This study is designed to evaluate strategies for reducing dental anxiety in pediatric patients. The commonly applied "Tell-Show-Do" method involves explaining and demonstrating dental procedures before they are performed. In this randomized controlled trial, three groups of children will be compared:

Children who receive only the Tell-Show-Do method,

Children who are prepared at home with a storybook prior to receiving the Tell-Show-Do method,

Children who are prepared at home with an animation video prior to receiving the Tell-Show-Do method.

Children's dental anxiety will be assessed using validated behavioral observation scales, including baseline measurement at the first examination, after preparation, and following completion of dental treatment. The study will determine whether the addition of a storybook or an animation video provides greater effectiveness in reducing dental anxiety compared with the Tell-Show-Do method alone.

Dental anxiety is a frequent challenge in pediatric dentistry and can complicate patient cooperation, lead to incomplete treatment, or necessitate the use of general anesthesia. Among the available behavior guidance techniques, the Tell-Show-Do (TSD) method is the most widely applied and has been shown to facilitate children's acceptance of dental procedures. However, recent approaches suggest that additional child-friendly strategies, such as storybooks and animation videos, may further enhance its effectiveness in reducing anxiety and improving cooperation.

This randomized controlled trial aims to evaluate the impact of incorporating a storybook or an animation video in addition to the TSD method on children's dental anxiety and cooperative behavior. Participants will be randomly assigned to one of three groups:

Control group: Tell-Show-Do only.

Storybook group: Children will be prepared at home with a storybook prior to the dental visit, followed by Tell-Show-Do.

Animation video group: Children will be prepared at home with an animation video prior to the dental visit, followed by Tell-Show-Do.

Children's anxiety and cooperation will be assessed at three time points: baseline (first examination), after preparation (before treatment), and after completion of dental treatment. The primary outcome measure will be the Jeet Wheel behavioral observation scale, which provides standardized ratings of children's anxiety and cooperation during dental procedures. In addition, baseline dental fear will be assessed using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and the potential need for general anesthesia will be evaluated with the SCAN Index. These baseline measures will be included as covariates in the statistical analysis to adjust for initial variability in anxiety and treatment requirements.

Data will be analyzed using mixed-effects models to examine the interaction between time (three assessment points) and group (three interventions), while controlling for CFSS-DS and SCAN Index scores. This design will enable comparisons of the relative effectiveness of each intervention independent of baseline differences.

The study is expected to provide new evidence on whether storybook and animation video adjuncts can enhance the effectiveness of the Tell-Show-Do method, offering more child-friendly approaches to reducing dental anxiety in pediatric dental practice.

Inclusion Criteria:

• Children aged 4 to 8 years
• Requiring dental treatment in the pediatric dentistry clinic
• Classified as cooperative enough for chairside treatment without mandatory general anesthesia
• Parent or legal guardian able to provide written informed consent
• Child assent obtained where appropriate -

Exclusion Criteria:

• Children with systemic medical conditions that contraindicate routine dental care
• Children with developmental, cognitive, or behavioral disorders that preclude completion of study procedures
• Children requiring urgent dental treatment under general anesthesia or sedation
• Prior exposure to the same storybook or animation video used in the study
• Parents/guardians who decline to provide consent

Individual participant data will not be shared due to privacy and confidentiality concerns in pediatric participants.

The children, parents, and treating dentist were aware of the assigned intervention (storybook, animation video, or Tell-Show-Do only). However, the outcome assessor who rated children's anxiety using the Jeet Wheel scale was blinded to group allocation.