Tell-Show-Do: Effective Behavior Management for Children aged 5 to 9 years
Main Article Content
Abstract
Dental fear affects 24–36% of children aged 5–9, complicating treatment and increasing risks of poor oral health outcomes. The Tell-Show-Do (TSD) technique, a non-pharmacological behavior management strategy, aims to reduce anxiety and enhance cooperation in pediatric dentistry.
Aim: This study evaluated TSD's effectiveness in a private dental clinic in Sofia, Bulgaria, from February to April 2025. It involved 60 children (30 boys, 30 girls) aged 5–9 with dental fear and no prior dental experience who required restorations for carious primary molars.
Material and methods: The TSD group (n=30) received structured explanations, demonstrations, and treatment, while the control group (n=30) received standard care. Outcomes were assessed using the Frankl Behavior Rating Scale for cooperation, the Modified Child Dental Anxiety Scale (MCDAS) for anxiety, and a 5-point Likert scale for parental satisfaction.
Results: The TSD group showed significantly higher cooperation, greater anxiety reduction, and higher parental satisfaction.
Conclusion: TSD's structured approach, supported by child-friendly environments, effectively mitigates dental fear, enhances cooperation, and improves satisfaction, reinforcing its value in private pediatric dental practice.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Sun IG, Chu CH, Man Lo EC, Duangthip D. Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis. Journal of Dentistry. 2024; 142: 104841.
Grisolia BM, Dos Santos APP, Dhyppolito IM, Buchanan H, Hill K, Oliveira BH. Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses. Int J Paediatr Dent. 2021 Mar;31(2):168-183.
Seligman LD, Hovey JD, Chacon K, Ollendick TH. Dental anxiety: An understudied problem in youth. Clin Psychol Rev. 2017 Jul;55:25-40.
Tickle M, Jones C, Buchannan K, Milsom KM, Blinkhorn AS, Humphris GM. A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age. Int J Paediatr Dent. 2009 Jul;19(4):225-32.
Coxon JD, Hosey MT, Newton JT. The impact of dental anxiety on the oral health of children aged 5 and 8 years: a regression analysis of the Child Dental Health Survey 2013. Br Dent J. 2019 Nov;227(9):818-822.
Coxon JD, Hosey MT, Newton JT. The oral health of dentally anxious five- and eight-year-olds: a secondary analysis of the 2013 Child Dental Health Survey. Br Dent J. 2019 Apr;226(7):503-507.
Mendoza-Mendoza A, Perea MB, Yañez-Vico RM, Iglesias-Linares A. Dental fear in children: the role of previous negative dental experiences. Clin Oral Investig. 2015 Apr;19(3):745-51.
Klingberg G, Berggren U, Carlsson SG, Noren JG. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci. 1995 Dec;103(6):405-12.
Barenie JT, Ripa LW. The use of behavior modification techniques to successfully manage the child dental patient. J Am Dent Assoc. 1977 Feb;94(2):329-34.
Farhat-McHayleh N, Harfouche A, Souaid P. Techniques for managing behaviour in pediatric dentistry: comparative study of live modelling and tell-show-do based on children's heart rates during treatment. J Can Dent Assoc. 2009 May;75(4):283.
Abbasi H, Saqib M, Jouhar R, Lal A, Ahmed N, Ahmed MA, Alam MK. The Efficacy of Little Lovely Dentist, Dental Song, and Tell-Show-Do Techniques in Alleviating Dental Anxiety in Paediatric Patients: A Clinical Trial. Biomed Res Int. 2021 May 23;2021:1119710.
Kharouba J, Peretz B, Blumer S. The effect of television distraction versus Tell-Show-Do as behavioral management techniques in children undergoing dental treatments. Quintessence Int. 2020;51(6):486-494.
American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2024:358-78.
Riba H. A Review of Behavior Evaluation Scales in Pediatric Dentistry and Suggested Modification to the Frankl Scale. EC Dental Science.2017; 16(6):269-275.
Wong HM, Humphris GM, Lee GT. Preliminary validation and reliability of the Modified Child Dental Anxiety Scale. Psychol Rep. 1998 Dec;83(3 Pt 2):1179-86.
Howard KE, Freeman R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paediatr Dent. 2007. July;17(4):281–8.
Arslan I, Aydinoglu S. Turkish version of the faces version of the Modified Child Dental Anxiety Scale (MCDASf): translation, reliability, and validity. Clin Oral Investig. 2022 Feb;26(2):2031-2042.
Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent 2016;8:35–50.
Jain A, Suprabha BS, Shenoy R, Rao A. Association of temperament with dental anxiety and behaviour of the preschool child during the initial dental visit. Eur J Oral Sci 2019;127:147–155.
Candan M, Kutlu E, Yilmaz Karaman İG. Predictors of parental acceptance towards contemporary behavior management techniques used in pediatric dentistry: a preliminary study on turkish population. Children (Basel) 2023;10:1592.
Cianetti S, Lombardo G, Lupatelli E, Pagano S, Abraha I, Montedori A, et al. Dental fear/anxiety among children and adolescents. a systematic review. Eur J Paediatr Dent 2017;18:121–130.
Allen KD, Stanley RT, McPherson K. Evaluation of behavior management technology dissemination in pediatric dentistry. Pediatr Dent. 1990 Apr-May;12(2):79–82.
Elicherla NR, Saikiran KV, Anchala K, Elicherla SR, Nuvvula S. Evaluation of the effectiveness of tell-show-do and ask-tell-ask in the management of dental fear and anxiety: a double-blinded randomized control trial. J Dent Anesth Pain Med. 2024 Feb;24(1):57-65.
Howard KE, Freeman R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paediatr Dent. 2007. July;17(4):281–8.
Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent. 2007 Nov;17(6):391-406.
Elicherla SR, Bandi S, Nuvvula S, Challa RS, Saikiran KV, Priyanka VJ. Comparative evaluation of the effectiveness of a mobile app (Little Lovely Dentist) and the tell-show-do technique in the management of dental anxiety and fear: a randomized controlled trial. J Dent Anesth Pain Med. 2019 Dec;19(6):369-378.
Jacobzon A, Engström Å, Gustafsson SR, Andersson M. Parents' perceptions of care quality at child health centres: A cross-sectional study from Sweden. J Clin Nurs. 2025 Jan;34(1):218-229.
Shanahan T, Cunningham J. Keys to Trust-Building with Patients. J Christ Nurs. 2021 Apr-Jun 01;38(2):E11-E14.
Wu L, Gao X. Children's dental fear and anxiety: exploring family related factors. BMC 2018 Jun 4;18(1):100.