Comparative Evaluation of Ego Defense Mechanisms among Cooperative and Uncooperative Children in a Pediatric Dental Setting: A Randomized Controlled Trial

mature children, however, may adopt adaptive mechanisms such as humor, anticipation, or sublimation, which facilitate cooperation and improve the overall dental experience.3 For pediatric dentists, recognizing these coping strategies is vital.Identifying specific EDMs allows practitioners to tailor behavior management techniques, such as tell-show-do, positive reinforcement, or parental involvement, to the child's psychological IntroductIonFear and anxiety are natural emotional responses that arise when individuals are exposed to unfamiliar or potentially threatening situations.In pediatric dentistry, these emotions are particularly prevalent, as children often fear pain, face an unfamiliar clinical environment, and may be separated from their caregivers.Such distress frequently manifests as uncooperative behavior, complicating dental procedures and creating challenges for practitioners. 1 The effective management of these psychological responses is therefore crucial to ensuring a positive and stress-free dental experience for young patients.One of the ways children cope with anxiety-provoking situations, including dental treatment, is through the subconscious use of ego defense mechanisms (EDMs).EDMs are psychological strategies employed to protect the mind from overwhelming emotional experiences.2 The type of defense mechanism employed by a child depends on multiple factors, such as age, emotional maturity, and previous dental or medical experiences.Younger children, who lack advanced emotional regulation, often rely on immature defense mechanisms.These include denial (refusing to acknowledge treatment), regression (crying or clinging to caregivers), and projection (blaming the dentist for their fear).2 With increasing cognitive development, children may shift toward neurotic mechanisms, such as repression (blocking unpleasant memories), rationalization (justifying fear with logical-sounding reasons like "the drill is too loud"), or displacement (redirecting frustration toward parents or siblings).