Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial

• Published in: BMC pediatrics Vol. 25; no. 1; pp. 503 - 7
• Main Authors: Khogeer, Layla N., Sabbagh, Heba Jafar, Felemban, Osama M., Farsi, Najat M.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.07.2025; BioMed Central; BMC
• Subjects: Anesthesia, Dental; Anesthesia, Local; Anxiety; Behavior; Care and treatment; Child; Child Behavior; Child, Preschool; Children; Children & youth; Clinical trials; Cognitive development; Dental Anxiety - prevention & control; Dental Anxiety - therapy; Dental assistants; Dental care; Dental Care for Children - methods; Dental Care for Children - psychology; Dental Clinics; Dentistry; Dentists; Emergency; Female; Health aspects; Heart beat; Heart Rate; Humans; Local anesthesia; Male; Methods; Pediatric; Pediatric emergencies; Pediatric research; Pediatrics; Play and Playthings; Play therapy; Play Therapy - methods; Psychosocial development; Psychotherapy; Puppets; Testing; Saudi Arabia; United States > US; Anxiety; Behavior; Children; Emergency; Dental care; Pediatric; Play therapy; Puppet
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-025-05849-5

Dental fear and anxiety can significantly hinder the treatment of children. The aim of this research is to compare the effect of puppet play therapy (PPT) and tell-show-do (TSD) behavior guidance technique on child's behavior and anxiety in emergency dental clinics during local anesthesia (LA) administration. This randomized clinical trial included 50 children aged 3-6 years in need of emergency dental treatment under LA. The subjects were randomized into 2 equal groups: the PPT group, where behavior management was provided using PPT, and the TSD group where TSD was used as the behavior guidance technique. Dental anxiety levels were evaluated using the Facial Index Scale (FIS) and Venham Anxiety Rating Scale. Pulse rates were measured before, during and after anesthesia administration. Patient behavior was also scored using the Frankl Behavior Rating Scale and Venham Behavior Rating Scale. The Face, Legs, Activity, Cry, Consolability (FLACC) scale was used to assess pain. The mean heart rates were lower for patients who received PPT (94.12 ± 15.71; 106.88 ± 12.67 and 103.16 ± 13.6) compared to TSD (103.4 ± 20.94, 112.5 ± 23.17 and 111.48 ± 25.07) before, during and after the LA, respectively. Anxiety levels measured by FIS were significantly reduced using PPT (p < 0.001) compared to TSD. This study presents a behavior modification method demonstrating efficacy in reducing anxiety among young children who had no previous dental exposure and underwent immediate invasive dental procedures, utilizing puppet play therapy. ClinicalTrials.gov with registration number NCT06326307 on March 21, 2024.