Comparative Evaluation of the Efficacy of Cognitive-behavioral Play Therapy and Tell-show-do Technique in the Behavior Modification of Children with Dental Anxiety during Dental Extraction under Local Anesthesia: A Randomized Controlled Trial
Umme Azher, Sarakanuru K Srinath
Keywords :
Behavior, Cognitive-behavioral play therapy, Dental anxiety, Tell-show-do technique
Citation Information :
Azher U, Srinath SK. Comparative Evaluation of the Efficacy of Cognitive-behavioral Play Therapy and Tell-show-do Technique in the Behavior Modification of Children with Dental Anxiety during Dental Extraction under Local Anesthesia: A Randomized Controlled Trial. J South Asian Assoc Pediatr Dent 2024; 7 (2):72-76.
Aim: To evaluate the efficacy of cognitive-behavioral play therapy (CBPT) and tell-show-do (TSD) technique in the behavior modification of uncooperative children during local anesthesia prior to dental extraction.
Materials and methods: Sixty-two children aged 6–11 years with Frankl's behavior rating of two during their first dental visit and requiring the extraction of retained or mobile primary anterior teeth under local anesthesia were divided into two groups: group I—CBPT, and group II—TSD. Children in group I were introduced to the dental instruments using verbal explanations, actual dental instruments, and a toy demonstration. They were then allowed to role-play as the dentist on a customized toy mouth. Children in group II received an explanation and a demonstration of the procedure before undergoing it. The behavior and anxiety levels of the children were assessed at three different points during the course of the trial. Pulse rate records served as an objective measure of anxiety.
Results: Group I showed a statistically significant reduction in pulse rate between the baseline and posttreatment scores (Z = 2.286, p = 0.067 and Z = 3.49, p = 0.002), while no significant change was observed in group II. Both groups showed a significant reduction in behavior and anxiety scores when comparing baseline to postintervention and baseline to posttreatment scores. There was no significant difference in behavior and anxiety scores between groups I and II with the Mann–Whitney U test, with a level of significance at p < 0.05.
Conclusion: Cognitive-behavioral play therapy showed greater amelioration in behavior and anxiety levels of children compared to TSD technique.
Clinical significance: Cognitive-behavioral play therapy is a safe and noninvasive method to educate children about dental procedures and allow them to role-play, promoting more positive memories and a greater willingness to return.
Clinical trial registration: The clinical trial was registered at Clinical Trials Registry—India (CTRI Reg. number: CTRI/2021/05/033675).
Palm AM, Kirkegaard U, Poulsen S. The Wand versus traditional injection for mandibular nerve block in children and adolescents: perceived pain and time of onset. Pediatr Dent 2004;26(6):481–484. PMID: 15646908.
Sixou JL, Marie-Cousin A, Huet A, et al. Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system (QuickSleeper). Int J Pediatr Dent 2009;19(5):360–366. DOI: 10.1111/j.1365-263X.2009.00983.x
Kuscu OO, Akyuz S. Is it the injection device or the anxiety experienced that causes pain during dental local anaesthesia? Int J Pediatr Dent 2008;18(2):139–145. DOI: 10.1111/j.1365-263X.2007.00875.x
Wright GZ, Stigers JI. Non-pharmacologic management of children's behaviors. In: Dean JA, Avery DR, Mc Donald RE (Eds). Dentistry for the Child and Adolescent, 9th edition. St Louis: CV Mosby Co.; 2011. p. 30.
Townsend JA. Behaviour guidance of the pediatric dental patient. In: Casamassimo PS, Fields HW, Mc Tigue DJ, Nowak AJ (Eds). Pediatric Dentistry—Infancy through Adolescence, 5th edition. Philadelphia: Elsevier Saunders; 2013. p. 358.
Landreth G. Play Therapy: The Art of the Relationship, 3rd edition. London, England: Routeledge; 2012.
Sandeep C, Nuvvula S, SVSG N. Play therapy in pediatric dentistry. J Pediatr Dent 2014;2:28.
Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent 2016;10(8):35–50. DOI: 10.2147/CCIDE.S63626
Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J 2013;58(4):390–407; quiz 531. DOI: 10.1111/adj.12118
Glassman P, Peltier B. Guidelines for the administration of local anesthesia in fearful dental patients. J Calif Dent Assoc 1995;23(9):23–26.
Duff AJ. Incorporating psychological approaches into routine paediatric venepuncture. Arch Dis Child 2003;88(10):931–937. DOI: 10.1136/adc.88.10.931
Nesse RM, Curtis GC, Thyer BA, et al. Endocrine and cardiovascular responses during phobic anxiety. Psychosom Med 1985;47(4):320–332. DOI: 10.1097/00006842-198507000-00002
Furlan NF, Gaviao MB, Barbosa TS, et al. Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children. J Clin Pediatr Dent 2012;37(1):83–87. DOI: 10.17796/jcpd.37.1.n32m21n08417v363
Carrillo-Diaz M, Crego A, Armfield JM, et al. Dental fear-related cognitive vulnerability perceptions, dental prevention beliefs, dental visiting, and caries: a cross-sectional study in Madrid (Spain). Community Dent Oral Epidemiol 2015;43(4):375–384. DOI: 10.1111/cdoe.12166
