Modifiable factors influencing dental fear in preschool children: the role of dentist appearance, clinical environment, and sensory perceptions

Dental fear is common among preschool children and may adversely affect their ability to cope with dental treatment. This study aimed to identify factors associated with dental fear, focusing on the dentist’s appearance, characteristics of the dental environment, and previous dental experiences. An observational cross-sectional stratified questionnaire-based survey was conducted in 15 randomly selected preschool facilities and included 897 children aged 2–7 years (mean age 4.8 years; 442 girls and 455 boys). Children were stratified according to age, sex, and geographic location. The comprised 18-questions questionnaire assessed dental fear, perceptions of the dental environment and the dentist, and previous dental experiences. It was administered directly to children by trained dentists using standardized verbal and pictorial instructions. Statistical analyses included two-sample t-tests, and multivariate ANOVA with post-hoc Duncan’s test. Associations were assessed using Pearson’s chi-square test, with odds ratios (OR) and 95% confidence intervals (CI) for binary comparisons and Cramér’s V for multi-category variables. Statistical significance was set at p = 0.05. A total of 89.1% of children have already visited a dentist, with the mean age at first visit 2.1 years. Girls were more likely than boys to prefer a female dentist and a “colorful” rather than “white outfit” (p < 0.001). Children afraid of drilling were more likely to perceive the dentist as having a “bad smell” (p = 0.003). Anxious children and girls preferred an office setting with picture (p < 0.001). Overall, 83.0% of children were afraid of at least one type of dental treatment. Children with drilling experience were afraid of tooth extraction and injection as well, which they had not experienced (p = 0.039). Dental fear was highly prevalent in this preschool population, with most children reporting fear of at least one dental procedure. The findings suggest that dental fear was associated with multiple factors, including previous dental experiences, demographic characteristics, and environmental conditions in the dental office. Several potentially modifiable aspects of the dental setting, such as dentist’s attire, perceived sensory characteristics, and visual features of the dental environment, were associated with children’s fear and preferences.