Tell-Show-Do for Reducing Dental Anxiety During Local Anesthesia

Overview

Dental anxiety is common in children and may increase during local anesthesia administration. Dental injection anxiety is one of the most frequently reported causes of dental anxiety in pediatric dental patients. Communication-based behavior guidance techniques are commonly used to reduce anxiety during dental procedures. Among these techniques, tell-show-do is widely used in pediatric dentistry and is generally accepted by parents. This completed interventional study evaluated the effect of introducing the syringe and related injection equipment using the tell-show-do technique on dental anxiety during local anesthesia administration in school-aged children. Children aged 5 to 7 years who required dental treatment under buccal infiltration local anesthesia and had no previous dental treatment experience involving injection were enrolled after parental consent was obtained. The study used a controlled within-subject design. Each child attended an adaptation appointment followed by two dental treatment appointments involving local anesthesia. The syringe and related equipment were introduced using the tell-show-do technique at one local anesthesia appointment, whereas the injection equipment was kept out of the child's field of vision at the other local anesthesia appointment. The order of exposure to the tell-show-do intervention differed between sequence groups. Dental anxiety, behavior, and pain-related responses were assessed using validated scales, including the Facial Image Scale, Human Figure Drawing scale, Frankl Behavior Scale, Modified Frankl Behavior Scale, and Sound-Eye-Motor scale. Parent-reported child dental fear and parental dental anxiety were also recorded.

This completed interventional study was designed to evaluate the effect of the tell-show-do behavior guidance technique on dental anxiety during local anesthesia administration in school-aged children. The behavioral intervention consisted of introducing the syringe and related injection equipment to the child before local anesthesia administration using the tell-show-do technique. Eligible participants were children aged 5 to 7 years who presented to the faculty pediatric dentistry clinic and required dental treatment involving buccal infiltration local anesthesia. Children were included if no previous dental treatment involving injection had been performed, no urgent dental treatment was required, and no special health care needs were present. Participation was based on parental informed consent. The study followed a controlled within-subject interventional design with two exposure conditions. Each participant attended an initial adaptation appointment followed by two treatment appointments involving local anesthesia. During the adaptation appointment, a preventive dental procedure not requiring injection, such as fissure sealant application, fluoride application, or prophylaxis, was performed to familiarize the child with the dental setting. At the end of the adaptation appointment, baseline trait dental anxiety was assessed using the Human Figure Drawing scale after the child was asked to draw a child receiving dental treatment in a clinic. Parent-reported child dental fear was assessed using the Children's Fear Survey Schedule-Dental Subscale. Parental dental anxiety was assessed using the Modified Dental Anxiety Scale and the Dental Anxiety Inventory Short Form. The child's behavior during dental treatment was evaluated using the Frankl Behavior Scale. Participants were assigned to one of two intervention sequences. In one sequence, the tell-show-do intervention was applied during the second appointment, and the hidden-instrument condition was applied during the third appointment. In the other sequence, the hidden-instrument condition was applied during the second appointment, and the tell-show-do intervention was applied during the third appointment. In this design, each child served as an internal control. During the tell-show-do condition, the syringe and related injection equipment were introduced before local anesthesia administration. The syringe and needle were assembled in front of the child, and the syringe was described in child-appropriate language, such as a hollow tube. Local anesthesia was then administered after the introduction of the equipment. During the hidden-instrument condition, the syringe and related equipment were kept outside the child's field of vision before and during local anesthesia administration. The injection was performed with the child's eyes closed, and the equipment was not introduced before the procedure. State dental anxiety after local anesthesia administration was assessed using the Facial Image Scale, which includes five facial images representing different emotional states. At the end of the second and third appointments, trait dental anxiety was reassessed using the Human Figure Drawing scale. Child behavior during local anesthesia administration was evaluated using the Modified Frankl Behavior Scale. Pain-related responses before, during, and after injection were assessed from video recordings using the Sound-Eye-Motor scale by an independent rater. Statistical analysis included Spearman correlation analysis, independent samples t-test, and Mann-Whitney U test, as appropriate. Statistical significance was set at p \< 0.05.