Sensory-based non-pharmacological interventions for reducing dental anxiety and improving behavioural cooperation in paediatric patients: a systematic review with GRADE assessment
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Drishadvati Mukherjee1, Swagata Saha2, Aishani Baksi1
1Department of Paediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Mangaluru, Karnataka, India.
Background And Objectives:
Dental anxiety affects an estimated 9%-20% of children and disproportionately impacts those with neurodevelopmental conditions. Sensory-based non-pharmacological interventions, which intentionally modulate auditory, visual, tactile, olfactory, or proprioceptive input, have emerged as promising approaches for anxiety and behaviour management in paediatric dentistry, but no published review has applied formal GRADE certainty assessment across multiple sensory-based modalities. This review evaluated the effectiveness of sensory-based interventions for dental anxiety and behavioural cooperation in paediatric patients (≤18 years) and assessed certainty of evidence using GRADE.
Eligibility Criteria:
RCTs and controlled clinical trials involving paediatric participants (≤18 years) evaluating sensory-based interventions delivered during dental treatment or as pre-visit preparation, reporting dental anxiety, behavioural cooperation, or physiological stress, were eligible for GRADE assessment; eligible non-randomised, observational, pilot, feasibility, descriptive, and secondary studies were retained for narrative synthesis only. Studies of exclusively pharmacological or non-sensory cognitive-behavioural interventions were excluded.
Methods:
MEDLINE (PubMed), Scopus, Embase, PsycINFO, and CENTRAL were searched from inception to 27 July 2026, supplemented by manual reference screening and Google Scholar searches. Two reviewers independently performed study selection, data extraction, risk-of-bias assessment (RoB 2), and GRADE assessment. Given substantial heterogeneity, findings were synthesised narratively.
Results:
Of 2,002 records identified, 47 studies met inclusion criteria: 25 RCTs/controlled crossover trials contributing to GRADE assessment, and 22 non-randomised, pilot, observational, or secondary studies retained for narrative synthesis. Nine modalities were evaluated: sensory-adapted dental environments (SADE), audiovisual distraction/virtual reality (VR), music therapy, aromatherapy, weighted blankets, social stories, video modelling, visual pedagogy, and emerging sensory-based approaches. SADE, audiovisual distraction/VR, and music therapy showed the most consistent improvements in anxiety, cooperation, physiological stress, and pain, supported by moderate-certainty evidence for SADE and audiovisual distraction/VR; for music therapy, the direct paediatric primary-trial base is now a single GRADE-eligible RCT following reclassification of Chen and Hawkins (2021) to Tier 2 as a single-arm pilot without a concurrent comparator; certainty for music-therapy anxiety reduction is correspondingly rated low, supported by corroborating secondary meta-analyses. Certainty across modalities ranged from very low to moderate, limited by risk of bias, heterogeneity, inconsistent outcome measures, and imprecision. [Table: see text].
Conclusions:
Sensory-based interventions show promising benefit for dental anxiety and behavioural cooperation in paediatric dental care, with the strongest (moderate-certainty) evidence for SADE and audiovisual distraction/VR, and low-to-moderate-certainty evidence for music therapy. Overall certainty remains low to moderate, supporting cautious, individualised clinical use rather than routine first-line implementation. Adequately powered trials with standardised outcomes, prospective registration, and GRADE-informed reporting are needed to strengthen the evidence base.Systematic Review Registration: identifier CRD420261456366.
