Non-pharmacological management of dental fear and anxiety in children and adolescents: An umbrella review

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ABSTRACT

Aim

To synthesise knowledge on the relative efficacies of non-pharmacological strategies for managing dental fear and anxiety (DFA) in children and adolescents, specifically their effects on behaviour, anxiety levels and pain perception.

Methods

An umbrella review on non-pharmacological strategies used to manage DFA in children and adolescents was conducted based the Joanna Briggs Institute methodology. Searches were performed in 5 main electronic databases and the grey-literature. Two independent reviewers selected and appraised the included studies using the AMSTAR2 tool. Disagreements were resolved by a third reviewer.

Results

From 191 studies, 13 systematic reviews (SRs) were included and the majority were of low or critically low quality. Findings from the SRs suggest that audio-visual distraction was the most effective strategy for reducing anxiety, but effects on pain perception and behaviour were inconclusive. Traditional behaviour management techniques and audio distraction had mixed outcomes. Other strategies like aromatherapy and cognitive behaviour therapy were found to be effective for reducing anxiety but the evidence was weak.

Conclusion

Audio-visual distraction was effective in reducing anxiety during a variety of dental procedures including those requiring local anaesthesia. A combination of techniques may be more effective in managing DFA in children and adolescents, possibly improving pain perception and cooperative behaviour.

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