DOI: 10.12688/f1000research.180391.2 ISSN: 2046-1402

Pediatric Dentist Attire as a Behavioral Strategy for Managing Dental Anxiety: A Systematic Review

Syed Taha, Srikala Bhandary, Urvashi A Shetty, Pratyasha Sharma, Sayan Das
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Background Dental anxiety is a common challenge in children and may adversely affect cooperation, treatment acceptance, and future dental attendance. Dentist attire represents a potentially modifiable environmental factor that may influence children’s perception of the dental setting. This systematic review aimed to evaluate the association between pediatric dentist attire and dental anxiety and behavioural responses in children, with particular emphasis on conventional professional attire compared with colourful, patterned, or child-friendly attire. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review protocol was registered in PROSPERO (CRD420251229652). PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched for studies published from January 1985 to August 2026. Studies involving children evaluating different types of pediatric dentist attire and reporting dental anxiety, fear, behavioural responses, or related outcomes were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Observational studies were assessed using a modified Newcastle–Ottawa Scale, while the randomized clinical trial was assessed using the Cochrane Risk of Bias 2 tool. Results The search identified 513 records, of which 10 studies involving 4,398 children were included in the final synthesis. Individual study sample sizes ranged from 120 to 1,155 children, with participants predominantly aged 6–12 years. Most studies used cross-sectional or observational comparative designs, while one randomized clinical trial was identified. Conventional white attire was compared with coloured, cartoon-themed, child-friendly, casual, or surgical attire. Dental anxiety was assessed using the Modified Child Dental Anxiety Scale, Children’s Fear Survey Schedule–Dental Subscale, Facial Image Scale, Children’s Fear Scale, and Child Anxiety Questionnaire. Overall, coloured and child-friendly attire demonstrated a favourable trend towards lower anxiety compared with conventional white attire. The effect appeared more pronounced among younger children in several studies. However, findings were not consistent across all attire modifications, and some studies primarily reported children’s attire preferences rather than direct comparative anxiety outcomes. Differences in study design, attire interventions, anxiety measures, assessment timing, and outcome reporting limited direct comparison between studies and precluded a reliable estimate of the magnitude of effect. Conclusion Pediatric dentist attire may influence children’s dental anxiety, with coloured, cartoon-themed, and explicitly child-friendly attire showing the most consistent favourable trend. The effect may be particularly relevant in younger children and may form part of a broader child-centred dental environment. However, the current evidence is heterogeneous and should be interpreted cautiously. Well-designed randomized controlled trials using standardized attire classifications and validated anxiety measures are required to establish the clinical effectiveness of modifying pediatric dentist attire. Registration for Systematic Review PROSPERO CRD420251229652 12 th November 2025.

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