Personality is the outcome of genetic predispositions of certain behavior influenced by environment. Pinkham writes that children of high self-esteem who have favorable and positive views of adults are able to meet the demands of dental appointments more easily than children with poor self esteem and unfavorable views of adults. Poverty, dysfunctional family life and abuse can lead to these findings.6
Additional Factors Influencing Behavior in the Dental Office
In addition to the developmental, genetic and environmental influences on child behavior in the dental office other factors may come into play.
The etiology of dental fear in children is multifactorial and a product of previous experiences, generalized fear and family (parent, sibling) anxiety regarding dental treatment.7 Dental fear has been found in most but not all misbehaving patients.4 Dental fear has been attributed to lack of trust in the dentist and lack of control over a traumatic event. Dental injection was the most feared procedure followed by “drilling” and “tooth scaling. Dental fear and anxiety has also been linked to increased general fears such as fear of heights, flying, claustrophobia and multiple other fears.8,9
Studies have shown the negative behavior in the dental office is most intense in younger children and decreases as children become older. Some studies have found no difference in dental anxiety and gender, while others have found increased anxiety in females.10
Children may be influenced by their cultural background once they reach the cognitive development stage.8
Children in pain will almost always exhibit behavior management problems. Pain has sensory, emotional, cognitive, and behavioral components that are interrelated with environmental, developmental, sociocultural and contextual factors. It is important to take reports of pain seriously and counterproductive to argue with the child that a sensation is uncomfortable but does not hurt or they are just feeling pressure.12,13
For the purpose of this course, the author will divide the youngest patients (under three years of age) into two categories: the child that does not possess or has limited ability to communicate with others (usually under 18 months) and the child possessing the ability to communicate with others.