Parental Presence/Absence in the Dental Operatory as a Behavior Management Technique: A Review and Modified View

Abstract

Introduction: Parental presence/absence in the dental operatory (also called: Parent-in-parent-out technique) is an extremely controversial aspect of the nonpharmacological BMTs. Historically, dentists used to exclude parents from dental operatory to avoid their interference with the dentist's aptitude to build a rapport and relationship with the child, hence increasing the child management problems by disrupting treatment and making the dentist unfocused and uncomfortable. Aim:The purpose of this article is to review and emphasize on the importance of parental presence/absence in the dental operatory, especially in a certain age group, as a behavior management technique (BMT) in pediatric dentistry, and to present a modified view of this technique. Results:This article reviews the current literature concerning behavior management in pediatric dentistry. It includes a medline database search and review of the comprehensive textbooks in pediatric dentistry. Some recommendations were based on the opinions of experienced researchers and clinicians.Conclusion: Parent-in-parent-out technique in dental operatory is advocated to gain emotional support and avoid the effect of traumatic separation, especially in younger children or special health-care needs patients. Clinical significance:The parent-in-parent-out technique in dental operatory is underused, or misused. This article clarifies the proper use of this technique along with a minor modification to it to make it more effective on young apprehensive dental patients.

Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials

“…The use of behaviour guidance techniques on both control and intervention groups was reported in included studies. Those are techniques employed by dentists to establish communication and adequate rapport with the patient, improving child's cooperation . They were used in both groups (intervention and control) as a matter of ethical aspects.…”

Influence of active versus passive parental presence on the behavior of preschoolers with different intelligence levels in the dental operatory: a randomized controlled clinical trial

“…The intervention was video recorded, and a blinded examiner evaluated the children’s overall behavior in both groups using FBRS [ 17 , 19 ] Rating 1 (– –) was given to the most negative child behavior and rating 4 (+ +) to the most positive child behavior. The FBRS of (3, 4) were re-coded to positive behavior, while scores (1, 2) were recoded to negative behavior.…”

“…On the other hand, it was reported that some dentists prefer to have the parents outside the operating room, as their presence may complicate communication with the child, or they may exhibit anxiety themselves [ 12 ]. Nevertheless, parental presence may be implemented to improve the children’s behavior, especially for the young ones and those with limited cooperation, by helping them reduce their anxiety and cope with the new environment [ 16 , 17 ].…”

Effectiveness of Parental Presence/Absence Technique as a Behavior Management Technique in Paediatric Dentstry

“…Children visiting dental office exhibit a marked fear and anxiety about their dental procedure which often culminatesin a wide variety of negative attitudes and behaviors There fore, a plethora of behavior management techniques are employed for children during theirdental treatment to lessen their fear and anxiety so that the dental practitioners can inspire a positive patient dental attitude, deliver good-quality dental care, establish communication and build a trustworthy relationship between the child and the dental team Wright 1 , suggested that a "positive dental atti-tude" was the aim of behavior management. In 1895, McElroy wrote: "Although the operative dentistry may be perfect, the appointment is the failure if the child departs in tears 2 .…”

“…Parental presence/absence (PPA) is common type of the nonpharmacological BMTs. In this technique, the parental presence is used as a factor to manage the child"s negative behavior to dental management 2 . Whether a parent should be present or not during a dental appointment is a dilemma among pediatric dentists because complete parental separation might cause emotional trauma to the child 6 .…”