In the last three decades, medical clowning was introduced into hospitals around the world as a tool that helps to "promote wellness and improve physical and mental health and quality of life of patients, their families and the healthcare staff who interacts with them" [1, 2].
Medical and dental clowns are seen touring the hospital's wards, bringing joy and humor to hospitalized people, and sometimes also escorting patients during frightening medical procedures. Consistent with the perception of the hospital as a place where pain and sadness are prevalent, the medical clown is often seen as the one in charge of introducing some laughter into an otherwise unhappy setting .
On the one hand the clowns help the patients and their families to get distracted, even if only momentarily, from the unpleasant situation in which they find themselves and on the other, they try to improve the quality of life of the hospital and its staff through the introduction of humor and comic relief [4, 5].
Most studies on medical clowning focus on the positive effects  that humor and laughter have been found to produce upon people. Quantitative research examined the clowns' contribution to the improvement of the patients' condition, connecting it with the presence of laughter, which causes the secretion of adrenaline and other substances that increase the blood ﬂow and the level of endorphins in the brain, appease pains, decrease infections and accelerate the recovery processes [ 6].
Review of Related Literature
A review of the scientific literature was undertaken to present a critical exposure and articulation of ideas, and concepts pertaining to Clown Care program in Medical and Dental hospitals.
An Integrated Team: Increasing Collaboration
In accordance with the guiding principle of collaboration, physical therapists ought to seek more interaction with community organizations. Therapeutic clowns are integrated members of professional healthcare teams, as they provide targeted empathetic care to compliment the work of other medical personnel . A study in England showed a majority of pediatricians believed clown doctors have a positive impact on children; this same study showed that even though many members of the healthcare staff personally did not like clowns, they still perceived they were having a positive impact .
Likewise, a study in Hamburg, Germany found that almost 91% of the hospital staff found the presence of hospital clowns enriching to daily routine, but the clowns themselves thought that interdisciplinary collaboration could be better . They would echo the satisfaction of healthcare staff with medical clowns to be true based upon my own clowning experiences in Davenport, Lowa his semester. In a particular case, a nurse at a nursing home came up to us and said, "You know, I typically don't like clowns, but you aren't scary clowns. You're nice clowns, and I like you!". The integration of the medical clowns into an otherwise unhappy physical setting has a positive ramification which promotes and improves the physical and mental well being of the quality of life of the patients in many locations. An imperative principle of collaborating the medical clowning with the community organizations must be considered and pursued as a valid means for improving health and bringing momentarily humour and comic relief to the patients.
Positive Psychology: Increasing Innovation in Healthcare Delivery
As healthcare becomes increasingly focused on a holistic approach, the need to use creative and artistic approaches becomes all the more crucial; creative and artistic thought and behavior has an overarching inﬂuence on the daily lives of people [ 9] Medical clowning is obviously an innovative approach to healthcare that provides room for creative expression with techniques which include music, storytelling, and magic tricks [ 6]. The importance of medical clowning is in part highlighted by research findings about the benefits of humor and laughter. This effort largely comes out of the recent positive psychology movement to increase the study of the factors that lead to increased psychological well-being and human strength . Research has shown laughter can increase immune function  lower blood pressure  and produce weight loss  Medical clowning, or simply the increased use of humor by physical therapists themselves, could clearly have many positive effects on health.
Empowerment: Increasing Consumercentricity
The heart of medical clowning is trying to empower patients. This is different from circus clowning, in which the goal of the clowns is to perform and attract attention to themselves. One way therapeutic clowns detract attention from themselves is by wearing minimal makeup, which also works to decrease the fears of those who may have coulrophobia or ballatrophobia, the fear of clowns . Research suggests an increased sense of perceived control can have positive health effects . There are many techniques clowns can use to specifically empower the patient and give them more perceived control . first, the clowns can empower patients by requesting permission to enter the room or approach them, something patients rarely get a choice.
Another method is for the clown to construct a "problem." The problems of clowns are limitless, from not being able to get their hat on, to perhaps losing their dinosaur in the hallway. Clowns tend to take a long time to solve their problems, but they take all of the patient's suggestions to heart, because he or she is the expert. In addition, being fully present is key to empowering the patient. The patient must be central to the clown in the present moment; all of the distractions of the larger world disappear. Physical therapists may practice medical clowning techniques in their day-to-day by giving patients control in less fantastical ways and being present; by asking patients if they are ready to start, giving them a choice of activity, and giving them full attention, presence can go a long way .
The newfangled milieu of the concept of medical clowning is a subtle approach as it works in a state of continuous stress in which interventions are needed to soothe the patient not only with regular clown's skills, intuition, and sensitivity, but also therapeutic vision. Their efforts are psychologically intricate and increasingly involute. As the profession of Dental clowning develops, their duties also expand from those of a funny entertainer to an integral part of the paramedical team. They make the stay comfortable and joyful for the patients as well as for their families at the hospital which brings a positive impact on improving health in cases of long and repeated hospitalizations. They can have friendly interactions with the patients to know their needs and his/her coping capability. Thus, it becomes apparent that it is not enough for Dental clowns to come in with the sole purpose of changing the atmosphere and entertaining.