Evaluation of Three Different Behaviour Management Strategies for Dental Management of Highly Anxious Children: A Randomised Clinical Study

Abstract

Introduction: Children often experience anxiety and behavioural issues when exposed to dental stimuli such as the sight, sound, and sensation of the airotor. Behaviour modification techniques that involve familiarising children with dental equipment and procedures can help reduce this anxiety. Aim: To evaluate the effectiveness of three behaviour management techniques: Tell-Show-Do (TSD), Tell-show-play-do (TSPD), and a smartphone dental game application in managing Dental Fear and Anxiety (DFA) in children aged 4-8 years. Materials and Methods: This randomised clinical study included 60 children aged 4-8 years who required Class-I restorations (ICDAS Code 2 and Code 3) in maxillary or mandibular molars. Participants were randomly assigned to one of three groups: TSD (n=20), TSPD (n=20), or the smartphone dental game app (n=20). Preoperative anxiety levels were assessed using the Children’s Fear Survey Schedule Scale-Dental Subscale (CFSS-DS). Anxiety levels were evaluated pre- and postoperatively using the Modified Child Dental Anxiety Scale (MCDAS-f) and the Visual Analogue Scale (VAS). Physiological parameters, including pulse rate and SpO2 levels, were measured before and after treatment. Statistical analyses included paired t-tests for pulse rate, Wilcoxon signed-rank tests for VAS and MCDAS-f scores, Kruskal-Wallis tests for intergroup comparisons, and one-way ANOVA with Bonferroni post-hoc tests. Data were analysed using SPSS version 27.00. Results: The TSPD group exhibited a significantly greater reduction in dental anxiety compared to the TSD (p=0.01) and smartphone dental game groups (p=0.05), as evidenced by MCDAS-f (p<0.001) and VAS scores (16.7%). Physiological parameters indicated significant changes in the TSPD group, with a notable decrease in pulse rate post-treatment (p=0.014) and the lowest mean SpO2 level (96.55). One-way ANOVA with Bonferroni post-hoc tests confirmed significant anxiety reduction in the TSPD group both before (p=0.048) and after treatment (p=0.009). The Wilcoxon signed-rank test demonstrated a substantial decrease in DFA, with 16.7% of children in the TSPD group no longer experiencing anxiety post-intervention (p<0.001). These findings underscore the superior efficacy of the TSPD technique in managing DFA. Conclusion: Among the three techniques, the TSPD technique was the most effective overall, while the TSD technique was the least effective. It is crucial for paediatric dentists to employ child-friendly and pain-free methods to improve children’s behaviour during dental treatments.

Keywords

• behaviour modification
• dental fear and anxiety
• tell-show-do technique
• tell-play-show-do
• smartphone game application