Comparative evaluation of Reframing and Tell-Show-Do behaviour guidance technique in the management of dental anxiety among children aged 6 to 12 years undergoing dental treatment without and with administration of local anesthesia: A single blind randomized clinical study

Dental anxiety is defined as a nonspecific feeling of apprehension,
worry, uneasiness or dread, the source of which may be vague or unknown. It accounts to 5 to 33 percent worldwide among children. It is
the primary emotions seen in a child while entering the dental operatory. Hence it is a matter of concern both to parents and dentist as and is
challenging for effective treatment since it can potentially thwart child
from seeking dental care. Stimuli such as strange environment,
sound, sight and sensation of airotor, bright light seen in dental operatory
can easily arose dental anxiety. To render high quality and successful
treatment cooperation of the child plays an important role. Hence it is
important to mold the child’s attitude towards pediatric dentistry and dental
outcomes.

Various behavior guidance techniques are available both pharmacological and non-pharmacological to reduce anxiety in a child. However, many parents prefer non-pharmacological techniques as they regard aversive and pharmacological techniques objectionable for the behavior guidance of children in dental office. The non-pharmacological behavior guidance techniques are the corner stone of successes in pediatric dentistry as they help in coping skills, assist to develop appropriate behaviour, alleviates fear and anxiety there by building trust with the dentist and dental team.

Tell-Show-Do (TSD) is the linchpin in behavior guidance and education for children which involves a brief, age-appropriate description of the care to be completed (Tell), demonstration of the care to be completed or equipment to be used (Show) and carrying out the care required with minimal delay (Do). The orderly rational way of thinking as in TSD may lead to differing of what is expected from child where in the solution of telling may become a problem.However, the dentist can create a different reality by changing the frame of the content, which in turn changes the behavior and response of a person. This can be done through reframing.  Reframing is defined as taking a situation outside the frame that up to that moment contained the individual in different conditions and visualize (reframe) it in a way acceptable to the person involved and with this reframing both the original threat and threatened solution can be safely abandoned. Also many fields have used reframing, like therapy, education, marketing and sales. In medical literature reframing is commonly used both by the caregiver as well as by the patient for coping with stressful situations. The literature search revealed that there are no randomised clinical trials done with this reframing technique in pediatric dentistry. Hence this study is aimed at evaluating Reframing and Tell-Show-Do technique in the management of anxiety among children undergoing dental treatment without and with administration of local anesthesia.