Background: In multicultural healthcare systems such as the Italian one, migrant children may experience dental care as particularly stressful because linguistic and cultural barriers can limit communication, emotional expression, and understanding of the clinical setting. Aim: Understanding the emotional experience of migrant children during dental visits is essential for improving clinical management in pediatric dentistry and orthodontics within multicultural contexts. Because linguistic barriers often limit verbal communication, this study aimed to explore children’s mental representations, emotional states, and perceptions of the dental environment through drawing and to evaluate the clinical implications for communication and therapeutic collaboration. Methods: This qualitative study was conducted in Italy between 2016 and 2025 and analyzed 50 drawings produced by 50 foreign-born migrant children aged 6–13 years, recruited through an educational cooperative in Piacenza. Most participants originated from developing countries and had limited proficiency in Italian, frequently showing a marked “experience gap” in drawing ability that interfered with normative developmental stages described by Lowenfeld. The analysis focused on spatial organization, line quality, color use, posture, interpersonal distance, and representation of the clinical environment, integrating graphic competence assessment with emotional interpretation. Results: Younger children commonly depicted rigid lines, essential settings, and oversized dental unit lamps, whereas older children increasingly represented threatening or disproportionate instruments, aggressive dentists, and omission of the patient figure. Around age 10, drawings became more detailed and colorful, although symbols of closure, such as locked doors, persisted. In adolescents, representations polarized between rich, coherent scenes and extremely essential drawings dominated by fear, rigidity, minimal environments, and symbols of constraint. The findings suggest that drawing may represent a valuable non-verbal clinical and communicative resource for exploring migrant children’s emotional experience of dental care and for identifying signs of anxiety and vulnerability that may not emerge through verbal interaction alone. Conclusions: These findings support the value of a culturally sensitive dental approach integrating drawing, visual aids, multilingual educational materials, and play-based strategies to reduce communication barriers and improve cooperation in migrant children receiving pediatric dental and orthodontic care.

Background: Dental anxiety is common in pediatric dentistry and may hinder care, particularly in behaviorally challenging children. Most anxiety measures rely on verbal report, which can be unreliable in young patients. This study explored whether the Lüscher Color Test, a non-verbal psychological instrument, shows associations with established anxiety proxies in a pediatric dental sedation setting. Methods: In this single-center prospective observational study, 100 children aged 4–12 years referred for dental treatment in a conscious sedation unit were recruited; 80 completed the protocol (exclusion rate 20%). N₂O/O₂ inhalation sedation was not randomized and was selected by the clinician based on clinical judgement. Anxiety was assessed pre- and post-operative using the Lüscher Color Test, heart rate (HR) monitoring, and the Visual Facial Anxiety Scale (VFAS). The primary outcome was the pre–post change in the Lüscher anxiety index calculated as the pre-operative score minus the post-operative score (Δ = pre − post). Associations between changes in anxiety measures and demographic/clinical variables were examined. Results: Anxiety scores decreased after treatment for both the Lüscher Color Test and VFAS (both p < 0.001). Change in Lüscher scores was positively associated with HR reduction (Spearman r = 0.68; p < 0.01), whereas VFAS change showed a weaker association (r = 0.28; p < 0.05). In regression analyses, treatment-related variables were explored; however, given the observational design and subgroup imbalance, these findings should be interpreted cautiously. Conclusions: Although pre–post scores suggested a reduction in anxiety, the Lüscher Color Test should be considered an exploratory, complementary non-verbal measure rather than a validated diagnostic instrument. In the multivariable logistic regression, nitrous oxide sedation showed only a non-significant trend toward greater anxiety reduction (p = 0.07). Further studies with appropriate validation frameworks and stronger designs are needed before clinical implementation can be recommended.