Genetic and Psychosocial Predictors of Child Dental Cooperation: The Interplay of Maternal Attachment and OXTR/5-HTTLPR Polymorphisms

Articles in Press

Document Type : original article

Authors

1 Department of Human Genetics, School of medicine, Mashhad University of medical sciences, Mashhad, Iran

2 Mashhad University of medical sciences, department of medical genetics

10.22038/jpp.2026.94945.5634

Abstract

Background: Uncooperative behavior in pediatric dentistry remains a significant barrier to effective care. While the correlation between maternal and child anxiety is established, the biological mechanisms moderating this relationship specifically the interaction between attachment styles and genetic susceptibility remain unexplored. This study investigated the combined predictive power of mother-child attachment and polymorphisms in the Oxytocin Receptor (OXTR) and Serotonin Transporter (SLC6A4) genes on children’s behavior during dental treatment.

Methods: A prospective cohort study was conducted with 200 mother-child dyads (children aged 4–8 years). Maternal attachment was assessed using the Experiences in Close Relationships-Revised (ECR-R) questionnaire. Child cooperation was rated during restorative procedures using the Frankl Behavior Rating Scale. Genomic DNA was extracted from peripheral blood samples. Genotyping for the OXTR rs53576 polymorphism was performed using the Amplification Refractory Mutation System (ARMS-PCR), and the 5-HTTLPR region was amplified via standard PCR.

Results: Secure maternal attachment was significantly associated with positive child cooperation (p<0.001). Genetically, children carrying the Short (S) allele of 5-HTTLPR exhibited lower cooperation scores (p=0.04). A hierarchical regression model revealed a significant Gene-Environment interaction (β=−0.38, p<0.01), indicating that children with the 'risk' genotype (S-carriers) were significantly more vulnerable to the effects of insecure maternal attachment than children with the protective genotype (L/L).

Conclusion: The child's behavioral phenotype in the dental operatory is shaped by a complex interplay of maternal emotional availability and the child's genetic stress sensitivity. These findings support a move toward personalized behavioral management strategies based on psychosocial and biological risk profiling.

Keywords

Journal of Pediatric Perspectives

Articles in Press, Accepted Manuscript
Available Online from 25 April 2026

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