In several developing nations today, the need for child dental care is increasing steadily, and any successful dental practice not only depends on the skillful performance of the practitioner but also on child behaviour and cooperation with the dental care plan. Building effective interactions between the child and the pediatric dentist is crucial to improving efficiency in dental care and child motivation to dental care.

Childhood dental anxiety is an extremely common problem that has a potential influence on oral health attitudes in relation to the acceptance of treatments. ¹ Dental anxiety experienced during childhood can sometimes develop into dental phobia later in adult life. Individuals with dental phobia often postpone or completely avoid dental visits until problems become severe, which can negatively affect their daily functioning and social interactions. ² Managing child behaviour and anxiety during dental treatment is therefore a cornerstone of pediatric dentistry. Several factors have been identified to influence a child’s anxiety level in the dental setting, such as previous dental experience, parental anxiety, clinical environment, and the dentist’s communication style. ³

Among these, the attire of the pediatric dentist has emerged as a subtle yet potentially powerful determinant of a child’s emotional response. The white coat is considered as standard attire because it symbolizes medical authority, respect and establishes a patient-doctor relationship as a beneficial encounter. ⁴ Traditional white coats may provoke fear or apprehension in young children, a phenomenon sometimes referred to as “white coat anxiety,” so pediatricians generally choose not to wear them. ^{4– 5} Children tend to respond more positively when their dentist wears bright, child-friendly or themed clothing -such attire can ease the clinical atmosphere and help lower anxiety, fostering better cooperation and behaviour during treatment. Studies have shown that such colourful, playful dental attire was associated with reduced anxiety and improved comfort among young patients. ⁶

Over the last two decades, several clinical and observational studies have examined how dentist attire influences children’s perception, preference, and cooperation. Results remain mixed-some report that colourful or cartoon-themed clothing lowers anxiety and improves behaviour, while others find minimal or situational effects. Most available studies are small, single-centre, and methodologically varied. To date, evidence examining the influence of pediatric dentist attire on child dental anxiety remains fragmented, and no comprehensive systematic synthesis focusing specifically on this topic has been widely reported. This review is the first to specifically synthesize evidence on pediatric dentist attire as a behavioral management modifier, integrating child preference, anxiety scales, and parental perception across cultural settings.

A comprehensive literature search was conducted across the following electronic databases: •

PubMed/MEDLINE

The search covered studies published between January 2015 and March 2025. A combination of Medical Subject Headings (MeSH) terms and free-text keywords related to pediatric dentistry, dentist attire, and dental anxiety was used.

The search terms included combinations of: •

dentist, pediatric dentist, pedodontist

Boolean operators (AND, OR) were used to combine search terms appropriately. Only studies published in the English language were included.

Reference lists of relevant articles were also manually screened to identify additional eligible studies.

Anxiety is the brain’s reaction to perceived threat—signals that prompt an organism to engage in active avoidance. It is an extremely primitive emotional state, which is traced right from infancy, through childhood, conditional on varied levels of intensity from mild to severe. In most circumstances, anxiety is not pathological but has an extremely useful function of acting as an effective guideline for avoidance of potential danger. ¹⁶ This systematic review was conducted for analyzing observational data regarding the effect of pediatric dentists’ uniforms on children’s levels of anxiety, behavior, and general comfort during dental settings. In all five cross-sectional studies, it was found that while child-friendly, colorful, or cartoon-centric uniforms kept anxiety levels low and emotional expressions more positive, there was a definite linkage of caution or neutrality with the conventional white coat.

These findings suggest that attire represents a salient environmental cue in the dental setting and may influence a child’s cognitive and emotional interpretation of the clinical encounter. ¹⁷ Anxious children clearly favoured non-traditional attire in studies that employed validated measures such as the CFSS-DS or Child’s Fear Survey Schedule-Dental Subscale and the FIS or Facial Image Scale. ^{18, 19} For example, Asokan et al. noted that 72% of anxious children preferred colored or playful aprons, while Yahyaoğlu et al. reported that children who favored colorful attire also had significantly higher CFSS-DS scores, suggesting that more anxious children may actively seek visual reassurance through softer, friendlier visual stimuli. ^{11, 13} Similarly, Sujatha et al. and Havale et al. noted that children who had higher FIS scores demonstrated a marked preference for cartoon-themed or child-friendly scrub attire, further supporting that attire can serve as an effective anxiety-modulating behavioural management tool. ^{12, 15}

Despite this general pattern, the magnitude of the effect varied. De Amorim et al. found that while most children favoured printed or character-themed clothing, anxiety levels did not significantly influence attire preference, suggesting the relationship may be modulated by other psychosocial variables. ¹⁴ Factors such as previous dental experience, intrinsic emotional traits, and parental expectations may interact with attire to influence observed anxiety levels. Havale et al. further highlighted this complexity in the context of the COVID-19 pandemic, noting that although anxious children preferred colourful scrubs, non-anxious children and parents with higher education levels preferred PPE or surgical attire, possibly due to enhanced awareness of infection-control protocols. ¹⁵ These contextual variations underscore the multidimensional nature of dental anxiety.

Developmental evidence shows infants and younger children use faces, expressions and other visual social cues to regulate emotions and to socially reference caregivers; this forms the developmental rationale for expecting visual cues including attire to affect young children ²⁰ and given evidence that white coat functions as a cultural symbol of professionalism and trust for many patients and parents, and preferences for attire vary by context and culture, ²¹ it is plausible that attire and particularly choice of child-friendly vs traditional uniform may serve as an environmental cue shaping both child and parent emotional interpretation of the dental encounter. However, to our knowledge, no peer-reviewed study has directly tested this dual effect.

The findings of this review have important implications for clinical pediatric dental practice. Pediatric dentist attire may serve as a simple, non-invasive behavioural management strategy to reduce anxiety and improve cooperation in children. Incorporating child-friendly or colourful attire, particularly during initial dental visits or when managing anxious patients, may help create a more welcoming and less intimidating clinical environment. Additionally, tailoring attire based on the child’s age, anxiety level, and sociocultural background may further enhance patient comfort. While maintaining infection-control protocols and professionalism, pediatric dentists may consider adapting their appearance as part of a holistic approach to behaviour guidance.

The findings of this review should be interpreted in the context of certain limitations. The limited number of eligible studies and their cross-sectional design reflect a broader gap in well-structured research in this area rather than a lack of clinical relevance. Variability in study design, cultural settings, and attire classification contributed to heterogeneity, precluding quantitative meta-analysis.

Additionally, most studies relied on self-reported or observational measures of anxiety, which may be influenced by subjective bias. Important confounding factors such as previous dental experience, parental anxiety, and temperament were not consistently controlled across studies.

These limitations highlight the need for standardized, high-quality, and longitudinal studies to better understand the role of dentist attire in pediatric dental anxiety and behaviour.

In conclusion, despite the current level of evidence indicating that colorful, child-friendly clothing could lead to a reduction in anxiety and an improvement in acceptance of dental treatments in children aged 6–12 years, variations and limitations in existing studies indicate that these results must be interpreted with care. Future studies would, therefore, require standardized forms of clothing classification, more objective behavioural assessment, and more extensive comparisons based on sociocultural factors.

This systematic review suggests that pediatric dentist attire affects children’s anxiety and behavior throughout dental visits. Throughout the studies, child-friendly clothing or colourful clothing has been associated with lower anxiety and more positive emotional responses than the traditional white coat, indicating that attire may serve as a simple, non-invasive behavioral management adjunct.

Nevertheless, cross-sectional approaches, cultural diversity, and small sample sizes still limit the data. Such results need further replication using objective behavioral measurements and pre-defined clothing categories.

In a nutshell, the inclusion of child-friendly clothing in pediatric dentistry could contribute to alleviated anxiety and improved cooperation, thus providing kids with much more positive dental experiences.

Not applicable. This study is a systematic review of previously published literature and does not involve human participants or patient data requiring ethical approval.

Not applicable.

Nil