Impact of Parenting Style on

Pediatric Dental Behavior Guidance Techniques

Natalie Umof, MHA DDS; Donna Kritz-Silverstein, PhD; Clarice Law, DMD MS

Section of Pediatric Dentistry, University of California School of Dentistry, Los Angeles, CA
Pediatric Dentists use a range of behavior guidance techniques to treat their patients. The American
Academy of Pediatric Dentistry
1
has guidelines for behavior guidance techniques based on level of patient
cooperation. Two categories of behavior guidance techniques are described: basic behavior guidance and
advanced behavior guidance. Basic behavior guidance includes tell-show-do, voice control, nonverbal
communication,positivereinforcement,distraction,parentalabsenceandnitrousoxide/oxygen inhalation.
Advanced behavior guidance includes protective stabilization, sedation and general anesthesia. Dentists
must direct the child-parent-dentist relationship triad with appropriate behavior guidance techniques;
however, parenting style may inFluence this relationship. Baumrind
2
deFined three parenting styles:
authoritarian,parentswhoexert control over their children;permissive,parentswhoallow their children to
be in control; and authoritative, parents who encourage their children to be responsible for themselves.
Parenting stylecan offerinsighton howparentsinteractwiththeirchildren andinFluencetheirexpectations
for their childs visit to the dentist. The dentists selection of behavior guidance techniques may be
inFluenced by parenting style. The purpose of this study is to determine the correlations between
Baumrindsthreeparenting styles(authoritarian,authoritative,andpermissive) andacceptanceof behavior
guidancetechniquesamong parentsof children 3-8 yearsof age.
Behavior guidance techniques based on AAPD guidelines were used to create a parental approval
questionnaire;eachtechniquewasillustratedwitha patientcarescenario.
This questionnaire was given to parents of healthy patients aged 38 years presenting for dental
appointments at the Pediatric Dental Clinics at UCLA; parents who did not speak English or presented for
an emergency visitwereexcluded.
Parents rated approval of each behavior guidance scenario on a 7-point Likert scale, (1=completely
disapprove and 7=completely approve) and completed the Parental Authority QuestionnaireRevised
(PAQ-R, Reitman
3
), to assess the three parenting styles; the PAQ-R is scored based on a subscale ranging
from 10-50 foreachof thethreeparenting styleswithamean valuedcalculatedforeachparenting style.If
the subscore was higher than the mean value, the parent was categorized as high; lower than the mean
valuetheparentwascategorizedaslow.Higher scores reFlect a greater degreeof that parentingstyle.
Datawereanalyzedwithindependentt-tests.
SamplePopulation:
Figure 2: Percent success and failure by restorative treatment type (P<.001).
(P<.001).
Figure1:BehaviorManagementTechniquesScenarios
Stage 4: outer dentin; #B-mesial
Figure4:Approvalof BehaviorGuidanceTechniquesby Parenting Style
* P.05,** P .01
1. American Academy of Pediatric Dentistry.Guidelineon BehaviorGuidanceforthePediatric DentalPatient.ReferenceManual,2011;33,161-173.
2. Baumrind,Din.CurrentPatternsof ParentalAuthority.DevelopmentalPsychology.1971;41:1-103.
3. Reitman,D,Rhode,PC,Hupp,SDA,Altobello,C.DevelopmentandValidation of theParentalAuthority QuestionnaireRevised.Journalof
Psychopathology andBehavioralAssessment;2002;24,2:119-127.
4. ChurchvilleCentralSchoolDistrict.(n.d.) ParentalAuthority QuestionnaireScoring GuideandDirections.Retrievedfromhttp://www.cccsd.org/
webpages/mmaslanka/8iles/parental%20authority%20questionnaire%20scoring%20guide%20and%20directions.pdf
A totalof 69 questionnaireswerecollected;22%of therespondentsweremen,78%werewomen
Hispanic
56%
White
31%
Other
13%
Elementary
10%
SomeHigh
School
15%
HighSchool
Grad
20%
Some
College
15%
CollegeGrad
23%
SomeGrad
School
17%
Figure 2: Ethnicity Figure 3: EducationLevelof Parent
Table1:Age,Numberof Children,ChildrensAge
Table2:Mean ScoreforeachParenting Subscale
*
0
1
2
3
4
5
6
7
A
c
c
e
p
t
a
n
c
e
R
a
+
n
g

Low AuthoritaFve
(n=39)
HighAuthoritaFve
(n=30)
**
**
0
1
2
3
4
5
6
7
A
c
c
e
p
t
a
n
c
e
R
a
+
n
g

Authoritarian
Low Authoritarian
(n=39)
HighAuthoritarian
(n=30)
* *
*
* **
**
0
1
2
3
4
5
6
7
A
c
c
e
p
t
a
n
c
e
R
a
+
n
g

Permissive
Low Permissive
(n=39)
HighPermissive
(n=30)
Please answei the following questions. Theie will be no peisonal iuentifying infoimation askeu in this questionnaiie. All
of youi iesponses will be kept confiuential.
!
"#$!#%&!'()!*#+,!-----------------------------------------------!
./'0!0*1)!#2!'11#3405)40!36!*#+(!7/3%&!/)()!2#(,!!
New Patient Exam Recall Exam Tieatment
./'0!36!0/)!/38/)60!%)9)%!#2!67/##%!*#+!/'9)!7#51%)0)&,!
uiaues 1-8 (Elementaiy School)
uiaues 9 - 11 (Some high school)
uiaue 12 oi uEB (Bigh school giauuate)
College 1 yeai to S yeais (Some college oi tech school)
College 4 yeais (College giauuate)
uiauuate school (Auvanceu uegiee)

:()!*#+!5'%)!#(!2)5'%),! Nale Female!!
"#$!5'4*!7/3%&()4!&#!*#+!/'9),!--------------------------!
./'0!'8)6!'()!*#+(!7/3%&()4!,!------------------------------!
"'6!*#+(!7/3%&!/'&!%#7'%!'4)60/)037!;)2#(),!--------------!
<%)'6)!61)732*!*#+(!)0/43730*!(check all that apply):!!
Ameiican Inuian oi Alaska Native
Bawaiian oi 0thei Pacific Islanuei
Asian oi Asian Ameiican
Black oi Afiican Ameiican
Bispanic oi Latino
Non-Bispanic White

Youi chilu has an appointment foi a filling. When the uentist begins giving himhei instiuction to begin injecting local
anesthesia (ie novacaine), heshe iefuses to coopeiate. The uentist iesponus accoiuing to one of the following scenaiios.
Please inuicate how you feel about the way the uentist tiies to move youi chilu towaiu coopeiation foi this appointment:
CB = Completely Bisappiove, NB = Nostly Bisappiove, SB = Somewhat Bisappiove, N = Neutial, SA = Somewhat Appiove, NA =
Nostly Appiove, CA = Completely Appiove


1. The uentist tells youi chilu we aie going to numb youi tooth with "sleepy juice",
shows them some of the supplies useu, anu then injects the local anesthetic............
2. The uentist alteis theii tone of voice, incieasing in volume to get youi chilu's
attention anu uiscouiage uisiuptive behavioi.....................
S. The uentist faces youi chilu, iemoves theii mask anu uses appiopiiate facial
expiessions to get youi chilu's attention anu uiscouiage uisiuptive behavioi..
4. When youi chilu sits still foi local anesthesia, the uentist piaises them foi
coopeiative behavioi ...................................
S. The uentist uistiacts youi chilu fiom the injection of local anesthetic by singing
a song anu telling youi chilu to wiggle theii toes ...................
6. The uentist asks you to step out of the opeiatoiy so youi chilu can focus on the
uentist's uiiections ............................................................................................................................
7. The uentist offeis youi chilu nitious oxiue (laughing gas) to bieathe thiough a
mask to ielax uuiing local anesthesia. Youi chilu is awake uuiing tieatment. The
effects uisappeai aftei the mask is iemoveu .......................
8. The uentist offeis to use a bouy wiap (papoose) to holu youi chilu's aims anu
legs away fiom theii mouth while injecting local anesthesia, minimizing iisk of
injuiy to themselves oi otheis ..............................
9. The uentist offeis to tieat youi chilu at anothei appointment foi oial conscious
seuation in the uental office. Youi chilu will uiink seuative meuication, causing
them to be uiowsy yet awake foi tieatment .....................
1u. The uentist offeis to tieat youi chilu at anothei appointment foi Iv geneial
anesthesia in the uental office. Youi chilu will be given anesthetic meuication
thiough an Iv by an anesthesiologist causing them to sleep foi tieatment .....
11. The uentist offeis to tieat youi chilu at a uiffeient appointment foi geneial
anesthesia in a hospital opeiating ioom. Youi chilu will be unuei geneial
anesthesia anu will sleep uuiing tieatment ......................


CB1 NB2 SBS N4 SAS NA6 CA7

1.


2.


S.


4.


S.


6.



7.



8.



9.



1u.



11.

Mean (SD) Range

Age of Parent 36.7 (8.9) 24-67
# of Children 2.1 (.93) 1-4
Children's Age 5.1 (.61) 3-8
Analysisof approvalratingsforscenariosdescribing behaviorguidancetechniquesshows:
Parents scoring high on the authoritarian subscale were more accepting of voice control and protective
stabilization (Figure 4)
Parentsscoring highon theauthoritativesubscalewerelessaccepting ofnitrousoxide/ oxygen (Figure4)
Parentswhowerehighon thepermissivesubscalewerelessaccepting of tell-show-doanddistraction and
moreaccepting of IV generalanesthesiaandORgeneralanesthesia(Figure4 )
Authorita+ve
Resultsof thisstudy provideassistancein determining strategiesforbehaviorguidance
techniquesthatwillmeetwithparentalapproval.
Parentsscoring highon theauthoritarian subscaleweremoreaccepting of voicecontroland
protectivestabilizationwhileparents scoringhighontheauthoritativesubscalewereless accepting
of nitrousoxide/oxygen andparentsscoring highon thepermissivesubscalewerelessaccepting of
tell-show-doanddistraction andmoreaccepting of IV generalanesthesiaandORgeneralanesthesia.
Pediatric dentistsshouldattempttodiscern theparenting styleof theirpatientsparents to
presentthemostappropriatebehaviorguidancetechniqueforthechildandtheparent.
Thethreeparenting stylesaredescribedas
4
:
Permissive:arelatively warmstylethatisnon-demanding,andnon-controlling.
Authoritarian: a style that values unquestioning obedience and an attempt to control the behavior of the
child, often throughpunitivedisciplinary practices.
Authoritative: a style that is Firm and clear in expectations, but Flexible and rational in setting limits or
making exceptions.
Mean (SD) Range
Authorita+ve 41.9 (4.5) 25-50
Authoritarian 33.3 (7.1) 13-49
Permissive 28.1 (7.6) 14-50