Behavioral Interventions to Improve Pediatric Patients' Cooperation During the Dental Injection: a Randomized Clinical Trial

Purpose:

This clinical trial aims to evaluate the impact of priming effect and endowment effect, concepts derived from psychology, on the behavior of children in mixed dentition period during the dental injection. The moderating role of the psychological traits and demographics of children will be investigated as well. The judgment on the children behaviors will be made based on a well-established instrument which categorizes the behaviors into four levels. The results will contribute to an interdisciplinary approach toward patient management and a treatment plan that let practitioners manage their time more efficiently, and also increase the chance of children's acceptable behaviors and cooperation during a dental visit and attendance in follow-up sessions.

Justification:

Patient management in pediatric dentistry is a matter of great importance as many children may not be as cooperative as adults with their dentist when undergoing dental procedures. Although there were developments in patient management in dentistry, particularly in the pediatric field, an interdisciplinary approach is still lacking to cover all aspects of behavioral management. Specifically, the findings derived from psychology and economics may have the potential to be implemented in the medical field. That being said, the concepts such as behavioral priming and endowment effect and constructs such as personality traits which have led to promising results in cognitive and behavioral management have been scarcely implemented in the medical field and dentistry.

Conditioning or contingency reinforcement is one of the universally accepted techniques in the behavioral management of children in dental clinics. The positive reinforcement is the common approach for reinforcing the desired behaviors in children. Positive reinforcement relies on promising children with positive social feedback (e.g., smile and praise) or non-social token and rewards (e.g., badges and stickers). Although positive reinforcement was reported to be successful, according to the concept of the endowment effect, other conditions of providing awards to children may be even more efficient. The endowment effect, which is a well-reported psychological phenomenon, states that people attribute more value to things that they own and more inclined to retain them than obtaining the same object when they do not possess it. Based on this concept, value is not absolute but perceptual in nature, and perceived ownership would affect perceived value. The endowment effect is supported by the loss aversion stating that losses have a stronger impact than gains. The asymmetry between the impact of positive and negative expectations or experiences on oneself is traced back to evolution. Organisms that had considered dangers as more important than opportunities had a better chance of survival and reproduction. Providing a condition in which children can keep the rewards after treatment only if they behave cooperatively may be more powerful reinforcement than the traditional conditioning. Up to the authors' knowledge, except for limited studies that applied the endowment effect in creating the health policies, it has not been used in the medical field for behavioral management.