Comparison of Distraction Technique Using Eye Massage Therapy Versus Tell-Show-Do Distraction Technique on Child’s Anxiety And Pain During Administration of Inferior Alveolar Nerve Block: A Randomized Crossover Clinical Trial

Abstract

Background:

Pain and anxiety associated with inferior alveolar nerve block NB) administration represent significant barriers to effective pediatric dental care.In children, anticipatory fear and heightened emotional reactivity often amplify pain perception, compromise cooperation, and negatively influence future dental attitudes. Although conventional behavior guidance techniques such as Tell–Show–Do (TSD) remain widely practiced, their effectiveness during invasive procedures may be limited. Periorbital eye massage therapy has recently emerged as a novel passive distraction modality capable of promoting relaxation while eliminating visual exposure to the needle. The present randomized crossover clinical trial aimed to evaluate the effectiveness of eye massage therapy compared with the conventional TSD technique in reducing anxiety, pain perception, and physiological responses during IANB administration in children.

Methods:

Twenty-four children aged 7–12 years requiring bilateral dental treatment under IANB participated in a randomized crossover design. Each child received both interventions—eye massage therapy and TSD—across two visits separated by a 14-day washout period, thereby serving as their own control. Anxiety was assessed using the Facial Image Scale (FIS), and pain perception was measured using the Wong–Baker Pain Scale (WPS). Physiological parameters, including pulse rate and oxygen saturation (SpO₂), were recorded at baseline, during needle penetration, and immediately post-procedure. Within-subject comparisons were performed using paired statistical analyses with a significance threshold of p < 0.05.

Results:

Baseline anxiety scores demonstrated a modest but statistically significant difference between visits (p = 0.0102). Following IANB administration, children exhibited significantly lower anxiety levels under the eye massage condition compared with TSD (mean difference = 1.50 ± 1.31; p < 0.0001). Pain perception was likewise significantly reduced with eye massage therapy (mean difference = 1.25 ± 1.87; p = 0.0033). Although baseline pulse rate differed between visits (p = 0.0251), no significant differences were observed during needle penetration or post-procedure (p > 0.05). Oxygen saturation remained stable across all time points, with no statistically significant interventional differences.

Conclusion:

Periorbital eye massage therapy significantly reduced both anxiety and pain during inferior alveolar nerve block administration in children without inducing adverse physiological alterations. By combining sensory relaxation with visual occlusion of the needle, this technique offers a safe, non-pharmacological, and clinically feasible adjunct to conventional behavior management strategies in pediatric dentistry.