Aim: To evaluate the efficacy of cognitive-behavioral play therapy (CBPT) and tell-show-do (TSD) technique in the behavior modification of uncooperative children during local anesthesia prior to dental extraction. Materials and methods: Sixty-two children aged 6–11 years with Frankl\'s behavior rating of two during their first dental visit and requiring the extraction of retained or mobile primary anterior teeth under local anesthesia were divided into two groups: group I—CBPT, and group II—TSD. Children in group I were introduced to the dental instruments using verbal explanations, actual dental instruments, and a toy demonstration. They were then allowed to role-play as the dentist on a customized toy mouth. Children in group II received an explanation and a demonstration of the procedure before undergoing it. The behavior and anxiety levels of the children were assessed at three different points during the course of the trial. Pulse rate records served as an objective measure of anxiety. Results: Group I showed a statistically significant reduction in pulse rate between the baseline and posttreatment scores (Z = 2.286, p = 0.067 and Z = 3.49, p = 0.002), while no significant change was observed in group II. Both groups showed a significant reduction in behavior and anxiety scores when comparing baseline to postintervention and baseline to posttreatment scores. There was no significant difference in behavior and anxiety scores between groups I and II with the Mann–Whitney U test, with a level of significance at p < 0.05. Conclusion: Cognitive-behavioral play therapy showed greater amelioration in behavior and anxiety levels of children compared to TSD technique. Clinical significance: Cognitive-behavioral play therapy is a safe and noninvasive method to educate children about dental procedures and allow them to role-play, promoting more positive memories and a greater willingness to return. Clinical trial registration: The clinical trial was registered at Clinical Trials Registry—India (CTRI Reg. number: CTRI/2021/05/033675).