Social support and pre-operative anxiety in patients undergoing elective surgical procedures: A systematic review and meta-analysis.

Pre-operative anxiety may adversely affect post-operative recovery and treatment satisfaction. This systematic review assessed the impact of social support on pre-operative anxiety in elective surgery patients. MEDLINE via Ovid, Embase, PsycINFO, Web of Science, CINAHL Plus, Emcare and LILACS were searched for publications (1950-2021). Fourteen studies were included for descriptive analysis and five for meta-analysis. The pooled estimate in the meta-analysis was r = -0.372 (95% CI: -0.578 to -0.122). Stronger social support was weakly associated with reduced pre-operative anxiety, but the quality of available evidence was low. The findings suggest potential benefit in enhancing utilisation of support networks before elective surgery.

CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol.

BACKGROUND: Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this "Caries OUT" study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. METHODS: In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children's oral-health behaviour change, parents' and dentists' process acceptability, and costs exploration. A sample size of 258 3-5 and 6-8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments' time. A trained examiner per centre will conduct examinations at baseline, at 5-5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child's CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents' and dentists' process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. DISCUSSION: The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. TRIAL REGISTRATION: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h . Protocol-version 2: 27/01/2021.

The effect of malocclusion on dating prospects.

OBJECTIVE: To establish whether the appearance of malocclusion affected dating prospects. The secondary objective was to identify any significant predictors relating to likelihood of dating. DESIGN: Cross-sectional study. SETTING: King's College London. PARTICIPANTS: A total of 232 undergraduate students. METHODS: Participants were shown images of either one man or one woman. The images had been manipulated using computer software to represent one of three differing dental appearances: post-orthodontic aligned teeth; pre-orthodontic crowded teeth; or pre-orthodontic missing teeth (developmentally absent maxillary lateral incisors). Sealed envelopes were randomly assigned to participants, who rated the individual in the image in relation to: attractiveness; intelligence; happiness; nervousness; and how much they would want to go on a date with them. The response format was a 100-mm visual analogue scale. RESULTS: The aligned dental appearance received statistically significant higher ratings of attractiveness (P < 0.001), intelligence (P = 0.031), likelihood of dating (P = 0.017) as well as lower ratings of nervousness (P = 0.020). There was no statistically significant difference in relation to happiness (P = 0.43), neither were there any statistically significant differences between the crowded and missing dental appearances. Regression analysis revealed that rated attractiveness was the most significant predictor in relation to likelihood of dating (P < 0.001). CONCLUSION: Malocclusion did influence dating prospects. Photographs of individuals with aligned teeth were more likely to be rated highly in relation to attractiveness, intelligence and likelihood of dating, when compared with images of malocclusions. The most significant predictor of likelihood of dating was rated attractiveness.

Does dental appearance affect employment prospects: a prospective cross-sectional study.

OBJECTIVE: The principal aim was to establish whether dental appearance affects employment prospects, and if so a secondary aim was to ascertain whether there is a difference between public-facing and non-public-facing jobs. DESIGN: A prospective cross-sectional experimental analogue study. PARTICIPANTS: Ninety undergraduates studying at London Metropolitan University School of Business. METHODS: Vignettes comprising curriculum vitae (CV) with a single photograph of the applicant attached formed the experimental manipulation. For each job application, the written information on the CV remained constant, but the attached photograph had one of three altered dental appearances: (1) aligned teeth, (2) maxillary stainless steel labial fixed appliance and (3) an absent maxillary left lateral incisor. To ascertain whether there are differences between public- and non-public-facing jobs, two different job descriptions with matching CVs were designed. Each participant was randomly assigned an envelope containing one CV with one photograph and asked if they would shortlist the candidate for an interview. Likert scales were used with higher scores indicating greater likelihood to shortlist. A Multivariate Analysis of Variance was conducted with Photo (three levels) and Job Type (two levels) as independent variables, and gender as a covariate. RESULTS: A trend was found for the candidate with an absent maxillary lateral incisor to be less likely to be shortlisted for the public-facing job, compared to both candidates with aligned teeth and with fixed appliances. There were no significant main effects and the interaction was not significant. The effect of gender was not significant. CONCLUSIONS: In this study, dental appearance did not influence employment prospects. When a photograph is attached to a CV, the dental appearance of the photograph did not influence whether a candidate was shortlisted for a job interview or their anticipated job performance. There were no differences between public-facing and non-public-facing jobs.

Lessons learned on recruitment and retention in hard-to-reach families in a phase III randomised controlled trial of preparatory information for children undergoing general anaesthesia.

BACKGROUND: Recruitment and retention are documented as two of the most difficult elements of conducting clinical trials. These issues are even more challenging in paediatric trials, particularly when the families being recruited and retained are deemed 'hard to reach'. METHODS: Through the authors' own reflection on the conduct of the trial this paper examines recruitment and retention with hard to reach families from the perspective of a recently completed clinical trial on preparatory information for children undergoing general anaesthesia for tooth extractions in which approximately 83% of those approached and eligible agreed to participate. RESULTS: The lessons learned for recruitment include: the importance of children's assent; maximising limited resources when screening and approaching potential participants; valuing families' time; and developing effective professional relationships. The retention rate was 83-85.5% at follow up time points up to 3.5 weeks following recruitment, insights into how this was accomplished include: ensuring continuity of care; determination to connect via telephone; valuing families' time; and close monitoring of appointment date changes. CONCLUSIONS: Implications for future paediatric trials with hard to reach families are discussed. TRIAL REGISTRATION: ISRCTN18265148 ; NIHR Portfolio 10,006. Date of Registration: 29 November 2013. The trial was registered after commencement but before completion of data collection.

Patient's expectations of lingual orthodontic treatment: a qualitative study.

OBJECTIVE: To investigate patients' expectations of lingual orthodontic treatment. DESIGN: In-depth interviews were conducted. A framework analysis was carried out to identify themes, concepts and a typology. SETTING: Two secondary care hospital departments and four primary care orthodontic practices, UK. MATERIALS AND METHODS: Fifteen new orthodontic patients aged 16-60 years participated in the interviews. All interviews were transcribed verbatim and analysed using framework analysis, including identification of themes within the responses, and typologies of respondents. RESULTS: Patients seeking lingual orthodontics reported expectations that were similar in quality but different in extent to those seeking labial orthodontics. These patients were well informed about lingual orthodontic treatment before they decide to start treatment. Two typologies were identified. Firstly, males less than 30 years of age, undergoing changes in their lives, who were confident that they wanted a hidden brace, but were not entirely sure of the specifics of the system. Secondly, females aged 30-45, who request a hidden brace and had actively researched what particular systems were available. CONCLUSIONS: This study shows that patients requesting lingual orthodontics have expectations that are similar in quality but greater in extent when compared to those seeking labial orthodontics.

Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management.

BACKGROUND: Plaque control in patients with periodontal disease is critically dependent upon self-care through specific oral hygiene-related behaviours. OBJECTIVES: To determine the relationship between adherence to oral hygiene instructions in adult periodontal patients and psychological constructs. To determine the effect of interventions based on psychological constructs on oral health-related behaviour in adult periodontal patients. DATA SOURCES: The Cochrane Oral Health Group's Trials Register, MEDLINE, EMBASE and PsycINFO. STUDY APPRAISAL AND SYNTHESIS METHODS: Studies were grouped according to the study design, and appraised using an appropriate methodology, either the Newcastle-Ottawa assessment for observational studies, or the Cochrane criteria for trials. RESULTS: Fifteen reports of studies were identified. LIMITATIONS: There was a low risk of bias identified for the observational studies. Older trials suffered from high risk of bias, but more recent trials had low risk of bias. However, the specification of the psychological intervention was generally poor. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The use of goal setting, self-monitoring and planning are effective interventions for improving oral hygiene-related behaviour in patients with periodontal disease. Understanding the benefits of behaviour change and the seriousness of periodontal disease are important predictors of the likelihood of behaviour change.

Improving access to preparatory information for children undergoing general anaesthesia for tooth extraction and their families: study protocol for a Phase III randomized controlled trial.

BACKGROUND: Children can find anaesthesia induction especially distressing and postoperative psychological and physical morbidity are common. Preparation programmes for general anaesthesia (GA) are highly effective in reducing this distress. A Phase II study has already verified the effectiveness of a prototype preoperative GA-coping computer game to help children cope with induction in a dental GA setting. The biggest patient users of pediatric GA services in the UK are children who need to have teeth removed (estimated to be 100,000 yearly). Tooth decay is the most common disease in children worldwide. This study is a Phase III randomized controlled trial (RCT) and will evaluate the effectiveness of the new internet version of this game. METHODS/DESIGN: The Phase III RCT will use a double-blind three-armed design. The clinical trial will recruit up to 210 children and will compare the web-based game against standard care and another non-medical game. At least 53 patients in each group will be required for 90% statistical power. Distress will be assessed through an evaluation of the child's behaviour during the visit and later parental reports of physical and psychological morbidity. The satisfaction of parents and children will be measured; the mode of usage of the web-based game will be automatically recorded and the impact on the service (for example, recovery time and throughput) will be reported.The Phase III study primary outcome will measure: (1) patient experience: acceptance of anaesthetic induction, child cooperation and distress, reduction of peri- and postoperative morbidity, child and family satisfaction, and (2) service improvement: anaesthetic time and improvement in throughput. Measures will be administered at baseline, at the time of the GA treatment visit, and at 48 hours and one week postoperatively. DISCUSSION: This study aims to determine the effectiveness of an online GA-coping game for children and families undergoing tooth extraction under GA. TRIAL REGISTRATION: ISRCTN18265148 (registered 24 November 2013).

Dental tooth surface loss and quality of life in university students.

AIM: To determine the relationship between toothwear into dentine and oral health-related quality of life impacts in a sample of university students not attending for dental treatment. METHODS: A cross-sectional survey of 1010 university students was undertaken. Clinical examination, including the Smith & Knight (1984) index of tooth erosion, was performed and completion of the Oral Health Impact Profile-49 (OHIP-49) measure of oral health-related quality of life was arranged. RESULTS: Seventy-seven per cent of the students had at least one tooth with tooth surface loss into dentine. Overall OHIP scores were similar for individuals with different levels of severity of tooth surface loss. Individuals with severe tooth surface loss were more likely to report that their appearance had been affected by, and that they had felt self-conscious because of, the condition of their mouth and teeth. CONCLUSIONS: Tooth surface loss into dentine was prevalent among the young adults who were examined in this study. They reported that it had little impact on oral health-related quality of life at the non-clinical levels seen in this study.

An appraisal of the quality of published qualitative dental research.

OBJECTIVES: To appraise the quality of published qualitative research in dentistry and identify aspects of quality, which require attention in future research. METHODS: Qualitative research studies on dental topics were appraised using the critical appraisal skills programme (CASP) appraisal framework for qualitative research. The percentage of CASP criteria fully met during the assessment was used as an indication of the quality of each paper. Individual criteria were not weighted. RESULTS: Forty-three qualitative studies were identified for appraisal of which 48% had a dental public health focus. Deficiencies in detail of reporting, research design, methodological rigour, presentation of findings, reflexivity, credibility of findings and relevance of study were identified. Problems with quality were apparent irrespective of journal impact factor, although papers from low impact factor journals exhibited the most deficiencies. Journals with the highest impact factors published the least qualitative research. CONCLUSIONS: The quality of much of the qualitative research published on dental topics is mediocre. Qualitative methods are underutilized in oral health research. If quality guidelines such as the CASP framework are used in the context of a thorough understanding of qualitative research design and data analysis, they can promote good practice and the systematic assessment of qualitative research.

What is the role of senior house officer or dental foundation year two posts in professional careers? Exploring the motivations for, and perceived benefits of, undertaking SHO posts in two London hospitals.

AIMS: To investigate the motivations for, and perceived benefits of, undertaking senior house officer (SHO) posts, and to explore the career pathways of those who do, examining trends in successive cohorts. METHOD: Postal cross-sectional questionnaire survey of all dental and maxillofacial SHOs (DF2s) who had worked for two South London hospitals within the previous nine years (n=137). Respondents were grouped into three cohorts to enable responses to be examined in relation to respondents' entry to their first SHO post. RESULTS: There were responses from 83 (61%) potential participants. The most frequent motivation for carrying out SHO posts from 79 (95%) of the respondents was the desire to 'learn from experienced clinicians'. The most common perceived benefit reported by those who had completed posts at the time of the survey was 'an improved understanding of the role of the hospital dental service' from 68 (97%) of those who answered this question. Difficulty in securing a job in general dental practice was not reported as a notable motivating factor, either before or after the implementation of the new dental contract. 'Fulfil approved training post requirements for postgraduate examinations' reduced as a motivator from 28 (88%) for the earlier cohort of SHOs to nine (36%) for the more recent cohort. Fifty-four of 78 (69%) respondents declared a definite plan to seek admission to the General Dental Council Specialist Lists in future, 24 (83%) in the first cohort, compared with 11 (46%) in the last (P=0.05). Of the males, 13 (52%) were significantly more likely to report that they were currently working in general practice compared with 15 (27%) females (P=0.028). CONCLUSION: The findings suggest that multiple benefits are identified from undertaking SHO posts. However, some of the motivations for undertaking SHO posts may have changed over the nine-year period investigated. Possible influences are discussed. This paper highlights the perceived benefits of junior training posts at a time of significant transition within the profession.

A qualitative investigation of the experiences of immigrant dentists working in New Zealand.

OBJECTIVES: To determine the nature of problems experienced by overseas-trained dentists settling in New Zealand (NZ), and to ascertain what can be done to improve their experiences. DESIGN: Qualitative study using semi-structured interviews. SUBJECTS AND METHODS: A convenience sample of fourteen overseas-qualified dentists was selected and individuals invited to participate in a semi-structured interview. Each interview was audiotaped, transcribed and analysed in order to identify key patterns and themes. RESULTS: Those who were required to sit the New Zealand Dental Registration Examination (NZDREX) found it very challenging, with the majority requiring more than one attempt. Most interviewees had moved to NZ for an improved quality of life and had settled well into dental practice. However, some reported that they had experienced significant difficulties. These primarily related to financial issues, employment issues, being accepted into the profession, and establishing suitable peer contact. The dentists considered that the Dental Council and the NZDA were very helpful, but that there was a need for clearer information about the content of the NZDREX examinations, and a peer support network for immigrant dentists. CONCLUSIONS: Improved support for immigrant dentists would aid their transition into general practice in this country.

Gender differences in dentists' working practices and job satisfaction.

OBJECTIVES: To describe the working practices and level of job satisfaction of male and female dentists. METHODS: A nationwide postal survey of all dentists holding an annual practising certificate in New Zealand (response rate 78.1%). RESULTS: The mean number of hours worked per week was 29.1 for female and 36.0 for male dentists. The main reason for part-time practice given by women was caring for children (cited by 67.2%) and for men was personal choice (cited by 63.6%). A greater proportion of females than males were employed on a salary or as an associate in practice rather than owning their own practice. Male dentists were more active in continuing education than females. The mean career satisfaction score for male respondents was 7.6 and for females 7.1 (P<0.001). Relatively more women than men had taken a career break, usually for child rearing. Two-thirds of women and one-third of men planned to retire from dentistry before 60 years of age. CONCLUSIONS: Male and female dentists differ in their working patterns and career satisfaction. There is a need for ongoing monitoring of the workforce, particularly as the gender distribution (and societal trends and expectations) continues to change.

Inequalities in the provision of NHS primary care dental services in Scotland in 2004.

OBJECTIVE: To assess inequalities in the provision of National Health Service (NHS) primary care dental services between Health Boards and the four provider groups (General Dental Service [GDS] non-specialist, GDS salaried, specialist working in primary care, Community Dental Service [CDS]) in Scotland. METHODS: A postal questionnaire survey of all dentists (N=2852) registered with the General Dental Council at an address in Scotland was undertaken. The following were assessed: the proportion of primary care dentists not accepting new children/adults for NHS care or using a waiting list, the proportion of dentists working in wheelchair-accessible surgeries, furthest distance travelled by patients to primary care surgery in an average week, waiting time for routine NHS treatment, and the proportion of dentists offering weekend or evening appointments to NHS patients. Data were analysed by Health Board and the four provider groups. RESULTS: A total of 2134 (74.8%) completed questionnaires were returned. One thousand, five hundred and seventy-seven dentists (73.9%) of the respondents were providing NHS primary care dental services for at least part of each week. There was a wide variation in the provision of NHS primary care dental services between Health Boards. Borders, Dumfries and Galloway, and Grampian performed poorly on most indicators, whereas Lanarkshire, Greater Glasgow, and Argyll and Clyde generally performed well. The CDS scored well on most indicators of service provision. There were problems with the provision of specialist dental services in primary care, and GDS services provided by Health Boards. CONCLUSIONS: Because the problem issues differed between Health Boards and the four provider groups, it is likely that both local and national solutions are required to improve the provision of services. Further research on service demand is required to confirm the apparent inequalities in provision suggested by the study.

The working practices and job satisfaction of dental hygienists in New Zealand.

OBJECTIVES: To describe the current working practices and level of job satisfaction of dental hygienists in New Zealand. METHODS: Postal survey of all dental hygienists on the New Zealand Dental Council's database. An initial mailing was followed by a 3-week follow-up. Information was sought on respondents' demographic characteristics, current occupation and working practice, history of career breaks, continuing education and career satisfaction. RESULTS: 213 responses were received (73.2%); 90.6% were currently working as hygienists, mostly in private practice. Many worked part time, particularly those with children. Almost 50% of respondents had taken at least one career break, most frequently for childrearing. The mean time taken in career breaks was 3.6 years. Overall, dental hygienists reported high levels of satisfaction with their careers and their income. Older hygienists had higher career satisfaction scores. Most respondents were actively involved in continuing education. Almost half were interested in expanding the range of procedures they perform. Over one-third plan to retire within the next 10 years. CONCLUSIONS: While many hygienists take career breaks and work part time, most have a high level of career satisfaction, actively participate in continuing education, and are satisfied with their remuneration.

A comparison of the impact of information from a clinician and research-based information on patient treatment choice in dentistry.

OBJECTIVES: There is an imperative that clinicians should employ an evidence-based approach to both clinical care and treatment, and involve patients in the decision-making process. In Britain, public policy emphasizes the importance of patient involvement, participation and partnership in health care, however little is known of the effect of evidence-based information on this. This study compares treatment decisions made by dental patients on the basis of two sources of evidence: clinician and research. METHOD: Vignette method with the two sources of evidence as experimental variables. The study population was a convenience sample of dental patients recruited from a clinic waiting area at a Dental Hospital (n=100). Each participant read a vignette describing a visit to the dentist for treatment of severe toothache in a back tooth. The nature and purpose of the visit was identical in each vignette. The participants indicated their decision about possible treatment, based on the information they had been given in the vignette and rated their confidence in the decision on a three point Likert scale. Additionally participants' were asked to rate their own oral health. RESULTS: Research evidence influences the confidence patients have in their in decision especially when it supports clinical judgement and where individuals value their oral health. Research evidence does not replace the confidence that patients have in the dentist's clinical judgement. CONCLUSION: Dental patients' willingness to engage in treatment is influenced by the dentist's clinical recommendation and the importance of oral health to the patient.

Exposure to 'ideal' facial images reduces facial satisfaction: an experimental study.

OBJECTIVE: Psychological research has suggested that exposure to media images of 'ideal' female models has a negative impact on women's perception of their body image. The present study examined the effects of exposure to images of faces rated as high in attractiveness upon facial satisfaction, compared with exposure to 'neutral' stimuli. METHODS: Participants comprised three groups of women: 24 women undergoing orthodontic treatment, 22 patients undergoing orthognathic treatment, and 20 women receiving no current dental treatment. All completed measures of facial and body image satisfaction after viewing images of houses or faces as follows: The Body Satisfaction Scale, The Revised Body Image Scale of Secord and Jourard and a Visual Analogue Scale measuring satisfaction with Facial Appearance. A repeated-measures design was adopted with a 4-6-week period between experimental conditions. All participants were randomly assigned to one of the two orders (Houses-Faces or Faces-Houses). The findings were analysed using general linear modelling analysis of variance. RESULTS: Exposure to idealized images of faces resulted in a significant decrease in facial satisfaction when compared with the control condition (mean facial satisfaction for all participants in Faces condition, Body Satisfaction Scale-Head Scale = 22.2, SD = 7.81; Revised Body Image Scale-Facial Subscale = 25.5, SD = 4.57; VAS = 7.8, SD = 2.47; Mean facial satisfaction for all participants in Houses condition, Body Satisfaction Scale-Head scale = 19.5, SD = 6.81; Revised Body Image Scale-Facial Subscale = 26.8, SD = 4.87; VAS = 6.2, SD = 2.72). CONCLUSIONS: Media may exert a negative influence on self-perception, particularly amongst individuals who, for one reason or another, are sensitive to the appearance of their face. The findings of the present study have implications for the demand for orthodontic treatment for aesthetic enhancement at a time when resources are limited. Interventions are discussed to help individuals question their acceptance of such media messages.

The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks.

Oral epidemiological research into the social determinants of oral health has been limited by the absence of a theoretical framework which reflects the complexity of real life social processes and the network of causal pathways between social structure and oral health and disease. In the absence of such a framework, social determinants are treated as isolated risk factors, attributable to the individual, having a direct impact on oral health. There is little sense of how such factors interrelate over time and place and the pathways between the factors and oral health. Features of social life which impact on individuals' oral health but are not reducible to the individual remain under-researched. A conceptual framework informing mainstream epidemiological research into the social determinants of health is applied to oral epidemiology. The framework suggests complex causal pathways between social structure and health via interlinking material, psychosocial and behavioural pathways. Methodological implications for oral epidemiological research informed by the framework, such as the use of multilevel modelling, path analysis and structural equation modelling, combining qualitative and quantitative research methods, and collaborative research, are discussed.

Students' perceptions of the acceptability of behaviour management techniques.

The aim of the present study was to determine the perceptions of dental students of the acceptability of different forms of behaviour management for children. The effect of client characteristics (typically developing or learning disabled), intervention method (relaxation training and reinforcement or physical restraint) and treatment outcome (good or poor) on acceptability ratings made by fourth year dental students was determined. Students rated the acceptability of treatments on the basis of written vignettes using a standardized measure of the acceptability of behavioural treatments (the Treatment Evaluation Inventory, TEI, Kazdin, French and Sherick 1981). The study had a full factorial design; all possible combinations of variables were represented in the vignettes. The results were analysed using ANOVA models. There were significant main effects of intervention method and treatment outcome, indicating that less restrictive methods and good intervention outcome were rated as more acceptable. Significant two- and three-way interactions were found, which suggested that the use of restrictive methods may be perceived as more acceptable for a child with learning disabilities even when the outcome was poor. The second order interactions revealed that the acceptability of restrictive techniques was improved less markedly by a good outcome. This study highlights the importance of empirically evaluating outcome and treatment restrictiveness when engaging in behaviour management during dental procedures.