Tell–Show–Do Alone or Combined with Artificial Intelligence? A Randomized Clinical Trial for the Management of Dental Anxiety in Children

Background: Dental anxiety represents a significant challenge in paediatric dentistry and may negatively affect children's cooperation and oral health outcomes. This study investigated the potential of artificial intelligence (AI) to generate personalised animated cartoons designed to positively engage paediatric patients and facilitate their desensitisation to dental treatment.

Methods: The effectiveness of an AI-based intervention as an adjunct to the conventional tell–show–do (TSD) behavioural management technique was evaluated and compared with TSD alone. Forty-two paediatric patients aged 5–10 years, presenting with high levels of dental anxiety according to the Modified Dental Anxiety Scale (MDAS) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale, were randomly allocated to either the Trial group (AI-generated animated video plus TSD) or the Control group (TSD alone). Dental anxiety and behavioural responses were assessed at baseline (T₀) and after 14 days (T₁) using the MDAS and FLACC scales. Oral hygiene status was evaluated using the Oral Hygiene Index-Simplified (OHI-S) and Bleeding on Probing (BoP), while caries status was recorded at baseline using the International Caries Detection and Assessment System (ICDAS). Data distribution was assessed using the D’Agostino–Pearson test. Statistical analyses included Analysis of Variance (ANOVA), followed by Tukey’s multiple comparison test, and linear regression analyses. Statistical significance was set at p < 0.05.

Results: At T₁, both groups demonstrated significant reductions in anxiety scores, non-verbal behavioural responses, and oral hygiene indices compared with baseline (p < 0.05). Intergroup analysis showed lower MDAS scores in the Trial group; however, the reported intergroup comparison did not reach statistical significance. Linear regression analysis demonstrated a significant effect of group allocation on MDAS scores, with lower anxiety levels observed in children receiving the AI-based intervention (p < 0.05).

Conclusions: AI-generated personalised animated content may represent a promising complementary strategy to conventional TSD techniques for the management of dental anxiety in children. The findings support the potential role of AI-based behavioural interventions in paediatric dental settings. Further studies with larger samples and longer follow-up periods are needed to evaluate their clinical applicability and effectiveness.