Background <p>Dental fear and anxiety (DFA) is a psychological response ranging from mild apprehension to severe phobia of dental procedures, affecting children and adolescents. Its prevalence is highly variable globally, influenced by culture, family conditions, personality traits, and assessment tools.This study aimed to assess dental anxiety levels in cooperative children aged 4–6 during their first dental visit using both self-reported and physiological measures.</p> Methods <p>A cross-sectional study included 100 children attending a pediatric dental clinic for the first time. The sample was collected from patients visiting the pediatric dentistry department in the faculty of dentistry. Self-reported anxiety was assessed using the Facial Image Scale (FIS), and pulse rate was recorded as a physiological indicator.</p> Results <p>The sample comprised 44% males and 56% females. No significant differences were found among age and gender groups for FIS scores (<i>p</i> = 0.162, <i>p</i> = 0.811) or pulse rate in age groups (<i>p</i> = 0.552), but females exhibited significantly higher pulse rates than (mean 106.93vs. 95.52&#xa0;bpm, <i>p</i> = 0.007).</p> Conclusion <p>Dental anxiety is similar across ages 4–6 during the first visit, with girls showing higher physiological indicators. Monitoring both self-reported and physiological measures is essential, Future studies should include non-cooperative children and assess pulse rate at multiple time points to better distinguish situational arousal from dental anxiety.</p> Clinical trial registration number <p>Not applicable</p>