Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials

Abstract

Objective To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment. Methods Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively. Results Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies. Conclusion There is a very low certainty of evidence that DT can be effective in managing children's/adolescents’ dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well‐executed RCTs are needed.

‘Message to Dentist’: Facilitating Communication with Dentally Anxious Children

“…There is an extensive literature on the numerous behavioural techniques that can be employed to ‘manage’ children’s dental anxiety [4,5,6]. However, in recent years there has been growing interest in the role of psychological approaches, such cognitive behavioural therapy (CBT), for not just ‘managing’ children’s dental anxiety, but reducing it in both the short and longer-term [7].…”

“Mom Let’s Go to the Dentist!” Preliminary Feasibility of a Tailored Dental Intervention for Children with Autism Spectrum Disorder in the Italian Public Health Service

“…Several studies underline the positive effect of daily use of ICT tools with people with ASD, in both learning contexts and social situations [ 38 , 39 , 40 , 41 ]. As reported in these studies, people with ASD seem to like innovative educational approaches enhanced by ICT tools mainly because when using technology, they can avoid typical issues involved in human interaction, such as impatience, feelings of inadequacy, unpredictability of people’s behavior, and poor recognition of emotions, irony, and figurative language.…”

Efficacy of audiovisual distraction using eyeglasses during dental care: a randomized clinical trial

“…A systematic review found that most of the evaluated distraction techniques had significant effects on reducing anxiety and fear levels at some point during dental treatments, but the evidence had a low certainty. 6 An audiovisual distraction, an eyeglasses system composed of a head-mounted display placed in front of the eyes and in-ear headphones, could be superior to traditional distraction methods as it is not only more engaging but also has the capability to block real-world visual and auditory stimuli. A systematic review 7 showed that there is some low-quality evidence suggesting that the use of audiovisual distractions during dental treatment may relieve children's anxiety related to dental treatment.…”

“…Considering that more robust and well-executed randomized clinical trials are still needed, 6 the objective of this study was to test the efficacy of audiovisual distractions using VR eyeglasses compared to conventional behavior management techniques during procedures requiring local anesthesia.…”