Preferences and Perceptions of Paediatric Dentists’ Attire among 4-12-year-old Children: A Cross-sectional Study

1. Associate Professor, Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. 2. Assistant Professor, Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. 3. Assistant Professor, Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. 4. General Dentist, Department of General Dentist, King Abdulaziz University, Jeddah, Saudi Arabia. 5. General Dentist, Department of General Dentist, King Abdulaziz University, Jeddah, Saudi Arabia. 6. Associate Professor, Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.

Abstract

Introduction: Dentists’ attire includes their choice of clothes and Personal Protective Equipment (PPE) required to follow infection control measures. Investigating and understanding the paediatric patient’s preferences and perceptions towards the dentist’s attire can aid in establishing a more efficient and smoother relationship between them.

Aim: To determine the children’s preferences and perceptions of their paediatric dentist’s attire and PPE among four to 12-year-old children.

Materials and Methods: This cross-sectional study included four to 12-year-old Arabic-speaking children attending Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia for dental treatment with their parents/guardians between February 2022 and April 2022. Data were collected from the participants using a validated Arabic electronic questionnaire to determine their preferences regarding different parts and types of the dentist’s attire and PPE, as well as their perceptions and feelings of comfort towards the dentist wearing the full standard PPE. Data were summarised as frequencies and percentages for categorical variables or means and standard deviations for continuous variables. The significance threshold was set at 0.05.

Results: A total of 362 participants with a mean age of 8.4±2.3 years and their parents/guardians participated in the study. Female dentists were significantly more favoured by both male and female participants, with statistical significance among females (p<0.001) and younger participants (p<0.001). Both males and females (p=0.025) and older participants (p=0.001) significantly favoured the traditional white coats over colourful paediatric coats. Furthermore, older participants significantly preferred surgical masks over paediatric masks (p<0.001), face shields as eye protection (p<0.001), and no head cover over colourful paediatric caps (p<0.001). Male participants showed significantly better acceptability towards the dentist wearing the full standard PPE.

Conclusion: Both genders and younger children preferred female dentists. The traditional white coat is the most preferred attire by both genders and older children. Male and older children showed higher acceptability for the full standard PPE.

Head protective devices, Masks, Patient preference, Personal protective equipment, Protective clothing, Surgical attire

Fear and anxiety related to dental care providers or dental treatment are considered significant barriers to quality dental care (1), which might compel paediatric dentists to consider using advanced behavioural management techniques like general anaesthesia. Therefore, the success of paediatric dentistry relies on employing the best methods and techniques to interact and establish a friendly relationship with paediatric patients in a comfortable atmosphere from the first visit (2). When a paediatric patient first enters the dental clinic, the dentist’s attire is usually the first component they notice. Moreover, during this initial visual impression, the child judges, analyses, and registers the dentist’s movements, communication, and attire (3). Dentists’ attire includes their choice of clothes and PPE required to adhere to infection control measures. The traditional white coat is one of the main attires worn by healthcare professionals. Fear of the white coat is one of the most prevalent fears among children (4), which, in turn, can act as a barrier to visiting the dentist and receiving the necessary dental treatment promptly (5). Investigating and understanding the paediatric patient’s preferences and perceptions towards the dentist’s attire can help in establishing a more effective and smoother relationship with them. Therefore, multiple studies (1),(6),(7),(8),(9),(10),(11),(12),(13),(14),(15) have investigated the influence of the dentist’s attire on children’s perception and preferences, with the traditional white coat being found to be the preferred attire by children in some studies (1),(6),(8),(9),(11),(12),(13),(14), while others reported that colourful and cartoonish attires were preferred, especially among younger or anxious children (7),(8),(13). The dentist’s gender was also examined, with some studies finding that children preferred to be treated by a dentist of the same gender (1),(12),(14), while others reported a preference for female dentists, particularly among highly anxious patients (6),(15). In the Middle East, a few studies have investigated children’s preferences and perceptions of their paediatric dentist’s attire (9),(13). However, the dental literature still lacks these reports, and more studies are needed to better understand paediatric patients’ preferences and perceptions towards their dentists. Therefore, the present study aimed to determine the children’s preferences and perceptions of their paediatric dentist’s attire and PPE among four to 12-year-old children attending King Abdulaziz University. The study also aimed to understand the differences in preferences and perceptions between male and female children and children in different age groups (4-8 years and 9-12 years).

Material and Methods

This cross-sectional study recruited children attending Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia for dental treatment with their parents/guardians between February 2022 and April 2022. The study was approved by the Research Ethics Committee of the Faculty of Dentistry, King Abdulaziz University (approval number: 4376410). The reporting of the study was guided by the checklist from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) (16). The study included four to 12-year-old Arabic-speaking children.

The aim of the study was explained verbally to the parents/guardians of eligible children by a single trained dentist.

Inclusion and Exclusion criteria: The parents/guardians who agreed to participate were asked to sign an Arabic consent form before participation. Additionally, an assent form was obtained from seven to 12-year-old children. Only one child was included in the study for parents/guardians accompanying more than one eligible child. Both participants and their included parents/guardians were asked to answer a validated Arabic electronic questionnaire on a tablet device. Children and/or parents/guardians who were non Arabic speaking and children of parents who refused to participate were excluded.

Sample size calculation: Using nQuery software, based on a previous study (10), it was estimated that when the sample size in each age or gender group was 120 subjects, a two-group Chi-square test with a 5% two-sided significance level would have 80% power. Hence, it was decided to aim for a minimum of 120 in each of the gender and age categories.

Study Procedure

The study entailed collecting data via a validated Arabic electronic questionnaire that was created and validated by the authors targeting the parents/guardians and the children participants. The questionnaire was initially designed in English and subsequently translated into Arabic. To validate the questionnaire, the translated version was then presented to three paediatric dentist consultants to obtain expert opinions, and their comments were considered and adopted. After that, the questionnaire was administered to 10 children and their parents/guardians who were asked to fill in the survey and offer their opinions on whether they had trouble understanding or answering any of the included questions. Two weeks later, the questionnaire was administered again to five of them, which showed high reliability (weighted kappa=0.817). The questionnaire consisted of three parts. In the first part, the participating parents/guardians answered seven questions about their participating child’s age, gender, nationality, previous medical history, number of previous dental visits, type of treatment provided, and parental assessment of their child’s behaviour during the previous visits. They also answered four questions regarding their demographics including age, marital status, level of education, and the number of children they have.

The second part of the questionnaire included 11 questions showing photographs of dentists taken by the researchers. Younger participants answered this part of the questionnaire with parental guidance, if needed, to demonstrate their preference regarding different parts and types of dentists’ attire and PPE. First, the participants were asked whether they preferred a male or female dentist. After stating their preference, photos of dentists of the same gender they chose as their preference were introduced to the participants. The photos of the male and female dentists were taken while maintaining similar postures and neutral facial expressions to avoid bias. The participants were asked to select their preferred dentist’s main attire, face protection, eye protection, the colour of disposable isolation gowns, and head covering. The dentists photographed were not involved in any data collection or dental treatment for the children. Once they had made their choices, they were not allowed to backtrack to change their answer. To ensure each question was answered, there was no option to state no preference. An illustration of the second part of the questionnaire is presented in (Table/Fig 1),(Table/Fig 2).

The third part of the questionnaire, consisting of seven questions, was regarding the participant’s perception and feelings of comfort toward the dentist wearing the full standard PPE protocol demonstrated by a photo of a male or female dentist wearing a traditional white coat with a disposable yellow isolation gown, a surgical face mask, a face shield, and blue vinyl surgical gloves. The questions in the third part of the questionnaire were based on the questionnaire of de Amorim CS et al., study, but the photos were taken by the researchers (10).

Younger participants answered this part of the questionnaire with parental guidance if needed. (Table/Fig 3) illustrates the photos of a male and a female dentist wearing the full standard PPE protocol, which was shown in the third part of the questionnaire. A copy of the questionnaire is provided as a supplementary document.

Statistical Analysis

Data were summarised as frequency and percentages for categorical variables or means and Standard Deviations (SD) for continuous variables. Participants were stratified by age (4-8 years and 9-12 years) and gender (male and female), and then comparisons of participants’ preferences were made using the chi-square test. All statistical analyses were done using The Statistical Package for Social Science software for Windows (SPSS) version 23.0.

Results

The study included 362 participants and their parents/guardians with a mean age of 8.4±2.3 years. 241 (66.6%) of the participants were females and 309 (85.4%) were Saudi citizens. The majority of the participating guardians, 249 (68.8%), were mothers, and 192 (53%) had a university or higher-level education. (Table/Fig 4) displays the demographic characteristics of the participants and their participating parents/guardians.

The vast majority of the participants 341 (94.2%) were healthy. Most of them had previous dental visits 341 (94.2%), with dental examinations being the major previously received dental care 319 (93.4%), followed by radiographs 319 (88.1%). According to their participating parents/guardians, most of the participants 258 (71.3%) were cooperative throughout their prior dental visits. (Table/Fig 5) provides more specific information about the participants’ previous medical and dental histories.

According to (Table/Fig 6), considerably more female respondents 189 (78.4%) favoured female dentists compared to 63 (52.1%) male respondents (p<0.001). Both genders preferred traditional white coats significantly over colourful paediatric coats (p=0.025), and blue disposable isolation gowns over the yellow ones (p=0.024). Finally, male participants showed significantly better acceptability regarding the participants’ perception and comfort with the dentist wearing the full standard PPE.

The participants’ preferences for the dentist appearance according to age has been listed in (Table/Fig 7). The majority of younger (4-8 years) participants (n=154, 80.2%) significantly favoured female dentists compared to 93 (54.7%) of the older (9-12 years) participants (p<0.001). While older participants significantly preferred a dentist wearing a traditional white coat over a colourful paediatric coat (p=0.001). Furthermore, older participants 123 (72.4%) preferred the surgical mask over the paediatric mask (p<0.001) and face shield 113 (66.4%) as eye protection equipment over goggles or no protection (p<0.001). Regarding the head covering, older participants 131 (77.1%) preferred a dentist without a head cover over a colourful paediatric cap (p<0.001). Most answers to the questions regarding the participants’ perception of the dentist wearing full PPE were positive.

Discussion

The present study was conducted to determine the children’s preference and perception of their paediatric dentist’s attire and PPE among four-12-year-old children, and female dentists were more favoured by both genders and younger participants. Both males and females and older participants favoured traditional white coats. Furthermore, older participants preferred surgical masks, face shields, and no head cover. Male and older participants showed better acceptability to the dentist wearing the full standard PPE.

While multiple other previously published studies reported that children, regardless of their gender, prefer a female dentist (6),(15). In 2015, Nirmala S et al., investigated the preferred dentist attire and gender among nine-14-year-old children and reported that female dentists were preferred among the highly anxious children (15). This finding was attributed to the perception that female dentists are believed to be more caring and have more empathy (1). Similarly, regardless of age, male and female children included in the study preferred a female dentist.

Furthermore, the present study found that younger children preferred the paediatric mask over the surgical mask and the colourful paediatric cap over the no-cap option, which again reinforces the notion that younger children prefer colourful attire over other options. This result is compatible with the previously cited study from Brazil, which also showed that younger children have a more positive perception towards a dentist wearing a printed face mask when compared to a white mask (10).

The traditional white coat was the preferred attire by the included children, especially older ones, which is consistent with what was reported by several previously published studies among older children in different populations (1),(6),(8),(9),(11),(12),(13),(14). In Saudi Arabia, Almutairi MA and Al-Essa EA in 2016 investigated the children’s and parents’ preference toward the attire of dentists and reported that the traditional white coat was the favourite attire of both children and their parents (6). Also, Bahammam S, assessed the children’s preferences toward their dentist attire and reported that a white coat with a white scarf was the most preferred attire (9). This could be because the traditional white coat encourages trust, professionalism, exemplifies cleanliness, and is the most spotted attire by healthcare providers (16).

Additionally, the findings showed more preference for the coloured paediatric coat with cartoon characters over the traditional white coat among the younger age group of children. This finding is similar to previously published studies, in which coloured attire was reported to be more favoured than the traditional white coat by the younger and dentally anxious children (7),(8),(13). This can be attributed to the fact that the traditional white coat may trigger anxiety in children with previous negative experiences with healthcare professionals (white coat syndrome). Also, the colourful prints lessen fear, increase the excitement for the dentist appointment, and create a positive environment, especially among younger and anxious children.

As colours play a significant role in the decision-making process, participating children showed a significantly higher preference for blue disposable gowns over yellow ones. When the association between colour and emotions in a dental clinic among 6-12-year-old children was investigated, blue and yellow enhanced a positive dental attitude among children (17).

There were no significant differences between the different forms of eye protection amongst male and female children. However, when comparing the two age groups, the face shield was the preferred choice for both groups compared to goggles or a dentist without any eye protection. This preference may be due to the popularity of face shields as eye protection for King Abdulaziz University Dental Hospital (KAUDH) dental care providers.

The study aimed to gain insight into the children’s perception of the dentists shown. This was achieved by asking questions about a typically dressed dentist in KAUDH, providing insights into the participants’ comfort levels towards the dentist. All responses indicated a positive perception of the dentist, except for one question where younger children were less likely to recommend the photographed dentist to their friends. This suggests that older children enjoy dental visits more and are more likely to recommend the dentist to their friends.

Limitation(s)

There were some limitations to this study. All participants were recruited from KAUDH, so the results cannot be generalised to the Saudi child population. Preferences may be related to the child’s personality, anxiety level, previous experiences in the dental clinic, or how their dentist dressed during previous appointments. Additionally, some young children may not have fully understood the differences between the various dentist attires due to their age. In the future, a larger sample size from different regions representing the children’s population in Saudi Arabia could be selected, considering the social, economic, and cultural variations amongst children in the country.

Conclusion

Females and younger children preferred female dentists. The traditional white coat was the most preferred attire for both genders and older children. Both males and females preferred blue gowns over yellow gowns. Older male children preferred dentists wearing a surgical mask, a face shield, and no head covering. Male and older children showed high acceptability for the full standard PPE. Understanding children’s psychology and perception towards dentists can help in providing a friendlier and more comfortable environment in the dental operatory for children, considering attire to ease a child’s anxiety and provide them with the best dental experience possible.

DOI and Others

DOI: 10.7860/JCDR/2024/68362.19365

Date of Submission: Oct 30, 2023
Date of Peer Review: Dec 08, 2023
Date of Acceptance: Jan 11, 2024
Date of Publishing: May 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 31, 2023
• Manual Googling: Jan 06, 2024
• iThenticate Software: Jan 09, 2024 (8%)

ETYMOLOGY: Author Origin

EMENDATIONS: 7