Reverse Psychology in Pediatric Dentistry: A Narrative Review

Pediatric dentistry requires effective behavior management to ensure successful treatment outcomes, particularly for children who exhibit anxiety or uncooperative behavior. Reverse psychology, a technique that involves encouraging a child to do the opposite of the desired behavior to elicit cooperation, is a non-pharmacological strategy gaining attention in pediatric dental settings.¹ This narrative review synthesizes the application of reverse psychology, provides practical examples, and evaluates its efficacy, ethical considerations, and limitations, supported by recent literature.

Understanding Reverse Psychology

Reverse psychology is based on the psychological principle of reactance, where individuals resist perceived control by acting contrary to suggestions.² In pediatric dentistry, it leverages a child’s desire for autonomy, particularly in stressful environments like dental clinics.³ This approach is most effective for children aged 4 to 12 years, aligning with Piaget’s preoperational (2 to 7 years) and concrete operational (7 to 12 years) cognitive stages, where children assert independence.⁴

In pediatric dentistry, reverse psychology is typically used for children displaying defiant or oppositional behavior. It requires careful tailoring to the child’s personality, developmental stage, and cultural context to ensure effectiveness.⁵ The technique is often combined with other behavior management strategies, such as tell-show-do or positive reinforcement, to enhance cooperation.⁶

Examples of Reverse Psychology in Practice

Reverse psychology may be utilized in a number of different ways in dental practice. One application can be for encouraging cooperation during examinations. A dentist might say, “I bet you can’t sit still in the chair for 1 minute while I check your teeth.”⁷ This challenge can motivate a child to sit still to prove their capability. For example, a 6-year-old refusing an oral exam may respond to, “Only big kids can open their mouths wide, and I’m not sure you’re ready,” by complying to demonstrate maturity.⁵

This approach may also be employed to help pediatric patients overcome their fear of dental tools. To reduce anxiety about a dental instrument, a dentist might state, “This tool is so special that only very brave kids get to see it up close. I don’t think you’re ready today.”⁸ This can spark curiosity, prompting the child to engage with the tool, thereby reducing fear through a sense of control.³

Another application of reverse psychology is for promoting oral hygiene habits. For children resistant to brushing, a dentist might say, “Some kids find brushing too hard to do right. You probably don’t want to try it twice a day.”⁹ This can motivate the child to adopt the habit to prove the dentist wrong, fostering long-term oral health behaviors.¹⁰

Efficacy of Reverse Psychology

Studies demonstrate that reverse psychology is effective in reducing dental anxiety and improving cooperation in children aged 4 to 14 years.^1,11 A systematic review by Hugar et al found that psychological behavior management techniques, including reverse psychology, significantly reduce fear during non-invasive procedures.¹ However, its efficacy in invasive procedures, such as extractions, may be limited compared to advanced methods like sedation or virtual reality.¹² Winnier et al noted that combining reverse psychology with techniques like tell-show-do enhances outcomes, particularly for children with mild to moderate anxiety.⁶ A 2024 study by Patel et al further confirmed that reverse psychology is most effective when tailored to the child’s temperament and used in a supportive environment.¹³

Ethical Considerations

The use of reverse psychology raises ethical concerns due to its manipulative nature, which may undermine trust if the child perceives deceit.¹⁴ The American Academy of Pediatric Dentistry emphasizes that behavior management techniques should respect patient autonomy and involve informed consent, particularly for older children.³ Overuse or inappropriate application may reinforce oppositional behavior, especially in children with behavioral disorders.¹⁵ Dentists must communicate the technique’s purpose to parents and ensure it aligns with the child’s best interests.¹⁶

Limitations

Reverse psychology is not universally effective. Its success depends on the child’s personality, cultural background, and trust in the dentist.⁵ Highly anxious children or those with special healthcare needs may not respond well, as noted in a 2023 study.¹⁷ Cultural differences in parenting styles and perceptions of autonomy can also affect its acceptance, with some parents viewing it as coercive.¹⁸ The lack of robust parental acceptance data remains a research gap.¹⁹

Recent Advances and Future Directions

Recent advancements, such as virtual reality and gamified dental education apps, have supplemented traditional techniques like reverse psychology.²⁰ A 2024 review highlighted that integrating reverse psychology with digital tools could enhance engagement by leveraging familiar mediums for children.¹³ For instance, a gamified app challenging a child to “avoid” brushing might encourage compliance; although there is a risk that this approach may backfire and the child actually avoids brushing, the child must be followed up with and shown the results of not brushing to help them understand the importance of complying.²¹ Reverse psychology remains valuable in resource-limited settings due to its simplicity and low cost.²²

Future research should focus on randomized controlled trials to compare reverse psychology with other techniques across diverse populations.²³ Longitudinal studies are needed to evaluate its impact on long-term dental attitudes, as early positive experiences are critical for lifelong oral health.²⁴

Conclusion

Reverse psychology is an effective, non-invasive behavior management technique in pediatric dentistry, particularly for children with mild to moderate anxiety or oppositional behavior.^1,6 By leveraging a child’s desire for autonomy, it facilitates cooperation and promotes positive oral health behaviors.¹⁰ However, its application must be tailored, ethically sound, and culturally sensitive.^14,18 While recent literature supports its efficacy, further research is needed to optimize its use and address limitations, ensuring its role in modern pediatric dentistry.

Sonu Acharya, BDS, MDS, PhD
Professor, Pediatric and Preventive Dentistry, Institute of Dental Sciences, Siksha ‘O' Anusandhan (SOA) (deemed to be) University, Bhubaneswar, Odisha, India; Private Practice, Bhubaneswar, Odisha; Fellow, International Association of Pediatric Dentistry

Sheetal Acharya, BDS, MDS
Senior Lecturer, Periodontology and Implantology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India