Effect of Personalized AI-Generated Picture Books on Anxiety During First Dental Visits in Young Children: Two Case...

This study tested whether a personalized picture book created using image-generation technology reduces caregivers' perceived child dental anxiety and improves cooperation during a child's first dental visit. The book is read to achieve familiarity and predictability before the visit and is synchronized with the clinical sequence. Two dentally naive toddlers were recruited from a university clinic. For each child, a device-based picture book was generated (using DALL·E 3) and tailored to the actual operation, attending dentist, and child's appearance. Caregivers read the book at home (7 days previsit). The clinical sequence was intentionally managed to mirror situations depicted in the book ensuring continuity from home preparation. The sequence included sitting on a dental chair, introducing the instrument, oral examination, and topical fluoride application. Immediately after the visit, caregivers completed an online questionnaire (1-4 scales) assessing precaregiver/postcaregiver anxiety and worry about the child crying, perceived child cooperation, perceived contribution to anxiety reduction, intention to schedule periodic checkups, and perceived reading burden with free-text feedback. Both caregivers reported lower anticipatory anxiety (pre-reading mean: 3.5; postreading mean: 2.5) and worry about the child crying (pre-reading mean: 4.0; postreading mean: 2.5). After the visit, they perceived the children to be highly cooperative (mean score: 4.0/4). Caregivers also felt that the picture book contributed to reducing their children's anxiety (mean score: 3.0/4). For the second-born child (single case), the caregiver reported lower anxiety than during the older sibling's first dental visit (score: 4/4). Caregivers' ratings of reading burden were mixed. Customized device-based picture books that mirror real clinical settings and are synchronized with actual clinical visits appear feasible and acceptable for toddlers' first dental visits. By offering familiar, concrete cues and a simple "what happens next" script, this approach may help mitigate negative expectations, support cooperation, and be adaptable to routine care.