Tactile distraction using sensory materials during restorative dental treatment in children: effects on pain perception, heart rate, and salivary cortisol

Non-pharmacological behavior guidance techniques are widely used to improve children’s comfort during dental treatment. Among these approaches, tactile distraction using sensory materials may represent a simple chairside strategy to reduce anxiety and perceived discomfort. This study aimed to evaluate the effects of tactile distraction using play dough, slime, and a plush toy on perceived pain and heart rate and salivary cortisol level in children undergoing restorative dental treatment. This prospective, non-randomized clinical study included 90 children aged 6–10 years requiring restorative treatment of maxillary primary molars under local anesthesia. Children were sequentially allocated to four groups (play dough, slime, plush toy, or control), and all received routine behavior guidance; children in the experimental groups held the assigned tactile material during treatment. Baseline dental fear was assessed using the Children’s Fear Survey Schedule–Dental Subscale (CFSS-DS), and post-treatment pain using the Wong–Baker Faces Pain Rating Scale. Heart rate was recorded before treatment, during local anesthetic injection, and after treatment, and salivary cortisol was measured before and after treatment by ELISA. Data were analyzed using the Kruskal–Wallis test, two-way mixed ANOVA, and ANCOVA adjusted for baseline cortisol. Baseline CFSS-DS scores were comparable among groups ( p = 0.685). Wong–Baker scores differed among groups (Kruskal–Wallis, p = 0.044); however, median scores were 0 in all groups and no pairwise comparison remained significant after Bonferroni correction. The proportion of children reporting any pain was 4.5% in the plush toy, 18.2% in the play dough, 36.4% in the slime, and 37.5% in the control group ( p = 0.028). Heart rate increased significantly during local anesthesia ( p < 0.001), with no significant group × time interaction ( p = 0.150). Salivary cortisol differed among groups at baseline ( p = 0.016); after adjustment for baseline values, post-treatment cortisol did not differ significantly among groups ( p = 0.082), and no significant within-group changes were observed. Tactile distraction with simple sensory materials did not produce statistically confirmed differences in pain, heart rate, or salivary cortisol compared with routine behavior guidance alone. The lower frequency of reported pain in the plush toy group suggests that this approach warrants further investigation in adequately powered randomized trials. This study was registered at ClinicalTrials.gov (NCT07445594) on February 16, 2026.