Influence of age, gender, and previous dental experience on children’s preferences for dentist attire: An observational study

Abstract

BACKGROUND

Treating young children in dental settings often poses a significant challenge, largely due to their ingrained fear and unease around white coats. These anxieties can stem from prior personal dental experiences, hearing peers’ stories, or simply being in a clinical environment. The stress intensifies when children encounter the traditional attire and atmosphere of dental clinics, making visits distressing. Understanding a child’s preferences - such as the dentist’s attire and mask, their previous visit experiences, and even the dentist’s gender - empowers dental professionals to tailor their approach and create a more comforting experience.

AIM

To explore how children’s gender, age, and history of dental visits influence their preferences for a dentist’s gender, attire.

METHODS

An observational study is conducted among 239 children aged 7 years to 15 years who visited the Department of Pediatric and Department of Preventive Dentistry. The following data were collected on each child’s age, gender, previous dental visit history, and their preference regarding the gender of the dentist who would perform their treatment (male, female, or either). Children’s preference for the dentist’s attire, mask color data was collecting by showing a series of hand drawn pictures of dentists in from traditional white coats, formal attire, professional green scrubs, or cartoon-themed clothing along with mask color from white, blue, green, or pink. Participants are asked to pick their choice of dentist attire, and asked to explain why they preferred a particular type of attire.

RESULTS

Most children preferred to be treated by female dentists. Boys showed a strong preference for male dentists, while girls favored female dentists. Both younger and middle-aged children, regardless of previous dental experience, preferred female dentists. Older children expressed that they were comfortable being treated by either a male or female dentist. Traditional white coat attire was the most favored choice, followed by child-friendly cartoon-themed attire.

CONCLUSION

Age, gender, and prior dental experiences remain important factors shaping children’s preferences for a dentist’s appearance. As children mature, their fear of the white coat tends to diminish, and preferences for a specific dentist gender or child-friendly mask types also decrease. Nonetheless, it is important to recognize that beyond appearance, qualities such as communication skills, behavior, and the dentist’s attitude have a greater influence on the child-dentist relationship.

Key Words: Dentist attire; Children preferences; White coat; Dentist gender; Mouth mask

Core Tip: Age, gender, and prior dental experiences remain important factors shaping children’s preferences for a dentist’s appearance. As children mature, their fear of the white coat tends to diminish, and preferences for a specific dentist gender or child-friendly mask types also decrease. Nonetheless, it is important to recognize that beyond appearance, qualities such as communication skills, behavior, and the dentist’s attitude have a greater influence on the child-dentist relationship.

INTRODUCTION

Dental attire refers to the clothing and personal protective equipment (PPE) worn by dental professionals, including pediatric dentists, to ensure a safe and hygienic environment for both patients and staff. This attire plays a crucial role in infection control, maintaining patient comfort, and upholding a professional appearance. The type of protective clothing required varies depending on the potential risks associated with specific dental procedures. While healthcare workers are legally responsible for assessing these risks and selecting appropriate attire, it is the employer’s duty to provide suitable PPE that is freely accessible and ready for use[1].

In pediatric dental practices, managing children's fear and anxiety remains an ongoing challenge. These emotions may stem from various sources, such as previous dental experiences or hearing about their peers and others encounters. Research in dental literature reveals that children form strong perceptions based on the appearance of healthcare professionals[2]. One recent study found that children primarily fixate on a dentist’s face, particularly the circum-oral area, followed by the dentist’s attire. Accessories like pens and ties have been noted as visual distractions, leading to longer visual fixations and greater attention[3].

Studies examining children’s preferences regarding dentist gender and protective equipment have yielded mixed results, often influenced by cultural, geographic, and environmental factors. For instance, non-anxious Indian children in middle and older age groups tend to prefer white coats, white gloves, and plain masks[4]. Gender preferences vary; some children favor female dentists, while others prefer a dentist of the same gender. These choices are often shaped by the child’s age, anxiety levels, and previous medical or dental experiences[5].

Many studies were been carried out to check for the factors that precipitate anxiety[6-10] and fear among child patients while undertaking dental visits[11-14]. Overall, the studies showed mixed findings and the dental literature suggests that dentists are generally more concerned about their attire than their patients are and this study explores how children’s gender, age, and history of dental visits influence their preferences for a dentist’s gender, attire, color and type of mouth mask.

MATERIALS AND METHODS

Study design

This observational study was conducted among children aged 7 years to 15 years attending the out-patient wing of Department of Pediatric and Department of Preventive Dentistry at ST. Joseph Dental College & Hospital (India). Duration period of the study is 3 months. The sample size was determined based on an estimated prevalence of pilot study 39.06% of children preferring a white coat. Using a 95% confidence interval and a 5% margin of error, a total sample of 240 children were required for the study.

Inclusion criteria: (1) Children aged between 7 years to 15 years; (2) Children willing to participate in the study; and (3) Children who are not syndromic, visually challenged and no cognitive impairment.

Exclusion criteria: (1) Children under the age of 7 years and above the age of 15 years; (2) Children not willing to participate in the study; and (3) Children who are syndromic, visually challenged and with cognitive impairment.

Ethical approval

This study was approved by the Ethics Committee of ST. Joseph Dental College & Hospital (Approval No. SJDC/CEC/PHD/2025/003) and securing written consent from parents as well as assent from the children is taken. Data were collected on each child’s age, gender, previous dental visit history, area of residence, type of school, and their preference regarding the gender of the dentist who would perform their treatment (male, female, or either) using the survey form for all the sample with the help of the single volunteer.

Survey form (Figure 1) included part I containing demographic information of the participant and part II including attire description and different colors mask pictures. Participants were then shown survey form with a series of hand drawn pictures and asked to tick or indicate their preference for the dentist’s attire, choosing from traditional white coats, formal attire, casual attire, professional scrubs, child-friendly attire, dentist with white coat, Protective mask and head cap. They were also asked to select their preferred mask color from white, blue, green, or pink. Male model pictures were shown to children who preferred male dentists, while female model pictures were shown to those who preferred female dentists. The pictures were drawn on white paper against a uniform background, featuring two volunteer students as models, who had no prior treatment relationship with the participating children. Their facial expressions were kept consistent throughout. Children were also asked an open-ended question to explain why they preferred a particular type of attire.

Figure 1 Survey form.

Statistical analysis

Descriptive statistics, including n (%), were used to present the preferences. The influence of the child’s age, gender, previous dental visit history, place of residence, and type of school visiting on their preferences was analyzed using the χ² test, with a significance level set at P < 0.05.

RESULTS

A total of 239 children participated in the study. Most participants were aged 13-15 years (52.3%), followed by 10-12 years (46.0%), with only 1.7% aged 7-9 years. Females (52.1%) slightly outnumbered males (47.2%). The majority of children were attending private schools (53.1%), resided in urban areas (60.7%), and were first-time dental visitors (61.9%). The demographic characteristics of the participants are mentioned in the Table 1.

Table 1 Demographic characteristics of the study participants (n = 239).

Number	Variable	Category	n (%)	95%CI
1	Age group	7-9 years	4 (1.6)	0.4-4.3
		10-12 years	110 (46)	39.7-52.3
		13-15 years	125 (52.3)	46.0-58.6
2	Gender	Male	102(42.7)	40.9-53.5
		Female	137(57.3)	45.8-58.4
3	Dental visit history	First dental visit	148(61.9)	55.7-68.0
		Previous dental experience	91(38.1)	32.0-44.3
4	Area of residence	Urban	145(60.7)	54.5-66.9
		Rural	94 (39.3)	33.1-45.5
5	School type	Government	112(46.9)	40.6-53.2
		Private	127(53.1)	46.8-59.4

CI: Confidence interval.

The majority of children, 199 (79%), felt that the dentist’s gender, attire, the color and type of mask worn were important factors. Children’s preferences for dentist attire varied, with the white coat being the most preferred option (59.4%). Other preferences included child-friendly attire (14.6%), formal attire (13.4%), casual attire (8.8%), dentist wearing a white coat with head cap and mask (4.1%), and professional scrubs (2.5%) represented in Table 2.

Table 2 Children’s preferences regarding dentist attire.

Number	Attire option	n (%)
1	White coat	142 (59.4)
2	Casual attire	21 (8.8)
3	Child friendly	35 (14.6)
4	Formal attire	32 (13.4)
5	Professional scrubs	6 (2.5)
6	Dentist with white coat, head cap and mask	10 (4.1)

Most children preferred to be treated by female dentists. Boys showed a strong preference for male dentists, while girls favored female dentists. Both younger and middle-aged children, regardless of previous dental experience, preferred female dentists. Older children expressed that they were comfortable being treated by either a male or female dentist.

Traditional white coat attire was the most favored choice, followed by child-friendly cartoon-themed attire. Preferences did not significantly differ between boys and girls or between children with and without prior dental experience. However, younger children tended to prefer cartoon attire, whereas the middle and older age groups favored the white coat. Professional green scrubs were the least preferred attire across all groups. Regarding masks, white masks were the most preferred overall. Girls, younger children, and children both with and without previous dental visits showed a preference for masks.

Association between age group and attire preference

The χ² analysis revealed no statistically significant relationship between the child’s age and their preferences for the dentist’s attire with Cramér’s V = 0.15, indicating a small effect size. Children aged 7-9 years tends to prefer child-friendly attire, whereas children aged 10-15 years predominantly preferred the white coat summarized in Table 3 and Figure 2A.

Figure 2 Associations between dentist attire preferences and demographic characteristics among children. A: Age group × dentist attire preferences; B: Gender × dentist attire preference; C: Children attending school type × dentist attire preference; D: Children area of residence × dentist attire preference. WC: White coat.

Table 3 Association between age and attire preference (χ² = 10.98), Cramer’s V = 0.15.

Number	Age group	Most preferred attire	P value	Interpretation
1	7-9 years	Child friendly	0.052	No significant relationship indicating a potential age-related trend in outfit choice; Cramer’s V suggests a weak but meaningful age-related influence on attire preference
2	10-12 years	White coat
3	13-15 years	White coat

Association between gender and attire preference

The χ² analysis revealed there is no statistically significant relationship found in children gender and dentist attire preference with Cramér’s V = 0.13, indicating a negligible effect size consistent with non-significant P-value. Both male and female participants showed similar overall preferences, with the white coat being the most commonly preferred attire summarized in Table 4 and Figure 2B.

Table 4 Association between gender and attire preference (χ² = 4.26) Cramer’s V = 0.13.

Number	Gender	Preferred attire	P value	Interpretation
1	Male	White coat	0.513	No significant relation and association between gender and attire preferences
2	Female	Mixed preferences

Association between school type and attire preference

Differences were also observed between children attending private and government schools and χ² analysis revealed strong significant association between Institutional setting and attire preferences, with private sector participants exhibiting different patterns compared to those from government institutions with Cramer’s V = 0.24 indicating small effect size summarized in Table 5 and Figure 2C.

Table 5 Association between children attending (type of Institution) and attire preference (χ² = 13.42), Cramer’s V = 0.24.

Number	Children attending (institution)	Preferred attire	P value	Interpretation
1	Private	Distinct preference (white coat)	0.02	Significant relationship observed stating Institutional setting affects attire preferences, with private sector participants exhibiting different patterns compared to those from government institutions
2	Government	Mixed preferences

Association between area of residence of children and attire preference

The χ² analysis revealed there is a statistically significant relationship between children area of residence and dentist attire preferences with Cramer’s V = 0.25 indicating small effect size mentioned in Table 6 and Figure 2D. Reasons given for choosing traditional white coat attire included: “They look like a doctor”, “Because nurses wear white dresses”, “Because they will do good treatment”, “Doctors should wear white”, “They do painless treatment”, “It helps them work”, “They look nice, decent, and smart”, and “It is protective wear for doctors”. For preferring cartoon attire, children said: “I like cartoons”, “It looked like my school”, “I usually watch cartoons”, “I like such dresses”, “It makes me feel jolly”, “It looks beautiful”, and “My pain will reduce on seeing this”.

Table 6 Association between children (area of residence) and attire preference (χ² = 15.04), Cramer’s V = 0.25.

Number	Children (area of residence)	Preferred attire	P value	Interpretation
1	Urban	White coat	0.01	Significant relation exists between children area of residence and dentist attire preference
2	Rural	Mixed preferences

DISCUSSION

A dentist’s professional appearance can sometimes increase a child’s anxiety, often due to the generalization of fear from previous unpleasant experiences in medical settings. Children also associate colors with emotions - for example, blue is linked with happiness and green with surprise - and using their favorite colors can encourage co-operation. Continuous research is being conducted to alleviate patient’s fear and anxiety by implementing various psychological techniques and modifying dental office settings and environments to facilitate the smooth delivery of dental treatment procedures. Celine et al[3], conducted a study on concept of eye tracking technology in children by using a conventional mouth mask modified by attaching lenticular stickers to create a “magic mask”, which was then shown to children and reported that circum-oral area has significantly more fixations than the eyes and adding distractions like different types of tie’s and badges on attire can lead to prolonged concentration and eye fixation of the patients.

The findings of this study are consistent with other studies and showed that majority of children preferred to be treated by female dentists. Although in few research studies such as involving children aged 9-12 years, showed a preference for male dentists. Asokan et al[7] found that most children, regardless of past dental or medical experiences, preferred female dentists - aligning with the observations in this study. Multiple studies indicate that children’s preferences for the dentist’s gender often depend on the child’s own sex, a pattern supported by the current findings[7,15].

Children tend to prefer female dentists because they are perceived as more caring, compassionate, and empathetic. In contrast, male dentists are often favored due to the belief that their strength and sturdiness contribute to more successful treatment outcomes. With increasing age, maturity, and changing attitudes, it is likely that older children in this study were comfortable being treated by either male or female dentists. Though this study did not specifically explore for this, but a notable observation found in this study is that the dental profession generally has more female practitioners than male, which may also influence children’s preferences.

Ethnic and cultural differences shape both children’s and adult’s perceptions and personal preferences regarding their healthcare professionals[15-17]. For example, Asian children have been shown to prefer physicians dressed in white coats. Similarly, in the present study, children favored white coats over cartoon attire regardless of their gender or previous dental visit history. Mistry and Tahmassebi[18] found no significant difference in attire preference between boys and girls. However, another study reported gender-based differences, with more girls than boys preferring colored coats. In research conducted among children in Rajasthan, younger children (aged 4-7 years) preferred cartoon aprons, while those in the middle (8-14 years) and older age groups tended to favor white coats, reflecting the findings of this study[19]. It has been suggested that as children grow older, their anxiety decreases, which may explain their increased preference for white coats[20].

Relationships between various demographic and contextual factors and outfit preferences

This study explored the relationship between various demographic and contextual factors and outfit preferences among a sample of 239 participants. χ² tests and Cramer’s V effect were used to assess the significance of associations across multiple variables.

Age and outfit preference: The analysis comparing age groups (7-9 years and 10-15 years) with outfit preferences resulted in a χ² value of 10.98, P-value of 0.052 and a Cramer’s V = 0.15(small effect). This finding is not statistically significant, indicating a small effect on potential age-related trend in outfit choice. However, the association is not strong enough statistically to draw definitive conclusions.

Gender and outfit preference: The analysis by gender showed a χ² value of 4.26, P-value of 0.513, with a Cramer’s V = 0.13 (negligible effect) and suggesting no statistically significant relationship between gender and outfit preferences. This means that both male and female participants exhibited similar patterns in their clothing choices.

Area of residence and outfit preference: A significant association was found between participants’ area of residence (urban vs rural) and their outfit preferences, with a χ² value of 15.04, P-value of 0.01 and a Cramer’s V = 0.25 (small effect). This statistically significant result indicates that urban and rural backgrounds strongly influence clothing choices, with urban participants showing more distinct preferences.

Institutional sector (government vs private) and outfit preference: There was also a significant relationship between the type of institution attended (government or private) and outfit preferences. The χ² value was 13.42, P-value of 0.02 and Cramer’s V = 0.24 (small effect) confirming that the institutional setting affects attire preferences, with private sector participants exhibiting different patterns compared to those from government institutions.

Study limitations

Limited sample size in younger age group: The 7-9 years age group included only 4 participants, which significantly limits the reliability of comparisons across age groups. Such a small subgroup reduces statistical power and increases the likelihood of type II errors (failing to detect a true effect).

Uneven group distribution: There was a notable imbalance in participant numbers across age groups - for instance, 235 participants were aged 10-15, while only 4 were aged 7-9. This disparity can skew results and makes it difficult to generalize findings for underrepresented subgroups.

Cross-sectional study design: As the study captures data at a single point in time, it cannot track changes in attitudes or preferences over time. Consequently, causal relationships cannot be established.

Lack of qualitative data: The study relied entirely on quantitative methods (e.g., χ² tests). Including qualitative feedback or open-ended responses could have provided deeper insight into the reasons behind children's preferences.

Cultural and regional constraints: The findings are likely shaped by local cultural norms and institutional practices (such as urban vs rural settings or government vs private institutions), which limits the generalizability of the results to other regions or populations.

Potential response bias: As the data was self-reported by children, responses may have been influenced by peer pressure, the desire to give socially acceptable answers, or misunderstanding of the questions - potentially affecting the accuracy of the findings.

Unaccounted confounding variables: Factors such as socioeconomic status, parental influence, media exposure, or school dress codes were not assessed. These unmeasured variables could have influenced the observed preferences and relationships.

CONCLUSION

The findings indicate that contextual factors, such as area of residence and type of institutional sector, have a stronger influence on outfit preferences than individual demographics like gender or age. While age shows a weak association with clothing choices, gender does not have a significant impact. These insights can help shape future interventions and educational materials focused on dress norms, particularly in varied socio-cultural and institutional settings.

Age, gender, and prior dental experiences remain important factors shaping children’s preferences for a dentist’s appearance. As children mature, their fear of the white coat tends to diminish, and preferences for a specific dentist gender or child-friendly mask types also decrease. Nonetheless, it is important to recognize that beyond appearance, qualities such as communication skills, behavior, and the dentist’s attitude have a greater influence on the child-dentist relationship. Future research should explore the alignment between parent’s attire preferences for their child’s healthcare provider and the child’s own preferences. Additionally, experimental studies are needed to evaluate how specific attire, colors, and mask types affect children’s behavior and acceptance of treatment.