<p>Therapeutic play and music therapy are promising behavioral techniques that could effectively reduce dental anxiety and pain perception. This study aimed to evaluate the effects of therapeutic play and music therapy on dental anxiety and pain levels in pediatric patients undergoing tooth extraction. 126 children aged 6–8&#xa0;years who required maxillary molar extraction were divided into three groups (n = 42): control (Tell-Show-Do), music therapy, and therapeutic play groups. Vital signs (eg, heart rate, blood pressure, oxygen saturation, and body temperature) were recorded, while the Modified Child Dental Anxiety Scale for faces (MCDAS_f) and the Facial Image Scale (FIS) were used for analysis before and after extraction. The Wong–Baker Faces Pain Rating Scale (WBFPRS) was used post-extraction. Statistical analyses included Pearson’s Chi-squared test, one-way ANOVA, Kruskal–Wallis test, paired samples T-test, and Wilcoxon’s signed-rank test. All groups showed significant reductions in MCDAS_f and FIS scores (p &lt; 0.001), with the greatest decrease seen in the therapeutic play group. There was no significant difference in physiological parameters, although all groups showed increased heart rate and blood pressure. WBFPRS scores were lowest in the therapeutic play group (p &lt; 0.001). Therapeutic play and music therapy can reduce dental anxiety and pain perception, thereby improving treatment compliance.</p><p><b>Trial registration:</b> The study was registered in the ClinicalTrials.gov database (Registration ID: NCT07112092) on August 7, 2025.</p>