This randomized triple-blind clinical trial aims to evaluate the effectiveness of positive pre-visit imagery in managing dental anxiety (DA) in children aged 5 to 13 years. DA is a common barrier to dental treatment and is often triggered by procedures such as local anaesthesia. Participants were randomly assigned to view either positive dental images or neutral nature images before treatment. Anxiety levels were assessed before and after the procedure using the Venham Picture Test. The study hypothesizes that exposure to positive dental imagery prior to the appointment may reduce anxiety levels, promoting a more positive dental experience for pediatric patients.

Dental anxiety (DA) is a significant barrier to dental care in children and is commonly associated with negative treatment experiences, particularly during procedures such as local anaesthesia. Children with DA are more likely to exhibit poor oral health outcomes and reduced quality of life. Behaviour management techniques (BMTs), such as distraction, tell-show-do, desensitization, and positive reinforcement, are routinely used in pediatric dentistry to help reduce anxiety and improve cooperation.

Among the newer BMTs, positive pre-visit imagery-where children view positive dental-related images prior to treatment-has shown promise. This technique is based on observational learning and aims to create positive associations with dental care. However, current evidence is limited and inconclusive.

This triple-blind randomized controlled trial investigates the effectiveness of positive pre-visit imagery in reducing DA in children. Sixty-nine children aged 5 to 13 years requiring local anaesthesia were randomly assigned to view either a series of positive dental images (intervention group) or neutral nature scenes (control group) prior to treatment. The intervention consisted of four A4 laminated images designed to elicit positive emotional responses related to dental care, while the control group viewed four neutral nature photographs.

Anxiety was assessed before and after the dental procedure using the Venham Picture Test (VPT), a validated tool for evaluating dental anxiety in children. The primary outcome was the change in anxiety level between pre- and post-treatment, and the data were analyzed using non-parametric statistical methods.

The study follows CONSORT guidelines and was approved by the Human Research Ethics Committee at the Federal University of Rio Grande do Norte. This trial aims to provide robust evidence regarding the effectiveness of positive pre-visit imagery as a non-pharmacological strategy for managing dental anxiety in children.

Inclusion Criteria:

• children aged 5-13 years who were admitted to the Paediatric Dentistry Clinic of the Federal University of Rio Grande do Norte, and who required local anaesthesia during dental treatment

Exclusion Criteria:

• Children with intellectual disabilities, visual or hearing impairments and children requiring emergency treatment were excluded