Behavioral Determinants in Pediatric Dentistry: A Comparative Analysis of Cooperative Versus Uncooperative Patients

Background/Objectives: Uncooperative behavior in pediatric dental settings remains a significant barrier to effective treatment. Factors such as demographics, psychological variables, and family influences may impact children's behavior, but their relative importance is not fully understood. This study explores the emotional, familial, and demographic factors influencing cooperation among children in dental clinics in Jeddah, Saudi Arabia. Methods: A cross-sectional study was conducted among children aged 6-11 years attending dental clinics in Jeddah, Saudi Arabia. Participants undergoing non-invasive dental procedures were recruited. Behavioral cooperation was assessed using the Frankl Behavior Rating Scale, and dental anxiety was measured using the validated Abeer Children Dental Anxiety Scale (ACDAS). Data on demographic characteristics, child cognitive factors, and parental dental anxiety were collected through structured interviews. Multivariable logistic regression analysis was performed to identify independent determinants of cooperative behavior. Results: A total of 906 children were included in the analysis. Demographic variables, including gender, age, and income, were not significantly associated with child behavior (all p > 0.05). Fear of losing control emerged as the strongest predictor in the model. Children reporting fear of losing control had significantly lower odds of cooperative behavior (AOR = 0.14, 95% CI [0.10-0.22], p < 0.001). Shyness in the clinic was not statistically significant (p = 0.216). Maternal dental anxiety was significantly associated with child behavior, with higher maternal anxiety scores linked to lower odds of cooperative behavior (AOR = 0.96, 95% CI [0.93-0.997], p = 0.032). Paternal dental anxiety was not significantly associated with child behavior (p = 0.701). Conclusions: Fear of losing control and maternal dental anxiety were independently associated with children's behavioral responses during dental visits. These findings highlight the relevance of children's perceived control and maternal anxiety in understanding behavioral outcomes in pediatric dental settings.