
have vs not to have the parents in the operatory and the actual fewer previous dental appointments and treatments a
situation would affect the providers’ satisfaction with the child’s child had, the more the parents wanted to accompany
treatment. For example, one could predict that dentists who their child.
wanted to have and actually allowed parents in the operatory
or dentists who did not want and did not allow parents in the Acknowledgments
operatory would be more satisfied than dentists who wished The authors wish to thank the residents and staff at the Pediatric
for parental presence but did not have any in the operatory or Dental Clinic, School of Dentistry, University of Michigan, for
dentists who did not wish parents to be present yet the parents their help with the data collection and participation in this
insisted on accompanying their child. The same reasoning research, and the staff at the office for central records for their
could be applied when predicting how happy pediatric patients help in accessing the clinical charts.
would be with their appointments. Future research could ex-
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