Batman or Joker? A mixed-method approach to understanding children's perceptions of dentists.

It is important to understand children's perceptions of dentists in order to improve child-dentist communication. The aim of this mixed-methods study was to develop and validate a conceptual model of individual determinants of children's perceptions of dentists. A total of 1014 children completed an oral health behaviour form, a metaphor form, the Children's Fear Survey Schedule-Dental Subscale, the Dental Trust Scale, and the Early Childhood Oral Health Impact Scale. A conceptual model, which included five endogenous and two exogenous variables, was developed and validated. Qualitative (metaphor analysis) and quantitative (path analysis) analyses were conducted. The metaphors that were used to describe dentists were classified into seven conceptual categories: chaotic and unlovable; scary; artistic; protective and alleviative; restorative; scientific; and educative. Better oral health behaviours, greater trust in dentists, and lower dental anxiety were associated with positive perceptions of dentists. Oral health behaviours, trust in dentists, and dental anxiety had the strongest direct effects on perceptions of dentists, but age had the strongest indirect effect. The developed model should help dentists to understand pathways between children's individual determinants and perceptions of dentists. Coupled with behaviour management, this understanding can be an important part of improving dental visit behaviours and fostering positive post-visit attitudes among children.