Efficacy of scenario-experiential behavior management techniques on dental fear in preschool children with dental caries: a randomized controlled trial

Abstract

Background

Children’s dental fear (CDF) has become a major factor compromising the quality of dental treatment. Over time, persistent dental fear may adversely affect both the physical and psychological well-being of pediatric patients.This study aims to assess the effect of scenario-experiential behavior management techniques on dental fear in preschool children with dental caries.

Methods

Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400090907) registered 15 October 2024. A total of 100 children who met the inclusion and exclusion criteria in the pediatric stomatology department were selected and randomly assigned to either a control group or an intervention group using a random number table. The control group received standard pediatric dental care, while the intervention group was given a scenarioexperiential plan before treatment. Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) scores, Frankl Rating Scale (FRS) scores, and parental satisfaction levels were compared between the two groups. Descriptive analysis, the independent test, the Pearson’s chisquare test, Wilcoxon rank sum test and Fisher’s exact test were applied.

Results

One hundred children were recruited in the study. Seven children were lost to follow-up or excluded, leaving 93 children with a mean age of 4.54 ± 0.98 years for final analysis (46 in the intervention group, 47 in the control group). Before the intervention, there were no significant differences in CFSS-DS or FRS scores between the two groups. After the intervention, the intervention group had significantly lower CFSS-DS scores (25.26 ± 6.96) compared to the control group (29.40 ± 10.15) (P = 0.024, t = 2.287, 95%CI = 0.545,7.742). In the intervention group, 34 children (73.91%) reached FRS level 3 and 8 (17.39%) reached level 4. In contrast, the control group had 25 children (53.19%) at level 3 and 6 (12.77%) at level 4. Children in the intervention group showed better treatment cooperation (P = 0.015,Z=-2.444, 95%CI = 0.009,0.012). At the end of the study, 36 (78.30%) parents in the intervention group reported being very satisfied, compared to 31 (66.00%) parents in the control group. Parental satisfaction was significantly higher in the intervention group (P = 0.027, χ² = 9.151,95%CI = 0.018,0.024).

Conclusions

The findings of this study indicated scenario-experiential behavior management techniques showed significant advantages in alleviating dental fear in preschool children and improving their compliance during visits. Through one-on-one interactive games, both children and their parents receive clear explanations of dental procedures, which helps improve their overall satisfaction. However, due to some limitations of this study, it would be necessary to conduct randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-025-07352-w.

Introduction

Child dental fear (CDF) is defined as the psychological state in which children exhibit pronounced worry, tension, and fear toward unfamiliar clinical settings, pain stimuli, dental instruments, and related factors during dental procedures. This emotional response typically leads to heightened sensitivity to dental care, reduced pain tolerance, and may even manifest as avoidance behaviors or explicit refusal of treatment [1]. Dental fear arises largely from the uncertainty associated with unfamiliar settings, individuals, and tools used during treatment [2]. Dental fear in children is a widespread issue across the globe, with incidence rates reported between 5.7% and 20.6% [3]. These rates vary across regions, reaching 21.9% in Europe, 19.2% in Asia, and 20.2% in the United States [4]. This phenomenon is primarily attributed to multiple interacting factors: inherent temperamental characteristics (children with timid or sensitive dispositions show higher susceptibility), familial influences (parental dental anxiety can subtly influence children’s attitudes through behavioral modeling) [5], and critical dental experiences (initial painful or unpleasant treatments often establish persistent negative associations) [6, 7].

Dental fear presents various challenges to children’s health. Delaying or avoiding treatment for dental caries may worsen the condition, causing pain, eating difficulties, sleep problems, and frequent school absences. In more severe cases, it can interfere with proper nutrition and reduce overall quality of life [8]. Over time, persistent fear can contribute to psychological distress, including low self-esteem, anxiety, and reluctance to seek oral healthcare, effects that may carry into adulthood [9]. Effective dental behavior management can help ensure that children complete treatment efficiently and with less distress. Additionally, it contributes to minimizing uncooperative behavior [10].

At present, most studies research on children’s oral behavior guidance mainly focus on traditional behavior management techniques, such as Tell-Show-Do (TSD) [11, 12] and audio-visual distraction [13, 14]. With the advancement of information technology and artificial intelligence, there has been a gradual increase in studies exploring the application of virtual reality technology in oral behavior guidance and some various digital intervention measures interventions [15, 16]. However, these methods do not provide children with an adaptive and vivid simulated medical environment. Scenario experience is a new type of intervention method adopted in this study, whose core lies in presenting an immersive narrative scene.It refers to the process by which individuals gain knowledge through role-playing in realistic environments, leading to insights and understandings that shape behavior and, in turn, influence the situation itself [17]. This approach has already been applied in the care of patients with diabetes [18] and colorectal cancer [19], where it has shown beneficial effects on mental well-being. At present, only a few clinical randomized controlled trials (RCTs) have examined this technique for managing children’s behavior in dental settings, which are constrained by several limitations, including small sample sizes and brief follow-up periods. This study is designed to further validate the efficacy and safety of this technique through a rigorously designed randomized controlled trial (RCT).

The psychological behaviour management program encourages children to engage directly in simulated diagnostic and treatment scenarios. By building familiarity, it aims to reduce cognitive resistance, ease emotional tension, and help children adapt to the treatment environment.We hypothesized that children who have undergone scenario experience behavior management techniques would report less anxiety and fear and exhibit fewer uncooperative behaviors.

Methods

Study design

This was a prospective, randomized, comparative clinical trial. The design phase adhered to the CONSORT reporting guidelines framework to ensure the completeness and transparency of subsequent results reporting [20].

Participants

Participants were recruited from the Department of Paediatric Dentistry at West China Hospital of Stomatology, Sichuan University, between July 1, 2021, and June 30, 2022. The inclusion criteria were as follows: children aged three to six years who have mild to moderate dental caries in primary teeth requiring resin restoration treatment, and present for an initial dental evaluation with no prior dental treatment. Diagnostic classifications were based on the Clinical Practice Guidelines: Stomatology Volume issued by the Chinese Medical Association. Mild caries (ICDAS 1–2) referred to incipient demineralization confined to the enamel surface, presenting as non-cavitated lesions without symptoms. Moderate caries (ICDAS 3–4) involved dentin and was identified by softened dentin detectable on tactile examination, with lesion depth nearing 2 mm [21]. The exclusion criteria were as follows: children diagnosed with neurological or developmental disorders (including cerebral palsy, intellectual disability, speech impairment, epilepsy, and other behavioral or psychiatric conditions) [22] or with significant oral or maxillofacial deformities. Children requiring root canal treatment during the therapy course were also excluded. During the initial visit, the study procedures were explained in detail to parents and children. Only those who provided written informed consent were included.

Sample size

Sample size was calculated based on an alpha error of 5% and a statistical power of 95%. The primary outcome measure was the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) score. Using an effect size (σ) of 13.56 from a previous study [23], and a mean difference (δ) of 9.59 between groups (δ = µ₁ - µ₂), the formula for sample size was: (n) = n₁ = n₂ =[2σ²(Z_α/2་Z_β/2)²]/(µ₁-µ₂)². This yielded a required sample of 42 per group. To account for a potential 20% dropout rate, the final sample size was increased to 50 participants in each group.

Ethical approval

This study was approved by the Institutional Review Board of West China Hospital of Stomatology, Sichuan University, Chengdu, China (WCHSIRB-D-2021-235). The trial was retrospectively registered on the Chinese Clinical Trial Registry on October 15, 2024 (Registration number: ChiCTR2400090907) under the title “Efficacy of scenario-experiential behavior management techniques on dental fear in preschool children with dental caries: a randomized controlled trial. " However, the study followed a prospectively designed research protocol (see the registration platform attachment for details), and all trial procedures did not change after registration.All participants’ legal guardians fully understood the research procedures, provided written informed consent, and agreed to the use of their medical records.

Randomization and allocation concealment

Children meeting the inclusion and exclusion criteria were selected using a convenience sampling method. Each participant was assigned a number from 1 to 100 based on their order of visit.One hundred children were randomly assigned in a 1:1 ratio using a list of random numbers generated by Office Excel.Allocation concealment was strictly enforced throughout the grouping process to maintain the integrity of randomization.

Blinding

This study was an assessor-blinded randomized controlled trial. Due to the nature of the intervention, complete blinding of children and their parents to the intervention method was not feasible; however, they remained unaware of their group allocation.Importantly, both the date collecters and statisticians were fully blinded to the group allocation.

Intervention

Before initiating the study, we established a collaborative healthcare team composed of one head nurse, two pediatric dentists, two data collectors, and three intervention implementers. All members had received training in child psychology and behavior management and had at least three years of experience in pediatric behavioral care. Each team member demonstrated strong communication skills when interacting with children and their parents.

The children in the intervention group received the scenario-experiential behavior management techniques. While the control group received conventional behavior management techniques, such as TSD, positive reinforcement, and provision of small rewards.The specific implementation process is as follows:

Drawing on principles of child psychology and behavioral traits, we created an immersive “little dentist” experience room within the pediatric department. This designated area was designed to simulate real diagnostic procedures in a playful and child-appropriate setting. The intervention implementers of the research team acted as experience mentors. Parents were invited to participate by playing the role of “patients”, while the children took on the role of “little dentists”.This setup allowed children to gain a hands-on, close-up understanding of dental procedures through role play. The experience room was equipped with child-safe dental instruments and props. Upon entering, children and their parents were welcomed by the mentor, who introduced the equipment using tools such as tooth models, animated videos, and cartoon illustrations. These materials were used to explain the function of diagnostic and treatment instruments in simple terms. Following the introduction, a role-play scenario was arranged where the parent acted as the patient and the child assumed the role of the dentist. Under the mentor’s supervision, the child used basic instruments including a mouth mirror, forceps, and a three-way syringe to simulate treatment on the parent. Throughout the session, children were encouraged to ask questions and share their feelings. The mentor responded supportively, offering praise and reassurance to help build the child’s confidence and reduce apprehension about actual treatment. To maintain focus and ensure quality engagement, the intervention was conducted one-on-one, with only one child participating at a time.

The control group did not receive the scenario-experiential behavior management technique. Instead, they received conventional nursing care, which included watching movies during waiting times to distract attention, adopting behavioral management techniques (such as Tell-Show-Do, positive reinforcement, and provision of small rewards), and educating parents and children on oral health through videos.

All children in this study received two treatment sessions. At the first visit, they underwent either fluoride varnish application or pit and fissure sealant placement. The second visit, scheduled seven days later, involved composite resin restoration. The intervention group received the scenario-experiential intervention before the first visit. After the study concluded, the control group was also offered the same behavioral management technique that had been provided to the intervention group. Children who missed follow-up appointments for personal reasons were recorded as missing and excluded from data analysis.

Outcomes

The primary outcome was the difference in CFSS-DS score changes between groups after treatment. We also compared children’s treatment cooperation and parental satisfaction as secondary outcomes.

The level of dental fear was assessed using the modified Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), validated by Lu Jiaxuan et al. [24]. The scale demonstrated good internal consistency, with a Cronbachs α of 0.87 and a test-retest reliability of 0.72. Item-dimension correlation coefficients ranged from 0.58 to 0.90. The CFSS-DS consists of 17 items evaluating fear in scenarios such as seeing the dentist, receiving an injection, opening the mouth wide, and undergoing tooth extraction. Each item is scored from 1 to 5 based on five facial expressions representing increasing levels of fear. The total score ranges from 17 to 85, with higher scores indicating higher anxiety. Children scoring above 35 were considered to have dental anxiety.

Treatment compliance was evaluated using the improved version of the Frankl Rating Scale (FRS) [25], which classifies behavior on a four-level scale: Level 1 indicates extremely uncooperative behavior, Level 2 uncooperative, Level 3 cooperative, and Level 4 very cooperative.

Parental satisfaction was assessed using a scale adapted from existing research [26, 27]. Clinical experts reviewed and revised the scale to fit the context of this study and the pediatric population. The questionnaire exhibited good internal consistency, with a Cronbach’s α of 0.97. Consisting of 10 items, the instrument systematically assessed multiple dimensions of patient experience, including the clinical environment, healthcare staff attitudes, professional conduct, interpersonal communication, health education delivery, and overall satisfaction with the care received.Each item was scored from 0 to 10, with a total possible score of 100. Scores of 90–100 indicated “Very Satisfied”, 80–89 “Relatively Satisfied”, 70–79 “Dissatisfied”, and scores below 70 were categorized as “Very Dissatisfied”.

Data collection

Baseline assessments were conducted before the children’s first treatment, while the follow-up assessmensts were performed during the second visit seven days later.

Data collectors initially screened newly registered children through the HIS system before their hospital visit, scheduled telephone consultations, and coordinated appointment times. During the first appointment, children underwent clinical and radiographic examinations to develop a treatment plan. For those who meet the inclusion and exclusion criteria, while waiting for their treatments, parents were guided to a separate consultation room by data collectors. The parent version of the CFSS-DS was used to evaluate the children’s dental fear and anxiety. Parents were also asked to complete a basic information form about their children, including age, gender, whether they are only-child, primary caregiver, etc. At the first oral examination and during the second treatment, the same pediatric dentist assessed each child’s behavior using the FRS and recorded the results in the medical record. Following the second visit, parents completed a satisfaction questionnaire. All completed forms were collected on-site by the research team. Each submission was checked immediately, and any missing items were addressed without delay.

Statistical analysis

Data analysis was conducted using SPSS 21.0. Measurement data were presented as mean, median, and standard deviation (SD), and compared between groups using the independent t-test or analysis of variance. Categorical data were presented as frequencies and proportions, with comparisons made using the Pearson’s chi-square test. Ranked data were compared using the Wilcoxon rank sum test or Fisher’s exact test. A significance level of P < 0.05 was used for all statistical tests.

Quality control

The behavior management team was led by a head nurse in the pediatric dentistry department and included nurses with over three years of experience in pediatric care. All team members received standardized training covering child behavior management theory, intervention protocol procedures, and proper data recording. They commenced their roles only after passing assessment. Weekly team meetings were held to review intervention cases and unify procedural standards. The consistency of intervention implementation and data collection was monitored by the head nurse.

Results

A total of 100 preschool children (50 males and 50 females) were enrolled and randomly assigned into two groups. In the intervention group, 2 children were excluded and 2 were lost to follow-up. In the control group, 2 were excluded and 1 was lost to follow-up. The number of excluded participants and those lost to follow-up was less than 20%, which fell within the allowable range and would not have affected the results.The patient flow throughout the trial is presented through a CONSORT Flow Diagram (Fig. 1). Ultimately, 93 children (46 in the intervention group and 47 in the control group) completed the study with a mean age of 4.54 ± 0.98 years. Among those who completed the study, 46.23% were male and 53.76% female. Age differences were analyzed using the independent t-test, while differences in gender and only-child status were assessed via the Pearson’s chi-square test. For differences among primary caregivers, Fisher’s exact test was employed.The mean age was 4.40 ± 1.00 years in the intervention group and 4.67 ± 0.96 years in the control group. There were no significant differences between groups regarding age (P = 0.193), gender (P = 0.471), only-child status (P = 0.178), or primary caregiver (P = 0.593) (Table 1).

Fig. 1.

CONSORT flow diagram showing the patients’ flow throughout the clinical trial

Table 1.

General information of two groups of the preschool children (N = 93)

Item	Category	Control group (n = 47)	Intervention group (n = 46)	Statistical value	P
Age(years)		4.67 ± 0.96	4.40 ± 1.00	1.311	0.193
Gender	Male	20	23	0.519	0.471
	Female	27	23
Only-child	Yes	30	23	1.814	0.178
	No	17	23
Primary caregivers	Parents	37	38	1.470	0.593
	Grandparents	10	7
	Else	0	1

Table 2 presents intragroup and intergroup comparisons of dental fear, with independent t-test applied for all analyses. At baseline, no significant difference was found between the two groups in CFSS-DS scores (P = 0.910,t = 0.113,95%CI=−3.885,4.354). After the intervention, the intra-group comparison results showed that there was a statistically significant improvement in CFSS-DS scores for both groups. The mean score of the CFSS-DS after intervention in the intervention group was 25.26 ± 6.96,which was lower than the pre-intervention score of 31.98 ± 9.69(P = 0.000, t = 3.811,95%CI = 3.22,10.22). The score of the control group after intervention was 29.40 ± 10.15, which was also lower than its pre-intervention score of 32.21 ± 10.29, however, there was no statistical difference(P = 0.186,t = 1.332,95%CI=−1.38,6.70).The intergroup comparison revealed that score of CFSS-DS in the intervention group (25.26 ± 6.96) was significantly lower than that in the control group(29.40 ± 10.15),indicating reduced dental fear (P = 0.024, t = 2.287, 95%CI = 0.545,7.742).

Table 2.

Comparison of mean CFSS-DS scores at different time using the independent t-test among a sample of preshool children (N = 93)

Group	cases(n)	Pre-intervention	Post-intervention	t	P
Control group	47	32.21 ± 10.29	29.40 ± 10.15	1.332	0.186
Intervention group	46	31.98 ± 9.69	25.26 ± 6.96	3.811	0.000
t		0.113	2.287
P		0.910	0.024

Table 3 shows the comparison of Frankl Rating Scale (FRS) scores between the two groups with Wilcoxon rank sum test for all analyses. No significant difference was observed at baseline (P = 0.406,Z=−0.831,95%CI = 0.414,0.433). However, after the intervention, the intervention group demonstrated significantly better behavioral compliance during treatment compared to the control group (P = 0.015,Z=−2.444, 95%CI = 0.009,0.012).

Table 3.

Comparison of Frankl Rating Scale (FRS) scores at different time using the Wilcoxon rank sum test among a sample of preshool children (N = 93)

	Group (n)	Level 1	Level 2	Level 3	Level 4	Z	P
Pre-intervention	Control group (47)	1(2.12%)	12(25.53%)	29(61.70%)	5(10.65%)	−0.831	0.406
	Intervention group (46)	0(0%)	11(23.91%)	27(58.70%)	8(17.39%)
Post-intervention	Control group (47)	0(0%)	16(34.04%)	25(53.19%)	6(12.77%)	−2.444	0.015
	Intervention group (46)	0(0%)	4(8.70%)	34(73.91%)	8(17.39%)

Pearson’s chi-square test was used to analyze parental satisfaction between the two groups. As shown in Table 4, parental satisfaction at the end of the study was significantly higher in the intervention group (P = 0.027, χ² = 9.151,95%CI = 0.018,0.024). Specifically, 36 (78.3%) parents in the intervention group reported being very satisfied, compared to 31 (66.0%) parents in the control group.

Table 4.

Comparison of parental satisfaction at the end of the study using the pearson’s chi-square test among a sample of preshool children (N = 93)

Group	cases(n)	Very Satisfied	Relatively Satisfied	Dissatisfied	Very Dissatisfied	χ2	P
Control group	47	31(66.00%)	4(8.50%)	9(19.10%)	3(6.40%)	9.151	0.027
Intervention group	46	36(78.30%)	8(17.40%)	2(4.30%)	0(0%)

Discussion

Young children often display uncooperative behaviors such as dodging, crying, and resistance during dental visits, which frequently result in poor oral health outcomes [28]. These behaviors stem largely from immature psychological development and limited coping capacity, compounded by anxiety in unfamiliar clinical settings, sensitivity to the sounds of dental equipment, and past negative healthcare experiences [29–31]. Dental simulation games can help children become familiar with instruments and procedures, reducing fear of the unknown and improving treatment cooperation [32].

This research focused on preschool children aged 3 to 6 years, a group with particularly high levels of dental fear, where incidence can reach up to 30% [33]. Selecting this age range helped reduce variability related to communication ability. Children under the age of 3 often lack the cognitive and expressive skills needed for guided behavioral techniques [34]. Children aged 3 to 6 are in the preoperational stage of cognitive development, where understanding is rooted in concrete thinking. At this stage, they require tangible stimuli to grasp abstract concepts [35]. They also tend to respond more readily to behavior guidance strategies applied by dentists [36]. The scenario-experiential techniques uses role-playing and simulation games to present dental procedures in an accessible and engaging way. By replicating real clinical tools and scenarios, this approach allows children to develop a clearer understanding of treatment processes. It transforms the experience into something more familiar and less intimidating, helping reduce anxiety and encouraging active cooperation.

As a behavioral management approach, scenario-experiential techniques are characterized by vividness, adaptability, and interactivity. These characteristics help convert otherwise rigid, formal health education into more engaging formats that children can understand and accept more easily [37]. In this study, children took on the role of “little dentists” while parents acted as “patients”, allowing children to engage actively with the tools and environment. This role-play framework helped build early awareness of the dental setting, instruments, and procedures. It encouraged children to participate willingly and formed a more concrete, relatable understanding of dental care. The program was designed especially for children with no prior dental experience. By starting with simple, non-invasive procedures during the first visit and progressing to basic invasive procedures at the second, the intervention followed a gradual path that supported children’s adjustment to treatment.

The empirical findings of this study support our core hypothesis, confirming that scenario-experiential techniques are superior to traditional behavior management intervention in reducing anxiety levels and improving cooperative behaviors.The results of this study show that, compared to baseline, CFSS-DS scores in the intervention group decreased by 21.01% after treatment, while the control group saw only an 8.7% reduction. Although anxiety and fear levels declined in both groups, the intervention group achieved significantly greater improvement.Scenario-experiential behavior management, which combines dental simulation games with role-playing, appears to be more effective in helping children become familiar with the dental environment and understand the instruments involved in treatment. This, in turn, contributes to reduced anxiety and fear. Karkoutly et al. [38] reported that dental simulation games can immediately reduce physiological responses related to dental anxiety after environmental adaptation. Similarly, Tahersoltani et al. [37] observed that while the TSD technique had no effect on pulse rate, participation in the “little dentists” game significantly lowered it. In our study, children in the control group who received TSD showed only slight reductions in dental fear. Abbasi et al. [39] also found that although TSD remains the most widely used behavior management technique, it is not effective in lowering anxiety levels. Meshki et al. [40] even suggested that TSD might intensify anxiety in some cases. These inconsistencies may result from differences in study design, patient demographics, clinical environments, and how the clinicians/dental teams’ approach and experience with the implementation of the technique.

After treatment, children in the intervention group demonstrated significantly better cooperative behavior during dental procedures compared to the control group. Although TSD has long been the standard approach in managing children’s behavior in dental settings [41], our findings show that scenario-experiential techniques can increase children’s cooperation. This is consistent with the findings of Meshki [40] and Maru et al. [42]. The “little dentists” role-playing activity facilitated an identity shift in participating children, helping them better understand the dentist’s role and the treatment process. This deepened understanding encouraged greater willingness to cooperate during procedures.Compared with the use of VR audio-visual distraction methods, the scenario-experiential techniques provided real-world environmental references, which are more aligned with the spatial cognition levels of preschool and early school-aged children [10]. When compared to conventional TSD methods, distraction-based strategies such as dental simulation games and dentist role-play were more effective in reducing anxiety and fear in pediatric patients [43].

Furthermore, the study showed that parental satisfaction of the intervention group reported significantly higher than those of the control group. Scenario-experiential techniques improved the treatment experience by emphasizing children’s emotions and engagement, while also reinforcing the connection between caregivers and dental staff. Through one-on-one interactive sessions, both children and their parents received clear, accessible explanations of dental procedures, which helped reduce uncertainty and improved their overall satisfaction with the care process [44].

This study has several limitations. First, it assessed only the short-term effects of scenario-experiential behavior management, with the gamified experience provided only before the first dental appointment. Second, physiological indicators such as pulse rate and blood pressure were not measured, and caries risk indices were not collected, which may have limited further analysis. Additionally, the convenience sampling method was used in this study, which may limit the representativeness of the sample.And the sample inclusion was restricted to tertiary hospitals in urban areas, which may introduce selection bias. An additional limitation is that the parentl satisfaction questionnaire used was an adapted version for which we only report internal consistency reliability, without a full validation. Future studies should conduct a more thorough validation of the questionnaire based on this foundation.Finally, the small sample size and age concentration (3–6 years old) limit the generalizability of findings to children in the late primary dentition stage. In the future, it is necessary to expand the sample size and include a larger age-span cohort (e.g., 7–12 years old) for validation.

Conclusion

The findings of this study indicated that compared to traditional behavioral management techniques, scenario-experiential behavior management techniques showed significant advantages in alleviating dental fear in preschool children and improving their compliance during visits. The scenario-experiential behavior management techniques emphasizes children’s participation and interactivity. Through one-on-one interactive games, both children and their parents receive clear and easy-to-understand explanations of dental procedures, which helps improve their overall satisfaction with the healthcare process. However, due to some limitations of this study, it would be necessary to conduct more rigorously designed randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.

Abbreviations

CDF

Children's Dental Fear

CFSS-DS

Children's Fear Survey Schedule-Dental Subscale

FRS

Frankl Rating Scale

TSD

Tell-Show-Do

RCT

Randomized Controlled Trial

ICDAS

International Caries Detection and Assessment System

Authors’ contributions

Yan Wang: Conceptualization, data collection, curation, performing the study measurements, analysis of the study results, drawing out the final study conclusions. Sha Luo: Conceptualization, data collection, curation, performing the study measurements, analysis of the study results, drawing out the final study conclusions, writing and preparing the original manuscript, reviewing and editing. Luping Yang: Data collection, curation. Xiaodan Wang: Data collection, curation. All authors contributed to critical revision and approval of the final manuscript.

Funding

This trial was funded by the Soft Science Foundation of West China Hospital of Stomatology, Sichuan (WCHSIRB-D-2021-235).

Data availability

The dataset and materials are available from the corresponding author upon reasonable request, but not publicly accessible due to patient privacy concerns.

Declarations

Ethics approval and consent to participate

The trial has been registered and approved by the Chinese Clinical Trial Registry on October 15, 2024 (Registration number: ChiCTR2400090907), with the name of the registry being “Efficacy of scenario-experiential behavior management technology on dental fear in preschool children with dental caries: a randomized controlled trial “. Participants and their legal guardians consented to the publication of relevant results and materals, and submitted the informed consent forms.This research was conducted in accordance with the World Medical Association Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.