Analyzing Nonpharmacological Behavior Management in Children With Dental Anxiety: A Systematic Review and Meta-Analysis.

Dental anxiety in children is a prevalent concern that affects compliance and treatment outcomes in pediatric dentistry. Nonpharmacological behavioral interventions (NPBI), including virtual reality (VR) and tell-show-do (TSD), are commonly used to manage dental anxiety. This systematic review and meta-analysis aim to evaluate the effectiveness of these interventions in reducing anxiety and pain perception in pediatric dental patients. Following PRISMA-2020 guidelines, a comprehensive search of PubMed, Scopus, Cochrane, and Web of Science was conducted until April 2024. Randomized controlled trials (RCTs) comparing NPBIs to controls in children undergoing dental procedures were included, focusing on changes in dental anxiety and pain. The risk of bias was assessed using the Cochrane RoB 2 tool for RCTs and the ROBINS-I tool for non-randomized studies. Meta-analysis was performed using a random-effects model, with standardized mean differences (SMD) and 95% Confidence Intervals (CI) calculated for anxiety and pain outcomes. Statistical heterogeneity was assessed using I² and Cochran's Q test. Of 2,957 records, 76 RCTs with 6,723 participants were included. Distraction techniques did not significantly reduce dental anxiety compared to Tell-Show-Do (SMD -0.34, 95% CI -0.71 to 0.04) but were effective in reducing pain (SMD -0.43, 95% CI -0.76 to -0.10). Virtual Reality (VR) distraction showed no significant reduction in anxiety or pain compared to traditional techniques. While certain distraction techniques may alleviate pain, their impact on anxiety is comparable to that of traditional methods such as TSD. Despite this innovative approach, VR distraction did not demonstrate superiority over traditional techniques in reducing anxiety or pain.