Assessing the effectiveness of robot-pets in reducing dental anxiety in children: A randomized controlled clinical trial

Objective: The aim of this study is to comparatively evaluate the effectiveness of using a robot-pet as a distraction technique on dental anxiety and behavior in children aged 6-10 years during dental treatment. Methods: A total of 72 children aged 6-10 years with no previous dental experience, needs fissure sealant treatment were included in this study. Children were randomly assigned to three groups according to received distraction technique during fissure sealant application; each group having 24 patients as follows: Group-1: Robot-Pet, Group-2: VR Glasses, and Group 3: Tell- Show-Do (Control). Dental anxiety levels and behaviors were assessed at different timepoints. Preoperative (T1) baseline levels of dental anxiety were measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Facial Image Scale (FIS), and behavior were measured using the Frankl Behavior Rating Scale (FBRS). Intraoperative (T2) cooperation levels were recorded using the Modified Houpt Scale (MHS) during the surface cleaning (T2A), isolation (T2B) and washing (T2C) phases of fissure sealant application. Postoperative (T3) dental anxiety level and behavior measurements (CFSS-DS, FIS, FBRS) were repeated. Physiological markers for dental anxiety, such as heart rate and oxygen saturation, were measured at all time points (T1, T2A, T2B, T2C, T3). Children and parents in the Robot-Pet and VR Glasses were received a questionnaire for their perception about the use of their distraction technique (T3). Chi-Square, Kruskal-Wallis, Brunner-Langer and Benjamini tests were used for statistical analysis. Type-1 error level was taken as p<0.05. Results: The average age of the 72 children included in the study was 7.63±1.1 years. Although there were no significant differences in pulse values between the groups (p>0.05), a significant increase in pulse rate was observed during the washing phase (T2C) compared to the pre-treatment phase (T1) across all groups (p<0.05). Frankl scores in all groups significantly increased post-treatment (T3) compared to pre-treatment (T1) (p<0.05); however, no significant differences were found between the groups (p>0.05). The VR group's Modified Houpt-Movement scores were found to be lower compared to the Robot-Pet and Control groups (p<0.05). No significant differences were found between the groups in Modified Houpt-Crying scores (p>0.05). The VR group's Modified Houpt-Overall Behavior scores were lower compared to the Control group (p<0.05). No significant differences were found between the Robot-Pet/Control and Robot-Pet/VR groups in Modified Houpt-Overall Behavior scores (p>0.05). CFSS-DS and FIS scores significantly decreased post-treatment (T3) compared to baseline (T1) in all groups (p<0.05); however, no significant differences were found between the groups (p>0.05). Both children and parents generally assessed the use of the robot-pet and VR positively. Conclusions: Distraction with using a robot-pet, VR glasses, and the tell-show-do technique have been found effective in reducing dental anxiety during fissure sealant application in children receiving dental treatment for the first time. However, no superiority among these techniques has been established. Due to the significant reduction in dental anxiety and the satisfaction of both children and their parents in the Robot-Pet group, It is considered that the distraction technique with robot-pet in children could potentially serve as a supportive tool for clinicians as a behavioral guidance technique. Key Words: Behavior control, Dental anxiety, Child Behavior