title: Dental fear, communication, and behavioural management problems in children referred for dental problems.
abstract: BACKGROUND
  Knowledge about the influence of the interaction between child, parent, and dentist and the referral pattern is very limited.
  
  
  OBJECTIVE
  This study intended to assess to what extent the pathways of Rachman could clarify why a child is being referred to a specialist in paediatric dentistry and if other aspects in the interaction between child, parent, and dentist play a role in the referral.
  
  
  METHODS
  The referral letters of 500 children referred to a Special Dental Care Centre in Amsterdam were examined. All parents filled out the Children's Fear Survey Schedule-Dental Subscale, on behalf of the child. Information about interaction and the referral was collected from the referral letter and a semistructured interview with the parent and dentist separately.
  
  
  RESULTS
  Eighty pairs of parents and dentists of referred children participated in a semistructured interview. Child factors seem to contribute the most to the referral. For the cause of referral the pathways of Rachman and communication were often combined.
  
  
  CONCLUSIONS
  Apart from fear acquisition, as implied in Rachman's pathways, the interaction between child, dentist, and parent also contributes to the referral of a child to a specialist clinic in paediatric dentistry.
authors.affiliation: Department of Cariology, Endodontology, and Pedodontology, Academic Centre of Dentistry Amsterdam, Amsterdam, The Netherlands. m.klaassen@acta.nl
authors.forename: Marleen Antoinette
authors.initials: MA
authors.lastname: Klaassen
authors.forename: Jacobus Simon Johannes
authors.initials: JS
authors.lastname: Veerkamp
authors.forename: Johan
authors.initials: J
authors.lastname: Hoogstraten
mesh_terms: D000786:Anger; D001291:Attitude of Health Personnel; D002605:Character; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000523:psychology*; D002675:Child, Preschool; D003142:Communication; D016854:Dental Anxiety / Q000523:psychology*; D003729:Dental Care / Q000523:psychology*; D003812:Dentist-Patient Relations; D003815:Dentists / Q000523:psychology; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000523:psychology; D010287:Parent-Child Relations; D010377:Pediatric Dentistry; D011368:Professional-Family Relations; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000523:psychology; D013694:Temperament