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The efficacy of hypnosis compared with the tell/show/do technique for the reduction of anxiety/pain in children undergoing pulpotomies: a randomized controlled trial

  • Claudia Butrón-Téllez Girón1
  • Alejandra Ramírez-Carrasco2
  • Omar Sánchez-Armass Cappello3
  • Amaury Pozos-Guillén4
  • Mauricio Pierdant-Pérez5,*,

1Department of pediatric dentistry, Faculty of Dentistry, Autonomous University of San Luis Potosí, 78290 San Luis Potosí, SLP, Mexico

2Private practice, 78200 San Luis Potosí, SLP, Mexico

3Faculty of Psychology, Autonomous University of San Luis Potosí, 78399 San Luis Potosí, SLP, México

4Basic Sciences Laboratory, Faculty of Dentistry, Autonomous University of San Luis Potosí, 78290 San Luis Potosí, SLP, Mexico

5Department of Clinical Epidemiology and Public Health, Faculty of Medicine, Autonomous University of San Luis Potosí, 78210 San Luis Potosí, SLP, Mexico

DOI: 10.22514/jocpd.2024.009 Vol.48,Issue 1,January 2024 pp.69-77

Submitted: 24 March 2023 Accepted: 23 May 2023

Published: 03 January 2024

*Corresponding Author(s): Mauricio Pierdant-Pérez E-mail:


Anxiety/pain is a combined experience that can hinder dental treatment in children and lead to the development of negative behaviours in any form of surgical treatment. Hypnosis is a suitable option with which to reduce anxiety and pain during dental treatment. In this study, we aimed to evaluate the efficacy of hypnosis compared to the tell/show/do technique for the reduction of anxiety and pain as measured by Face, Legs, Activity, Crying, Consolability (FLACC) scale in children undergoing pulpotomies. We performed a randomized and controlled clinical trial involving 60 children aged 5 to 7 years without previous dental experiences but with clinical and radiographic indications for pulpotomy in the primary mandibular right or left first or second molar. The children were divided into two groups: a control group (treated by conventional behaviour management techniques) and an experimental group (treated by hypnosis). The FLACC scale was used to evaluate anxiety/pain during preoperative, transoperative and postoperative pulpotomy treatment; we also analysed variations in heart rate and skin conductance. The trial was registered at (NCT03739346). Statistical analysis was performed in R Studio version 1.2.1335. The FLACC scale was significantly lower in the experimental group (p = 0.022) throughout the entire treatment duration. In addition, heart rate and global skin conductance were both significantly lower in the experimental group when measured at different times (p = 0.005 and p = 0.032, respectively). When compared to conventional behavioural management techniques, the FLACC scale demonstrated that hypnosis was associated with significant reductions in heart rate, skin conductance and anxiety/pain throughout the entire duration of treatment. decreases anxiety/pain during the entire operative procedure. There was clear improvements in anxiety and pain control in patients receiving hypnotic therapy.


Anxiety; Pain; Behavior; Hypnosis; Randomized controlled clinical trial

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Claudia Butrón-Téllez Girón,Alejandra Ramírez-Carrasco,Omar Sánchez-Armass Cappello,Amaury Pozos-Guillén,Mauricio Pierdant-Pérez. The efficacy of hypnosis compared with the tell/show/do technique for the reduction of anxiety/pain in children undergoing pulpotomies: a randomized controlled trial. Journal of Clinical Pediatric Dentistry. 2024. 48(1);69-77.


[1] Sabherwal P, Kalra N, Tyagi R, Khatri A, Srivastava S. Hypnosis and progressive muscle relaxation for anxiolysis and pain control during extraction procedure in 8–12-year-old children: a randomized control trial. European Archives of Paediatric Dentistry. 2021; 22: 823–832.

[2] Ramírez-Carrasco A, Butrón-Téllez Girón C, Sanchez-Armass O, Pierdant-Pérez M. Effectiveness of hypnosis in combination with conventional techniques of behavior management in anxiety/pain reduction during dental anesthetic infiltration. Pain Research and Management. 2017; 2017: 1434015.

[3] Bahrololoomi Z, Sadeghiyeh T, Rezaei M, Maghsoudi N. The effect of breathing exercise using bubble blower on anxiety and pain during inferior alveolar nerve block in children aged 7 to 10 years: a crossover randomized clinical trial. Pain Research and Management. 2022; 2022: 7817267.

[4] Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clinical, Cosmetic and Investigational Dentistry. 2016; 8: 35–50.

[5] Gómez-Polo C, Vilches AA, Ribas D, Castaño-Séiquer A, Montero J. Behaviour and anxiety management of paediatric dental patients through virtual reality: a randomised clinical trial. Journal of Clinical Medicine. 2021; 10: 3019.

[6] Scandurra C, Gasparro R, Dolce P, Bochicchio V, Muzii B, Sammartino G, et al. The role of cognitive and non‐cognitive factors in dental anxiety: a mediation model. European Journal of Oral Sciences. 2021; 129: e12793.

[7] Santos SA, Gleiser R, Ardenghi TM. Hypnosis in the control of pain and anxiety in pediatric dentistry: a literature review. RGO—Revista Gaúcha de Odontologia. 2019; 67: e20190033.

[8] Modabber M, Campbell KM, McMurtry CM, Taddio A, Dempster LJ. Children’s perceptions of dental experiences and ways to improve them. Children. 2022; 9: 1657.

[9] Wood C, Bioy A. Hypnosis and pain in children. Journal of Pain and Symptom Management. 2008; 35: 437–446.

[10] Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/fear, sensory over-responsivity, and oral health behaviors and outcomes: a conceptual model. International Journal of Environmental Research and Public Health. 2022; 19: 2380.

[11] Najafpour E, Asl-Aminabadi N, Nuroloyuni S, Jamali Z, Shirazi S. Can galvanic skin conductance be used as an objective indicator of children’s anxiety in the dental setting? Journal of Clinical and Experimental Dentistry. 2017; 9: e377–e383.

[12] Guinot F, Mercadé M, Oprysnyk L, Veloso A, Boj JR. Comparison of active versus passive audiovisual distraction tools on children’s behaviour, anxiety and pain in paediatric dentistry: a randomised crossover clinical trial. European Journal of Paediatric Dentistry. 2021; 22: 230–236.

[13] Smolarek PDC, da Silva LS, Martins PRD, Hartman KDC, Bortoluzzi MC, Chibinski ACR. Evaluation of pain, disruptive behaviour and anxiety in children aging 5–8 years old undergoing different modalities of local anaesthetic injection for dental treatment: a randomised clinical trial. Acta Odontologica Scandinavica. 2020; 78: 445–453.

[14] de Camargo Smolarek P, da Silva LS, Martins PRD, da Cruz Hartman K, Bortoluzzi MC, Chibinski ACR. The influence of distinct techniques of local dental anesthesia in 9- to 12-year-old children: randomized clinical trial on pain and anxiety. Clinical Oral Investigations. 2021; 25: 3831–3843.

[15] Bai J, Hsu L, Tang Y, van Dijk M. Validation of the COMFORT behavior scale and the FLACC scale for pain assessment in Chinese children after cardiac surgery. Pain Management Nursing. 2012; 13: 18–26.

[16] Crellin D, Harrison D, Santamaria N, Babl FE. Comparison of the psychometric properties of the FLACC scale, the MBPS and the observer applied visual analogue scale used to assess procedural pain. Journal of Pain Research. 2021; 14: 881–892.

[17] Peng T, Qu S, Du Z, Chen Z, Xiao T, Chen R. A systematic review of the measurement properties of face, legs, activity, cry and consolability scale for pediatric pain assessment. Journal of Pain Research. 2023; 16: 1185–1196.

[18] Raslan N, Masri R. A randomized clinical trial to compare pain levels during three types of oral anesthetic injections and the effect of Dentalvibe® on injection pain in children. International Journal of Paediatric Dentistry. 2018; 28: 102–110.

[19] Peretz B, Bercovich R, Blumer S. Using elements of hypnosis prior to or during pediatric dental treatment. Pediatric Dentistry. 2013; 35: 33–36.

[20] Pedersen LK, Rahbek O, Nikolajsen L, Møller-Madsen B. The revised FLACC score: reliability and validation for pain assessment in children with cerebral palsy. Scandinavian Journal of Pain. 2015; 9: 57–61.

[21] Sandhyarani B, Kevadia MV, Patil AT, Gunda SA. Comparative evaluation of effectiveness of tell-play-do, film modeling and use of smartphone dental application in the management of child behavior. International Journal of Clinical Pediatric Dentistry. 2021; 13: 682–687.

[22] Oberoi J, Panda A, Garg I. Effect of hypnosis during administration of local anesthesia in six- to 16-year old children. Pediatric Dentistry. 2016; 38: 112–116.

[23] Rienhoff S, Splieth CH, Veerkamp JSJ, Rienhoff J, Krikken JB, Campus G, et al. Hypnosis and sedation for anxious children undergoing dental treatment: a retrospective practice—based longitudinal study. Children. 2022; 9: 611.

[24] Baakdah RA, Turkistani JM, Al-Qarni AM, Al-Abdali AN, Alharbi HA, Bafaqih JA, et al. Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study. BMC Oral Health. 2021; 21: 186.

[25] Hugar S, Kohli N, Soneta S, Saxena N, Kadam K, Gokhale N. Psychological behavior management techniques to alleviate dental fear and anxiety in 4–14-year-old children in pediatric dentistry: a systematic review and meta-analysis. Dental Research Journal. 2022; 19: 47.

[26] Wilson S. Management of child patient behavior: quality of care, fear and anxiety, and the child patient. Journal of Endodontics. 2013; 39: S73–S77.

[27] Vijayakumar M, Sabari Lavanya SJ, PonnuduraiArangannal JJ, AarthiJ AS. Key stone entity in paediatric dentistry: tell play do. European Journal of Molecular and Clinical Medicine. 2020; 7: 6563–6566.

[28] Rousseaux F, Faymonville M, Nyssen A, Dardenne N, Ledoux D, Massion PB, et al. Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial. Trials. 2020; 21: 330.

[29] Venkiteswaran A, Tandon S. Role of hypnosis in dental treatment: a narrative review. Journal of International Society of Preventive and Community Dentistry. 2021; 11: 115–124.

[30] Madeo D, Castellani E, Santarcangelo EL, Mocenni C. Hypnotic assessment based on the recurrence quantification analysis of EEG recorded in the ordinary state of consciousness. Brain and Cognition. 2013; 83: 227–233.

[31] Sabherwal P, Kalra N, Tyagi R, Khatri A, Srivastava S. A conceptual review on pretreatment anxiety management in a dental setting using hypnosis and progressive muscle relaxation. Archives of Depression and Anxiety. 2022; 8: 019–026.

[32] Huet A, Lucas-Polomeni MM, Robert JC, Sixou JL, Wodey E. Hypnosis and dental anesthesia in children: a prospective controlled study. International Journal of Clinical and Experimental Hypnosis. 2011; 59: 424–440.

[33] Browne RH. On the use of a pilot sample for sample size determination. Statistics in Medicine. 1995; 14: 1933–1940.

[34] Tran HT, Kong Y, Talati A, Posada‐Quintero H, Chon KH, Chen I. The use of electrodermal activity in pulpal diagnosis and dental pain assessment. International Endodontic Journal. 2023; 56: 356–368.

[35] Gokli MA, Wood AJ, Mourino AP, Farrington FH, Best AM. Hypnosis as an adjunct to the administration of local anesthetic in pediatric patients. ASDC Journal of Dentistry for Children. 1994; 61: 272–275.

[36] Probst TM, Jiang L. Mitigating physiological responses to layoff threat: an experimental test of the efficacy of two coping interventions. International Journal of Environmental Research and Public Health. 2016; 13: 338.

[37] Sakly EH, Grissa MH, Zoghlami S, Khayati A, Zokkar N. Assessment of hypnosis knowledge among dentists: a cross-sectional study. Pesquisa Brasileira em Odontopediatria e Clínica Integrada. 2021; 21: e0213.

[38] Achmad H, Djais AI, Rieuwpassa IE, Riyanti E, Primarti RS, Vionita V. Hypnodontics as an alternative to relieve anxiety in children: a systematic review. Systematic Reviews in Pharmacy. 2021; 12: 405–413.

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