INNOVATIVE DISTRACTION TECHNIQUES TO MANAGE ANXIETY IN PAEDIATRIC DENTISTRY

Abstract

Distraction techniques in pediatric dentistry are crucial for managing anxiety and fear in young patients, ensuring a positive dental experience.These techniques aim to create a calm and supportive environment, promoting positive dental experiences for children and reducing fear associated with dental visits. Children frequently experience anxiety and apprehension when visiting the dentist, which can impact their cooperation and overall experience. Distraction techniques have emerged as valuable tools to divert attention away from dental procedures, thereby reducing fear and improving patient outcomes.Techniques encompassed various modalities, including audio-visual aids, interactive toys, virtual reality, and behavior guidance strategies. Thus these methods represent a pivotal aspect of contemporary pediatric dentistry, offering innovative solutions to mitigate anxiety and enhance patient cooperation. Continued research and integration of novel technologies will further refine these strategies, ultimately promoting positive dental experiences and long-term oral health in children.

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Journal Homepage: - www.journalijar.com
Article DOI: 10.21474/IJAR01/19288
DOI URL: http://dx.doi.org/10.21474/IJAR01/19288
RESEARCH ARTICLE
INNOVATIVE DISTRACTION TECHNIQUES TO MANAGE ANXIETY IN PAEDIATRIC DENTISTRY
Dr. Avani S., Dr. Deepti Jawa, Dr. Shipra Jaidka, Dr. Ashjan Ashraf Batha, Dr. Ashish Kumar and Dr.
Anaswara S.
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Manuscript Info Abstract
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Manuscript History
Received: 15 June 2024
Final Accepted: 17 July 2024
Published: August 2024
Key words:-
Distraction, Anxiety, Emotional
Freedom Technique, Hypnosis, Glove
Puppet, Anxiety Management
Distraction techniques in pediatric dentistry are crucial for managing
anxiety and fear in young patients, ensuring a positive dental
experience.These techniques aim to create a calm and supportive
environment, promoting positive dental experiences for children and
reducing fear associated with dental visits. Children frequently
experience anxiety and apprehension when visiting the dentist, which
can impact their cooperation and overall experience. Distraction
techniques have emerged as valuable tools to divert attention away
from dental procedures, thereby reducing fear and improving patient
outcomes.Techniques encompassed various modalities, including
audio-visual aids, interactive toys, virtual reality, and behavior
guidance strategies. Thus these methods represent a pivotal aspect of
contemporary pediatric dentistry, offering innovative solutions to
mitigate anxiety and enhance patient cooperation. Continued research
and integration of novel technologies will further refine these
strategies, ultimately promoting positive dental experiences and long-
term oral health in children.
Copyright, IJAR, 2024,. All rights reserved.
……………………………………………………………………………………………………....
Introduction:-
Anxiety isn‘t you, it‘s something moving through you, it can leave out the same door it came in. Nothing diminishes
anxiety than action.
Dentistry exposes patients to an environment and particular experiences that trigger a natural response of fear in
many people1. Dental anxiety can be defined as a state where an individual is evoked and prepared for something to
happen, with a non-specific feeling of apprehension associated with abnormal conditions.2 Dental anxiety is majorly
seen in children , Fear and anxiety in children might trigger behavioural management problems during dental
appointments manifesting as inability or difficulty to cooperate and engage during dental treatment and delivery of
oral care advice. Additionally, negative dental experiences during childhood and adolescence can also influence
people‘s perceptions of dental care in their adult life.3 The role of a dentist in managing a child with anxiety, so that
a child can become a co-operative patient is twofold - firstly, to control and treat the problem with which the child
reports and secondly, to teach the child appropriate ways of managing the anxiety 4. A range of fear management
techniques have been described in the literature. They can be grouped into five general approaches: physical
restraint, pharmacological methods, behavioural modelling reinforcement/contingency techniques, and distraction
methods. Each method has its own advantages and disadvantages . Among these a non-aversive modality to manage
a child appropriately in a dental clinic is distraction5. Distraction as a behavior guidance technique is defined by the
American Academy of Pediatric Dentistry (AAPD) as ―the technique of diverting the patient‘s attention from what
Corresponding Author:- Dr. Avani S.

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may be perceived as an unpleasant procedure‖ 6 .Distraction is identified as a much safer , effective and an
inexpensive tool, where the child‘s aggressive or non-cooperative behaviour can be ameliorated by diverting their
attention by various methods which they are more interested in or which they find more attracted to. These
techniques have significant immersive, interesting and innovational capabilities which allows dentists to efficiently
manage children with behavioural problems and perform effective treatment in a stress free environment.7
Dental Anxiety
Dental anxiety has been ranked fifth among commonly feared situations8 .And many factors are behind this which
increases and decreases anxiety in people.Dental anxiety is a multidimensional complex phenomenon, and no one
single variable can account exclusively for its development there are a number of factors that have consistently been
linked with a greater incidence of dental anxiety
Factors Causing Dental Fear And Anxiety
1. Personality characteristics
2. Fear of pain
3. Blood-injury fears
4. Age and gender
5. Passed on by others
6. Dental phobia
7. Lack of dental awareness
8. Financial barriers
9. Difficult access to dental service
Signs And Symptoms Of Anxiety
There are various signs and symptoms for anxiety. Few are listed below,
1.Emotional response
● Feeling of fear
● Feeling of anxiety
● Apprehension
● Panic
2.Physiological response
● Increased heart rate
● Breathlessness
● Sweating
● Nausea
● Shaking
● Low blood pressure
● Fainting /syncope
3. Behavioural response
● Visible distress / crying
● Agitation
● High vigilance
● Withdrawal
● Using humour or aggression to mask anxiety
Anxiety Management Techniques
A range of fear management techniques have been described in the literature. They can be grouped into five general
approaches:
1. Physical restraint
2. Pharmacological methods
3. Behavioural modelling
4. Reinforcement/contingency techniques
5. Distraction methods5
Clinical and research reports provide varying degrees of support for the effectiveness of each method. However,
some methods also involve significant disadvantages. Physical restraint and pharmacological intervention may

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involve a potential physical hazard to the child. Reinforcement and modelling techniques can be quite time
consuming and impractical for the private practitioner to implement. In contrast, distraction methods can be safe,
efficient, and inexpensive for the clinician to use. If it can be demonstrated that distraction procedures effectively
reduce young children‘s anxiety, these procedures could be readily adopted by private practitioners5. There are many
anxiety management techniques which we can use in the dental office but to manage the child in a more easier and
efficient manner is one of the most used method called DISTRACTION
Distraction
Previous literature supports the management of anxiety by using distraction in their studies since 1970 . Since ages
yoga and meditation has been used for treating many mental illness ,this was done by diverting the mind of the
person and dentistry is also not far behind ,in dental operatory also these techniques are used to control the fearful
and anxious mind of the patient . For this various methods have been used worldwide. For over a decade, distraction
has been investigated and successfully applied in clinical practice to reduce pain associated with medical
procedures.9,10,11 Successful traditional distraction techniques include, for example, watching movies 12, listening to
music 13, counting objects in the room 14, and nonmedical conversation15. The application of distraction is based on
the assumption that pain perception has a large psychological component in that the amount of attention directed to
the noxious stimuli modulates the perceived pain.
Objectives of distraction
• Decrease the perception of unpleasantness,
• Avert negative or avoidance behavior.16
Principle of distraction
Distraction or redirection is believed to work by diverting attention to modulate pain perception. Gate control theory
by Melzack and Wall 17 clearly explains the principle behind distraction through the stimulation of the larger
diameter type A and type B nerve fibers in a specified area using appropriate pressure or vibration, decreasing the
perception of pain by closing a neural gate to nociceptive signals18. Cognitive affective attention theory is the one
which explains the psychological aspects of distraction .
Types of distraction
1. Active distraction
2. Passive distraction
3. Contingent distraction
Classification Of Various Distraction Techniques Used In Paediatric Dentistry For Anxiety Management
Audio distraction
● Cassette player with headphones
● Cd player
● Prayer music
● Instrumental music
● Stories
● Rhymes
● White noise
Audio visual distraction
● Films
● Audiovisual eye glasses
● Videogames in play station
● Videogames in I pad
● Cartoons
● Virtual reality distraction
● Virtual private theatre system
Distraction using other sources
● Aromatherapy
● Thaumaturgy

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● Magic tricks
● Thumb sleeves – Thumb and light method
● Magic book
Hypnotic methods
● Magnetic finger technique
Energy methods
● Emotional freedom technique
Miscellaneous methods
● Guided imagery
● Camouflage syringe
● Glove puppets
● Sleeping statues
● Distraction using games
● The ‗mystery prize box
● Competition time
● Rest Breaks
● Balloon breathes

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Fig 1:- Various distraction methods used in our department.
1. Audio Distraction
Audio distraction is a non-aversive technique in which patients listen to music or stories during a stressful
procedure. Music‘s potential within healthcare settings and its broader application as a health and wellbeing
intervention in the community has received much attention from researchers and practitioners in recent years.
Although this is partly due to an increasing recognition that the creation, consumption and clinical application of the
arts can bring considerable benefit (AHRC 2018)19, music has received special attention in this respect
Principle
The commonly accepted theory explaining the pain-, anxiety-, and stress-reducing effects of music is that music acts
as a distracter, focusing the patient‘s attention away from negative stimuli to something pleasant and encouraging.
Music occupies the patient‘s mind with something familiar and soothing, which allows the patient to escape into his
or her ―own world.
Techniques used
● Cassette player with headphones
● CD player with headphones
● Different genre of music like prayer music , rhymes and stories for kids ,
● White noise distraction
a) White Noise
The name white noise comes from the analogy to white light, which contains the whole spectrum of colours of light.
White noise is similar to the sound of the rain, a rumbling waterfall, rustling leaves, a fan or a static TV. White noise
can also be produced digitally or it can come in form of so called white noise machines, which are physical devices
that produce white noise. White noise used as an audio distraction technique has the same amplitude or intensity,
throughout the audible frequency range (20 to 20,000 Hertz). Some examples of white noise are the sound of
waves, beach sounds, heartbeat noise that is used to mimic that of the mother, instrumental lullabies etc.
2. Audio Visual Distraction
Audiovisual (AV) distraction, is a passive technique composed of two sensations, visual and auditory. Audiovisual
distraction is a non‐pharmacological intervention technique which diverts the patient's attention from harmful or
unpleasant stimuli. It is superior to traditional distraction methods, as it not only is more engaging due to the
occlusive headsets that can play high quality nursery rhymes, cartoon, music, games, movies right in front of the
user's eyes, but also has the capability to block out real‐world stimuli.20,
Techniques used
● presentation through headphones or audiovisual story presentation on television
● And presentation of videotaped material or a video game.
● audiovisual video eyeglasses

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● Virtual reality
a) Audio Visual Eyeglasses
Another type of AV distraction gaining popularity is the AV eyeglasses. AV eyeglasses are a device composed of a
head- mounted display and in-ear headphones which provide close proximity device aimed at reducing visual and
auditory interferences from the environment.
b) Virtual Reality Distraction
In recent years, there has been an increase in behavioural research in virtual reality (VR) and virtual world. VR
refers to a human–computer interface that enables the user to interact dynamically with the computer-generated
environment21.The working principle of VRD is that it does not interrupt the pain signals but acts both directly and
indirectly on pain perception and signalling.
c) The Virtual Private Theatre System
The virtual private theatre system (VPTS) is viewed with video glasses that integrate video storage, playing and
display in one digital broadcast . It features a 72-inch screen, along with it a clear screen and ear phones are
provided for surround sound.
3. Aromatherapy
Aromatherapy, being an inexpensive and non-invasive relaxant is currently used worldwide in the management of
various anxiety and stress-related disorders, chronic pain, and depression.It is a type of complementary medicine in
which the volatile oil of plants is used to promote the level of physical, spiritual, psychological, and physiological
health.
Principle
Aromatherapy using essential oil acts through the inhalation of scented oils which results in localization of the
volatile molecules from oil in the lungs leading to the rapid diffusion of these molecules into the blood which causes
brain activation via systemic circulation.
Techniques used
● Humidifier
● Olfactory
● Soaking gauze
● Nebulizer
● Inhaler
● Electric aroma diffuser
● Sensory
● Massage
● Topical application
● Compress
● Baths
Oils used for aromatherapy
● Lavender essential oil
● Oil of orange (Citrus aurantium)
● Sweet floral
● Eucalyptus oil,
● Apple oil
● Bergamot oil
4. Thaumaturgy
Thaumaturgy is a fancy way to say magic, It is called so because it is said that it works as a technique of work of
miracles. It is originated from thumb plus turgid technique where people used to show magic trick using hand and
their thumb in the early 18th century . Now recently Thaumaturgy has been used to manage anxiety in children in
the form of a distraction method

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Principle
● Brain is composed of two hemispheres, the left and the right, and specific functions have been attributed to
each. The left hemisphere in right-handed people is characterized with verbal and voluntary skills. Language,
speech analysis, and problem- solving are mediated on this side. The right side can be associated with non-
verbal skills and emotions. Skills, such as art and music, are right hemisphere activities. Imagination is also
thought to be associated with right hemisphere22.
Techniques used
● Magic tricks
● Magic book
● Thumb and light trick
● Animal figurines have been used as the thaumaturgical aids
5. Smart Phone Applications And Mobile Dental Apps
In today‘s world, most households have different electronic devices such as smartphones, tablets, and televisions
through which children get introduced to various aspects of life which include medical treatment cartoons, more
specifically dental treatments. The use of such electronic devices by children is also has elevated . Cartoon songs
have been a source of great enjoyment for almost all children, using the dental song to reduce dental anxiety of the
patients responded positively as the anxiety levels decreased .Currently, different applications have been developed
or are being currently developed for use in medical and dental fields to educate the patients regarding the procedures
in the hope of decreasing anxiety of the patients23
a) Mobile Dental Apps
Another interesting invention in smart phone was the mobile dental apps for the patients and dentist , which
encounters with variety of procedures like dental check-up , doctor appointment etc . Children mostly have the fear
of unknown rather than known , so it would be very much helpful if we introduce them to the world of dentistry
prior to their treatment procedure.
Apps used
● Little lovely dentist
● Tooth savers
● Chomper chums
● Brush up – tooth brush
● Brush DJ
● And some apps are created just to relieve dental anxiety they are acupressure , calm , colorfy ,dare and
headspace.
6. Hypnosis
Hypnosis has been one of the old and non-invasive ways to manage childhood dental anxiety, fear, phobia, and
frustration24. Hypnosis is a non-pharmacological technique still underutilized but effective in dentistry25. Franz
Mesmer is the founder of modern hypnotherapy26. Hypnosis is defined as an induced altered state of consciousness
characterized by heightened suggestibility and responsivity to the direction (Oberoi et al. 2016)27. The hypnosis is a
practice that is summarized in methods and techniques that improve the therapeutic results in the Dentistry
specialties, not needing additional resources as medications or instruments. It can be used in a clinical environment.
Through his voice, the dentist expands the patient‘s conscience state directing him to access the natural resources of
the body and mind in favor of his well-being . Several terms can be attributed to the professional that uses this
technique in dentistry, such as: hypnotist, hypnotist dental therapist, clinical hypnotist, hipnodontist and hipniatra .In
the pediatric dental arena Through hypnosis it becomes possible to capture the child‘s attention, reduce their distress
and transform their experiences of pain. These aspects can be achieved through dissociation, and it may be
suggested that the child take his thoughts to another place. In fact, lies are not told the patient, because the
suggestion is not that the pain will disappear, but that it gradually becomes another sensation, which is more
acceptable, like a tingle or heat 28, .Suggestions can be used with all children, and yet, hypnosis may turn out to be
the only approach with a few as long as they can understand and respond to the suggestions given.

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Principle
In hypnosis, there are several underlying principles that are used in many of the methods and applications.
Collaboration: You need their help too. Forced cognition: Saying it makes them think it. Sensory thought: Thinking
about events triggers senses. Physical thought: Thinking changes the body. Feedback: Check that it is working and
works. Utilization: Make use of what happens. Everything's a resource. Confidence: The attitude of the hypnotist is
key. The therapist induces a deep hypnosis, where the conscious mind steps aside, giving control to the
subconscious mind, which has tremendous powers.
Techniques used
a) Hypnotic Method
● Focus on one point ,hold breath for 5 sec followed by exhaling (5 -10 times )
● Close eyes and begin reverse count from 50 , at random intervals clinician snapped his/her fingers and ask
patient to go one number up from the current count.
● On reaching 0 , clinician lightly touches middle of the patients forehead and uses the words deep sleep
● Child was told how different body parts are relaxing to imagine himself/ herself in a happy and relaxed place eg
; birthday party , festival , playground , sea side.
● Count to 5 and the patient was asked to open eyes slowly
b) Magnetic Finger Technique
● Here in the method we have to make the child take two breaths
● Close your eyes
● Keep your hands straight in front of you and imagine that the forefingers are turning toward each other, as
though there is a magnet between them
● With the number of 1–5, both hands will be so tight that even though you want to do so, you would not be able
to separate the hands.
● You will be able to separate your hands by counting 5–1 and lay them on the side of the chair and experience a
good sense of calmness and relaxation.
● Now you can open your eyes
● The eye rolling technique and the pulse rate are tested to further validate the patient‘s hypnotization22.
Fig. 2:- Magnetic finger induction method.
7. Emotional Freedom Technique
EFT was introduced in 1990 by Gary Craig.it states that there is a close association between emotions and energy.
Any emotional disturbance is accompanied by a corresponding distortion of energy lines, these major meridian lines
are stimulated by tapping on them. It is considered as an alternative treatment for physical pain and emotional
distress. These tapping techniques send calming signals to the amygdala.EFT uses stimulation of acupressure points
on the face, upper torso, and hands, via self-tapping. This is done while holding in mind a troubling memory or
emotion in an accepting, mindful way (Church, 2013b)29. EFT works experientially with key past events or with
present-day symptoms, which, in the course of the work, are often traced back to earlier experiences (Church,
2013b; Church & Feinstein, 2013)29

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Principle
Callahan‘s basic TFT technique relies on knowledge of the body‘s meridians, the flow of energy along them and
where the each meridian ends on the body. A patient thinks about a disturbing event while tapping on various
acupoints on the body in a particular order. Different tapping sequences called algorithms are used for each
particular condition as well as a strange routine called the gamut series which is derived from neurolinguistic
programming (NLP). In simple words our body has an energy system which is effected by any distortion in our
emotions , Energy and emotions are very much connected through this system , The flow of energy should not be
hindered .If the flow is distorted the humans well-being also gets affected . When anxiety and fear happens in a
patient the energy flow becomes blocked , so this block has to me removed , to remove this block applying pressure
to certain locations helps. It relieves the blockage . So acupressure have been used . Tapping in certain sites gives
pressure in those areas and it has a positive effect on relieving the blockage. This is the principle of EFT.
Technique used
Craig‘s method is to help a client to identify a pain or emotionally painful event
Ask what their level of distress is from 0 (no distress) to 10 (unbearable). This is known as the SUD (subjective unit
of distress) level and the aim of tapping is to reduce it as far as possible, ideally to 0.
● Craig maintains that ―the cause of all negative emotions is a disruption in the body‘s energy system‖ (Feinstein
et al., 2005, p. 19)30.The tapping process is in the sequence of
● Begin by stating what is on your mind and rating your distress on a scale of 0 to 10
● Speak your "set-up statement," which identifies the issue and includes a statement of self-acceptance
● Begin the tapping sequence, using your fingers to tap on the specified sites
● As you tap, use a reminder phrase to stay focused on your problem area
● At the end of the sequence, rate your distress
● Continue the process until your distress rating is very low.
● The acupressure points used are the heel of the hand, three locations around the eye, the area below the nose,
the area below the lips, the collarbone, the underarm, and the top of the head. From seven to nine taps are
delivered on each spot.
Tapping spots
● Top of head
● Eyebrow
● Corner of the eye
● Under the eye
● Below the nose
● Under the mouth
● Collar bone
● Under arm
● Karate chop
Fig. 3:- Emotional freedom technique being performed.

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8. Guided Imagery Or Visual Imagery
The visual imagery technique has been defined as a directed, deliberate daydream that uses all the senses to create
a focused state of relaxation and a sense of physical and emotional well-being. Further, it is believed to work with
children very well because they have good ability to imagine and fantasize. 31 There are generally three stages to
guided imagery: relaxation, visualization, and positive suggestion.32 The patient, seated in the dental chair [
relaxation], is asked to use their imagination skills to focus on pleasant places (e.g. beach or mountain scenery)
[visualization] . This consciously encourages their psyche to reach a state of relaxation and well-being. The
emotional well -being guides the body to a complete physical relaxation.
9. Camouflage Syringe
Children could link colours and emotions as pleasing or unpleasant effect.33 Colours such as red , blue , yellow ,
green , black and white were associated with anger , happiness , sadness, surprise , disgust and fear respectively .
One way of motivating children is by using their favourite colour . A novel , simple and child friendly modification
of conventional syringe conceals the needle from child‘s sight , whereas still keeping the syringe functional to
deliver the intended drug.
10. Glove Puppets
Blow up a glove with the three -in-one syringe (thus introducing the three-in-one syringe too). Then encourage the
child to help you draw a face on it including a big smile to draw on some teeth Get the child to help you count the
number of teeth on the glove puppet and then to count their own teeth. This technique gives a feeling of newness to
the child and creates a distraction in the childs mind thereby reducing his / her anxiety7 .
11. Sleeping Statues
It is a competitive game which helps in distracting the child‘s mind . The introduction of a competition with the ‗last
little boy/girl‘ can help to encourage good behavior, e.g. ‗Margaret, can you lie very still, like a ―sleeping statue‖,
and see how long you can stay still for? The last little boy/girl managed to stay still until we counted to 100 and
he/she was very clever like you. Do you think you can beat him/her? I bet you can!‘7
12. The ‘mystery prize box’
Sometimes, reward from the ‗mystery prize box‘ can entice the child enough to allow that final piece of more
difficult treatment, e.g. extraction, to be completed. The prize box sits high on the shelf so it is visible, but the child
doesn‘t know what is inside it until the end of the appointment. It contains various inexpensive items such as
toothbrushes, colour boxes or current movie trend characters on pencils, rubbers, note pads, hair clips, rulers, etc7.
13. Competition Time
It is a Competitive game between patient and dentist . When placing separators prior to Hall technique of stainless
steel crown placement, the concept of a competition between a patient and dentist appears to work well e.g. when
placing the separators (using f loss, authors preference), the dentist tries really hard to ‗make your head wriggle from
side to side but you have to try and stay very still. If you can stay still then you win the sticker, if your head wriggles
then I win the sticker‘; inevitably and thankfully, it is almost always 1:0 to the patient. When they return for their
Hall crown, this time to ‗beat the dentist‘, they have to have the crown put on then bite really hard on the cotton
wool roll, while the dentist tries to wriggle out the cotton wool roll from between their teeth, again, generally 1:0 to
the patient.
14. Rest Breaks
AAPD recognizes that giving the child patient a short break during a stressful procedure can be an effective use of
distraction prior to considering more advanced behavior guidance techniques.34
15. Baloon Breathes / Belly Breaths
Balloon breaths is a fun themed deep breathing aka belly breathing exercise. The idea of the exercise is for children
to use their imaginations to help them visualise a balloon in their bellies. When they are able to imagine the balloon
in their belly, then it easier for them to focus their attention on directing the air they inhale deeper and breathing in
fuller. Imaging that you are inflating a brightly coloured balloon also makes the breathing exercise playful and fun7.

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Technique used
The patient prior to their treatment sitting in the dental chair is been asked to ―Imagine that he/ she is holding a
brightly coloured balloon between their hands, as it fills with air the hands expand and as the air deflates from the
balloon the hands get closer, that‘s how the bellies will feel.‖ (You can model expanding and decreasing the
imaginary balloon between your hands or use a Hoberman sphere if you have one available.)the dentist have to
explain this to the child .the dentist starts by saying ―Now let me show you first, I relax my shoulders and sit up tall,
put my hand on my belly and take a big breath in, I can feel my belly getting bigger and slowly as I breathe out the
balloon is deflates.‖ The following have to be done sequential ,
● Wiggle your shoulders and Sit up tall. pop your hand on your belly.
● Imagine that your belly is a balloon. Take in a slow, deep breath and imagine filling up the balloon.
● Then exhale slowly, deflating the balloon in your belly
● Let‘s try that again, but this time if you feel comfortable you can close your eyes. Really focus on filling your
belly with air and noticing the belly getting bigger.
● As you exhale, imagine the balloon slowly floating away high up into the sky.
Fig 4:- Post distraction happy faces.
Conclusion:-
Behavior management is as fundamental to the successful treatment of children as are skills and knowledge of dental
materials35. Uncooperative behavior can interfere significantly with providing quality dental care, resulting in
increased delivery time, risk of injury to the child and eventually unsatisfied parents. In fact, surveys of clinicians
have found that the dentists consider the uncooperative child to be among the most troublesome problems in clinical
practice36 Thus, Professional recognition of these difficulties significantly heightened the interest in behavior
management and led to the development of a well-established child behavior management armamentarium for
dentists. Further, it also led down the path where dental practitioners began to confer the subject of behavior
management, the same respect and objectivity that they have accorded with other areas of science in dentistry37.
Thus, paving the way to the invention of newer non-invasive behavior management techniques for children, among
which distraction techniques like, magic tricks, audiovisual distraction, mobile dental apps, video game distraction,
virtual-reality based distraction has gained immense popularity. These contemporary distraction techniques have
significant immersive, interesting and innovative capabilities which allows dentists to efficiently manage children
with behavioural problems and perform effective treatment in a stress-free environment38. A stress free dental
environment is the No 1 need of a pediatric specialist to do his work with ease and confidence ,for that these
techniques will be very much helpful.
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