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

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)

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.

Study Overview

• Status: Recruiting
• Conditions: Distraction; Behavior Management
• Intervention / Treatment: Behavioral: Behavioral Treatment; Behavioral: Behavioral Treatment

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.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rana Soleman; Phone Number: +963 934 966 599; Email: drranasoliman66@gmail.com

Study Locations

• Syria
  • Damascus, Syria
    • Recruiting
    • Damascus University
    • Contact: Rana Soliman; Phone Number: +963 934 966 599drranasoliman6; Email: drranasoliman66@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

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

Exclusion Criteria:

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Tell-Show-Do behavior management technique; Children in this group will receive restorative treatment with following the traditional TSD technique without any visual aids.	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; Other Names: Tell-Show-Do Technique; 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 as 'sleepy juice'-depicting the 'tooth worm' falling asleep-and the rubber dam was shown as a barrier to prevent its escape. These segments sequentially covered examination, anesthesia, rubber dam placement, and cavity preparation. Each viewing was followed by a standardized verbal explanation before performing the clinical procedure. All participants underwent conservative restorative treatment of the mandibular primary molars; Other Names: Real-Oral Simulation Video-Assisted Tell-Show-Do Technique
Experimental: Real-Oral Simulation Video-Assisted Tell-Show-Do Technique; Children in this group will receive restorative treatment with following the enhanced Tell-Show-Do technique with a video simulating the real oral environment	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; Other Names: Tell-Show-Do Technique; 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 as 'sleepy juice'-depicting the 'tooth worm' falling asleep-and the rubber dam was shown as a barrier to prevent its escape. These segments sequentially covered examination, anesthesia, rubber dam placement, and cavity preparation. Each viewing was followed by a standardized verbal explanation before performing the clinical procedure. All participants underwent conservative restorative treatment of the mandibular primary molars; Other Names: Real-Oral Simulation Video-Assisted Tell-Show-Do Technique

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart Rate	Assessment tool: Pulse oximeter Measurement unit: Beats per minute (bpm) Assessment time points: Heart rate was assessed 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.	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)	Assessment tool: Facial Image Scale questionnaire Measurement unit: Ordinal score (1-5) Assessment time points: Facial Image Scale was assessed during a single dental treatment visit at baseline and during treatment.	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

Outcome Measure	Measure Description	Time Frame
Oxygen Saturation (SpO₂)	Assessment tool: Pulse oximeter Measurement unit: Percentage (%) Assessment time points: Oxygen saturation was measured using a pulse oximeter and recorded during a single dental treatment visit at baseline, after behavior management, during local anesthetic injection, before and during rubber dam placement, before handpiece use, and during dental treatment.	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.

Collaborators and Investigators

• Sponsor: Damascus University
• Investigators: Study Director: Chaza Kouchaji, Damascus University

Publications and helpful links

General Publications

• 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.
• 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.
• 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.
• 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.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): August 1, 2026

Study Registration Dates

• First Submitted: May 7, 2026
• First Submitted That Met QC Criteria: June 2, 2026
• First Posted (Actual): June 8, 2026

Study Record Updates

• Last Update Posted (Actual): June 8, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Dental anxiety; Video modeling / Simulation; Tell-Show-Do technique
• Additional Relevant MeSH Terms: Psychotherapy; Behavioral Disciplines and Activities; Behavior Therapy
• Other Study ID Numbers: UDDS-Pedo-03-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No