Evaluation of tell-show-do method on dental anxiety in school-age children local anesthesia injection

Dental anxiety is defined as a state of anxiety that occurs before a dental visit/treatment and is a term that usually encompasses all the different dentistry related fears. Dental injection anxiety is the most reported cause of dental anxiety. Local anesthesia is often required in the treatment of dental caries. Communication-based behavioral guidance methods are applied to reduce anxiety during visits to the dentist. Among these, "tell-show-do" is the most frequently used communication method and is approved by most parents. In our study, it was aimed to examine the effect of introducing the injector with the tell-show-do (TSD) method on the child's anxiety during local anesthesia injection. Children seeking dental treatment in our faculty clinic between 5-7 years of age in dental treatment need with buccal infiltration local anesthesia, who did not receive dental treatment with injection before, not requiring urgent dental treatment, without special medical needs, were included after obtaining the consent of their parents for our study. The first appointment was intended for adapting the children to dental setting and a preventive procedure (fissure sealant, fluoride, prophylaxis) that does not require injections was utilized for this purpose. At the end of the appointment, the child's trait anxiety was assessed with the HFD (Human Figure Drawing) scale, which was projected with a drawing with the command "Can you draw a child receiving dental treatment at the clinic" at the end of the adaptation appointment, and with the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) based on parent response. The Modified Dental Anxiety (MDAS) Scale and the Dental Anxiety Inventory Short Form (S-DAI) were used to measure the anxiety of the parent. The child's behaviour during treatment was evaluated using the Frankl Scale (FS). İnjectors its apparatus was introduced to half of the children was introduced to 2nd appointment, and the other half 3. rd appointment using TSD was introduced. Each child was evaluated in a controlled manner. İnjector and its apparatus were described as a hollow tube and the syringe and needle were assembled in front of the child before injection. To determine the state anxiety after injection, the child was asked how he felt, and the state anxiety was evaluated using a five-level rating face image scale (FIS). At the end of the 2nd and 3rd appointments, the trait anxiety measurement, was assessed again using HFD during the appointment the injector were hiddden, the injector and its parts were kept out of the child's field of vision and administered with eyes closed. To determine the state anxiety after the injection, the child was evaluated according to the FIS by asking how he felt. The behaviour of the child was evaluated with the Modified Frankl Behavior Scale (MFDS) during injection, and pain during, before and after the injection was assessed with Sound-Eye-Motor (SEM) scale from video records by another rater. Descriptive statistics of the data were conveyed as mean, standard deviation and median, min- max. Spearman's correlation test, independent sample t test and Mann Whitney U test were used for statistical analysis. Statistical significance was set at p< 0.05 level. Regardless of whether the injector is shown or not: at the 2nd and 3rd appointments; the correlation between the child's trait dental anxiety drawed by the child (p=0.740), child's behaviour during local anesthesia (p=0.085), the child's trait anxiety based on the parent's response, and the parent's dental anxiety (p=0.585); The correlation between pain during the injection (0.471) in the 2nd and 3rd appointments, before and after the injection in the 3rd appointment (p=0.135) was not significant. The correlation between state dental anxiety at the 2nd and 3rd appointments (r=0.491 p=0.007 moderate agreement), and the correlation between pre- and post-injection pain at the 2nd appointment (r=0.422 p=0.023 moderate agreement) were found significant. At the 2nd appointment, pain values during injection were not different between the cases where the injector and apparatus were shown and not. When evaluated according to gender, the child's trait anxiety based on the parent's response (p=0.947), the child's adaptation appointment projected with HFD (p=0.303); The order of showing the syringe: 2nd and 3rd appointments to state dental anxiety (p=0.447) (p=0.731), child's behaviour during local anesthesia (p=0.635) (p=0.106), trait dental anxiety projected by the child with drawing (p=. 0.317) (p=0.877), the effect on pain during injection (p=0.175) (p=0.803) was not significant. In our study, it was determined that parental anxiety level, gender, showing the injector or the order of showing had no effect on anxiety level, pain perception and behavior during injection. For this reason, contrary to the general belief, we think that treatment can also be performed by showing the injector using the TSD method in school-age children (5-7 years old). Keywords: Tell-show-do, dental anxiety, local anesthesia