Preparing a child for the dentist before the appointment: what the evidence shows

Updated November 10, 2026. Written for pediatric dentists and practice managers.

Showing a child positive pictures of the visit beforehand is on the AAPD’s list of basic techniques for any patient. The trials so far found small effects with low certainty. It is cheap and low-risk, so it is worth doing, and not worth overselling.

What the AAPD lists

The Academy’s best-practice document on behavior guidance, revised in 2024, groups its techniques into basic and advanced. Among the basic ones is positive previsit imagery: the child looks at positive photographs or images of dentistry and dental treatment before the appointment. Its stated aims are to show children and parents what to expect and to give the child enough context to ask questions before anything starts. The indication is any patient, and no contraindication is listed. AAPD behavior guidance

The same document names inadequate preparation as one of the things that can contribute to a child not cooperating, and says schedulers can help set expectations for a first visit.

What the trials found

In 2023 an AAPD workgroup published a systematic review of non-drug behavior guidance during preventive visits. It screened 219 articles and included 15 randomized trials. Its conclusion was that most basic techniques produced a trivial to small reduction in self-reported anxiety or improvement in behavior, with the certainty of the evidence ranging from very low to moderate. Dhar and others, 2023

Previsit imagery. One trial, in Brazil, showed 70 children aged 4 to 11 photos of positive dental situations before an examination. The effect on anxiety was trivial and no different from neutral images. The children had low anxiety to begin with, which limits what the trial can show. The reviewers rated the certainty low.
An earlier study cited in the review found that children who looked at positive images of dentistry had less anticipatory anxiety in the short term. It did not measure anxiety during or after treatment.
Modeling and mobile applications showed large effects on some anxiety scales and small effects on others, again with low or very low certainty.

The reviewers’ own summary is that preparing a child could help behavior and anxiety, but the existing literature is inconclusive.

What that means for an office

Do it, for everyone. It is on the list of basic techniques, it has no listed contraindication, and it costs a message.
Expect a nudge. Nothing in the trials suggests pictures alone will turn a frightened child into a calm one.
Pair it with what happens in the chair. Tell-show-do, praise and a way to ask for a break still do the work on the day.
Don’t promise outcomes to parents. “This helps children know what to expect” is supported. “This will stop your child being scared” is not.

Doing it well

Use your own office. The stated aim is to show what to expect. Pictures of another clinic show something else.
Show the steps in order, one idea at a time, in words a child would use.
Send it early enough to repeat. A few days before, so a parent can go through it more than once.
Include the way out. Show how to ask for a break. Knowing there is one is part of what you are teaching.

For wording and timing, see what to send families before a first visit. For something to send today, our first-visit social story is free.

Where a playable version fits

Little Rehearsal is previsit imagery a child can play with: your own reception and chair, drawn from your photos, with a mirror, a polisher and a puff of air to try on an otter called Pip. No trial has tested it. The review above reports larger effects for mobile applications and modeling than for still pictures, on some scales and with low certainty. That is a reason to try it, not proof that it works.

US$99 per location a month. Free to build. You pay only if you approve it. Each month we tell you how many times your game was played, so you can judge it by your own front desk. See an example or ask for a free preview of your clinic.

Sources

American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry, revised 2024. https://www.aapd.org/research/oral-health-policies--recommendations/behavior-guidance-for-the-pediatric-dental-patient/
Dhar V, Randall CL, Marghalani AA, and others. Nonpharmacological behavior guidance for children during preventive dental visits: a systematic review, part 1. Pediatric Dentistry 2023;45(3):181-96. https://www.aapd.org/globalassets/181-96.e16-e19.pdf