Nonverbal communication is a behavior management technique used by pediatric dentists17,18. A child-friendly atmosphere in the clinic is one aspect of this technique. Jayakaran et al.19 evaluated the pediatric dental operatory environment and found that cartoon-painted walls, toys, and a scented environment reduced anxiety in children. In this current study we focused on the pediatric dental waiting room environment. We found no significant difference in the anxiety of children waiting for dental treatment in a multisensory waiting room or conventional waiting room.
Coffey and Di Giusto4 also found no difference between anxiety scores of patients in two different dental hospitals with different waiting room environments. In the Coffey and Di Giusto study, the test environment aimed to increase patient ease and relaxation by including comfortable padded seats, reading material for patients, large windows overlooking a garden, and piped music played at low volume. However, this study was conducted on an adult population, and excluded patients requiring a tooth extraction or those who had other stress-inducing problems. Our study, on the other hand, included participants regardless of their visit purpose.
In regards to the pediatric population, it has been suggested that waiting rooms designed for children can reduce their anxiety. Studies have found that positive dental images reduce anxiety compared with neutral images5,6. In addition, viewing positive images of dentistry and dentists was correlated with short-term reductions in anticipatory anxiety in children5,6. Panda et al.20 evaluated 212 children between 6 and 11 years of age, and found that majority of children preferred music and the ability to play in a waiting room. They also preferred natural light and walls with pictures. Children favored gazing at an aquarium or watching television; as well as, sitting on beanbags and chairs. They were fond of plants and oral hygiene posters15.
In our study, anxiety was found to be correlated with visit purpose. Children waiting for dental examination or those scheduled for dental treatment with conscious sedation were less anxious than children waiting for emergency treatment. Since groups differed by visit purpose it is difficult to conclude about the effect of waiting environment according to visit purpose. It can be expected that children waiting for treatment after receiving a dose of premedication will be less anxious prior treatment as a result of the medication. Children presenting for dental check-up should be less anxious than those who are aware of the need for dental treatment due to pain or another emergency. Peretz and Kharouba21 reported high dental anxiety among patients who expected operative procedures. Soares et al.22 also found differences in dental anxiety in children associated with the visit purpose when analyzing three treatment types: preventive care, endodontic treatment, and dental extraction. Coffey and Di Giusto4 reported that anxiety levels were higher in adult patients who presented for the first time than in those who came for a subsequent visit4. These findings emphasize the need for establishing a dental home, having periodic check-ups, and scheduling routine dental visits; thus, it is proposed that preventing the need for emergency dental treatment in an unfamiliar environment can reduce children’s dental anxiety.
This study found that longer waiting time is associated with higher anxiety. This finding corroborates previously published literature showing that anxiety levels are significantly higher in dental patients who waited for longer periods of time4,23. Dentists must make the effort to shorten the waiting time as possible.
In contrast to other studies24,25, the current study did not find any relation between age or gender and dental anxiety, perhaps because it tested anxiety while waiting for treatment and not dental anxiety in general.
This study was limited by the low overall anxiety in the study group, based on the low VPT scores. This limitation may have contributed to the non-significant findings in anxiety scores between patients treated in different waiting room environments. It is possible that conducting the study in a population with higher levels of anxiety would have different results. Another limitation is the difference in visit purpose between groups that may affect the results and the ability to compare between them. In addition, due to the nature of the intervention, two different waiting areas with different design, the participants and the examiner could not be blinded to the intervention. Although there was a potential for bias, it did not influence the results of this study as we found no significant difference in the anxiety of children.
In view of the limitations of the current study, future research should include a more heterogenous sample of anxiety levels and more homogeneity in visit purpose.