## 1 Introduction  
One of the main challenges of practicing dentistry in children depends on the practitioner's ability to provide a favorable experience [1]. Fear and anxiety in children are multifactorial and can be conditioned by personality, previous experiences, sex, age, etc. Therefore, the estimation of the degree of anxiety in the first consultation will guide the professional in defining the appropriate management techniques for each patient [2, 3]. Dental anxiety can be defined as a fear associated with a situation that can cause some type of pain in relation to dental treatment, which is magnified when there is a feeling of loss of control. It is estimated that dental anxiety affects approximately 16% of school children and has been shown to continue into adulthood [4, 5, 6, 7, 8, 9, 10]. There are various scales to assess anxiety:  
* Modified Corah scale: A short questionnaire with a response pattern ranging from \"not anxious\" to \"extremely anxious\". It has universal application and is a good detector of dental anxiety in patients over 10 years of age, including adults and individuals in communities with limited literacy [3, 6]. * Facial Image Scale: Images of seven faces that represent children's sense of responsiveness. It is used to measure dental anxiety in young children, who normally have a medium-low reading ability [11]. * Venham Picture Test: Eight cards with two figures each that are recorded as one point or zero points, with the range being between a minimum of zero and a maximum of eight. This test is acceptable for children between 6 and 15 years old [12]. * Wong-Baker Visual Analog Scale (VAS): Six sides with ratings ranging from 0 to 10 according to the patient's pain sensation. This scale provides a self-report and is inexpensive, easy to use and acceptable for patients between the ages of three and seven years [13; 14]. * Pulse oximeters: A noninvasive method used in children that helps record oxygen and pulse measurements. Some dentists are beginning to use them, as an increase is a direct physiological measure that is associated with stress and anxiety [15; 16; 17; 18; 19; 20; 21]. * Likert-type scale: A technique that calculates favorable and unfavorable responses to a stimulus or information previously given. It is applied through some kind of questionnaire, which is created based on five sections, and the results are separated into three categories: the first and the last will indicate extreme affirmative and negative responses, and the average will express that the subject does not know what to think or is indecisive [22]. * Frankl's Behavioral Scale: This technique has been used in a wide variety of behavioral studies because it is an easy, practical and inexpensive technique for rating patients' behavior in four categories: type 1: definitely negative; type 2: negative; type 3: positive; type 4: definitely positive [23; 24; 25; 26]. In pediatric dentistry, behavioral management is a crucial part of controlling patient anxiety, obtaining patient cooperation and achieving favorable outcomes. The American Academy of Pediatric Dentistry (AAPD) currently classifies the techniques into two groups: basic and advanced [12]. * Basic behavior management methods: Tell-show-do, voice control, nonverbal communication, positive reinforcement, distraction, parental presence or absence, and the use of nitrous oxide. * Advanced Behavioral Management Approach: Protective Stabilization, Sedation, and General Anesthesia. Today, traditional techniques are being replaced by nonaversive techniques such as distraction. They are based on the assumption that children perceive pain when their brain concentrates on the fact that there is or will be a painful stimulus and result in an analgesic effect. * Active interaction encourages the child patient to participate in some activities during treatment, such as interactive games, singing, squeezing objects, breath control or guided imagery, but has a high risk of increasing the patient's physical activity, which could complicate the dentist's work.