The influence of immersive tools on children's dental anxiety: a systematic review and meta-analysis

This systematic review assesses the effectiveness of immersive tools, including virtual reality (VR) and augmented reality (AR), in reducing dental anxiety among children aged 3-10 years, and compares immersive VR with conventional behaviour management techniques.

A comprehensive search was conducted across various databases from inception to date. Randomised and non-randomised controlled studies evaluating dental anxiety in children using immersive VR or AR for behaviour management were included. The risk of bias was assessed using the Cochrane RoB 2.0 tool for randomised controlled trials and the ROBINS-I tool for non-randomised controlled trials. A meta-analysis was conducted with heart rate as the primary outcome measure, and certainty of the evidence was evaluated using GRADEpro.

Thirty-seven studies involving 2,505 children were included, of which 13 studies (n = 819) were pooled for meta-analysis. Immersive VR resulted in a significant reduction in heart rate compared with non-immersive VR (mean difference:  - 8.12 bpm; 95% CI -14.69 to- 1.56; p = 0.02) with moderate certainty of the evidence. Comparisons with kaleidoscope distraction favoured immersive VR (mean difference: - 1.59 bpm; 95% CI-4.84 to 1.66). Compared with the Tell-Show-Do technique, immersive VR showed a trend toward lower heart rate (mean difference: -7.92 bpm; 95% CI-16.16 to 0.32).

As a non-pharmacological adjunct for reducing dental anxiety in children, immersive VR may be superior to non-immersive distraction techniques, supporting its integration into paediatric dental practice. However, the evidence is primarily based on VR studies, and findings related to AR remain limited and preliminary.