Background <p>Children’s dental fear (CDF) has become a major factor compromising the quality of dental treatment. Over time, persistent dental fear may adversely affect both the physical and psychological well-being of pediatric patients.This study aims to assess the effect of scenario-experiential behavior management techniques on dental fear in preschool children with dental caries.</p> Methods <p>Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400090907) registered 15 October 2024. A total of 100 children who met the inclusion and exclusion criteria in the pediatric stomatology department were selected and randomly assigned to either a control group or an intervention group using a random number table. The control group received standard pediatric dental care, while the intervention group was given a scenarioexperiential plan before treatment. Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) scores, Frankl Rating Scale (FRS) scores, and parental satisfaction levels were compared between the two groups. Descriptive analysis, the independent test, the Pearson’s chisquare test, Wilcoxon rank sum test and Fisher’s exact test were applied.</p> Results <p>One hundred children were recruited in the study. Seven children were lost to follow-up or excluded, leaving 93 children with a mean age of 4.54 ± 0.98 years for final analysis (46 in the intervention group, 47 in the control group). Before the intervention, there were no significant differences in CFSS-DS or FRS scores between the two groups. After the intervention, the intervention group had significantly lower CFSS-DS scores (25.26 ± 6.96) compared to the control group (29.40 ± 10.15) (<i>P</i> = 0.024, <i>t</i> = 2.287, 95%CI = 0.545,7.742). In the intervention group, 34 children (73.91%) reached FRS level 3 and 8 (17.39%) reached level 4. In contrast, the control group had 25 children (53.19%) at level 3 and 6 (12.77%) at level 4. Children in the intervention group showed better treatment cooperation (<i>P</i> = 0.015,<i>Z</i>=-2.444, 95%CI = 0.009,0.012). At the end of the study, 36 (78.30%) parents in the intervention group reported being very satisfied, compared to 31 (66.00%) parents in the control group. Parental satisfaction was significantly higher in the intervention group (<i>P</i> = 0.027, <i>χ</i>^<i>2</i> = 9.151,95%CI = 0.018,0.024).</p> Conclusions <p>The findings of this study indicated scenario-experiential behavior management techniques showed significant advantages in alleviating dental fear in preschool children and improving their compliance during visits. Through one-on-one interactive games, both children and their parents receive clear explanations of dental procedures, which helps improve their overall satisfaction. However, due to some limitations of this study, it would be necessary to conduct randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.</p>