AI Avatar Video vs. Tell-Show-Do for Reducing Anxiety and Improving Cooperation in Children During Local Anesthesia

Artificial Intelligence-driven Avatar-based Video vs. Tell-show-do for Reducing Anxiety and Improving Cooperation in Children During Local Anesthesia: a Randomized Controlled Trial

This randomized clinical trial aims to compare two behavior guidance techniques used to reduce anxiety in children during local anesthesia injections in dental treatment. The study evaluates the traditional Tell-Show-Do (TSD) technique versus an artificial intelligence (AI)-driven, avatar-based video method called the "Mini Dentist."

Children aged 5 to 7 years who require local anesthesia for routine dental treatment will be randomly assigned to one of two groups. The control group will receive the conventional Tell-Show-Do explanation from the pediatric dentist. The experimental group will watch a short animated video featuring an AI-generated avatar that explains and demonstrates the procedure in a child-friendly manner before the injection.

Anxiety and behavior will be assessed using heart rate monitoring, behavioral observation (FLACC scale), and a self-reported pain scale (Wong-Baker FACES). The goal is to determine whether the AI-based method improves cooperation and reduces anxiety compared to the traditional approach.

Participation is voluntary, and all procedures follow ethical research standards.

Dental anxiety is common among children, particularly during local anesthesia injections. The Tell-Show-Do (TSD) technique is widely used in pediatric dentistry to reduce fear by explaining and demonstrating procedures before performing them. However, its effectiveness may vary depending on communication style and child engagement. With increasing exposure to digital media, children may respond more positively to visual and technology-based tools.

This randomized controlled clinical trial will compare traditional TSD with an AI-driven avatar-based video modification ("Mini Dentist") during buccal infiltration anesthesia in children aged 5-7 years receiving local anesthesia for the first time. Eligible children will be randomly assigned (1:1) to:

• Group A: Traditional Tell-Show-Do
• Group B: AI-driven avatar-based Tell-Show-Do video

All injections will follow a standardized protocol and be performed by the same pediatric dentist to ensure consistency.

Primary outcome:

Physiological anxiety measured by heart rate at five standardized time points.

Secondary outcomes:

• Behavioral pain response assessed using the FLACC scale
• Self-reported pain using the Wong-Baker FACES Pain Rating Scale

Behavior during injection will be video recorded for objective scoring by calibrated evaluators.

The study is approved by the Research Ethics Committee of Saint Joseph University of Beirut. Participation is voluntary, and informed consent is obtained from parents or legal guardians.

The objective is to determine whether integrating AI-based behavioral preparation improves anxiety control and cooperation during pediatric dental injections.

Inclusion Criteria:

• Inclusion Criteria:

  • Children aged 5 to 7 years
  • Medically healthy (ASA I)
  • Cooperative behavior during dental examination
  • No known allergy to local anesthetics
  • Require non-urgent dental treatment under local anesthesia
  • First-time experience receiving local anesthesia
  • Able to understand and communicate

Exclusion Criteria:

• History of epilepsy
• Diagnosed anxiety or behavioral disorders
• Cognitive or developmental delay
• Hearing or visual impairment
• Previous experience with dental anesthesia
• Require inferior alveolar nerve block anesthesia

Exclusion Criteria:

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