Behavioural Impact of Parental Presence Versus Absence in Paediatric Dentistry: A Systematic Review

Background/Objectives: Parental presence or absence (PPA) in the dental operatory remains a central issue in paediatric behaviour guidance, commonly employed as a non-pharmacological approach, yet frequently perceived as a professional dilemma among paediatric dentists. Its behavioural impact on children during dental treatment remains debated. This systematic review evaluates the influence of PPA on children's behaviour in dental settings and explores moderating factors. Methods: A PRISMA-guided systematic review was conducted in PubMed, Web of Science, and Scopus for primary studies published between 2005 and 2025. Eligibility criteria included clinical studies involving paediatric patients primarily aged 2-14 years, comparing parental presence vs. absence during dental visits. Results: The 16 included studies consisted of randomized controlled trials (n = 9), cohort studies (n = 3), and analytical cross-sectional designs (n = 4). Findings were heterogeneous; nine of sixteen studies reported that PPA improved cooperative behaviour, particularly in younger children (ages 4-6), those with higher IQ, or those with initially negative behaviour. Five studies found no significant effect, while two noted increased anxiety or disruptive behaviour with parental presence. Parenting style and cultural context influenced outcomes, with authoritative styles associated with better cooperation. Conclusions: PPA can enhance behaviour in specific subgroups but lacks universal benefits. Paediatric dentists should individualize its use according to each child's developmental stage, emotional profile, and family dynamics, particularly parenting style, to optimize outcomes.