Psychological Particular Aspects in the Child-Dentist Medical Relation in the Dental Treatment


In this article I present a concept in dentistry which becomes one of the main branches of contemporary medicine. Attitudes toward medical treatment are influenced by a number of factors related to the child's environment, education, the medical skills and competence. To highlight the psychological factors involved in attitude towards dental treatment we used a lot of 260 children aged 6-12 years who were asked to make a drawing theme ′a child to the dentist′. Subjects were divided into three categories of patients: reluctant, docile collaborators and active collaborators. The children's drawings were interpreted in psychological terms to highlight the psychological particular aspects that arise in child-dentist relationship. Interpreting findings show that in reluctant patients, drawings are done in cool colours with changes of components in all cases. In docile collaborators patients drawings contain elements changes and use cool colours to 67.10% of cases, and active collaborators work designs are modified and used cool colours only 35.15% of cases. Following research conducted both hypotheses (H1 - I assumed that emotional states experienced by children to the dentist can be found in their designs, H2: We assumed that the different categories of reluctant patients, docile collaborators and active collaborators will present drawings different features) have been confirmed in practice. The drawing theme used before dental treatment can be an indicator of a child's emotional state and help the dentist to take a proper attitude in dealing with it.

Keywords: dental treatmentchild in treatmentprojection through drawingpsychological particular aspectschild-dentist medical relationship

1. Theoretical frame:

Doctor-child confrontation for a good collaboration during therapeutic methods, are required some

knowledge which go beyond the dental profession itself: knowledge development stages of physical,

mental and psycho-social aspects of child; knowing psychological protective methods in accordance

with development stages of child helps (Gavrilă-Ardelean, 2008).

Modern dentistry requires the use of all means for a more comfortable treatment for both dentist and

patient, which was lacking on the influence of environmental aspects: physical and mental environment

and issues related to children's psychosocial transformations. That's why modern medicine has felt the

need for a new approach to patient as a human regarded as completely, this new direction is called

psychosomatic medicine. It is considered a total-integral medicine, a complete full medicine (Gavrilă-

Ardelean, 2009, pp. 210-214; Gavrilă-Ardelean & Gavrilă-Ardelean, 2015). This process was re-

humanized the medicine (Cherlea, 2009). In this way knowledge of the psychology and methods of

psychological investigation (in our case design theme) helps the physician to know the patient can refer

influences related to the physical structure, the type of character and intelligence level of the patient

and find an optimal solution for successful treatment.

The physician must consider the patient child comes to him in a state of physical and mental

discomfort; most times there is a state of stress, fear both the patient and the doctor as sometimes when

it is not well trained or insufficiently empowered in this area. Consequently doctor, besides

professional competence, must be armed with a range of psycho-pedagogical concepts to overcome

fear of the suffering (Gavrilă-Ardelean, 2009).

In pediatric dentistry for a good collaboration with the child, specialists must take into account the

child's psychosocial transformations and use a number of means psycho-protective stages according to

its age (Cosman, 2010).

The doctor's behaviour towards the child, their good cooperation depends which determine the

success of treatment. Also doctor with parents and teachers can contribute to the formation of

personality and psychosocial behaviour of the future man (Gavrilă-Ardelean, 2015). Unfortunately

dental practice uses very little psychotherapy (Cosman, 2010).

Individual treatment means adopting measures in relation to these matters, which respect individual

characteristics of the child. Knowing the child's interests and inclinations are of great importance to the

doctor because they can achieve a nearby fast and powerful mind of a child (Gavrilă-Ardelean, 2009).

2. Hypotheses

H1: I assumed that emotional states experienced by children to the dentist can be found in their


H2: We assumed that the different categories of patients (reluctant, docile collaborators and active

collaborators) will have different features drawings.

3.The study group

We used a sample of 260 children, aged between 6 and 12 years, students in the first class of

primary school, which was at least once in contact with the dental office, so the dentist. Depending

cooperative attitude they showed during treatment children were divided into three groups: reluctant,

docile collaborators and active contributors (see Table 1 ).

Table 1 -
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Children were to carry charge for a design theme ′a child to the dentist′. Projection of emotional

states in representation of the design allows you to individualize how the child lives a determined

situation, in our case the dental treatment. Drawing gives us information on the power of representation

of the real world around him (Grivu, Gavrilă-Ardelean, 2007); because children in the dental office will

design drawings after conception, intellect, emotions and their personality.

Psychological adaptation situation dental treatment is evidenced by the drawings faithfully

reproduce reality without deformation. After Canton, Tassarotti, Vicinti and Asuntosi (1969),

(Dumitraşcu, 2005), significant elements of the design can be grouped into 4 categories:

-Significant items on the composition of the drawing: the presence or absence of the child, the doctor, the mother of the device;

-Significant elements of construction graphic design: treatment, figures, dimensions, perspective;

-Significant elements on the structure design: spatial relationship between the characters and

between the human figure and device, a link between these materials, mixing human figures,

dynamism existing relationships (child runs away);

-Symbolic elements: the child with a closed mouth, no hands dentist, dentist identification device, exaggerating certain elements and replacing others.

This group is for guidance only. If absence deformities of this type is considered as an adaptation to dental treatment, the presence of one or more of the above represents a block of maladjustment, whether it's a state of fear, be preceded by bad experiences or to child maladjustment as seen in other children, especially in cases of poor family relationships and prolonged mental conflict.

5.Results and discussions

Hypothesis 1:

The analysis drawing "A child at the dentist" may find that it provides an indication of the type of

child psychological situation dental treatment. Not a maladaptive corresponding multiline fearful

behavior, but it may be imprinted in shyness.

Colours give affection and relationships on the child's personality in the sense that a rich colon

reflects a high activity, while drawing in black and white or dark colours reflect reduced activity and

poor imagination. If we interpret the meaning of the colours used in the sense of Max Luscher Color

Test (Dumitraşcu, 2005), we can say that children's emotional feelings were reflected in their design

(see Table 2 ).

Table 2 -
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We can see that: the type of colours used by the children is identical with their degree of

collaboration with the dentist. In this way we can state that our first hypothesis is confirmed by our

research: the emotional state of the children towards the medical treatment is reflected in their pictures.

Hypothesis 2:

Absence the characteristic elements of design can mean slow adaptation to the environment and the

presence of several human characters denote sociable child.

Tests used by Kunzel in examining the child's attitude toward medical and dental treatment have

proven that little meeting with the dentist patient lives dramatically, especially dental treatment and

dental extraction is experienced as an attack on the integrity of the body (Dumitraşcu, 2005). When the

doctor is considered a being very aggressive in children's drawings can sometimes get a distorted

appearance by assigning the property right animal.

Of the 260 children screened 109 drawings (42%) are no modified elements and 151 (58%) shows

the modified elements (see Table 3 ).

Table 3 -
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To better illustrate this, in Table 4 present situation designs altered according to the three types of

patients: refractory docile collaborators and active collaborators.

Table 4 -
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Note that most designs change occurring in reluctant patients 100% of their group. Docile

collaborators register a rate of 67.10% modified drawings and to actively work with the patients, the

percentage drops to 35.15% modified designs.

Reluctant patients: all the drawings show the changes. Interpretation of the theme design provides

the following issues: the most frequent changes were: self-mutilation, self-exclusion, exclusion doctor

sizing apparatus or instruments, apparatus aggression, female doctor presented as a spirit of evil;

refusal to draw, the patient has wings to flee, patient seizure by machine, use cold colours.

Docile collaborators patients, out of 76 children, 25 normal and 51 shows drawings shows the

modified drawings , changes indicating state of fear. In these cases docility collaborators patients are

driven by fear and mental inhibition. In most designs exclude six patients, hence the fear to participate

in treatment. As elements of the design changed to meet this patient: patient exclusion, exclusion

doctor flee cabinet, self-mutilation, sizing tools, cool colours. In the normal designs of paediatric

patients we meet: warm colours, the presence of the doctor as a character in the stories enjoyable,

pleasant cabinet. In these cases the children were able to overcome their fear; if at first they were

anxious feeling of fear disappears while remaining pleasant.

In case of active collaborators patients out of 128 cases, 83 cases showed normal designs and only 45

shows drawings modified elements. In normal designs meet: warm colours, are pleased to participate in

treatment, proportion and symmetry details reproduced correctly, go to cabinet, cabinet atmosphere.

In designs with elements changed most common self-exclusion with or without exclusion doctor,

probably caused by reactions after treatment.

Thus the second hypothesis was formulated new research confirmed the deal.


Psychological investigation methods such as drawing dentist help topic to know his pediatric

patient, thus finding optimal solutions depending on the type of character, level intelligence and

psychic structure of the small patient. Thus it can be seen that there is a significant project in the

doctor-patient relationship drawing on "a child at the dentist", 58 % of children presenting some

elements that lean toward iatrogenic phobia these trends being more marked children being more

refractory than docile collaborators or active collaborators patients.

Doctor-patient relationship is decisive in developing the correct treatment, the initiative in this

direction always belongs doctor. The dentist must have some knowledge of psychology and possess

qualities necessary pedagogical small patient treatment, which almost always is distrustful and anxious.

It is necessary to know the child's mental particularities to establish easy collaboration with the

patient, this conditioning the success of the treatment. Gaining a thorough patient motivation and

reasons for using these relations are established between the patient and physician, have beneficial

effects during treatment.

In the treatment, as well as its relationship with the patient, the dentist must always bear in mind that

although his actions are carried out on somatic, they echo the patient's psychic structure. The physician

should be caring, courteous, have the necessary understanding and discernment adoption most

appropriate therapeutic measures (Gavrilă-Ardelean, Gavrilă-Ardelean, 2016). Treatment successes his

good conduct are conditioned by the tact and medical skills to work with the patient.


The exposure to the study’s activities did not involve, for the children, a greater stress than usual stress of creating a drawing. To use the data from the research, the written agreement of the parents of children involved in the study was obtained.


  1. Cherlea, V. (2009). Tratamentul endodontic. Bucureşti: Editura Național.
  2. Cosman, D. (2010). Psihologie medicală. Iaşi: Editura Polirom.
  3. Dumitraşcu, N. (2005). Testul culorilor Luscher. In Dumitraşcu, N., Dragomir, S., Zamfirescu V.D., Tehnicile proiective în evaluarea personalităţii. Editura Trei, Bucureşti.
  4. Gavrilă-Ardelean, M. (2008). Politici sociale, asigurări de sănătate şi contribuţii la managementul serviciilor de sănătate. Arad: Editura Universităţii „Aurel Vlaicu”.
  5. Gavrilă-Ardelean, M. (2009). The Psychological Conditionality Involved in Children′s Medical Treatment, in International Symposium ′Research and Applications in Psychology′. Buziaş, Timişoara: Editura Eurobit. Gavrilă-Ardelean, M. (2009). The Psychological Conditionality Involved in Children′s Medical Treatment. Revista AS&PS Agora Psycho-Pragmatica, 12, Editura Universităţii „Aurel Vlaicu” Arad.
  6. Gavrilă-Ardelean, M. (2015). Education of Youth Oral Health Like a Method of Development for Culture of Health. In Gavrilă-Ardelean, M. (coord.). (2015). Dezvoltarea competențelor de exprimare culturală a tinerilor / Development of cultural expression skills of youngs, bilingual volume: romanian-english, Biblioteca Dezvoltării Comunitare Collection, Școala Ardeleană Publishing, Cluj, Eikon, București.
  7. Gavrilă-Ardelean, M., Gavrilă-Ardelean, L. (2015). Neuropsihofiziologie: curs, Ed. a 2-a, rev. și adăug., Colecția Medica. Cluj-Napoca: Editura Școala Ardeleană, București: Editura EIKON.
  8. Gavrilă-Ardelean, M., Gavrilă-Ardelean, L. (2016). Elemente de medicină internă și socială: note de curs. Ed. a 2a, rev. și adăug. Colecția Medica. Cluj-Napoca: Editura Școala Ardeleană, București: Editura EIKON.
  9. Grivu, O., Gavrilă-Ardelean, M. (2007). Community Dental Medicine. Timișoara: Editura Waldpress.

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