Video-Enhanced Tell-Show-Do for Managing Dental Anxiety in Children

Official title

Reinforcing the Tell-Show-Do Technique With a Simulated Real-mouth Video to Manage Dental Anxiety in Children During Dental Treatment (A Randomized Controlled Trial)

Overview

This study is the first of its kind to examine the effect of integrating the real oral environment with a video that supports the expressions used during the Tell-Show-Do technique (such as "we will see the cavity," "the cavity will drink juice to fall asleep," and "we will clean the tooth from the cavity"). This approach aims to enhance the Tell-Show-Do technique, build trust with the child, and reduce anxiety at the different stages of dental treatment in the clinical setting.

Detailed description

Dental fear and anxiety in children are associated with several visual stimuli, such as the shape of the dental handpiece or saliva ejector, as well as painful procedures like local anaesthesia, which may create a barrier to receiving dental treatment. Many studies have explored various behaviour management techniques to reduce anxiety during treatment; however, few have investigated the effect of using a video simulation of the real oral environment to familiarise children with treatment steps and reinforce the phrases commonly used by the dentist. This study was designed to reassure children by using a video that demonstrates carious lesions and dental instruments, including the mirror, saliva ejector, handpiece, and syringe, and shows how they work inside the mouth in a child-friendly manner.

This research is a randomised controlled clinical trial in which participants were assigned to two groups based on the behaviour management technique used. Anxiety was assessed using three integrated measures: a self-reported anxiety scale, an observer-rated behaviour scale, and physiological indicators including oxygen saturation and heart rate. All measures were recorded before, during, and after treatment to provide a comprehensive evaluation of the intervention's effect on children's anxiety levels.

Interventions

• Behavioral Behavioral Treatment
  This group received treatment guided by the Tell-Show-Do (TSD) method. Each step was explained through simple analogies-referring to local anesthesia as 'sleepy juice' and the rubber dam as a 'trap' for the 'tooth worm.' After the explanation and instrument demonstration, restorative treatment was carried out. The protocol excluded the use of any audiovisual aids. All procedures involved conservative restoration of the mandibular primary molars
• Behavioral Behavioral Treatment
  Children in this group were managed using a video-assisted Tell-Show-Do (VATSD) approach incorporating real-oral simulation. Each procedural step was preceded by a specific segment of a pre-recorded video tailored to the upcoming task. The video featured a simulated intraoral environment where dental caries was personified by an animated 'tooth worm' to explain decay and its removal. Consistent with conventional TSD, the video integrated child-friendly analogies: local anesthesia was introduced

Primary outcome measures

• Heart Rate [Time frame: during a single dental treatment visit at baseline before treatment, after behavior management, during local anesthetic injection, before and during rubber dam placement, before handpiece use, and during restorative treatment.]
• Facial Image Scale (FIS) [Time frame: The Facial Image Scale was assessed during a single dental treatment visit at baseline (first visit before intervention) and during dental treatment.]

Secondary outcome measures (1)

• Oxygen Saturation (SpO₂) [Time frame: Baseline; after behavior management; during injection; before rubber dam placement; during rubber dam placement; before handpiece use; during treatment during a single dental treatment visit.]

Eligibility criteria

Inclusion criteria

• Children aged 4-6 years, with or without previous dental experience.
• Children with a positive behavior rating according to the Frankl scale.
• Children with primary molars requiring conservative dental treatment.

Exclusion criteria

• Children with systemic or mental disorders.
• Children who received sedative or analgesic medications within the 3 hours prior to the dental visit.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Other

Study locations

Syria · 1 center

• Damascus University — Damascus

Publications

• Abbasi H, Saqib M, Jouhar R, Lal A, Ahmed N, Ahmed MA, Alam MK. The Efficacy of Little Lovely Dentist, Dental Song, and Tell-Show-Do Techniques in Alleviating Dental Anxiety in Paediatric Patients: A Clinical Trial. Biomed Res Int. 2021 May 23;2021:1119710. doi: 10.1155/2021/1119710. eCollection 2021. PMID 34124238
• Khandelwal D, Kalra N, Tyagi R, Khatri A, Gupta K. Control of Anxiety in Pediatric Patients using "Tell Show Do" Method and Audiovisual Distraction. J Contemp Dent Pract. 2018 Sep 1;19(9):1058-1064. PMID 30287704
• Seligman LD, Hovey JD, Chacon K, Ollendick TH. Dental anxiety: An understudied problem in youth. Clin Psychol Rev. 2017 Jul;55:25-40. doi: 10.1016/j.cpr.2017.04.004. Epub 2017 Apr 19. PMID 28478271
• Liu Y, Gu Z, Wang Y, Wu Q, Chen V, Xu X, Zhou X. Effect of audiovisual distraction on the management of dental anxiety in children: A systematic review. Int J Paediatr Dent. 2019 Jan;29(1):14-21. doi: 10.1111/ipd.12430. Epub 2018 Oct 26. PMID 30362187

Identifiers

NCT: NCT07632547 · UDDS-Pedo-03-2026

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗