Non-Cochrane · intervention · PM42491220
Technology-enhanced behavior guidance for pediatric dental anxiety: a systematic review and meta-analysis of effectiveness and safety of virtual reality, augmented reality, biofeedback, and games.
Haridoss Selvakumar, Swaminathan Kavitha, Madiraju Guna Shekhar, et al. · Frontiers in dental medicine · 2026 · PubMed · doi:10.3389/fdmed.2026.1819864
Findings
Population Children and adolescents receiving dental care (about 4 to 16 years)
4 findings
| Technology-enhanced/digital distraction (virtual reality, augmented reality, games, audiovisual distraction, biofeedback) | Control (usual care, conventional behavior guidance such as tell-show-do, or non-digital distraction) | Dental anxiety/fear score, trim-and-fill sensitivity analysis Intra-procedural · Pediatric dental procedures (e.g., local anesthesia, restorations, pulp therapy, extractions) · Sensitivity analysis: trim-and-fill | SMD -0.52 [-1.06, 0.01] GRADE not reported 48 studies · 2946 participants |
| Technology-enhanced/digital distraction (virtual reality, augmented reality, games, audiovisual distraction, biofeedback) | Control (usual care, conventional behavior guidance such as tell-show-do, or non-digital distraction) | Pulse rate (lower is better) Intra-procedural · Pediatric dental procedures (e.g., local anesthesia, restorations, pulp therapy, extractions) | SMD -0.61 [-0.99, -0.23] Very low Downgraded: risk of bias, inconsistency, publication bias 30 studies · 1727 participants |
| Technology-enhanced/digital distraction (virtual reality, augmented reality, games, audiovisual distraction, biofeedback) | Control (usual care, conventional behavior guidance such as tell-show-do, or non-digital distraction) | Pain score (lower is better) Intra-procedural · Pediatric dental procedures (e.g., local anesthesia, restorations, pulp therapy, extractions) | SMD -1.08 [-1.56, -0.60] Very low Downgraded: risk of bias, imprecision, inconsistency 18 studies · 1319 participants |
| Technology-enhanced/digital distraction (virtual reality, augmented reality, games, audiovisual distraction, biofeedback) | Control (usual care, conventional behavior guidance such as tell-show-do, or non-digital distraction) | Dental anxiety/fear score (lower is better) Intra-procedural · Pediatric dental procedures (e.g., local anesthesia, restorations, pulp therapy, extractions) | SMD -0.97 [-1.41, -0.53] Very low Downgraded: risk of bias, inconsistency 42 studies · 2569 participants |
Included primary studies 61
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Karkoutly 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 |
| Bahrololoomi 2024 Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A… PMID:38250512 | 2024 | 1 other review | not stated | not extracted yet |
| Kevadia 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 |
| Khan 2019 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Niharika 2018 Effects of distraction using virtual reality technology on pain perception and anxiety levels in children during pulp therapy of primary… PMID:30324926 | 2018 | 1 other review | not stated | not extracted yet |
| Shetty 2019 Effect of Virtual Reality Distraction on Pain and Anxiety During Dental Treatment in 5 to 8 Year Old Children. PMID:30730798 | 2019 | 1 other review | not stated | not extracted yet |
| Aditya 2021 Comparison of effectiveness of three distraction techniques to allay dental anxiety during inferior alveolar nerve block in children: A… PMID:34632153 | 2021 | this review only | not stated | not extracted yet |
| Al-Khotani 2016 Effects of audiovisual distraction on children's behaviour during dental treatment: a randomized controlled clinical trial. PMID:27409593 | 2016 | this review only | not stated | not extracted yet |
| Al-Namankany 2014 Video modelling and reducing anxiety related to dental injections - a randomised clinical trial. PMID:24970519 | 2014 | this review only | not stated | not extracted yet |
| Alsibai 2023 Assessing an active distracting technique during primary mandibular molar pulpotomy (randomized controlled trial). PMID:36478192 | 2023 | this review only | not stated | not extracted yet |
| Aly 2025 Effectiveness of virtual reality glasses versus white noise on dental anxiety in children with attention-deficit hyperactivity disorder: A… PMID:39245983 | 2025 | this review only | not stated | not extracted yet |
| Aminabadi 2022 Assessing the Different Levels of Virtual Reality That Influence Anxiety, Behavior, and Oral Health Status in Preschool Children:… PMID:35436233 | 2022 | this review only | not stated | not extracted yet |
| Anchala 2024 Efficacy of kaleidoscope, virtual reality, and video games to alleviate dental anxiety during local anesthesia in children: a randomized… PMID:38840651 | 2024 | this review only | not stated | not extracted yet |
| Asl 2012 The Impact of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 4-6 Year-Old Children: a Randomized Controlled… PMID:23277857 | 2012 | this review only | not stated | not extracted yet |
| Asokan 2020 Effectiveness of distraction techniques in the management of anxious children - A randomized controlled pilot trial. PMID:33402625 | 2020 | this review only | not stated | not extracted yet |
| Attar 2015 Comparative efficacy of active and passive distraction during restorative treatment in children using an iPad versus audiovisual… PMID:25416522 | 2015 | this review only | not stated | not extracted yet |
| Bagattoni 2018 Effects of audiovisual distraction in children with special healthcare needs during dental restorations: a randomized crossover clinical… PMID:28399334 | 2018 | this review only | not stated | not extracted yet |
| Bagher 2023 The effect of virtual reality distraction on anxiety level during dental treatment among anxious pediatric patients: a randomized clinical… PMID:37408348 | 2023 | this review only | not stated | not extracted yet |
| Balik 2024 The effect of virtual reality glasses on dental anxiety in children who will receive dental treatment for the first time: a randomized… DOI:10.1007/s12144-024-06717-8 | 2024 | this review only | not stated | not extracted yet |
| Buldur 2021 Does Virtual Reality Affect Children’s Dental Anxiety, Pain, And Behaviour? A Randomised, Placebo-Controlled, Cross-Over Trial DOI:10.1590/pboci.2021.002 | 2021 | this review only | not stated | not extracted yet |
| Cermak 2015 Sensory Adapted Dental Environments to Enhance Oral Care for Children with Autism Spectrum Disorders: A Randomized Controlled Pilot Study. PMID:25931290 | 2015 | this review only | not stated | not extracted yet |
| Chandran 2024 Effectiveness of Two Types of Distraction Techniques in the Management of Pain and Anxiety during Dental Treatment in 6-9-year-old Children. PMID:39144506 | 2024 | this review only | not stated | not extracted yet |
| Demir Kosem 2024 The effect of virtual reality glasses used in dental treatment on anxiety and fear in children: A randomized controlled study DOI:10.1016/j.pdj.2024.09.003 | 2024 | this review only | not stated | not extracted yet |
| Du 2022 A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth… PMID:35485000 | 2022 | this review only | not stated | not extracted yet |
| Fakhruddin 2015 Effectiveness of audiovisual distraction eyewear and computerized delivery of anesthesia during pulp therapy of primary molars in phobic… PMID:26929683 | 2015 | this review only | not stated | not extracted yet |
| Gomez-Polo 2021 Behaviour and Anxiety Management of Paediatric Dental Patients through Virtual Reality: A Randomised Clinical Trial. PMID:34300185 | 2021 | this review only | not stated | not extracted yet |
| Gs 2021 Comparative Evaluation of the Efficacy of Virtual Reality Distraction, Audio Distraction and Tell-show-do Techniques in Reducing the… PMID:35645488 | 2021 | this review only | not stated | not extracted yet |
| Guinot 2021 Comparison of active versus passive audiovisual distraction tools on children's behaviour, anxiety and pain in paediatric dentistry: a… PMID:34544253 | 2021 | this review only | not stated | not extracted yet |
| Hande Sari 2023 Evaluation of the success of distraction through virtual reality using the Child Drawing Hospital Scale DOI:10.51463/cpd.2023.155 | 2023 | this review only | not stated | not extracted yet |
| Hoge 2012 Use of video eyewear to manage distress in children during restorative dental treatment. PMID:23211912 | 2012 | this review only | not stated | not extracted yet |
| Isong 2014 Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media. PMID:24391123 | 2014 | this review only | not stated | not extracted yet |
| Jamil 2023 Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients. PMID:37731807 | 2023 | this review only | not stated | not extracted yet |
| Karuppiah 2024 Evaluation of Effect of Distraction Techniques Using Virtual Reality and Eight-dimension Audio Analgesia Methods on Pain Perception and… PMID:39650306 | 2024 | this review only | not stated | not extracted yet |
| Khandelwal 2018 Control of Anxiety in Pediatric Patients using "Tell Show Do" Method and Audiovisual Distraction. PMID:30287704 | 2018 | this review only | not stated | not extracted yet |
| Koticha 2019 Effectiveness of Virtual Reality Eyeglasses as a Distraction Aid to Reduce Anxiety among 6-10-year-old Children Undergoing Dental… PMID:31866714 | 2019 | this review only | not stated | not extracted yet |
| Lekhwani 2023 Comparative evaluation of Tell-Show-Do technique and its modifications in managing anxious pediatric dental patients among 4-8 years of age. PMID:37635473 | 2023 | this review only | not stated | not extracted yet |
| Mehrotra 2023 Comparative evaluation of the effect of audio and virtual reality distraction on the dental anxiety of healthy and mild intellectually… PMID:37282411 | 2023 | this review only | not stated | not extracted yet |
| Mehrotra 2024 Effect of audio and virtual reality distraction on the dental anxiety of children with mild intellectual disability. PMID:37849240 | 2024 | this review only | not stated | not extracted yet |
| Mishraa 2022 Comparative evaluation of audio, audiovisual and virtual reality distraction techniques on dentally anxious children DOI:10.5958/2230-7273.2022.00016.3 | 2022 | this review only | not stated | not extracted yet |
| Nunna 2019 Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children. PMID:31723668 | 2019 | this review only | not stated | not extracted yet |
| Nuvvula 2015 Effect of audiovisual distraction with 3D video glasses on dental anxiety of children experiencing administration of local analgesia: a… PMID:25256207 | 2015 | this review only | not stated | not extracted yet |
| Ozukoc 2020 Reducing Anxiety in Children with Molar Incisor Hypomineralization Using Virtual Reality - a Randomized Crossover Study DOI:10.7546/crabs.2020.11.16 | 2020 | this review only | not stated | not extracted yet |
| Padmanabh 2025 A Comparative Evaluation of Bubble Breath Play Therapy and Hand-held Video Gaming Used in Reducing Dental Anxiety among Children DOI:10.5005/jp-journals-10077-3355 | 2025 | this review only | not stated | not extracted yet |
| Padminee 2022 Effectiveness of biofeedback relaxation and audio-visual distraction on dental anxiety among 7- to 12-year-old children while… PMID:33735517 | 2022 | this review only | not stated | not extracted yet |
| Panchal 2022 Comparative evaluation of the effectiveness of two innovative methods in the management of anxiety in a dental office: a randomized… PMID:35991359 | 2022 | this review only | not stated | not extracted yet |
| Pande 2020 Effectiveness of different behavior guidance techniques in managing children with negative behavior in a dental setting: A randomized… PMID:33004724 | 2020 | this review only | not stated | not extracted yet |
| Pathak 2023 Clinical evaluation of feasibility and effectiveness using a virtual reality device during local anesthesia and extractions in pediatric… PMID:37184588 | 2023 | this review only | not stated | not extracted yet |
| Radhakrishna 2019 Comparison of three behavior modification techniques for management of anxious children aged 4-8 years. PMID:30859131 | 2019 | this review only | not stated | not extracted yet |
| Ran 2021 Application of virtual reality on non-drug behavioral management of short-term dental procedure in children. PMID:34425901 | 2021 | this review only | not stated | not extracted yet |
| Salama 2024 Effectiveness of virtual reality glasses with integrated sign language in reducing dental anxiety during pulpotomy in children with… PMID:39548423 | 2024 | this review only | not stated | not extracted yet |
| Shafeeq 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Shams 2024 Comparison of Effectiveness of Audio and VR Distraction Techniques in Managing Pediatric Dental Patients. PMID:38595406 | 2024 | this review only | not stated | not extracted yet |
| Shekhar 2022 Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels… PMID:35274286 | 2022 | this review only | not stated | not extracted yet |
| Sullivan 2000 The effect of virtual reality during dental treatment on child anxiety and behavior. PMID:10902078 | 2000 | this review only | not stated | not extracted yet |
| Suresh 2024 Effect of Virtual Reality Distraction Method on the Level of Salivary Cortisol in Children With Autism Spectrum Disorder During Dental… PMID:39738788 | 2026 | this review only | not stated | not extracted yet |
| Tahersoltani 2021 Effect of the Tiny Dentist game on 4-10 years old children’s anxiety compared with Tell-Show-Do method: A clinical trial DOI:10.17352/2394-8418.000102 | 2021 | this review only | not stated | not extracted yet |
| Thosar 2022 Effectiveness of Two Different Behavior Modification Techniques for Anxiety Reduction in Children. PMID:36134077 | 2022 | this review only | not stated | not extracted yet |
| Varshitha 2023 Effectiveness of Distraction with Virtual Reality Eyewear in Managing 6-11-year-old Children with Hearing Impairment during Dental… PMID:38344382 | 2023 | this review only | not stated | not extracted yet |
| Vishwanathaiah 2025 Effect of Buzzy Bee in Reducing Pain Perception during Local Anesthesia in Children: A Split-mouth Crossover Study. PMID:41328375 | 2025 | this review only | not stated | not extracted yet |
| Vitale 2025 Reducing dental anxiety in children through tell-show-do technique vs. additional instructions with an artificial intelligence-based… DOI:10.22514/jocpd.2025.098 | 2025 | this review only | not stated | not extracted yet |
| Zhang 2025 Effectiveness of oral simulation games and ``tell-show-do'' behavioral management in alleviating dental fear in children: a randomized… DOI:10.22514/jocpd.2025.035 | 2025 | 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 | Children and adolescents receiving dental care | Pediatric dental patients aged about 4-16 years (n=2569 in anxiety analysis) |
| Intervention | Technology-augmented/digital distraction (VR, AR, games, audio, biofeedback) during dental care | VR, AR, digital/mobile and simulation games, audiovisual and audio distraction, biofeedback (61 studies) |
| Comparison | Usual care, conventional behavior guidance, or non-digital distraction | Standard care, tell-show-do, non-digital distraction |
| Outcomes | Dental anxiety/fear and safety/adverse events (primary); pain and pulse rate (secondary) | Anxiety (42 studies), pain (18 studies), pulse rate (30 studies); safety summarized narratively (5 studies) |
| Study designs | Randomized and non-randomized studies, English language | 56 RCTs and 5 non-randomized studies |
| Timing | Intra-procedural time point | Intra-procedural |