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The effect of undergraduate clinical training on dental students' perceptions of paediatric behaviour management techniques: a longitudinal cohort study

This longitudinal cohort study demonstrates that undergraduate clinical training significantly influences dental students' evolving perceptions of paediatric behaviour management, revealing a strong preference for communicative and reinforcement-based techniques over restrictive approaches while highlighting the need for curricula that explicitly integrate communication and ethical reflection.

Original authors: Nerea Sanz Pablos, Natalia del Río Cantero, Joany Gouveia Venezel, Alberto Adanero Velasco, Laura Velayos Galán, Marta Piñeiro Herraiz, Mónica Miegimolle Herrero

Published 2026-07-07

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CC BY 4.0

Original authors: Nerea Sanz Pablos, Natalia del Río Cantero, Joany Gouveia Venezel, Alberto Adanero Velasco, Laura Velayos Galán, Marta Piñeiro Herraiz, Mónica Miegimolle Herrero

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine dental school as a long journey where students learn not just how to fix teeth, but how to talk to the little passengers in the chair. This study is like a travel log that tracks how a group of dental students' feelings about managing scared or wiggly children change from the start of their final year to the end.

Here is the story of their journey, broken down simply:

The Big Question

Managing a child in a dental chair is tricky. It's not just about having steady hands; it's about having a good voice, a kind heart, and knowing when to be firm and when to be gentle. The researchers wanted to know: Does actually working with kids in a clinic change how students think about these techniques?

The Map (The Study Design)

The researchers followed 338 students at the European University of Madrid. Think of this as taking a "before" snapshot at the start of the school year and an "after" snapshot at the end. They asked the students to rate 17 different ways to handle a child's behavior, from "Tell-Show-Do" (showing the child what will happen) to "Hand-over-mouth" (covering the child's mouth).

The Results: What They Liked and Disliked

The "High-Five" Techniques:
At the very beginning, the students already loved the gentle, communicative approaches. They gave high scores to:

Positive Reinforcement: Giving praise or a sticker.
Tell-Show-Do: Explaining and demonstrating tools before using them.
Distraction: Using videos or music to take the child's mind off the drill.

The "No-Go" Techniques:
Conversely, the students strongly disliked the forceful methods right from the start. They gave low scores to:

Passive Restraint: Strapping a child down.
Hand-over-Mouth: Covering the child's mouth to stop them from talking.
Silencing: Not allowing the child to speak.

The Hidden Structure (The Two Buckets)

When the researchers looked closely at the data, they found something new that hadn't been mapped out before. The 17 techniques naturally fell into two separate buckets that had nothing to do with each other:

The "Connection" Bucket: Techniques based on talking, distracting, and rewarding.
The "Control" Bucket: Techniques based on physical restraint, sedation, or anesthesia.

The study found that a student could love the "Connection" bucket while hating the "Control" bucket, or vice versa. They are two completely different mindsets.

The Detours: Who Believes What?

The study found that a student's background acted like a filter, changing how they viewed these techniques:

Gender: Male students were slightly more open to the "Control" bucket (like covering a mouth or using anesthesia), while female students preferred the "Connection" bucket (like distraction and sensory stimulation).
Nationality: Students from outside the European Union were less likely to accept positive reinforcement or using polite "white lies" (euphemisms) compared to Spanish or EU students.
Experience: Students who had already worked with children or had dental jobs were more willing to use physical restraints than those who hadn't.

The Twist: The "Malleable Clay" Effect

This is the most surprising part of the story. Usually, we think people's opinions are set in stone. But this study found that the students' opinions were like wet clay, not stone.

When the researchers compared the "before" and "after" snapshots, there was almost no connection between what a student thought at the start of the year and what they thought at the end. Their views shifted significantly based on the training they received during that single year.

The Takeaway

The paper concludes that dental school isn't just about teaching students how to do things; it's about reshaping how they feel about doing them.

Because students' attitudes are so changeable, the authors argue that schools need to be very intentional. They shouldn't just teach the technical skills; they must actively guide students to build an identity based on empathy, ethics, and communication. The training process itself is the sculptor that turns the "wet clay" of a student's initial opinions into a professional attitude.

Technical Summary: The Effect of Undergraduate Clinical Training on Dental Students' Perceptions of Paediatric Behaviour Management Techniques

Problem Statement
Paediatric dentistry requires professionals to possess not only technical skills but also the ability to manage patient behavior, fear, and anxiety. While behaviour management techniques have evolved from coercive models to those centred on communication and well-being, there is limited understanding of how undergraduate clinical training shapes dental students' perceptions of these techniques over time. Existing literature largely relies on cross-sectional designs, leaving gaps in knowledge regarding the psychometric structure of measurement instruments and the temporal stability of student attitudes throughout a single academic year of training.

Methodology
The study employed a longitudinal cohort design involving 338 fourth- and fifth-year dental students at the European University of Madrid during the 2024/2025 academic year. Data collection occurred at two time points: the beginning (baseline) and the end of the academic year, following theoretical and practical clinical training.

Instrument: A researcher-developed questionnaire assessed the acceptance of 17 specific behaviour management techniques using a five-point Likert scale (1 = 'strongly disagree' to 5 = 'strongly agree'). The instrument was linguistically validated through translation and back-translation.
Variables: The survey collected sociodemographic data (age, gender, nationality, marital status, children) and experiential variables (previous dental/medical observation, experience caring for children).
Statistical Analysis: Given non-normal data distribution, non-parametric tests (Mann-Whitney U, Kruskal-Wallis) were used for subgroup comparisons. Reliability was assessed via Cronbach's alpha and McDonald's omega. An Exploratory Factor Analysis (EFA) using a polychoric correlation matrix, minimum residuals extraction, and oblique rotation was conducted to determine the internal structure. Temporal stability was evaluated using Spearman correlations between baseline and final scores.

Key Results

Acceptance Patterns: At baseline, students showed the highest acceptance for communicative and reinforcement-based techniques: Positive Reinforcement (T10, M=4.36), Tell-Show-Do (T1, M=4.30), and Distraction (T9, M=4.11). Conversely, restrictive and aversive techniques received the lowest scores: Passive Restraint (T8, M=2.12), Hand-over-Mouth (T4, M=2.35), and Not Allowing the Child to Speak (T2, M=2.26).
Psychometric Structure: The questionnaire demonstrated acceptable internal consistency ( $\alpha$ $α$ = .69; $\omega$ $ω$ = .76). EFA revealed a distinct two-factor structure:
1. Factor 1 (Communication/Reinforcement/Distraction): Included techniques such as sensory stimulation, positive reinforcement, and distraction.
2. Factor 2 (Restrictive/Pharmacological): Included passive/active immobilisation, pharmacological sedation, and general anaesthesia.
  The correlation between these factors was negligible ( $\Phi$ = −.04), indicating they are conceptually independent constructs.
Influence of Demographics and Experience:
- Year of Study: Fourth-year students showed higher acceptance of pharmacological sedation and promising gifts compared to fifth-year students.
- Gender: Male students demonstrated higher acceptance of restrictive techniques (e.g., hand-over-mouth, general anaesthesia), while female students rated communicative techniques (distraction, sensory stimulation) higher.
- Nationality: Non-EU students showed lower acceptance of positive reinforcement and euphemisms compared to Spanish and EU students.
- Experience: Prior work experience correlated with higher acceptance of passive immobilisation and reporting pain. Experience with children correlated positively with communicative techniques and negatively with restrictive ones.
Temporal Stability: Analysis revealed low temporal stability; there were no significant correlations between baseline and final scores for any of the 17 techniques. This suggests that student perceptions are not fixed and are significantly reshaped by the educational and clinical exposure received during the year.

Significance and Claims
The authors claim this study provides a novel contribution to the literature by being the first to demonstrate the instability of perceptions regarding behaviour management techniques over the course of a single academic year. The findings suggest that undergraduate clinical training plays a critical role in shaping professional attitudes, moving students away from restrictive approaches and reinforcing communicative strategies.

The study validates a two-dimensional structure for measuring these perceptions, empirically distinguishing between communication-based and restrictive/pharmacological approaches. This structure supports the theoretical classification of behaviour management techniques and implies that educational curricula should address these as distinct constructs.

Furthermore, the results highlight the malleability of student attitudes, indicating that educators have a responsibility to actively shape empathetic and evidence-based professional identities through explicit ethical reflection, case discussion, and supervised practice. The authors conclude that while students generally prefer communicative techniques, their acceptance of specific methods is influenced by cultural background, gender, and clinical exposure, necessitating adaptable training programmes.