Effectiveness of origami and puzzle game in alleviating dental anxiety and pain perception during local anesthesia administration in children: a randomized clinical trial.

Background: Children experience anxiety in unfamiliar dental environments, impacting their behavior and impeding dental treatment. Local anesthetic infiltration (LA) induces anxiety in children. Distraction is recommended to alleviate the pain and anxiety associated with LA administration. Origami and puzzle games are promising, economical, nonpharmacological techniques to minimize dental anxiety and can enhance intellectual and cognitive development. This study aimed to evaluate the effectiveness of origami and puzzle games as distraction techniques for reducing dental anxiety and pain during local anesthesia infiltration in children aged 5-10 years during local anesthesia infiltration. Methods: Fifty-two healthy children, aged 5-10 years, undergoing dental procedures requiring local anesthesia were chosen and divided into two groups. Each group comprised 26 children as determined by simple randomization. Group I: Puzzle game group; Group II: Origami group. In both groups, a physiological measure (pulse rate by pulse oximeter) was measured prior to, during, and following LA administration, while the face, legs, activity, cry, and consolability (FLACC) scale was used to record anxiety levels before and after the intervention. The FLACC Scale, an objective measure, was used to record pain perception during LA administration, whereas the faces pain scale, a subjective measure, was used to record pain perception following LA administration. This was followed by the needful treatment. Pulse rates were compared between the two groups using independent and paired t-tests for inter-and intragroup assessments, respectively. The Wilcoxon signed-rank test and Mann-Whitney U test were used to analyze anxiety and pain scores. Results: Intragroup comparisons of pulse rates before, during, and after LA administration were statistically significant (P < 0.001). Inter-group comparison of pulse rates was also statistically significant during LA administration (P = 0.04); however, there was no significant difference before intervention and after LA administration. However, after the intervention, the mean anxiety scores were significantly reduced in the puzzle game group (P = 0.004). The mean pain scores of the FLACC and Faces Pain Scale-Revised were lower (P < 0.001) in the puzzle game group than in the origami group. Conclusion: Puzzle games were the most effective in lowering children's pain and anxiety during LA administration.