Impact of Mobile Oral Health Applications on Pediatric Dental Anxiety: A Systematic Review and Network Meta-Analysis

Dental anxiety (DA) in children remains a significant barrier to effective oral healthcare, often leading to treatment avoidance and poor outcomes. While traditional behavioral techniques such as Tell-Show-Do (TSD) and animated videos have been widely used, emerging digital interventions, particularly mobile oral health applications, offer novel, child-friendly approaches for anxiety reduction. Thus, the aim of this review is to evaluate the effectiveness of mobile oral health applications in reducing DA among 4-11-year-olds, compared to other non-pharmacological behavioral management techniques. This review included 13 randomized controlled trials (RCTs) involving 1,002 children aged 4-11 years. Ten studies were eligible for meta-analysis. Information sources included PubMed, Cochrane Library, CINAHL, ScienceDirect, and Google Scholar, with the last search conducted on June 15, 2025. Interventions included mobile applications, maternal voice recordings, animated videos, and chairside techniques (TSD, TPD (Tell-Play-Do), Tell-Show-Play-Distraction (TSPD)). Primary outcomes were changes in validated anxiety scales; secondary outcomes included heart rate and oxygen saturation. Risk of bias was assessed using the Cochrane Risk of Bias 2 (ROB 2) tool for randomized trials and the ROBINS-I tool for non-randomized studies. A Bayesian hierarchical model was applied to rank interventions using surface under the cumulative ranking curve (SUCRA) probabilities. Mobile applications significantly reduced anxiety scores and heart rate compared to the TSD and control groups. TSPD ranked highest for anxiety reduction (SUCRA: 99.53%), followed by maternal voice (66.34%) and mobile apps (60.23%). For heart rate reduction, maternal voice (83.24%) and mobile apps (76.5%) were most effective. Funnel plot asymmetry and Egger's test indicated potential publication bias. Mobile oral health applications, particularly when combined with maternal voice or presence, are effective and scalable complements to traditional behavioral techniques for managing pediatric DA. However, these findings should be interpreted with caution, as the network meta-analysis demonstrated moderate heterogeneity across included studies.