Non-Cochrane · intervention · PM41462193
The effect of dental rehabilitation under general anesthesia on dental anxiety in children: a systematic review and meta-analysis.
Keykha Elham, Hajisadeghi Samira, Heidari Mohammad Taha · BMC oral health · 2025 · PubMed · doi:10.1186/s12903-025-07334-y
Findings
Population Healthy children (ASA I-II) under 12 years old receiving dental care
6 findings
| Dental treatment under general anesthesia (DGA) | Pre-treatment (baseline) dental fear and anxiety in the same children | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) Follow-up up to 16 weeks · Sensitivity: excluding Guney 2018 | SMD -0.70 [-2.14, 0.75] GRADE not reported 6 studies |
| Dental treatment under general anesthesia (DGA) | Pre-treatment (baseline) dental fear and anxiety in the same children | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) Follow-up 2 weeks to 16 weeks · Overall | SMD -0.7 [-1.993, 0.593] Very low Downgraded: risk of bias, imprecision, inconsistency 7 studies · 673 participants |
| Dental treatment under general anesthesia (DGA) | Pre-treatment (baseline) dental fear and anxiety in the same children | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) Follow-up up to 16 weeks · Sensitivity: leave-one-out, omitting Mathew 2023 | SMD -0.19 [-0.71, 0.32] GRADE not reported 6 studies |
| Dental treatment under general anesthesia (DGA) | Pre-treatment (baseline) dental fear and anxiety in the same children | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) Follow-up up to 16 weeks · Sensitivity: excluding Heaton 2023 (16-week follow-up) | SMD -0.80 [-2.36, 0.76] GRADE not reported 6 studies |
| Dental treatment under general anesthesia (DGA) | Matched children without DGA experience (controls) | Dental fear and anxiety, CFSS-DS (DGA experience vs controls) Follow-up 1 month to 2 years · Overall | SMD 0.132 [-1.048, 1.313] Very low Downgraded: imprecision, inconsistency 3 studies · 184 participants |
| Dental treatment under general anesthesia (DGA) | Matched children without DGA experience (controls) | Dental fear and anxiety, MCDASf (DGA experience vs controls) Follow-up 1 year to 3 years · Overall | SMD 0.850 [-0.152, 1.853] Very low Downgraded: imprecision, inconsistency 2 studies · 138 participants |
Included primary studies 12
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Aldossari 2019 The long-term effect of previous dental treatment under general anaesthesia on children's dental fear and anxiety. PMID:30506997 | 2018 | this review only | Dental fear and anxiety, CFSS-DS (DGA experience vs controls); Dental fear and anxiety, MCDASf (DGA experience vs controls) | not extracted yet |
| Arch 2001 Children choosing between general anaesthesia or inhalation sedation for dental extractions: the effect on dental anxiety. PMID:11309872 | 2001 | this review only | not stated | not extracted yet |
| Cantekin 2014 Assessing change in quality of life and dental anxiety in young children following dental rehabilitation under general anesthesia. PMID:24717700 | 2014 | this review only | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) | not extracted yet |
| Duruk 2021 Impact of Dental Rehabilitation Under General Anesthesia on Oral Health-Related Quality-of-Life and Dental Anxiety in Turkish Children DOI:10.1590/pboci.2021.006 | 2021 | this review only | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) | not extracted yet |
| Gazal 2004 A double-blind randomized controlled trial investigating the effectiveness of topical bupivacaine in reducing distress in children… PMID:15525311 | 2004 | this review only | not stated | not extracted yet |
| Guney 2018 Dental anxiety and oral health-related quality of life in children following dental rehabilitation under general anesthesia or intravenous… PMID:30297563 | 2018 | this review only | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) | not extracted yet |
| Heaton 2023 Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and… PMID:37017506 | 2023 | this review only | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) | not extracted yet |
| Klaassen 2008 Dental treatment under general anaesthesia: the short-term change in young children's oral-health-related quality of life. PMID:18793595 | 2008 | this review only | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) | not extracted yet |
| Klaassen 2009 Young children's Oral Health-Related Quality of Life and dental fear after treatment under general anaesthesia: a randomized controlled… PMID:19583755 | 2009 | this review only | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA); Dental fear and anxiety, CFSS-DS (DGA experience vs controls) | not extracted yet |
| Mathew 2023 Evaluation of Change in Quality of Life, Dental Fear and Dental Anxiety in Young Children Following Full-mouth Dental Rehabilitation under… PMID:37469264 | 2023 | this review only | Dental fear and anxiety, CFSS-DS (post-DGA vs pre-DGA) | not extracted yet |
| Yildirim 2018 Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia. PMID:29354884 | 2018 | this review only | not stated | not extracted yet |
| Zhou 2022 The long-term effect of dental treatment under general anaesthesia or physical restraints on children's dental anxiety and behaviour. PMID:35274539 | 2022 | this review only | Dental fear and anxiety, MCDASf (DGA experience vs controls) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Healthy children (ASA I-II) under 12 years receiving dental care | Healthy children under 12 years, mean age 5.4 years (n=12 studies; 9 in meta-analysis) |
| Intervention | Dental treatment under general anesthesia (DGA) | DGA (n=12) |
| Comparison | Pre-treatment dental fear and anxiety in the same children or matched children without DGA | Pre-DGA baseline (n=7 pooled); children without DGA (n=3 datasets CFSS-DS, n=2 MCDASf) |
| Outcomes | Change in dental fear and anxiety (DFA) measured with validated psychometric tools | CFSS-DS, MCDASf, MCDAS, VPT, FIS, five-point face scale |
| Study designs | Observational, cross-sectional, case-control, clinical trial and cohort studies | 6 cross-sectional, 2 cohort, 2 RCT (before-after or DGA vs control) among meta-analyzed; overall 8 cross-sectional, 2 RCT, 2 cohort |
| Timing | Not specified | Post-DGA assessment 2 weeks to 3 years |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | No | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: No · NRSI: Yes | RCT: N/A · NRSI: Partial Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: No | RCT: N/A · NRSI: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |