Comparative Study of the Tell-Show-Do Technique With and Without a Dental Simulation Game to Reduce Pain and Anxiety in Pediatric Dental Patients: A Randomized Controlled Trial.

BACKGROUND

Dental anxiety and pain in pediatric patients remain significant barriers to effective treatment delivery. The Tell-Show-Do (TSD) technique is a widely accepted non-pharmacological behavior management strategy; however, its efficacy may be augmented by interactive digital interventions such as dental simulation games. This study aimed to compare the effectiveness of the TSD technique with and without a dental simulation game in reducing pain and anxiety among pediatric dental patients.

METHODS

This parallel-group randomized controlled trial enrolled 68 children aged 4-10 years requiring dental treatment (pulp therapy or extraction). Participants were randomly allocated into two groups: the control group (n = 34) received the TSD technique alone, while the intervention group (n = 34) received the TSD technique supplemented with a dental simulation game (BabyBus). Pain was assessed using the Wong-Baker Faces Pain Rating Scale (WBFPRS) and the Modified Toddler-Preschooler Postoperative Pain Scale (MTPPPS). Anxiety was evaluated through pulse rate - at baseline, during, and after treatment/procedure. Data were analyzed using the chi-squared test and independent-samples t-test, with statistical significance set at p ≤ 0.05.

RESULTS

The intervention group had a lower mean WBFPRS score than the control group (3.12 ± 1.92 versus 4.47 ± 2.31), with a mean difference of 1.35 points (95% CI: 0.32-2.38; p = 0.011). MTPPPS scores did not differ significantly between the intervention and control groups (3.98 ± 1.73 versus 3.86 ± 1.40; mean difference: -0.12, 95% CI: -0.88 to 0.64; p = 0.757). Baseline pulse rates were comparable between the groups (81.00 ± 5.85 versus 79.67 ± 6.20 beats/min; p = 0.539). During treatment, the intervention group had a lower mean pulse rate than the control group (84.33 ± 7.10 versus 97.00 ± 8.40 beats/min; p < 0.001). No significant between-group difference was observed after treatment (73.67 ± 5.40 versus 74.67 ± 5.90 beats/min; p = 0.501).

CONCLUSION

The addition of a dental simulation game to the conventional TSD technique significantly reduced pain and anxiety in pediatric dental patients aged 6-10 years. Simulation-based pre-exposure may serve as a valuable adjunct to standard behavior management, particularly for technologically adept children of Generation Alpha.