Objective: Distraction is a highly acceptable technique for diverting a patient's attention from what may be perceived as an unpleasant procedure, reducing anxiety and helping the patient relax. The objective of the present study was to evaluate the effect of watching television during dental treatment on pediatric patients' anxiety and cooperation compared to the commonly used conventional Tell-Show-Do (TSD) behavioral management method. Method and materials: Sixty-nine children (mean age 6.8 years) scheduled to undergo restorative dental treatment were randomly divided into two intervention groups: a group that was managed by television distraction and a control group that was managed by TSD. During treatment, anxiety was assessed by the Facial Image Scale and cooperative behavior was assessed by the Frankl scale. Pulse rate and oxygen saturation were also measured during the treatment. Results: Compared to TSD, television distraction significantly reduced anxiety by 1.27 (95% confidence interval [CI] 0.798 to 1.744, adjusted P .001), decreased pulse rate by 6.44 beats per minute (bpm) (95% CI 4.60 to 8.28, adjusted P .001), and significantly increased cooperation by 1.17 (95% CI −1.318 to −1.020, adjusted P .001). A greater effect of television distraction on reduced anxiety and increased cooperation was observed during administration of the anesthetic injection. No effect of television distraction on saturation levels was noted. Conclusions: Television distraction is an effective method for reducing anxiety and improving cooperative behavior in children during dental treatments. Keywords: anxiety, behavior management, children, cooperation, dental treatment, television distraction