Non-Cochrane · intervention · PM42116990
Impact of Mobile Oral Health Applications on Pediatric Dental Anxiety: A Systematic Review and Network Meta-Analysis.
Srinivasan Shanthosh Raj, Karthikayan Ravi, Vignesh K C, et al. · Cureus · 2026 · PubMed · doi:10.7759/cureus.106756
Findings
Population Children (4 to 11 years in included trials) with dental anxiety undergoing dental procedures
57 findings
| Tell-Show-Play-Distraction (TSPD) | Recorded maternal voice | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.17 [-1.65, 1.31] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Recorded maternal voice | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD 3.05 [-8.07, 14.17] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Mobile game with maternal presence (MG + MP) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.64 [-2.06, 0.78] GRADE not reported Studies not reported |
| Recorded maternal voice | Mobile game with maternal presence (MG + MP) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.47 [-1.93, 1.00] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Mobile oral health application | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD 0.7 [-7.2, 8.6] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Mobile oral health application | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.73 [-1.76, 0.30] GRADE not reported Studies not reported |
| Recorded maternal voice | Mobile oral health application | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -2.35 [-10.17, 5.47] GRADE not reported Studies not reported |
| Recorded maternal voice | Mobile oral health application | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.55 [-1.61, 0.51] GRADE not reported Studies not reported |
| Mobile game with maternal presence (MG + MP) | Mobile oral health application | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.09 [-1.10, 0.93] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Tell-Show-Do with maternal presence (TSD + MP) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.85 [-2.27, 0.56] GRADE not reported Studies not reported |
| Recorded maternal voice | Tell-Show-Do with maternal presence (TSD + MP) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.68 [-2.15, 0.79] GRADE not reported Studies not reported |
| Mobile game with maternal presence (MG + MP) | Tell-Show-Do with maternal presence (TSD + MP) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.21 [-1.36, 0.93] GRADE not reported Studies not reported |
| Mobile oral health application | Tell-Show-Do with maternal presence (TSD + MP) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.13 [-1.14, 0.89] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Animated video | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -4.17 [-15.60, 7.26] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Animated video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.29 [-2.73, 0.15] GRADE not reported Studies not reported |
| Recorded maternal voice | Animated video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.11 [-2.58, 0.36] GRADE not reported Studies not reported |
| Recorded maternal voice | Animated video | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -7.23 [-18.69, 4.24] GRADE not reported Studies not reported |
| Mobile game with maternal presence (MG + MP) | Animated video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.65 [-2.08, 0.78] GRADE not reported Studies not reported |
| Mobile oral health application | Animated video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.56 [-1.58, 0.46] GRADE not reported Studies not reported |
| Mobile oral health application | Animated video | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -4.88 [-13.25, 3.50] GRADE not reported Studies not reported |
| Tell-Show-Do with maternal presence (TSD + MP) | Animated video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.43 [-1.86, 0.99] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Standard video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.42 [-2.69, -0.15] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Standard video | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -3.19 [-12.32, 5.94] GRADE not reported Studies not reported |
| Recorded maternal voice | Standard video | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -6.25 [-15.57, 3.08] GRADE not reported Studies not reported |
| Recorded maternal voice | Standard video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.25 [-2.56, 0.06] GRADE not reported Studies not reported |
| Mobile game with maternal presence (MG + MP) | Standard video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.78 [-2.04, 0.47] GRADE not reported Studies not reported |
| Mobile oral health application | Standard video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.70 [-1.46, 0.07] GRADE not reported Studies not reported |
| Mobile oral health application | Standard video | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -3.90 [-8.97, 1.18] GRADE not reported Studies not reported |
| Tell-Show-Do with maternal presence (TSD + MP) | Standard video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.57 [-1.82, 0.68] GRADE not reported Studies not reported |
| Animated video | Standard video | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.14 [-1.15, 0.88] GRADE not reported Studies not reported |
| Animated video | Standard video | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD 0.98 [-7.67, 9.63] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Tell-Show-Do (TSD) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -5.58 [-13.53, 2.37] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Tell-Show-Do (TSD) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.62 [-2.66, -0.58] GRADE not reported Studies not reported |
| Recorded maternal voice | Tell-Show-Do (TSD) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.45 [-2.59, -0.31] GRADE not reported Studies not reported |
| Recorded maternal voice | Tell-Show-Do (TSD) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -8.63 [-17.29, 0.03] GRADE not reported Studies not reported |
| Mobile game with maternal presence (MG + MP) | Tell-Show-Do (TSD) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.98 [-2.00, 0.04] GRADE not reported Studies not reported |
| Mobile oral health application | Tell-Show-Do (TSD) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -6.28 [-10.00, -2.56] GRADE not reported Studies not reported |
| Mobile oral health application | Tell-Show-Do (TSD) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.89 [-1.31, -0.47] GRADE not reported Studies not reported |
| Tell-Show-Do with maternal presence (TSD + MP) | Tell-Show-Do (TSD) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.77 [-1.78, 0.25] GRADE not reported Studies not reported |
| Animated video | Tell-Show-Do (TSD) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.33 [-1.41, 0.75] GRADE not reported Studies not reported |
| Animated video | Tell-Show-Do (TSD) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -1.41 [-10.34, 7.53] GRADE not reported Studies not reported |
| Standard video | Tell-Show-Do (TSD) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.20 [-1.02, 0.63] GRADE not reported Studies not reported |
| Standard video | Tell-Show-Do (TSD) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -2.39 [-7.81, 3.04] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -2.08 [-3.32, -0.83] GRADE not reported Studies not reported |
| Tell-Show-Play-Distraction (TSPD) | Control (no technique) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -7.40 [-16.53, 1.74] GRADE not reported Studies not reported |
| Recorded maternal voice | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.90 [-3.19, -0.62] GRADE not reported Studies not reported |
| Recorded maternal voice | Control (no technique) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -10.45 [-19.84, -1.05] GRADE not reported Studies not reported |
| Mobile game with maternal presence (MG + MP) | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.44 [-2.67, -0.21] GRADE not reported Studies not reported |
| Mobile oral health application | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.35 [-2.08, -0.62] GRADE not reported Studies not reported |
| Mobile oral health application | Control (no technique) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -8.10 [-13.30, -2.89] GRADE not reported Studies not reported |
| Tell-Show-Do with maternal presence (TSD + MP) | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -1.23 [-2.46, 0.00] GRADE not reported Studies not reported |
| Animated video | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.79 [-2.04, 0.46] GRADE not reported Studies not reported |
| Animated video | Control (no technique) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -3.22 [-12.80, 6.35] GRADE not reported Studies not reported |
| Standard video | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.65 [-1.70, 0.39] GRADE not reported Studies not reported |
| Standard video | Control (no technique) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -4.20 [-10.46, 2.06] GRADE not reported Studies not reported |
| Tell-Show-Do (TSD) | Control (no technique) | Dental anxiety (validated scales, post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | SMD -0.46 [-1.24, 0.33] GRADE not reported Studies not reported |
| Tell-Show-Do (TSD) | Control (no technique) | Heart rate (post-intervention) Post-intervention · Pediatric dental procedures (prophylaxis, restorations, pulpotomy) | MD -1.81 [-7.13, 3.50] GRADE not reported Studies not reported |
Included primary studies 26
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Abbasi et al., 2021 Congenital adrenal hyperplasia: simultaneous determination of plasma aldosterone and 17-hydroxyprogesterone. PMID:202131 | 1978 | 3 other reviews | not stated | not extracted yet |
| Chintala M et al., 2025 Central sites of action of gastrointestinal drugs. PMID:202539 | 1978 | 2 other reviews | not stated | not extracted yet |
| Karkoutly M et al., 2024 Effectiveness of a dental simulation game on reducing pain and anxiety during primary molars pulpotomy compared with tell-show-do… PMID:39174937 | 2024 | 2 other reviews | not stated | not extracted yet |
| Nair SM et al., 2024 Serum lipids in angiographically assessed coronary atherosclerosis. PMID:202436 | 1978 | 2 other reviews | not stated | not extracted yet |
| Karkoutly M et al., 2024 Perinatally acquired viral infections. PMID:202435 | 1977 | 1 other review | not stated | not extracted yet |
| Kevadia M V et al., 2020 Guanosine 3',5'-monophosphate: a central nervous system regulator of analgesia. PMID:202029 | 1978 | 1 other review | not stated | not extracted yet |
| Kevadia M V et al., 2020 Comparative Evaluation of Effectiveness of Tell-Play-Do, Film Modeling and Use of Smartphone Dental Application in the Management of Child… PMID:33976496 | 2020 | 1 other review | not stated | not extracted yet |
| Panchal J et al., 2022 [Origin of the receptor cells and their evolution]. PMID:202233 | 1977 | 1 other review | not stated | not extracted yet |
| Sasikumar T et al., 2025 Biological evaluation of the third pancreatic hormone (APP): hepatocyte and adipocyte effects. PMID:202540 | 1977 | 1 other review | not stated | not extracted yet |
| Verma N et al., 2022 [Cytochemical study of various enzymes of the rabbit crystalline lens epithelium]. PMID:202232 | 1977 | 1 other review | not stated | not extracted yet |
| Abbasi et al., 2021 The Efficacy of Little Lovely Dentist, Dental Song, and Tell‐Show‐Do Techniques in Alleviating Dental Anxiety in Paediatric Patients: A… DOI:10.1155/2021/1119710 | 2021 | this review only | not stated | not extracted yet |
| Aziz SZ et al., 2023 Effect of hydrolytic enzymes and protein-modifying reagents on gonadotropin receptors in bovine corpus luteum cell membranes. PMID:202334 | 1978 | this review only | not stated | not extracted yet |
| Aziz SZ et al., 2023 The Efficacy of Little Lovely Dentist and Tell Show Do in Alleviating Dental Anxiety in Iraqi Children: A Randomized Clinical Trial. PMID:38124727 | 2023 | this review only | not stated | not extracted yet |
| Chintala M et al., 2025 Comparative evaluation of the effectiveness of video modeling, mobile app (Little Lovely Dentist), and animated video modeling technique… DOI:10.4103/jisppd.jisppd_129_25 | 2025 | this review only | not stated | not extracted yet |
| Derbala GA et al., 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Derbala GA et al., 2021 Effect of TSH on cAMP and cGMP levels in thyroid cancers, adenomas and normal human thyroid tissue. PMID:202130 | 1978 | this review only | not stated | not extracted yet |
| Elicherla SR et al., 2019 Comparative evaluation of the effectiveness of a mobile app (Little Lovely Dentist) and the tell-show-do technique in the management of… DOI:10.17245/jdapm.2019.19.6.369 | 2019 | this review only | not stated | not extracted yet |
| Elicherla SR et al., 2019 A clinical situation of unusual cardiac pain. PMID:201928 | 1977 | this review only | not stated | not extracted yet |
| Nair SM et al., 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Panchal J et al., 2022 Comparative evaluation of the effectiveness of two innovative methods in the management of anxiety in a dental office: a randomized… DOI:10.17245/jdapm.2022.22.4.295 | 2022 | this review only | not stated | not extracted yet |
| Santhoshpriya AKR et al., 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Santhoshpriya AKR et al., 2024 State of the art. Sleep and control of breathing. PMID:202437 | 1978 | this review only | not stated | not extracted yet |
| Sasikumar T et al., 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sedky MM et al., 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sedky MM et al., 2024 Laryngeal abductor activity during sleep. PMID:202438 | 1978 | this review only | not stated | not extracted yet |
| Verma N et al., 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Pediatric patients aged 2 to 14 years undergoing dental procedures with anxiety | 1,002 children aged 4 to 11 years in 13 studies (network: 707 children for dental anxiety, 687 for heart rate) |
| Intervention | Mobile oral health applications (Android/iOS; educational or game apps for children) | Mobile apps (mostly Little Lovely Dentist), maternal voice, animated video, standard video, TSD, TSPD, TSD with maternal presence, mobile game with maternal presence |
| Comparison | Standard dental care without mobile applications or other behavioral management interventions | Tell-Show-Do, other behavioral techniques, videos, control |
| Outcomes | Primary: dental anxiety on validated scales; secondary: heart rate (also pain, oxygen saturation) | Dental anxiety (10 RCTs, 9 interventions); heart rate (9 RCTs, 7 interventions); SUCRA rankings |
| Study designs | Randomized controlled trials and clinical trials | 12 RCTs and 1 non-randomized trial; 10 RCTs in the network meta-analysis |
| Timing | Post-intervention | Post-intervention |
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 | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | No | Yes | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |