Comparative Evaluation of Tell-Show-Do, Modeling and Audiovisual Distraction in Children Receiving Pediatric Dental Treatment: A Randomized Controlled Clinical Trial

Abstract

Background: Behavioural management is an essential component of pediatric dental care, particularly during dental procedures, where anxiety, negative behaviour, and physiological stress may interfere with treatment. Tell-Show-Do (TSD), Modeling, and Audio-Visual Distraction (AVD) are commonly used approaches for improving children's behavioural adaptation during dental treatment.

Aim: To compare the effectiveness of TSD, video modeling, and AVD in reducing dental anxiety and improving behavioural and physiological responses during stainless steel crown (SSC) preparation in children.

Materials & Methods: A comparative three-group clinical study was conducted among 120 children, equally allocated to a TSD group (n=40), Modeling group (n=40), and AVD group (n=40). Dental anxiety was assessed using the Facial Image Scale (FIS) at baseline, during treatment, and immediately after treatment. Behaviour was assessed using the Frankl Behaviour Rating Scale. Heart rate was recorded before, during, and after treatment, while total treatment duration was recorded in minutes. Continuous variables were compared using one-way analysis of variance (ANOVA), followed by Tukey's honestly significant difference (HSD) post-hoc test when appropriate. Within-group changes in FIS scores were evaluated using paired-samples t-tests.  Categorical behavioural data were analyzed using frequencies and percentages and compared between groups using an appropriate categorical-data test. Statistical significance was set at probability (p) <0.05.

Results: Baseline FIS scores were comparable among the TSD, Modeling, and AVD groups (2.81±0.60, 2.55±0.61, and 2.71±0.62, respectively; p=0.155). During treatment, FIS scores were significantly different among the groups (2.54±0.46, 1.90±0.55, and 1.56±0.38, respectively; p<0.001), with the lowest anxiety observed in the AVD group. Post-treatment FIS scores were also significantly lower in the AVD group (1.43±0.33) compared with the Modeling (1.79±0.43) and TSD (2.35±0.48) groups (p<0.001). Significant reductions in FIS scores from baseline to post-treatment were observed in all three groups, with mean changes of −0.464, −0.763, and −1.283 in the TSD, Modeling, and AVD groups, respectively (all p<0.001). Favourable Frankl behaviour was observed in 67.5% of children in the TSD group, 82.5% in the Modeling group, and 92.5% in the AVD group. During treatment, mean heart rates were 91.98 ± 8.42, 88.46±7.50, and 84.90±8.38 beats / min in the TSD, Modeling, and AVD groups, respectively (p<0.001). Mean treatment duration was significantly shorter in the AVD group (26.66±4.06 min) than in the Modeling (30.09±4.08 min) and TSD (31.27±4.53 min) groups (p<0.001).

Conclusion:  All three behavioural management approaches were associated with improved anxiety scores following treatment; however, AVD demonstrated the most favourable overall outcomes, with lower dental anxiety, more favourable  behaviour, lower treatment-related heart rate, and shorter treatment duration compared with conventional TSD and Modeling.