DISCUSSION
vomiting reflex, Inferior Alveolar Nerve Block, anxiety, pain
POSITIVE
Dental fear and anxiety have an impact on the quality of dental treatment (Milgrom et al., Therefore, many procedural, behavioral, and nonpharmacological techniques have been proposed to reduce pain and discomfort during pediatric dental treatment. This study was conducted to compare different distraction techniques (active distraction–passive distraction) in reducing perceived pain during pulpotomy in children.There are many scales for classifying behavior in children, the most famous of which is the Frankel Scale, which divides behavior into four categories (Definitely negative, Negative, Positive, and Definitely positive) (Dean, This study dealt with a new technique that a child plays video games through a wireless joystick linked via Bluetooth with a portable tablet on the dental chair and placing Bluetooth headphones during pulpotomy, starting from IAN injection (Inferior Alveolar Nerve Block) and ending with the final restoration, because of the use of Bluetooth Dental treatment usually includes painful procedures, repetitive injections, use of sharp tools at high speed, and frequent visits. These aspects affect the child's ability to tolerate treatment, which poses a challenge to the dentist and, therefore, it is difficult to achieve successful dental treatment if the child's behavior is not controlled technology and wireless devices, the workspace was comfortable for the dentist and did not interfere with the movement of his hands, The tablet was placed in a high position on the dental chair, so the child raised his head high, which facilitated treatment.As our study results show, the use of the joystick and video games added a significant improvement in the behavior of children and the self‐reported pain during the dental treatment procedure, so that all children in active distraction group were treated with acceptable and satisfaction general behavior according to the scales used in the research. Thus, our method of distraction outperformed the passive distraction using video films. this is due to the physical activity of the child and they were blocked out from the surrounding environment, and our results agreed with many research that have been studied the effectiveness of active distraction through video games on a tablet device while performing different dental procedures, and their results showed that active distraction is superior to passive distraction (Attar & Baghdadi, In addition, active distraction using the joystick, which was fixed to the dental chair, was superior in pain control during pulpotomy compared to using AV distraction and control group, but it was similar in child behavioral management during pulpotomy compared to using AV distraction.Active distraction using video games is superior to passive distraction using video games for pain described by children, although other studies used an effective technique in improving self‐reported pain, PlayStation video games did not affect overall behavior (Guinot et al., Some studies have found that playing video games has improved a child's adaptation to the dentist, compared to watching cartoons while injecting local anesthesia. In addition, playing a video game and watching cartoons film during dental treatment reduced heart rate, compared to traditional distraction techniques (Kumprasert et al., On the other hand, some studies used effective distraction in reducing the vomiting reflex while taking the upper and lower alginate impression, and they used the Intellectual Colored Game, which distracted the child's attention during the stressful alginate impression (Kulkarni et al., In contrast to our study, some studies found that distraction did not provide additional advantages in reducing fear and pain when compared to traditional methods such as directing behavior and positive reinforcement, but it is a way to attract the child's attention and activate the child's nervous and emotional centers, which leads to relaxation (Al‐Khotani et al., This study found that playing a video game during dental treatment could better method a child's cooperation with the dentist, compared with watching cartoons and other conventional distractions (Cozzi et al., 