Kaur Kanwalpreet, Saini Ravinder S, Binduhayyim Rayan Ibrahim H, Mosaddad Seyed Ali, Heboyan Artak
Rutgers School of Dental Medicine Newark New Jersey USA.
Allied Dental Health Sciences, COAMS King Khalid University Abha Saudi Arabia.
Health Sci Rep. 2025 Aug 19;8(8):e71176. doi: 10.1002/hsr2.71176. eCollection 2025 Aug.
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.
儿童牙科焦虑是一个普遍存在的问题，会影响儿童牙科治疗的依从性和治疗效果。非药物行为干预（NPBI），包括虚拟现实（VR）和示范-讲解-操作（TSD），常用于管理牙科焦虑。本系统评价和荟萃分析旨在评估这些干预措施在减轻儿童牙科患者焦虑和疼痛感知方面的有效性。
按照PRISMA-2020指南，对PubMed、Scopus、Cochrane和科学网进行了全面检索，直至2024年4月。纳入了比较NPBI与接受牙科治疗儿童的对照组的随机对照试验（RCT），重点关注牙科焦虑和疼痛的变化。使用Cochrane RoB 2工具评估RCT的偏倚风险，使用ROBINS-I工具评估非随机研究的偏倚风险。采用随机效应模型进行荟萃分析，计算焦虑和疼痛结果的标准化平均差（SMD）和95%置信区间（CI）。使用I²和Cochrane Q检验评估统计异质性。
在2957条记录中，纳入了76项RCT，共6723名参与者。与示范-讲解-操作相比，分散注意力技术在减轻牙科焦虑方面没有显著效果（SMD -0.34，95% CI -0.71至0.04），但在减轻疼痛方面有效（SMD -0.43，95% CI -0.76至-0.10）。与传统技术相比，虚拟现实（VR）分散注意力在减轻焦虑或疼痛方面没有显著效果。
虽然某些分散注意力技术可能减轻疼痛，但其对焦虑的影响与示范-讲解-操作等传统方法相当。尽管采用了这种创新方法，但VR分散注意力在减轻焦虑或疼痛方面并未显示出优于传统技术的效果。
