Comparative Evaluation of Bubble Breath Play, Thaumaturgy Magic Book Technique, and Smartphone Dentist Games on Dental Anxiety in Children Aged 6–9 Years: A Randomized Clinical Trial
Keywords:
Dental anxiety; Pediatric dentistry; Bubble Breath Play; Thaumaturgy; Smartphone games; Distraction; Local anesthesia; Behavior management.Abstract
Background:
Dental anxiety remains a significant challenge in pediatric dentistry, particularly during administration of local anaesthesia. Newer distraction techniques have gained popularity as safe and effective adjuncts to conventional behaviour management. Bubble Breath Play (BBP), the Thaumaturgy Magic Book Technique (TMBT), and Smartphone Dentist Games represent three such active distraction approaches, with different cognitive and physiological mechanisms to reduce procedural anxiety.
Aim:
To compare the effectiveness of Bubble Breath Play, Thaumaturgy Magic Book Technique, and Smartphone Dentist Games in reducing dental anxiety in children aged 6–9 years undergoing dental procedures requiring inferior alveolar nerve block (IANB) administration.
Materials and Methods:
A randomised trial was conducted on 45 healthy children aged 6–9 years allocated equally into three groups: Group I – Bubble Breath Play, Group II – Thaumaturgy Magic Book Technique, and Group III – Smartphone Dentist Game. Anxiety was assessed at three time points (T1: baseline; T2: post-distraction; T3: after local anaesthesia administration) using pulse rate, Venham Clinical Anxiety Rating Scale (VCARS), and Facial Image Scale (FIS). Intragroup comparisons were performed using the Friedman test and intergroup comparisons using one-way ANOVA and Kruskal –Wallis tests
Results:
All three groups demonstrated statistically significant intragroup reductions in pulse rate, VCARS, and FIS scores across time points (p < 0.05). Intergroup comparisons at T2 and T3 revealed no statistically significant differences among the three techniques. Numerically, the Smartphone Dentist Game group showed the greatest immediate reduction in anticipatory anxiety (VCARS ↓ 85.71% at T2), while Bubble Breath Play demonstrated more stable physiological control during the injection phase.
Conclusion:
All three behavior management techniques — Bubble Breath Play, Thaumaturgy Magic Book Technique, and Smartphone Dentist Game — are equally effective in reducing dental anxiety in children aged 6–9 years. These age-appropriate distraction strategies serve as valuable additions to the pediatric dental behavior management armamentarium.
