Background: Dental anxiety about injections are common challenge in pediatric dentistry, often leading to delayed dental treatment. Aim: The aim of the study was to evaluate the anesthetic effectiveness of three different topical agents in pediatric dental procedures. Settings and design: The study was a cross-sectional in vivo study carried out in the department of pediatric and preventive dentistry. Ninety children were chosen using convenience sampling and divided into three groups based on the topical anesthetic agent administered. Materials and methods: The procedure included anxiety assessment using the Modified Venham Picture Scale (MVPS) before and after the procedure, and pain perception was measured with the visual analog scale (VAS) and sound, eye, and motor scale (SEMS). Group A received 2% lidocaine gel, group B experienced precooling of the injection site with an ice cone, and group C was treated with clove oil, followed by a 0.9 mL infiltration injection of 2% lidocaine with 1:1,00,000 epinephrine using a 30-gauge needle for all groups. Statistical analysis: Variations in scores of the MVPS, VAS, and SEMS within and between the three groups were examined with the Kruskal–Wallis test. Spearman’s correlation was employed to assess the relationships between the three scales with statistical significance set at p < 0.05. Results: Clove oil demonstrated the best anesthetic properties and exhibited the least pain perception among all groups. Conclusions: Natural options like clove oil and precooling with ice cones may serve as cost-effective alternatives to lidocaine gel in reducing pain and anxiety during pediatric dental procedures. © 2025 Elsevier B.V., All rights reserved.