Sir, anxiety or fear affects a child's behaviour and to a large extent, determines the success of a dental appointment. Anxiety is generalised apprehension due to the unknown or a new situation whereas fear is a state of apprehension based upon actual experience, memory and imagination. Dental fears are acquired – not innate. Several factors affect children's behaviour in the dental office: parental anxiety – particularly maternal – being an important one. Most investigators indicate a significant relationship between the level of maternal anxiety and the behaviour of their children in the dental office. It has been seen that high maternal anxiety tends to affect children's behaviour negatively. The effect of maternal anxiety is greatest with those under four years of age, though children of all ages can be affected. This might be anticipated because of mother-child symbiosis that begins in infancy and gradually diminishes with age. Early mother-child interaction is critical in determining the child's later socialisation and ability to adapt to situations requiring adjustment. Children below the age of four years behave better with their parent present; however, parental presence or absence did not seem to significantly affect the behaviour of children older than four. However, separation anxiety when the parent is removed is a normal developmental stage, and young children are best treated with a parent present.

Since maternal anxiety is closely associated with children's behaviour, strategies that aim to decrease parental anxiety may also improve children's behaviour. The dentist must help the parent to understand that what will happen allows them to prepare their child and improves the treatment alliance by reducing the child's anxiety. Preparatory information sent prior to first appointments produced improved behaviour compared to children whose parents had not received information. In circumstances of high maternal and child anxiety, efforts should first be made towards instituting behaviour management skills like 'tell show do' and modelling to bring about a higher level of cooperation before starting a treatment. By passing special attention to these children, it is possible that the dentist would succeed in improving the acceptance of treatment, thus making children's first and subsequent dental visits enjoyable for child, parents and dentist.