Abstract
BACKGROUND: Effective behavior guidance in pediatric dentistry depends on both clinical technique and effective communication with parents. Understanding which techniques parents prefer, and how these preferences relate to demographics and dental anxiety, is essential for guiding clinician-parent and supporting informed decision-making. OBJECTIVE: To assess the acceptance of twelve behavior-guidance techniques (BGTs) among Egyptian parents of younger (3–6 years) and older (7–12 years) children. Additionally, the study aimed to examine whether parental acceptance is influenced by reported levels of dental anxiety and previous dental experiences. MATERIALS AND METHODS: Two hundred twenty two parents of children aged 3–12 years scheduled for dental treatments watched video demonstrations of twelve BGTs. The basic guidance techniques included tell-show-do, pre-visit imagery, audio distraction, audiovisual distraction, virtual reality, enhanced control, modeling, social and non-social positive reinforcement, and voice control. Advanced guidance techniques included active protective stabilization and general anesthesia. Parents rated their acceptance 0–5, provided demographic information, and completed the Arabic Modified Dental Anxiety Scale (MDAS). Mann–Whitney U tests were used to compare acceptance scores between two age groups (3–6 and 7–12 years). RESULTS: The average MDAS score was 13.84 (± 5.35). The mean age was 4.68 (± 1.16) years in the 3–6 group and 9.03 (± 1.61) years in the 7–12 group. Non-social positive reinforcement received the highest acceptance (mean = 4.79), followed by social reinforcement (4.42) and tell-show-do (4.32). Conversely, active protective stabilization (2.77), general anesthesia (2.80), and voice control (2.95) were least accepted. A weak positive correlation (r = 0.23, p = 0.01) existed between MDAS scores and non-social positive reinforcement acceptance. CONCLUSIONS: Egyptian parents’ acceptance of BGTs varied by child age, socioeconomic status, anxiety, and dental history, with non-social positive reinforcement most favored and active protective stabilization and general anesthesia least preferred. These findings highlight the need for clear, tailored communication when discussing behavior guidance options, particularly for more restrictive techniques. CLINICAL RELEVANCE: Understanding parental preferences for BGTs is essential for pediatric dentists to tailor their approaches effectively. This personalized strategy can enhance treatment acceptance, create a more supportive environment for children, and ultimately improve clinical outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12903-026-07954-y.