Dental fear, communication, and behavioural management problems in children referred for dental problems.

Background: Knowledge about the influence of the interaction between child, parent, and dentist and the referral pattern is very limited.

Aim: This study intended to assess to what extent the pathways of Rachman could clarify why a child is being referred to a specialist in paediatric dentistry and if other aspects in the interaction between child, parent, and dentist play a role in the referral.

Design: The referral letters of 500 children referred to a Special Dental Care Centre in Amsterdam were examined. All parents filled out the Children's Fear Survey Schedule-Dental Subscale, on behalf of the child. Information about interaction and the referral was collected from the referral letter and a semistructured interview with the parent and dentist separately.

Results: Eighty pairs of parents and dentists of referred children participated in a semistructured interview. Child factors seem to contribute the most to the referral. For the cause of referral the pathways of Rachman and communication were often combined.

Conclusions: Apart from fear acquisition, as implied in Rachman's pathways, the interaction between child, dentist, and parent also contributes to the referral of a child to a specialist clinic in paediatric dentistry.