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

Abstract Background 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 a...

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Main Authors: Layla N. Khogeer, Heba Jafar Sabbagh, Osama M. Felemban, Najat M. Farsi
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Pediatrics
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Online Access:https://doi.org/10.1186/s12887-025-05849-5
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author Layla N. Khogeer
Heba Jafar Sabbagh
Osama M. Felemban
Najat M. Farsi
author_facet Layla N. Khogeer
Heba Jafar Sabbagh
Osama M. Felemban
Najat M. Farsi
author_sort Layla N. Khogeer
collection DOAJ
description Abstract Background 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. Methods 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. Results 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. Conclusions 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. Trial registration ClinicalTrials.gov with registration number NCT06326307 on March 21, 2024.
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spelling doaj-art-9e646459e4ac4d1481aa27a6e08e97f82025-08-20T03:42:00ZengBMCBMC Pediatrics1471-24312025-07-012511710.1186/s12887-025-05849-5Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trialLayla N. Khogeer0Heba Jafar Sabbagh1Osama M. Felemban2Najat M. Farsi3Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz UniversityPediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz UniversityPediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz UniversityPediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz UniversityAbstract Background 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. Methods 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. Results 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. Conclusions 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. Trial registration ClinicalTrials.gov with registration number NCT06326307 on March 21, 2024.https://doi.org/10.1186/s12887-025-05849-5AnxietyBehaviorChildrenDental careEmergencyPediatric
spellingShingle Layla N. Khogeer
Heba Jafar Sabbagh
Osama M. Felemban
Najat M. Farsi
Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial
BMC Pediatrics
Anxiety
Behavior
Children
Dental care
Emergency
Pediatric
title Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial
title_full Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial
title_fullStr Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial
title_full_unstemmed Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial
title_short Puppet play therapy in emergency pediatric dental clinic. A randomized clinical trial
title_sort puppet play therapy in emergency pediatric dental clinic a randomized clinical trial
topic Anxiety
Behavior
Children
Dental care
Emergency
Pediatric
url https://doi.org/10.1186/s12887-025-05849-5
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AT osamamfelemban puppetplaytherapyinemergencypediatricdentalclinicarandomizedclinicaltrial
AT najatmfarsi puppetplaytherapyinemergencypediatricdentalclinicarandomizedclinicaltrial