Introduction
In modern society, specialization in the dental field has become increasingly prominent[1]. The dental profession has implemented a dental specialist system for 21 years to safeguard the public’s access to specialized dental care. Upon graduation from dental school (School of Dentistry), individuals must undergo a one-year internship and a three-year residency program to qualify for a dental specialist examination. Specialist fields are divided into 11 disciplines, among which pediatric dentists focus on children’s oral health, motivating and educating families[2] and contributing significantly to enhancing overall oral health for children and their families[3]. Pediatric dentistry extends beyond oral health and encompasses comprehensive management, positively influencing school attendance rates and problem-solving abilities. Moreover, it facilitates holistic care through collaborations with other pediatric medical specialties[4].
As of April 2024, 369 pediatric dental clinics (13 university hospitals and 356 private clinics) exist nationwide. Since the introduction of the pediatric dental specialist system in 2008, there have been 765 pediatric dental specialists, as reported by the Health Insurance Review and Assessment Service. Despite parents recognizing their responsibility for their children’s oral health, they often experience confusion when choosing an appropriate dental clinic. This confusion can negatively affect children’s oral health. Parents require a clear and comprehensive understanding of pediatric dental services and their importance to engage adequately in decision-making regarding pediatric dental care[5].
Previous studies have examined the treatment status, distribution of new patients, and the regional distribution and status of pediatric dental clinics or offices[6], offering vital data for pediatric dentists to comprehend the present state of pediatric dentistry. Pediatric dentists must cater to the needs of patients and parents. However, existing research has not adequately addressed parents’ experiences with and perceptions of pediatric dental care.
This study explores the factors parents consider when choosing a dental clinic for their children, particularly their perceptions of pediatric dentistry and dental specialists. By understanding the key decision-making factors for parents in selecting dental care for their children, this study elucidates the necessary improvements and promotions required for children’s oral healthcare by pediatric dental clinics and specialists.
Materials and Methods
This study was approved by the Institutional Review Board of Chonnam National University (approval no. CNUDH-2024-005).
1. Participants
An online survey was conducted between February 15 and February 19, 2024. About 500 parents of children aged 15 years or younger who accompanied their children to dental visits were surveyed. Participants were included from the following regions: 170 from Seoul, Gyeonggi, and Incheon regions; 100 each from the Chungcheong, Gyeongsang, and Jeolla regions; 30 from Gangwon. Participants were recruited using an online survey platform operated by a specialized online survey company. This company recruited individuals who met the inclusion criteria and conducted the survey on its website.
2. Procedure
Participants were informed about the study’s purpose, and they provided their consent through an online consent form. Those who did not consent to participate or discontinued the survey midway were excluded from the study. The survey was conducted anonymously with the support of a professional online survey company. Participants answered voluntarily and could partake only once during the study period. No personally identifiable information was collected.
3. Assessment Items and Survey Tools
The questionnaire was designed to align with the study’ s objectives and comprised four sections.
1) Demographic Information
This section included items to investigate parents’ age, sex, occupation, highest education level, presence of children, number of children, children’s ages, residential area, and total monthly household income (after tax).
2) Factors Considered When Choosing a Dental Clinic for Children
This section comprised nine items evaluating the factors parents considered when selecting a dental clinic for their children, using a Likert scale from 1 to 5.
3) Experience with Pediatric Dental Clinics and Awareness of Pediatric Dental Specialists
This section included questions based on whether the participants had visited pediatric dental clinics and their awareness of pediatric dental specialists.
4) Evaluation of Dental Care Values and Perceptions Based on Experience with Pediatric Dental Clinics
Survey items were categorized based on whether the participants had experience related to pediatric dental clinics. For those with experience, the questions included reasons for visiting, satisfaction, dissatisfaction, and willingness to return. For those without experience, the questions included reasons for not visiting, the perceived necessity of pediatric dental care, and future willingness to use such services.
4. Statistical Methods
Data from the survey were collected using Microsoft Excel and analyzed using R (version 4.3.3), Python (Scipy v1.12.0), and SPSS (version 29.0; SPSS Inc., Chicago, IL, USA). The Friedman Test, chi-square test, and logistic regression analysis were performed, with the significance level set at a p-value of < 0.05. The consistency of the responses to the nine items evaluating the factors considered when choosing a dental clinic for children was assessed using Cronbach’s alpha. Each factor’s importance was evaluated using the Friedman Test to determine which items were considered more important. Pearson’ s chi-square test was conducted to analyze differences in dental care perceptions and values based on experience with pediatric dental clinics. Post hoc analysis was performed using binomial logistic regression analysis for sections showing statistically significant differences between the groups.
Results
1. Demographic Characteristics of Respondents
Demographic analysis of the participating parents indicated 150 males (30.0%) and 350 females (70.0%). Among the 500 participants, the age distribution of parents was as follows: 268 in their 40s (53.6%), 172 in their 30s (34.4%), 44 in their 50s (8.8%), and 16 in their 20s (3.2%). Most respondents were parents, predominantly mothers, accompanying their children to dental clinics. Regarding educational attainment, 382 (76.4%) participants were university graduates, 74 (14.8%) held postgraduate degrees or higher, and 44 (8.8%) were high school graduates.
Occupational distribution was as follows: 277 (55.4%) held office and management positions, 109 (21.8%) were full-time homemakers, 51 (10.2%) were professionals, 29 (5.8%) were self-employed, 23 (4.6%) were public officials, and 11 (2.2%) belonged to other occupations. The most common monthly family net income was 5.5 - 6.5 million KRW, reported by 87 respondents (17.4%). The residential distribution included 169 (33.8%) from Seoul, Gyeonggi, and Incheon, 99 (19.8%) each from Jeolla, Gyeongsang, and Chungcheong, and 34 (6.8%) from Gangwon.
The general characteristics of the respondents’ children showed 730 children, with 368 boys (50.4%) and 362 girls (49.6%). The age distribution was as follows: 165 aged 10 - 12 years (33.0%), 80 aged 4 - 6 years (16.0%), 110 aged 7 - 9 years (22.0%), 86 aged 13 - 15 years (17.2%), and 59 aged 0 - 3 years (11.8%). The number of children per family was two for 231 families (46.2%), one for 229 families (45.8%), and three for 40 families (8%). The birth order of the respondents’ children was as follows: firstborn, 431 (59.0%); second-born, 259 (35.5%); third-born, 40 (5.5%) (Table 1).
2. Experience with Pediatric Dental Clinics and Awareness of Pediatric Dental Specialists
Among the parents, 378 (75.6%) had visited a pediatric dental clinic, and 248 (49.6%) were aware of pediatric dental specialists. Among those with experience at a pediatric dental clinic, 225 (59.5%) were aware of pediatric dental specialists, whereas 153 (40.5%) were not. Conversely, among those without pediatric dental clinic experience, 23 (18.9%) were aware of pediatric dental specialists, and 99 (81.1%) were not. Among parents aware of pediatric dental specialists, 225 (90.7%) had visited a pediatric dental clinic, whereas 23 (9.3%) had not. In the group unaware of pediatric dental specialists, 153 (60.7%) had visited a pediatric dental clinic, and 99 (39.3%) had not (Table 2).
3. Differences in Demographic Information Based on Experience with Pediatric Dental Clinics
Statistically significant differences were observed between the groups based on the number and age of the children concerning their experience with pediatric dental clinics (Table 3, p < 0.05). Ridge logistic regression analysis, considering multicollinearity among the independent variables, revealed that having three children significantly increased the likelihood of visiting a pediatric dental clinic. Additionally, the likelihood of visiting a pediatric dental clinic was notably higher in children aged 7 - 9 years and significantly lower in those aged 0 - 3 years (Table 4).
4. Differences in Awareness of Pediatric Dental Specialists Based on Demographic Information
Statistically significant differences were found in the awareness of pediatric dental specialists based on parents’ age, residential area, household monthly income, and parents’ occupation (Table 5, p < 0.05). Ridge logistic regression analysis showed that parents in their 40s had significantly lower awareness. Household income between 3.5 - 4.5 million KRW was associated with the lowest awareness, whereas the middle-income range (especially 5.5 - 6.5 million KRW) tended to show increased awareness. Parents in professional occupations had significantly higher awareness; those living in Seoul, Gyeonggi, and Incheon showed significantly higher awareness, whereas those in Chungcheong had significantly lower awareness (Table 6).
5. Importance Evaluation of Factors Considered When Choosing a Dental Clinic for Children
Table 7 presents the variances in the significance of factors considered when selecting a dental clinic for children based on their experience with pediatric dental clinics. The reliability of the survey results was evaluated using Cronbach’s alpha coefficient, resulting in a value of 0.782, indicating high reliability.
1) Overall Ranking
The importance of the factors considered by parents when choosing a dental clinic for their children was scored on a 5-point Likert scale. The factor “dentists with expertise in pediatrics” scored the highest with an average of 4.05 points (standard deviation [SD] = 0.94), followed by “convenience of transportation” with an average of 4.00 points (SD = 0.78) and “treatment cost” with an average of 3.99 points (SD = 0.81). Thus, parents highly value the expertise of pediatric dental staff when selecting dental clinics. Conversely, “availability of sedation treatments (laughing gas and sleep treatment)” scored the lowest average of 3.36 points (SD = 0.94), followed by “child-friendly hospital atmosphere” with an average of 3.55 points (SD = 0.99) and “availability of parking” with an average of 3.76 points (SD = 0.94) (Table 7, Fig. 1).
2) Differences in Importance Evaluation Based on Experience with Pediatric Dental Clinics
In the group with experience at pediatric dental clinics, the highest-scoring factors were “dentists with expertise in pediatrics” with 4.10 points (SD = 0.86), “convenience of transportation” with 4.04 points (SD = 0.78), and “short waiting times” with 4.02 points (SD = 0.77). In the group without pediatric dental clinic experience, the highest-scoring factors were “short waiting times” with 3.97 points (SD = 0.84), “convenience of transportation” with 3.94 points (SD = 0.85), and “treatment cost” with 3.93 points (SD = 0.83). Thus, parents with pediatric dental clinic experience valued “dentists with expertise in pediatrics” the most, while those without experience valued “short waiting times” the most (Table 7, p < 0.0001).
3) Differences in Importance Evaluation of Factors Considered When Choosing a Dental Clinic for Children Based on Demographic Characteristics
The average values for the evaluation of the factors considered when choosing a dental clinic for children varied significantly across the groups classified by demographic characteristics (Table 8, p < 0.01). Differences between groups based on parental age showed that parents in their 20s did not have any particularly important factors, while parents in their 30s considered “dentists specializing in pediatric dentistry” most important. Parents in their 40s prioritized “cost of treatment,” and those in their 50s valued “convenience of transportation” the most.
Differences between groups based on parental sex revealed that males considered “dentists specializing in pediatric dentistry” most important, while females prioritized “cost of treatment.” Differences between groups based on the number of children showed that parents with one child valued “dentists specializing in pediatric dentistry” the most, whereas parents with two or three children considered “cost of treatment” the most important.
Differences between groups based on children’s age indicate that parents of children aged 0 - 3, 4 - 6, and 7 - 9 years valued “dentists specializing in pediatric dentistry” the most, while parents of children aged 10 - 12 and 13 - 15 years prioritized “cost of treatment.” Further, differences between groups based on residential area showed that parents from Seoul, Gyeonggi, Incheon, Chungcheong, and Gyeongsang regions valued “dentists specializing in pediatric dentistry” the most. Conversely, parents from Jeolla and Gangwon regions prioritized the “cost of treatment.”
Differences between groups based on average monthly household income indicate that parents in the income groups below 1.5 million KRW and between 1.5 and 2.5 million KRW did not have any particularly important factors. Parents in the 2.5 - 3.5 million KRW and 5.5 - 6.5 million KRW income groups prioritized “convenience of transportation.” Those in the 3.5 - 4.5 million KRW, 4.5 - 5.5 million KRW, and 6.5 - 7.5 million KRW income groups valued “dentists specializing in pediatric dentistry” the most. Parents in the 7.5 - 8.5 million KRW income group prioritized the “cost of treatment,” while those in the income group above 8.5 million KRW valued “recommendations from acquaintances” the most.
Differences between groups based on parental occupation showed that full-time homemakers and office/management professionals valued “dentists specializing in pediatric dentistry” the most. Professionals prioritized “convenience of transportation,” while the self-employed and others valued “proximity.” Public officials did not show any significant preferences. The occupations of parents who answered “others” included production workers, freelancers, transport workers, and field workers.
Differences between groups based on parents’ highest educational level showed that parents with high school diplomas and those with postgraduate degrees prioritized “convenience of transportation,” while university graduates considered “dentists specializing in pediatric dentistry” the most important.
6. Factors Influencing Revisit Intention and Analysis of Revisit Intention
Among parents who had previously visited a pediatric dental clinic, 281 (74.3%) expressed their willingness to revisit, 53 (14.0%) refused to revisit, and 44 (11.6%) were undecided. However, among parents without prior experience of visiting a pediatric dental clinic, 59 (48.4%) expressed their willingness to visit, 23 (18.9%) had no intention to visit, and 40 (32.8%) were undecided.
A chi-square test was conducted to determine the differences between the groups concerning their intention to visit a pediatric dental clinic (intention to visit, no intention to visit, or undecided) based on their previous experience with pediatric clinics. The results revealed a statistically significant difference (p < 0.0001, Table 9). The group having previous experience with a pediatric dental clinic had a higher proportion of individuals who intended to revisit and a lower proportion of those who were undecided about revisiting. This suggests that participants’ previous experience with a pediatric dental clinic significantly influenced their intention to revisit in the future. Among those with prior experience in pediatric dentistry, 74.3%, 14.0%, and 11.6% of participants expressed an intention, no intention, and uncertainty about revisiting, respectively. This suggests that individuals with previous experience in pediatric dentistry had a relatively high willingness to return and low uncertainty. In contrast, among individuals without prior experience in pediatric dentistry, 48.4%, 18.9%, and 32.8% expressed an intention, no intention, and uncertainty about visiting, respectively. This finding suggests that individuals without prior experience had a relatively low willingness to visit and high uncertainty. Therefore, prior experience in pediatric dentistry can significantly enhance parents’ intention to visit a pediatric clinic.
Among parents who visited a pediatric dental clinic, 74.3% (281) expressed an intention to revisit. Binomial logistic regression analysis of revisit intention and perceived differentiating factors at the pediatric dental clinic revealed that the likelihood of revisiting increased when parents perceived the following differentiating factors: “dentists skilled in treating uncooperative children (U2)” (Exp [B] = 1.803), “clinics specializing in pediatric orthodontics (U5)” (Exp [B] = 2.123), and “feeling better treated compared to general dental clinics (U6)” (Exp [B] = 1.812) (Table 10, p < 0.05).
Discussion
This study explored the factors parents consider when choosing a dental clinic for their children and their awareness of pediatric dental clinics and specialists. The findings indicate that the factors considered by parents differ based on their experience in pediatric dental clinics.
Parents experienced with pediatric dental clinics prioritized expertise, whereas those without such experience prioritized waiting times. Thus, experience with pediatric dental clinics is a significant factor influencing parents’ choice of dental clinics. This observation provides a deeper understanding of parents’ decision-making process and highlights the importance of pediatric dental expertise. A previous study reported similar results-the presence of a pediatric dental specialist was the primary reason for parents to choose a pediatric dental clinic[7].
The analysis of differences based on demographic characteristics revealed significant variations across groups based on parents’ age, sex, number of children, children’ s age, residential area, monthly household income, occupation, and educational level. These findings align with those of previous studies indicating that parental interest in children’s oral health and dental visit frequency varies according to demographic characteristics[8,9].
Notably, male parents prioritized dentists’ expertise, while female parents prioritized treatment costs. Similarly, a previous study found that male parents with stable jobs had fewer barriers to taking their children to the dentist, whereas female parents without stable jobs faced significant challenges. Although female caregivers recognized the importance of oral health, they experienced significant challenges due to their employment status, which led to sex-based disparities in dental care access[10].
The group with the highest proportion of pediatric dental clinic experience comprised parents with three children aged 7 - 9 years, probably because parents with more children have broader parenting experiences, influencing their perceptions and behaviors. Additionally, the higher rate of pediatric dental clinic visits in children aged 7 - 9 could be related to common dental issues at this age, such as the transition from primary to permanent teeth. According to a previous study, children visit a dentist for the first time between 6 and 9 years of age because of toothache and caries[11]. This indicates that their initial dental visits generally occur in the early school years when parents usually begin to consider pediatric dentistry for their children. Therefore, parents should be actively educated to ensure that their children receive preventive care and maintain oral health before caries develops. Furthermore, it is essential to emphasize the role of pediatric dentistry. A child’s initial dental visit typically overlaps with their early school years. It is during the early school years when parents consider pediatric dental care for their children and become aware of pediatric dentistry. Therefore, it is crucial to actively educate parents to ensure that their children receive preventive dental care before caries develops and maintain optimal oral health. Furthermore, the education should emphasize the importance of pediatric dentistry.
Parents’ age, residential area, occupation, and income level significantly affected their awareness of pediatric dental specialists. Regarding parents’ age, those in their 20s reported the highest awareness of pediatric dental specialists, followed by those in their 50s, 30s, and 40s. A previous study reported that parents in their 40s expressed significantly higher trust in dental interventions and treatments than those in their 30s[12]. Another study reported that younger parents were more likely to recognize the necessity of dental treatment for their children[13]. However, another previous study reported that parental age did not significantly affect their knowledge of and attitudes towards their children’s oral health[14]. Considering these inconsistent results, the findings of the present study concerning the awareness levels among specific age groups may not be generalizable. Most notably, the sample size of each group in the present study was not uniform. The group of parents in their 20s who reported the highest awareness also had a smaller sample size than the other age groups. Therefore, the relationship between parental age and their awareness of pediatric dental specialists is difficult to generalize. To obtain more reliable results, it would be necessary to adjust the sample sizes across age groups.
The Seoul/Gyeonggi/Incheon region showed the highest awareness of pediatric dental specialists in the survey. Considering the statistics from the Health Insurance Review and Assessment Service in April 2024, the Seoul/Gyeonggi/Incheon region had the highest number of pediatric dental clinics and specialists[15]. This suggests that parents and children in this area have greater access to pediatric dental services, which may have a potential correlation with the high awareness of pediatric dental specialists. These findings are consistent with previous research conducted in South Korea investigating the relationship between residential areas and awareness of specialized hospitals and specialists[16]. According to the result of the research, consumers in major cities (such as Seoul and Busan) had higher accessibility and awareness of specialized dental services than those in smaller cities or rural areas[16].
Meanwhile, in the Chungcheong and Gangwon regions, the awareness of pediatric dental specialists did not seem to have a correlation with the number of pediatric dental clinics and specialists. Parents in the Chungcheong region had the lowest awareness of pediatric dental specialists compared to those in other regions, despite having more pediatric dental clinics and specialists than those in the Jeolla and Gangwon regions. According to the Health Insurance Review and Assessment Service, the number of pediatric dental clinics and hospitals in the Chungcheong region (38) was higher than those in the Jeolla (37) and Gangwon regions (10) in April 2024. Similarly, the number of pediatric dental specialists was higher in the Chungcheong region (955) than in the Jeolla (770) and Gangwon regions (163)[15]. This indicates that awareness of pediatric dental specialists does not correlate with the number of pediatric dental clinics and specialists in the Chungcheong region.
In contrast, the Gangwon region, which has the fewest pediatric dental clinics and specialists according to the Health Insurance Review and Assessment Service in April 2024. However, the findings of the present study revealed that parents’ awareness of specialists in the Gangwon region and Seoul/Gyeonggi/Incheon region was similar. These results may be influenced not only by regional and cultural differences but also by the significantly smaller sample size in the Gangwon region compared to other regions. This smaller sample size may have influenced the findings and should be considered as a potential source of statistical distortion, suggesting that despite statistically significant differences between regions, the comparison of results may be inappropriate. Therefore, this finding highlights the need to secure a uniform sample size across regions in future studies to assess regional differences in parents’ awareness of pediatric dental specialists clearly.
The comparison of parents’ awareness of pediatric dental specialists across regions suggests that regional differences significantly affect parental awareness. Additionally, this emphasizes the need to increase parents’ awareness of pediatric dentistry and improve their access to pediatric dental care through educational programs on children’s oral health management, particularly in rural and small town areas.
Professional parents and those with higher household income had higher awareness. A previous study reported that parents working in the healthcare sector were more concerned about their children’s oral health and their children reportedly had better oral health[17]. These findings suggest that parental occupation significantly affects children’s oral health. Another previous study demonstrated a relationship between the higher socioeconomic status of parents and the extent to which children received the required[18]. According to a previous study conducted in South Korea, there were differences in children’s experiences with dental caries based on parental occupation. Authors reported higher rates of dental caries among children of parents working in the public service and service industries; however, a higher rate of children of housewives and office workers reported no experience with dental caries[19]. These findings are similar to the results indicating a higher awareness of pediatric dental specialists among professionals, housewives, office workers, self-employed individuals, and public servants. Therefore, parental occupation influences the level of attention paid to children’s oral health management and dental care.
Previous studies have shown that lower-income families prioritize physiological needs over professional and safe dental care, leading to delayed dental visits[20,21]. Thus, economic disparities influence access to, and perceptions of, dental services. Remarkably, parents’ awareness of pediatric dental specialists decreased with incomes above 8.5 million KRW. A previous study reported that high-income families can acquire the latest health information through the Internet, health apps, and various health-related publications, which enables them to prevent their children’s health issues in advance. This leads to the effective management of oral health using various preventive dental care programs[22,23]. Therefore, high-income families are not only financially capable of affording costly treatments but are also fundamentally more likely to maintain their children’s oral health. Thus, it can be inferred that low awareness of pediatric dental specialists among high-income parents may be because these families have high access to health management information and preventive treatments, which makes them less likely to feel the need to visit a specific dental clinic to address their children’s oral health issues. Consequently, they may believe that they can maintain their children’s oral health without visiting a pediatric dental specialist. Careful synthesis of previous studies findings led to this interpretation.
Positive perceptions of children’s oral health among mothers encourage preventive and routine dental visits, lowering the risk of dental diseases[24]. This underscores the significance of consistent oral healthcare and educational efforts within pediatric dentistry. Similar findings have been highlighted in other studies, demonstrating that parental education and awareness positively influence children’s dental visits[25]. Meanwhile, receiving specialized orthodontic treatment emerged as the most significant factor in increasing the likelihood of revisiting a pediatric dental clinic. Parents perceived specialized orthodontic treatment as a major differentiating factor[26].
This study has some limitations, including the potential non-representativeness of the sample due to the online survey method and short data collection period. Efforts were made to mitigate errors by meticulously designing the survey questions and refining the data. Future research should address these limitations by employing diverse data collection methods and expanding the sample size to include nationwide surveys. Additionally, previous studies have indicated that the number of dental clinics including pediatric dentistry as a specialty totaled 8,379 and accounted for 43.83% of all dental clinics. However, registered pediatric dental specialists were available at 317 clinics only, representing only 3.78% of pediatric dental clinics have registered pediatric dental specialists[27]. Therefore, the parents who responded to the survey in this study might have been unable to distinguish whether the dental practitioners providing pediatric dental care were specialists in pediatric dentistry. This should be carefully considered when interpreting the findings of this study. Considering this, future research could yield more insightful findings by creating a study environment that only includes parents who visited clinics of registered pediatric dental specialists. Future research should focus on increasing parents’ awareness and access to pediatric dental clinics and specialists. Continuous monitoring of changes in parents’ considerations and awareness of pediatric dentistry through long-term follow-up studies is necessary to consistently evaluate their impact. Expanding the sample size and using various data collection methods would also enhance the reliability and representativeness of future studies.
Conclusion
This study surveyed 500 parents to investigate the factors influencing their choice of dental clinic for their children, as well as their awareness and expectations of pediatric dental clinics and specialists. The most common experience of visiting pediatric dental clinics was observed among families with three children and children aged 7 - 9 years. Awareness of pediatric dental specialists was highest among parents in their 20s, those living in Gangwon and Seoul/Gyeonggi/Incheon, households with a monthly income of 7.5 - 8.5 million KRW, and professional parents. Parents with pediatric dental clinic experience prioritized expertise, whereas those without such experience prioritized short waiting times. Prior experience at pediatric dental clinics was found to be a key factor in increasing the intention to revisit and reducing hesitation.
Improving parental awareness of pediatric dental expertise is crucial for selecting a specialized pediatric dental clinic. Efforts should be made to increase awareness among pediatric dental clinics. Additionally, pediatric dental specialists should enhance their expertise in pediatric dentistry and specialized orthodontic care.
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