Non-pharmacological Behavior Guidance Techniques on Dental Anxiety And Cooperation in Children With Autism: A...

Behavior guidance is recommended as a core component of pediatric dentistry, yet the effectiveness of specific non-pharmacological techniques for autistic patients has not been systematically quantified. The researchers systematically searched PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED for randomized controlled trials of non-pharmacological behavior guidance techniques in autistic children undergoing dental procedures. Eligible studies enrolled children with a clinical diagnosis of autism spectrum disorder and compared a structured behavior guidance strategy with routine behavior management or another guidance technique, and reported anxiety and/or cooperation outcomes using validated measures. Electronic searches identified 1,242 records; after deduplication, 487 titles and abstracts were screened, 9 full texts were assessed, and 5 trials (n = 445; sample size 19-162) were included. All were conducted in specialist pediatric dental services and focused on non- or minimally invasive procedures, including examination, prophylaxis, and fluoride application. Interventions comprised a multisensory sensory-adapted dental environment, visual pedagogy, electronic media-based guidance (video modeling and video goggles), and immersive virtual reality. Owing to heterogeneity, quantitative synthesis was feasible for only two VR trials that reported Frankl Behavior Rating Scale scores. In the larger parallel-group RCT, VR improved cooperation versus conventional care (mean difference [MD] 0.55, 95% CI 0.23-0.88); the smaller crossover study showed a similar direction (MD 0.39, 95% CI -0.35 to 1.13). Pooled in a fixed-effect model, VR was associated with a moderate improvement of about half a Frankl point (pooled MD 0.52, 95% CI 0.22-0.82). Non-pharmacological behavior guidance techniques may improve clinically relevant outcomes in autistic children during routine dental care. However, pooled quantitative evidence in the present review was available only for virtual reality-related improvements in cooperation, whereas evidence for other techniques, including sensory-adapted environments, remained limited and was based primarily on narrative synthesis.