Effect of Tell-Show-Do Versus Audiovisual Distraction on Pediatric Dental Anxiety and Cooperation: A Prospective Non-randomized Study in Greece.

backgroundDental anxiety in children is a multifactorial condition influenced by biological, psychological, and environmental determinants. It is commonly associated with uncooperative behavior, compromised treatment outcomes, and negative attitudes toward dental care. To address these challenges, a wide range of non-pharmacological behavior management techniques have been developed and applied in pediatric dentistry, including Tell-Show-Do (TSD) and Audiovisual Distraction (AVD), both of which aim to reduce dental anxiety and enhance cooperative behavior during treatment. Despite their extensive clinical use, comparative evidence on their effectiveness in Greek pediatric patients remains limited.

methodsA prospective, non-randomized, comparative exploratory study was conducted in a private dental clinic in Athens, Greece, involving 50 children aged 4-15 years, who were allocated to the TSD or AVD group using a non-randomized allocation procedure intended to balance group sizes; allocation concealment was not implemented. Children's anxiety and cooperative behavior during dental treatment were assessed in real time by an observer not involved in the clinical procedure, using the Venham Behavior Rating Scale (VBRS) and the Venham Clinical Anxiety Scale (VCAS). Demographic and procedural variables were also collected. Statistical analysis was performed using descriptive statistics and the Mann-Whitney U test, with significance set at p < 0.05. Between-group differences were reported with effect sizes (Cliff's delta) and 95% confidence intervals to quantify magnitude and precision.

resultsFifty children (mean age 9.8 ± 2.5 years) participated in this study. Both techniques were associated with low anxiety levels and improved cooperation during dental treatment. No statistically significant associations were observed in this sample; however, the study may be underpowered to detect small-to-moderate effects, estimates were imprecise, and residual confounding could not be excluded.

conclusionsNo statistically significant between-group differences were detected in this small, non-randomized clinic sample; equivalence cannot be inferred. These findings contribute population-specific data from Greek children that may support individualized behavior management in routine clinical settings and guide future, larger comparative studies.