Using flavour in your favour: does giving children an element of control help them engage more positively with the dental experience?

A commentary on: Karim R, Splieth C H, Schmoeckel J. Effect of choice of flavour of fluoride varnish on behaviour in dental visits in schoolchildren. Clin Exp Dent Res. 2025; https://doi.org/10.1002/cre2.70069 .

Aim: To assess the efficacy of giving children choice within the dental surgery to improve behaviour outcomes, investigated by letting them choose the flavour of fluoride varnish (FV). This single-blinded, randomised control trial recruited children attending the specialised paediatric dental service within the Greifswald University Hospital for a dental check-up and preventative FV application. Upon attendance, children were randomly assigned to one of two groups: the control group, where the flavour of FV was predetermined, or the test group, where the children selected their preferred flavour. A blinded observer used Frankl behaviour rating scale (FBRS) to assess behaviour during the appointment, and taste acceptance was assessed using the Facial image scale (FIS).

Case selection: 70 participants were recruited at the time of their appointment. These were healthy (ASA I or ASA II) German children aged 5 to 10. Exclusion criteria included their first dental experience, experiencing dental pain or an allergy to FV. 35 children were randomly allocated to both groups.

Results: Most children, regardless of their allocation, were assessed as positive, or definitely positive according to FBRS (n = 58, 82.8%), though results on behaviour outcomes were statistically insignificant (p = 0.376). There were no significant differences between the control group or the test group on flavour ratings of the FV, with most children (n = 53, 75.7%) scoring happy, or very happy according to FIS. History of negative dental behaviour was also taken into consideration (n = 27), and whilst it appeared children with history of negative experience displayed more positive behaviour in the test group vs the control group (75% vs 54.5%), results were not statistically significant (p = 0.244).

Conclusion: This study shows that allowing children a sense of control by permitting them to choose their flavour of FV may be a useful behaviour management tool, though the results are not statistically significant.