Effectiveness of Puppet Modeling During Dental Emergency Visits on Dental Anxiety and Behavior of Children in a Subsequent Visit

实验性的：Puppet-aided TSD

Children who received puppet-aided tell-show-do as a behavior guidance technique in the emergency dental visit.

行为的：Puppet Play Therapy

The investigator used the puppet to interact with the participants and explain the treatment in simple language before starting the dental procedure.

其他名称：

• Puppet Guidance

有源比较器：TSD

Children who received traditional tell-show-do as a behavior guidance technique in the emergency dental visit.

行为的：Tell-Show-Do (TSD)

Tell: The dentist explained what is about to happen using simple, age-appropriate language.

Show: The dentist demonstrated the tool outside of the patient's mouth. Do: The dentist performed the procedure in the patient's mouth exactly as described.

Subjective Dental Anxiety as Assessed by Venham Picture Test (VPT) for Children Aged 3-5 Years

The scale consists of eight pairs of images, each showing a child in both anxious and calm states. Children are asked to select one image from each pair that best represents how they feel. Each anxious image chosen is scored as one, while calm selections are scored as zero. The total dental anxiety score, which ranges from zero to eight, is calculated by summing the individual scores, with higher totals indicating greater anxiety.

Subjective Dental Anxiety as Assessed by Abeer Children Dental Anxiety Scale (ACDAS) for Children Aged 6-9 Years

The scale is divided into three sections. Part A includes 13 self-reported items presented in a logical sequence, in which children indicate their feelings toward different dental situations using three facial expressions: happy/relaxed (score = 1), neutral/ "OK" (score = 2), and scared/anxious (score = 3). The total score ranges from 13 to 39; scores ≥26 indicate significant dental anxiety. Part B consists of three yes/no questions exploring the child's cognitive concerns, such as shyness about their teeth or dentist, and fear of losing control during treatment. Part C gathers additional information from both the parent/guardian and the dentist: parents report on the child's previous dental experiences and anticipated behavior, while the dentist records the child's behavior after treatment. By combining self-reported, parental, and clinical perspectives, ACDAS provides a comprehensive assessment of dental anxiety in children

Objective Dental Anxiety as Assessed by the Venham Anxiety Rating Scale (VARS)

The VARS is constructed of six behaviorally defined categories that range from zero to five, with higher scores indicating higher levels of dental anxiety. The score gradually increases from relaxed (Score 0), to the child is totally out of control (Score 5). The target population for this scale is children aged 3-12 years.

Behavior as Assessed by the Behavior Profile Rating Scale (BPRS)

An independent observer, other than the operating dentist, is required to systematically record the occurrence of 27 distinct behavioral aspects over a series of 3-minute intervals. Four of these behaviors assess the child's reaction to his separation from a parent. The remaining 23 aspects assess the child's behavior in the dental office. Each behavior is assigned a weighted score that reflects its level of disruptiveness. The total score is calculated by multiplying the frequency of each behavior during the 3-minute periods by its weight, then summing the results across all categories and dividing by the number of intervals.

In this study, the BPRS was adapted to be applied once per quadrant during oral prophylaxis, rather than at fixed 3-minute intervals, because the procedure was short and, in some cases, did not extend to three minutes.

Behavior as Assessed by the Frankl Behavior Rating Scale (FBRS)

This scale classifies patient behavior into four specific categories.:Definitely Negative (Rating 1): The child completely refuses treatment, cries forcefully, shows extreme fear, or displays overt negativism.Negative (Rating 2): The child is reluctant to accept treatment and uncooperative, but there is no extreme negativism (e.g., no forceful crying or treatment refusal).Positive (Rating 3): The child accepts treatment and is generally willing to comply with the dentist's directions, though they may be a bit cautious or reserved.Definitely Positive (Rating 4): The child has excellent rapport with the dentist, shows genuine interest in the procedure, laughs, and enjoys the visit.