effects of pretreatment exposure to dental practice using a smartphone dental simulation game on children’s pain and anxiety: a preliminary double-blind randomized clinical trial

Objectives: studies on modeling a pre-exposure technique for the prevention of anxiety in children are rare, and there is no study on interactive modeling using computer games. we assessed the effect of playing a dental simulation game before operation on pain and anxiety in 4- to 7-year-old children during their first dental treatment session. materials and methods: in this double-blind randomized clinical trial, 50 children needing unilateral pulpotomy and placement of stainless-steel crowns (ssc) on mandibular primary first molars were enrolled and randomly divided into experimental (a simulation game) and control (no intervention) groups. the experimental group played the game twice a day for two weeks before the scheduled visit. at the dental session, their pre- and post-operative pains were recorded using the wong-baker facial rating scale (w-bfrs). also, heart rate (hr; as an indicator of anxiety) was measured using a finger pulse oximeter at six treatment stages: (1) baseline (at the initial session, two weeks before treatment) and (2-6) during different stages of treatment. effects of playing the simulation on pain and hr were analyzed using t-test and repeated-measures two-way analysis of covariance (ancova). results: game playing significantly reduced the hr (p=0.031). the interaction of playing with the treatment period was also significant (p=0.004). when the groups were compared in each of the six time points, the experimental group showed reduced hr during anesthetic injection and cavity preparation using a high-speed handpiece (p<0.003). conclusions: based on the results, playing certain dental simulation games before the first dental visit might reduce the anxiety felt during anesthetic injections and drilling.