Journal Article

Cartoon-assisted visual/auditory distraction usage in paediatric dental care, assessment of effects on patient anxiety, pain, and behaviour: a randomised crossover clinical trial

Akgöl, Beyza Ballı, Üstün, Nilüfer, Bayram, Merve

2025

Overview

Objectives This randomized crossover clinical trial designed to evaluate the impact of visual and auditory distraction techniques on pediatric patients’ anxiety, pain perception, and behavior during dental treatment. The study specifically focuses on children, aiming to determine whether distraction methods can effectively reduce anxiety levels, alleviate pain experiences, and improve cooperative behavior in a clinical setting. Method and materials Children aged 4 to 9 years receiving routine dental care at the Pediatric Dentistry Clinic, Istanbul Medipol University, were randomly assigned to Group 1 (distraction first, then tell-show-do) or Group 2 (tell-show-do first, then distraction), with a two-week washout period before switching interventions. Anxiety was assessed using the Venham Picture Test and pulse rate, pain perception with the Sounds, Eyes, and Motor Scale during local anesthesia and the Wong-Baker FACES Pain Rating Scale during treatment, while cooperation and behavior were evaluated using the Houpt Scale. Statistical analysis was conducted using Mann-Whitney U, Student’s t-test, Paired t-test, and Wilcoxon test, with the significance level set at 0.025 using the Bonferroni correction. Results Sixty-eight patients (37 female, 31 male) with a mean age of 6.69 ± 1.08 years completed the study (Group 1: n  = 32, Group 2: n  = 36). The cartoon-assisted distraction technique did not significantly reduce anxiety compared to the tell-show-do method. A non-significant reduction in pain perception was observed during local anesthesia with distraction. However, this technique significantly reduced self-reported pain during treatment ( p  < 0.025) and improved child cooperation and behavior. Conclusion Cartoon-assisted visual and auditory distraction can alleviate pain perception and improve behavior during pediatric dental procedures. However, it does not appear to reduce dental anxiety or pain perception during local anesthesia. Integrating this technique with the traditional tell-show-do approach may enhance the pediatric dental experience. Trial registration The trial was registered at ClinicalTrials.gov, number NCT04927754, 06/01/2021.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Anesthesia / Anxiety / Anxiety in children / Attention / Audio-visual materials / Behavior / Behaviour guidance / Care and treatment / Caricatures and cartoons / Cartooning / Cartoons as Topic / Child / Child Behavior / Child, Preschool / Children / Cooperation / Cross-Over Studies / Crossover clinical trial / Dental anxiety / Dental Anxiety - prevention & control / Dental care / Dental Care for Children - methods / Dental Care for Children - psychology / Dentistry / Dentists / Disease prevention / Distraction / Female / Hearing / Humans / Local anesthesia / Male / Medicine / Methods / Oral and Maxillofacial Surgery / Paediatric patients / Pain / Pain in children / Pain Measurement / Pain Perception / Patients / Pediatric research / Pediatrics / Pedodontics / Pilot projects / Professional ethics / Psychological aspects / Sensory integration / Statistical analysis / Variables