Dental anxiety, defined as a persistent and excessive fear of dental stimuli and procedures occurs across a wide range of countries. The incidence of dental anxiety in children varies between 6-20%. Dental anxiety can result in deferred, cancelled or missed dental appointments and adverse dental outcomes. A broad range of behavioural techniques have been used to manage this issue including, tell-show-do, atraumatic restorative treatment, hypnosis, cognitive behavioural therapy and systematic desensitisation. Where these approaches are unsuccessful sedation or general anaesthesia are advocated. Audiovisual distraction using television, computer games and 3D video glasses provide a non-aversive approach is easy to manage and may be helpful in this area.
The aim of this review was to assess the effectiveness of audiovisual distraction for reducing dental anxiety in children.
Methods
Searches were conducted in the PubMed, Embase and Cochrane Central Databases with no date or language limitations. Randomised controlled trials (RCTs or controlled clinical trials (CCTs) comparing audiovisual distraction against no audiovisual were considered.
Two reviewers independently selected studies and abstracted data with study quality being assessed using the Cochrane Risk of Bias tool. Random effects meta-analysis was carried out.
Results
- 9 studies (6 RCTs, 3 CCTs) were included.
- Children aged 3- 14 yrs of age were included.
- All 9 studies were considered to be at high risk of bias.
- 6 studies contributed to a meta-analysis
- Pulse rate/heart rate was significantly lower with audiovisual distraction than without it; MD= −3.78 (95%CI; −6.73, −0.83); p = .01; I2 = 61% [6 studies, 352 patients]
- 2 studies recorded oxygen saturation finding no significant difference MD = 0.47 (95% CI; −0.35, 1.29); p = .26; I2 = 44.
Conclusions
The authors concluded
Our study suggests that the audiovisual distraction approach is helpful in reducing dental anxiety among children. This method may be considered a useful intervention in clinical practice to enhance the dental health of children. Additional high-quality studies are needed to verify our conclusions.
Comments
The reviewers have searched a good range of databases identifying 6 clinical trials 6 of which were randomised. While they considered all of them to be at high risk of bias this was due to the difficulty in blinding patients and personnel to the intervention. The authors conducted meta-analysis for two physiological measures of anxiety, heart rate/pulse rate, and oxygen saturation finding a lower pulse/heart rate in those patients receiving audiovisual distraction. The use of a wide range of self-reports and behaviour rating scales involving visual analogue scales, numerical rating scales, verbal rating scales, and pictorial representation scales made summarising and quantitively assessing these findings difficult. Consequently, it would have been helpful if the review had included additional narrative summary of the included studies. As this is a relatively new approach with rapid technological development additional high quality studies using a common outcomes set would be helpful.
Links
Primary Paper
Zhang C, Qin D, Shen L, Ji P, Wang J. Does audiovisual distraction reduce dental anxiety in children under local anaesthesia? A systematic review and meta-analysis. Oral Dis. 2018 Mar 2. doi: 10.1111/odi.12849. [Epub ahead of print] Review. PubMed PMID: 29498793.
Other references
Dental Elf – 24th Jul 2018
Dental anxiety in paediatric patients: Is cognitive behavioural therapy effective?
