Anxiety and fear management in paediatric dentistry using distraction techniques

Data sources: PubMed, Web of Science, Scopus, Cochrane Library, Latin American and Caribbean Health Sciences Literature (Lilacs), US National Library of Medicine and Google Scholar. There were no limits on language or publication dates.Study selection: Two independent reviewers performed the study selection of randomised controlled trials (RCT) investigating distraction techniques to manage dental anxiety & fear in patients under 18 years old compared to no interventionData extraction and synthesis: Data were extracted by two independent reviewers using standardised data tables. Risk of bias was assessed using Cochrane Collaboration's Risk of Bias Tool. Study heterogeneity precluded meta-analysis. Qualitative analyses were performed.Results: Twenty-one RCTs were included in this systematic review. Participant ages ranged from 4 to 16 years old. Distraction techniques included use of audio and audio-visual techniques, instrument camouflage, biofeedback therapy, dental operating microscope and toys. Data were collected pre- and post-dental procedures including: dental examination; prophylaxis; local anaesthetic administration; restoration placement; exodontia; and placement of rubber dam. Within studies, between one and six instruments were used to measure children's anxiety and dental fear. Objective measures with pulse oximeters and blood pressure cuffs were used most frequently.Conclusions: The studies included in this systematic review suggest that distraction techniques might be useful to control children's anxiety and fear during dental appointments, however, the certainty of evidence is very low. There are no contraindications for the use of distraction techniques during children's and adolescents' dental appointments.