Magic trick: a behavioural strategy for the management of strong-willed children.

Objective: The purpose of this study was to compare the effectiveness of using a magic trick to persuade strong-willed children who refuse to sit in the dental chair at the first visit with more conventional methods like tell-show-do (TSD).

Methods: Seventy children aged 3-6 years of age who were identified as manifesting strong-willed behaviour were selected for this study. The children were randomly assigned to be managed either by a magic trick distraction or by TSD. There were 35 subjects in each group. The following variables were recorded for each child: time from the beginning of the session to sitting on the dental chair (in minutes); ability to perform a dental examination (yes or no); and Frankl's behavioural category.

Results: Children who were shown a magic trick (Magic+) sat significantly faster on the dental chair than children who were not shown the magic trick (Magic-) (141.2+/-71.5 and 221.7+/-110.7 s, respectively). In addition, radiographs could be taken in significantly more Magic+ children (91% and 54%, respectively). When time till sitting on dental chair, radiographs taken and Frankl's behavioural categories were examined by gender, age, first time at the dentist and by parent assessment, the following pattern emerged: (1) Children in the Magic+ group sat on the dental chair significantly faster than children in the Magic- group. (2) Radiographs could be taken for more Magic+ children. (3) The Magic+ children demonstrated more cooperative behaviour (Frankl's categories 3 and 4).

Conclusion: This study demonstrates that a magic trick is able to facilitate two types of cooperative behaviour: (1) it expedites the movement of the child into the dental chair; and (2) it enables the dentist to take radiographs more easily.