title: Parental presence versus absence in the dental operatory: a technique to manage the uncooperative child dental patient.
abstract: OBJECTIVE
  Societal changes have led to an increased parental presence in paediatric dental surgeries. The aim of this study was to assess the deliberate use of a parental presence/absence (PPA) intervention as a behavioural technique to manage very uncooperative children.
  
  
  METHODS
  This is a retrospective study of the PPA technique in a Greek paediatric dental practice.
  
  
  METHODS
  Practice patient records were examined over a six year period, during which time Frankl behaviour ratings were made for each patient. At the initial dental visit, 85 otherwise normal healthy children were found to be very uncooperative (Frankl score of definitely negative); 46 female and 39 male, mean age 4.6+/-1.5 yrs (range 2.7-8.8). Their parents stepped out of the operatory and returned after the child became cooperative. These children were compared with 85 randomly selected cooperative children, matched for age and gender.
  
  
  METHODS
  A one sample binomial test was used to assess the technique's success, while chi(2) and t-tests were used for between group comparisons of proportions and means, respectively.
  
  
  RESULTS
  Seventy-four out of the 85 initially uncooperative children displayed Frankl positive behaviour as the initial appointment progressed, while 6 children remained uncooperative during the first appointment but were cooperative at following visits. The total technique success was 80/85 (94%, p<0.001). The two groups differed significantly with regards to control in caries scores (frequency 77.6% with 12.2 +/- 11.8 dmfs as opposed to 54.1% with 6.7 +/- 5.7 dmfs), and in parent's awareness of patient dental needs or symptoms (76 vs 52). There was no significant difference between groups with regards to completing the treatment planned (63/80 vs 75/85). There was no significant difference in the proportion of returning children who displayed uncooperative behaviour in subsequent visits.
  
  
  CONCLUSIONS
  The PPA technique can be successful in gaining the cooperation of children displaying very negative behaviour, thus minimising the need for other more aversive techniques.
authors.affiliation: Department of Paediatric Dentistry, Dental School, Aristotle University Thessaloniki, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Kotsanos
authors.forename: A
authors.initials: A
authors.lastname: Arhakis
authors.forename: T
authors.initials: T
authors.lastname: Coolidge
mesh_terms: D032763:Behavior Control / Q000379:methods*; D002653:Child Behavior Disorders / Q000517:prevention & control*; D002675:Child, Preschool; D016854:Dental Anxiety / Q000517:prevention & control; D019140:Dental Care for Children / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D018709:Statistics, Nonparametric