Dental anxiety is relatively common with studies indicating that just over a third of the population (36%) have suffered and a range of different management approaches have been used in its management (Dental Elf – 12th Aug 2022). A number of studies have compared audio-visuals, music, or virtual reality suggesting a benefit although no direct comparisons of these approaches have been undertaken.
The aim of this review was to compare the effectiveness of relaxing music, audio-visuals (AV), and virtual reality (VR) in reducing dental anxiety associated with tooth extraction.
Methods
The review protocol was registered with PROSPERO. Searches were conducted in the PubMed, Embase, Cochrane Library, and Scopus databases with no limits on date or language. Randomised controlled trials (RCTs) in children or adults requiring tooth extraction where music AV or VR equipment was compared to standard care/guidance procedures, counter-stimulation, tell-show-do, or no special relaxation treatment were considered. Two reviewers independently searched and selected studies extracted data and assessed risk of bias using the Cochrane RoB2 tool. The pooled standard mean difference (SMD) and 95% confidence interval (CI) of anxiety scale scores were analysed using Bayesian network meta-analysis (NMA). The network ranking of the interventions was determined based on the surfaces under the cumulative ranking curve (SUCRA)
Results
- 11 RCTs published between 2007 and 2023 were included.
- 8 anxiety scales were used,the Spielberger State-Trait Anxiety Inventory subscale for trait anxiety (STAI-T), the Spielberger State-Trait Anxiety Inventory subscale for state anxiety (STAI-S), the modified child fear survey schedule dental subscale (CFSS-DS), the visual analog scale (VAS), the modified dental anxiety scale (MDAS), the Corah dental anxiety scale (CDAS), the facial image scale (FIS), and Venham’s Picture Test (VPT).
- 4 studies were considered to be at low risk of bias, one at high risk and 6 had some concerns.
- The NMA showed that music and VR were associated with a reduction in dental anxiety compared to control (see table below).
| Compared to control | No. of studies | Mean difference (95%Cl) |
| Music | 10 | -0.64(-1.04 to -0.25) |
| Audio-visual | 4 | -0.34 (-0.97 to 0.33) |
| Virtual reality | 5 | -0.54 (-1.08 to -0.02) |
- The SUCRA findings showed the following efficacy ranking: Music > VR > audio-visuals>control.
Conclusions
The authors concluded: –
the use of relaxing music may be prioritized as a non-pharmacological intervention to reduce dental anxiety associated with tooth extraction in both adults and children. This conclusion can be valuable for dentists or patients when selecting interventions to alleviate dental anxiety. However, it is important to note that the certainty of the evidence supporting this conclusion is only moderate due to the sample size. To enhance the certainty of this NMA, further large-scale studies with direct comparisons and 3-arm designed RCTs are required.
Comments
Previously we looked at a review of management strategies for adult patients with dental anxiety (Dental Elf – 12th Aug 2022) and music and virtual reality interventions were well represented. This new review aimed to compare music, AV and VR interventions for patients undergoing dental extractions. Four major databases were searched with no restrictions with 11 RCTs meeting the reviewers’ criteria. The 11 studies used 8 different anxiety scales with the NMA indicating that music had the highest probability of being effective followed by VR. However, the number of available studies is limited and the range of anxiety scales and musical and visual interventions used in the various studies means that the findings should be interpreted cautiously.
Links
Primary Paper
Hao T, Pang J, Liu Q, Xin P. A systematic review and network meta-analysis of virtual reality, audiovisuals and music interventions for reducing dental anxiety related to tooth extraction. BMC Oral Health. 2023 Sep 22;23(1):684. doi: 10.1186/s12903-023-03407-y. PMID: 37735362; PMCID: PMC10515077.
Other references
Dental Elf – 12th Aug 2022
Dental Elf – 10th Jun 2019
Distraction techniques for managing dental anxiety in children and adolescents
Dental Elf – Dental Anxiety blogs
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