Structured art therapy for reducing pediatric dental anxiety: A randomized, controlled clinical trial

Umesh Vishnu Hambire¹ image, Chaitali Keshav Mirajkar2 image

Highlights

Structured art therapy represents a clinically relevant,  nonpharmacological approach for the management of pediatric dental anxiety.

Participation in art therapy significantly reduced both dental anxiety levels and uncooperative behavior in children.

Clay modeling emerged as the most effective art therapy modality, with direct and practical implications for routine pediatric dental practice. 

Abstract

Aim: This study aimed to evaluate the effectiveness of structured art therapy in reducing dental anxiety among children aged 6–12 years attending a pediatric dental clinic. Methods: A randomized controlled clinical trial was conducted involving 500 children (292 females and 208 males) aged 6–12 years. Participants were randomly allocated to either a study group, which received structured art therapy (drawing, coloring, collage, and clay modeling) for 15 minutes before each dental visit, or a control group, which was managed using routine tell–show–do techniques only. Dental anxiety was assessed at baseline and after three consecutive visits using the Frankl Behavior Rating Scale (FBRS), the Five-Facial Anxiety Scale (FFAS), and the Child Drawing: Hospital (CD:H) scale. Statistical analyses included paired t tests, independent t tests, chi-square tests, and Pearson correlation coefficients. The level of significance was set at p < 0.05. Results: At baseline, 59.2% of participants exhibited high or very high levels of dental anxiety. After three consecutive visits, children in the study group demonstrated a substantial reduction in anxiety, with 72% classified as having little or no anxiety, compared with only 16% in the control group (p < 0.001). Mean CD:H scores in the study group decreased significantly from 149.4 ± 22.1 to 91.3 ± 18.7 (p < 0.001), whereas changes in the control group were minimal and not statistically significant. Among the art therapy modalities, clay modeling was the most effective, followed by coloring and free drawing. Correlation analyses revealed strong associations between projective anxiety assessment (CD:H) scores and both self-reported (FFAS) and behaviorally observed (FBRS) measures. Conclusions: Structured art therapy is a simple, inexpensive, and highly effective adjunct to conventional pediatric behavior management techniques. It significantly reduces dental anxiety, enhances cooperation during treatment, and can be easily integrated into routine pediatric dental practice.

Keywords: Art Therapy; Behavior Therapy; Dental Anxiety; Drawings; Pediatric Dentistry

Author Affiliations

  1. PhD, Professor, Department of Mechanical Engineering, GECA, Chhatrapati Sambhajinagar, Maharashtra, India
  2. PhD, Associate Professor, Department of Pediatric and Preventive Dentistry, GDCH, Chhatrapati Sambhajinagar, Maharashtra, India (Correspondence:chaitalikmirajkar@gmail.com)
  1. Girsolia Bm, Santos APPD, Dhyppolito IM, Buchanan H, Hill K, Oliveira BH. Prevalence of dental anxiety among children and adolescents: A systematic review and meta-analysis. Int J Paediatr Dent 2021;31:168–183
  2. Shim YS, Kim AH, Jeon EY, An SY. Dental fear and anxiety and dental pain in children and adolescents: A systematic review. J Dent Anesth Pain Med 2020;20:287–295
  3. Manan N, Yusof ZY, Hassan R, Ismail AR. The effectiveness of art therapy in reducing dental anxiety in children: A pilot study. J Indian Soc Pedod Prev Dent 2015;33:225–230
  4. Patil S, Kumar P, Shree S, Bansal R, Saxena S. Child’s drawing as a projective measure for dental anxiety: An observational cross-sectional study. Contemp Clin Dent 2023;14:293–301
  5. Zhang W, Li H, Chen X, Liu Y, Wang J, Zhao L. Art therapy for children and adolescents with anxiety: A systematic review and meta-analysis. Front Psychol 2024;15:1331–1342
  6. Mathur J, Chaturvedi R, Khandelwal V, Jain A, Shukla S. Correlation of children’s drawings with dental anxiety and behavior in the dental setting. J Indian Soc Pedod Prev Dent 2017;35:131–136
  7. Clatworthy S, Simon K, Tiedeman M. Child Drawing: Hospital—An instrument designed to measure the emotional status of hospitalized school-aged children. J Pediatr Nurs 1999;14:2–9
  8. American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. Pediatr Dent 2022;44(6):292–310
  9. Frankl SN, Shiere FR, Fogels HR. Should the parent remain with the child in the dental operatory? J Dent Child 1962;29:150–163
  10. Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: A review of prevalence and concomitant psychological factors. Int J Paediatr Dent 2007;17:391–406
  11. Buchanan H, Niven N. Validation of a facial image scale to assess child dental anxiety. Int J Paediatr Dent 2002;12:47–52
  12. Venham LL, Bengston D, Cipes M. Children’s response to sequential dental visits. J Dent Res 1977;56:454–459
  13. Shetty RM, Khandelwal D, Rath S. Role of psychological interventions in the management of dental anxiety in children. Int J Clin Pediatr Dent 2018;11:219–223
  14. Newton JT, Buck D. Anxiety and pain measures in dentistry: A guide to their quality and application. J Am Dent Assoc 2000;131:1449–1457
  15. Howard KE, Freeman R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paediatr Dent 2007;17:281–288
  16. Cuthbert MI, Melamed BG. A screening device: Children’s Fear Survey Schedule–Dental Subscale. J Dent Child 1982;49:432–436
  17. Kaur R, Jindal V, Dua R, Saha S. Effectiveness of distraction techniques in managing anxious pediatric dental patients. J Clin Pediatr Dent 2019;43:30–34
  18. Raj S, Reddy NV, Sujatha B, Rao V. Effect of audiovisual distraction on child anxiety and behavior during dental procedures. J Indian Soc Pedod Prev Dent 2019;37:75–81
  19. Baghdadi ZD. Children’s drawings as a projective measure for anxiety: Revisited. Saudi Dent J 2012;24:105–112
  20. Kimport ER, Robbins SJ. Effect of art-making on anxiety: Updated evidence from randomized trials. Arts Psychother 2021;74:101–119
  21. Abdallah A. Effectiveness of art therapy in reducing procedural anxiety in pediatric health care: A systematic review. J Pediatr Nurs 2023;70:110–118
  22. Moula Z, Palmer K, Walshe N. A systematic review of creative arts interventions for children’s mental health. Front Psychol 2020;11:1951
  23. Tegano RA. Art-based emotional expression as a clinical assessment tool in children: Current evidence and methodological advances. Clin Child Psychol Psychiatry 2021;26:101–115
  24. Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: A review. Aust Dent J 2013;58:390–407
  25. Porritt J, Marshman Z, Rodd HD. Understanding children’s dental anxiety and psychological approaches to its reduction. Int J Paediatr Dent 2012;22:397–405
  26. Singh K, Tandon S, Singh H, Prabhu S. Play therapy in dentistry: A behavioral modification technique. Int J Clin Pediatr Dent 2014;7:105–108
  27. Gao X, Hamzah SH, Yiu CKY, McGrath C. Dental fear and anxiety in children: A review with recommendations for evidence-based behavior guidance. Int J Paediatr Dent 2022;32:523–533
  28. Al-Namankany A, de Souza M, Ashley P. Evidence-based dentistry: Update on behavioral management techniques. Eur Arch Paediatr Dent 2021;22:489–497
  29. Chaturvedi S, Mathur R, Surana R. Impact of art-based interventions in reducing stress among children in hospital settings. Indian J Pediatr 2016;83:1121–1125
  30. Malchiodi CA. Art Therapy and Health Care. 1st ed. New York: Guilford Press; 2013

Article Info

Contemp Pediatr Dent 2025:6(3):229-239

Received: 24 October 2025

Accepted: 05 December 2025

Online First: 28 December 2025

DOI: 10.51463/cpd.2025.65

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					Umesh Vishnu Hambire, Chaitali Keshav Mirajkar. Structured art therapy for reducing pediatric dental anxiety: A randomized, controlled clinical trial. Contemp Pediatr Dent 2025:6(3):229-239

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