Pediatric dentistry meets clinical child psychology. Studying groups of uncooperative child dental patients

Abstract: This thesis investigated child dental patients, referred for specialist treatment because of dental behaviour management problems (DBMP). The primary aims were to explore personality characteristics and concomitant factors, and to investigate a hypothesis of heterogeneity within this group of children. A further aim was to evaluate the outcome of ad hoc individualised treatment initiated and agreed in a structured negotiated agreement interview (NAI) with the parent. A methodological study investigated the test-retest reliability of a questionnaire designed to measure aspects of parental dental attitudes, and was followed by a cross-sectional baseline study of the dental attitudes among parents of children showing DBMP (n=86) as compared to parents of ordinary child dental patients (n=117). Baseline data on child fear and personality characteristics were analysed according to a variable-based approach, including comparisons between the DBMP group and ordinary child dental patients, as well as a person-based approach (cluster analyses), where four subgroups with different fear and personality profiles were identified within the DBMP group. In addition to a higher dental fear level, the DBMP group differed from ordinary child dental patients in both temperamental and general behaviour respects, although general behavioural symptomatology seemed to be associated with socio-economic factors. The four subgroups identified by cluster analyses were labelled 'non-fearful, extrovert, outgoing', 'fearful, extrovert, outgoing', 'fearful, inhibited' and 'externalising, impulsive', the latter two representing temperamental extremes. Very few of the referred children were characterised as stable in their mood. The subgroups were validated by different networks of family risk factors and potentially traumatic experiences. Longitudinal treatment outcome evaluations among DBMP children, separated into subgroups, showed that the ad hoc individualised treatment was mainly successful, although poorer success was shown for externalising, impulsive children, who may need special treatment programmes. A considerable proportion of the children, in particular the fearful, inhibited children, were still reported to have moderate or high dental fear after completion of specialist treatment. Avoidance behaviour at the specialist clinic and post-treatment dental fear predicted a poorer outcome at follow-up. In addition to increased acceptance and decreased dental fear among children, the results indicated parental benefits from the treatment, which was especially evident among parents of externalising, impulsive children.