Abstract
BACKGROUND: Dental anxiety is a common psychological barrier that negatively influences dental attendance, patient cooperation, and treatment outcomes. Traditional anxiety-management strategies are often resource-intensive and difficult to implement routinely. Artificial intelligence (AI)-based chatbots offer a scalable and accessible digital approach that may help reduce dental anxiety through patient education, reassurance, and emotional support. METHODS: A quasi-experimental pre-post interventional study was conducted among 415 adult dental patients attending the outpatient clinics of the University of Ha'il, Saudi Arabia. Participants interacted with an AI-based chatbot for 10-15 min prior to treatment. Dental anxiety was assessed before and immediately after chatbot use using the Modified Dental Anxiety Scale (MDAS) across five common dental scenarios. Demographic variables, including gender, age, educational level, and monthly income, were analysed. Chi-square tests and Spearman's correlation were applied to evaluate changes in the severity of dental anxiety and associations between pre- and post-intervention scores. RESULTS: A statistically significant reduction in dental anxiety was observed across all five dental scenarios following chatbot interaction (p < 0.001). The greatest reductions were noted for invasive procedures, particularly tooth drilling and local anaesthetic injection. The severity of dental anxiety decreased consistently across gender, age, educational, and income groups, indicating a broadly similar effect of the intervention across these subgroups. Although patients with greater baseline severity of dental anxiety remained relatively more anxious post-intervention, the overall severity of anticipatory anxiety was substantially reduced. Female patients exhibited higher baseline anxiety, but gender-based differences were markedly reduced after chatbot use. CONCLUSION: The use of the AI-based chatbot demonstrated a consistent association with reduced anticipatory dental anxiety across diverse patient groups and clinical scenarios. As a low-cost, scalable, and patient-centred tool, chatbot-based support may complement conventional anxiety-management strategies and support the patient experience in routine dental care.