LET’S GEAR PAST THE FEAR – COMPARATIVE

EVALUATION OF FILMED MODELLING AND

TELL-SHOW-DO TECHNIQUE BASED ON

SITUATIONAL ANXIETY DURING FIRST

DENTAL VISIT– AN ORIGINAL STUDY

Dr.Nancy Solomon, Dr. Rangeeth BN, Dr. Sharanya Ravindran,Dr. Joyson Moses

Department of Pedodontics, Thai Moogambigai Dental college, Chennai, Tamil Nadu, India.

JIDAM

“An Official Journal of IDA - Madras

Available online

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ABSTRACT

BACKGROUND:

A successful dental treatment by a Paediatric

dentist is depicted with a smile on the treated child’s face. The most

popular techniques followed in practice for behaviour management

of a child is Filmed Modelling and Tell-Show-Do which is

compared in the present study.

AIM:

To compare the effectiveness of Filmed Modelling and Tell-

show-Do behaviour management technique on situational anxiety

amongst the children during their first dental visit.

MATERIALS & METHODS:

Children of age group between

5 to 9 years presenting for the first time to the dental outpatient unit

were randomly selected for the study. 50 children were divided

into two groups; Group I received Filmed Modelling technique and

Group II received Tell-Show-Do technique. Each child’s anxiety

was measured using modified Venham’s anxiety rating scale and

physiological changes were monitored using pulse oximeter before

behaviour management and after treatment by oral prophylaxis.

RESULTS:

Student’s t test was done to compare the anxiety rating

and Chi square test was done to compare the heart rates measured

at two intervals. Statistically significant differences were seen in

clinical anxiety rating scores between the two groups where Filmed

Modelling was found to be better and no statistically significant

differences were observed on comparison of heart rates between

the two study groups.

KEYWORDS:

Filmed modelling, Tell-Show-Do, Situational

anxiety, Dental anxiety, Anxiety measurements

JIDAM/Chennai/Volume:7/Issue:2/Pages 38 - 43/April-Jun 2020

Address for correspondence:

Dr.Nancy Solomon
Post Graduate Student,
34/40, Gill Nagar 2nd Street,
Choolaimedu, Chennai, India.
Email id: nancysolomon94@gmail.com

Received

: 18.02.2020

Accepted

: 05.04.2020

Published

: 27.06.2020

ORIGINAL ARTICLE

JIDAM/Chennai/Volume:7/Issue:2/Pages 38 - 43/April-Jun 2020

Nancy et al: Comparative Evaluation of Filmed Modelling and Tell-Show-Do Technique

INTRODUCTION

Professional dental care is necessary for

continued maintenance of good oral health. The

AAPD emphasizes the importance of initiating

professional oral health intervention in infancy and

continuing through adolescence and beyond.

1-3

Every

child in each age group has distinct developmental

needs to be satisfied at specific intervals as a part of

comprehensive evaluation.

4,5

The greatest obstacle

that prevents an individual from actively involving

in professional dental care are fear and anxiety.

Odontophobia (dental fear) is a “unique phobia with

special psychosomatic components that impact on

the dental health of the odontophobic persons.”

Processes contributing to the etiology of dental fear

and phobia are a variety of genetic, behvaioural and

cognitive factors.

Disruptive behaviour is found

to occur when the level of fear is incongruent with

the circumstance and patient exhibits an inability

to control the impulses.

The reported incidence of

dental fear and anxiety was found to be 17.1% in

Singapore population, 30% in Chinese and 50% in

Danish population, 11% incidence of dental phobia in

German population.

9,10,11

The prevalence of dental fear

was found to be 7.1% in Scottish population, 24.3%

in Netherland population and a highest prevalence

of 42.1% in Japan population.

12,13,14

These emotions

cause behavioural changes that can interrupt

with the treatment procedures. Certain behaviour

management techniques like non-pharmacological

or pharmacological techniques can be followed to

manage these emotions at the dental operatory. One

of the most common non-pharmacological technique

adopted is Tell-show-Do as given by Addleston

in 1959

where each procedure is explained to the

patient to his/her level of understanding and this

technique can be implemented only if the child is 3

year of age or older. Modelling is another technique

by Bandura in 1967

that helps to alleviate the fear

and anxiety in children. It is the process of acquiring

behaviour through observation of a model where the

child learns through social learning. In the current

study, a comparison between Filmed Modelling

and Tell-Show-Do non-pharmacological behaviour

management techniques for children at their first

dental visit was done.

MATERIALS AND METHODS:

STUDY SAMPLE:

The study was conducted in the outpatient

unit of the department of Pedodontics where a total

of 50 subjects between 5 to 9 years of age were

randomly selected for the study.

The selection criteria included children

reporting for their first dental visit and with no history

of any medical conditions, especially those affecting

the heart rate. Medically compromised and special

children were excluded from the study including those

with acute dental pain, abscess and those whose parents

were not willing to allow their children to participate

in the study. An informed consent was obtained from

the parents of all participants after explaining in detail

about the study procedure and the subjects were placed

into two groups – Group I and Group II by random

sampling.

Group I consisted of 25 children, who were

conditioned using Filmed modelling technique, using

an animated movie, to receive dental management.

Group II consisted of 25 children, who

were conditioned using Tell-Show-Do technique

by step-by-step explanation of the procedure and

demonstration of the dental procedure, to receive the

dental management.

The procedure of the study included initial

evaluation by a blinded observer to record the Anxiety

rating using modified Venham’s 6-point anxiety

rating scale

(Table 1) followed by recording of the

heart rate by a peripheral pulse Oximeter (S.cure).

The behaviour shaping was done according to the

groups assigned. (Fig 1 and Fig 2) The anxiety rating

scale and heart rate was evaluated and recorded

following dental treatment. The data recorded was

tabulated in a data sheet (Excel, MS Office. Ver2016)

and evaluated statistically using a software (SPSS

Ver 20). Statistical analysis for Venham’s Anxiety

rating was done using Chi-Square Test (Table 2) for

evaluation of anxiety rating and Student’s t Test for

evaluation of pulse rate, before and after the anxiety

management procedures in the children.

JIDAM/Chennai/Volume:7/Issue:2/Pages 38 - 43/April-Jun 2020

Nancy et al: Comparative Evaluation of Filmed Modelling and Tell-Show-Do Technique

Fig 1: Filmed modelling

Fig 2: Tell-Show-Do

Fig 3: Graph showing the anxiety rating after the

Treatment

RESULT:

A total of 50 children between 5 to 9 years

of age participated in the study out of which 22 were

male and 28 were female children. The first reading

of anxiety rating score as measured by the blinded

observer, showed that 72% of the children were

tensed, 14% were reluctant, 12% were unease and

2% of the study group exhibited interference. More

number of children were tense with the characteristic

features expressed in tone of voice, question, and

answers reflecting anxiety; verbal protest, crying,

hands tensed and raised but not interfering very

much; protest more, distract, troublesome; children

still complied with the request to cooperate.

A second anxiety rating using modified

Venham’s index as measured following the treatment

showed that 72% of the children were relaxed and

the remaining 28% of them were unease. Out of the

relaxed 72% of the population, most of the children

belonged to Group 1 (Fig 3). Therefore, based on

the anxiety rating score, Filmed Modelling was

found to be significantly efficient than Tell-Show-Do

technique.

Mean of heart rates in both the treatment

groups were calculated and Student t test was done

to analyse the differences in heart rate prior to

behaviour management and following the treatment.

(Table 3 & 4) Statistics showed a definite 5-point

reduction in filmed modelling group whereas not

much of a difference was observed in Tell-Show-

Do technique. Although the overall correlation of

Table 1. Venham’s Index. (modified 6-point anxiety rating scale)

Score

Criteria

RELAXED. Smiling, willing, able to converse, displays behaviour desired by the
dentist

UNEASY. May protest briefly to indicate discomfort, hands remain down or
partially raised; tense facial expression, high chest, capable to cooperate

TENSE. Tone of voice, question, and answers reflect anxiety; during stressful
procedure, verbal protest, crying, hands tensed and raised but not interfering very
much; protest more distract troublesome; child still complies with the request to
cooperate

RELUCTANT. Pronounced verbal protest, crying using hands to stop procedure;
treatment proceeds with difficulty

INTERFERENCE. General crying, body movements sometimes needing
physical restraint, protest disrupts procedure

OUT OF CONTACT. Hard loud crying, swearing, screaming; unable to listen,
trying to escape; physical restraint required

JIDAM/Chennai/Volume:7/Issue:2/Pages 38 - 43/April-Jun 2020

Nancy et al: Comparative Evaluation of Filmed Modelling and Tell-Show-Do Technique

heart rates measured before and after the treatment

was not significant (Table 2), the measured heart rate

was found to be in accordance with the changes in

anxiety rating score.

DISCUSSION:

The study was undertaken to compare

between filmed modelling and TSD in reducing

children’s anxiety at the dental operatory during

their first dental visit. The comparison between the

groups showed that Filmed modeling was more

efficient than Tell-Show-Do technique which was

Value

Asymp. Sig

(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)

Pearson Chi-Square

6.349

.012

0.025

0.013

Continuity Correction

4.861

.027

Likelihood Ratio

6.653

.010

Fisher's Exact Test

Linear-by-Linear

Association

6.222

.013

N of Valid Cases

Table 3. Mean of measured heart rates before and after oral prophylaxis

Table 4. Student t test for measured heart rates

Table 2. Chi-square test to analyse the difference in anxiety reading

HEART RATES MEAN HEART RATE

Filmed Modelling Tell-Show-Do

Pre-treatment

102.08±14.52

97.92±16.75

After treatment

97.04±19.18

97.12±11.09

Paired T test

N Behaviour Management SIGNIFICANCE
25 Filmed modelling

0.273

25 TSD

0.076

50 Overall correlation

0.075

in accordance with the study results conducted by

Mehsra Paryab and Zeinab Arab 2011,

Hrishikesh

Walimbe et al 2017

and Roshan et al 2018.

the study conducted by Mehsra Paryab and Zeinab

Arab,

the behaviour management techniques were

employed as pre-appointment preparation where

they concluded that Filmed Modelling could be an

effective alternative to TSD. Similarly, Roshan et

al,

compared between filmed modelling and TSD

between 6 to 9 years of age and had similar kind of

results as concluded by Mehsra Paryab and Zeinab

Arab.

As a variant, there are other articles that

JIDAM/Chennai/Volume:7/Issue:2/Pages 38 - 43/April-Jun 2020

Nancy et al: Comparative Evaluation of Filmed Modelling and Tell-Show-Do Technique

support a newer behaviour shaping technique that

could be effective than modelling. Modelling can be

done as live modelling or filmed modelling. Between

which, filmed modelling has more significance as the

child may not be able to connect with the selected

live model, as the social skills acquired is a varying

parameter with every child. Also, in routine dental

practice, a cooperative live model may not be always

available for behaviour shaping of the child and it

is also time consuming technique.

In our study, for

filmed modelling technique, a previously existing

film was extracted from the animated series named

Caillou which depicted the clear picturization of

a child at his/her first dental visit. The duration of

the video was 4 minutes and the audio-visual were

made available in both English and other regional

language, Tamil. Children were given the freedom

of choosing the language of their choice before the

start of the video. Since it was an animated version,

the acceptance amongst the children was more and

therefore the concentration and observance towards

the scene was well oriented. The age group selected

for our study was between 5 to 9 years. At this age,

sufficient communication skills to understand the

behaviour shaping techniques are developed. The

most important is the cognitive ability to understand

the filmed modelling. The increment in the vocabulary,

attention, and concentration abilities in this period is

sign of their readiness for social communications as

given by Piaget’s classification. Therefore, a basic

understanding of cognitive development of the child

helps in providing ideal behaviour modification

technique.

Hrishikesh Walimbe et al,

compared

between live modelling, filmed modelling and TSD

out of which filmed modelling was found to have

better results than the other behaviour management

techniques.

In contrast to the above discussed articles,

other type of non-pharmacological technique was

given by Aruna Prashanth Vishwakarma et al 2017

which they evaluated the effectiveness of customized

Tell-Play-Do technique with live modelling for

behaviour management of children between 5 – 7

years and concluded that TPD is effective in reducing

children’s fear and anxiety about dental treatment as

the children enjoy playing with customized dental

object.

Therefore, from the results obtained from

various studies that were compared, it is evident that

all non-pharmacological behaviour management

techniques are found to reduce the fear and anxiety

in the dental operatory. Based on the results obtained

from our study, it was found that Filmed modelling

cannot only be an alternative but also serve more

effectively than TSD.

CONCLUSION:

Assessment of behaviour is the most

important factor in the hands of Paediatric dentist

that enables to execute proper treatment plan in the

most appropriate manner. Considering our study

results, Filmed modelling is found to be more

efficient than Tell-Show-Do. Even though, there was

no statistically significant difference, it is evident that

there lies a direct correlation between the changes in

heart rate and anxiety rating score and also shows

that both behaviour management techniques, Filmed

Modelling and Tell-Show-Do are effective in reducing

the child’s anxiety during the dental treatment.

FINANCIAL SUPPORT AND

SPONSORSHIP:

Nil

CONFLICTS OF INTEREST:

There are no conflicts of interest.

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