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

  • Razieh Meshki Assistant Professor, Department of Pediatric Dentistry, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  • Leila Basir Assistant Professor, Department of Pediatric Dentistry, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  • Fatemeh Alidadi Dentist in private practice, Ahvaz, Iran
  • Azam Behboudi Mail Pediatric Dentistry Resident, Department of Pediatric Dentistry, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  • Vahid Rakhshan PhD Student, Department of Cognitive Neuroscience, Institute for Cognitive Sciences, Tehran, Iran
Anxiety, Pain, Pediatric Dentistry, Computer Simulation


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.


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How to Cite
Meshki R, Basir L, Alidadi F, Behboudi A, Rakhshan V. 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. Front Dent. 15(4):250-258.
Original Article