Management of Fear and Anxiety in Dental Treatments Under Local Anesthesia: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: This systematic review was to compare the effects of interventions for the management of fear and anxiety for dental treatments under local anesthesia.
Methods: This research project was applied to PubMed, CENTRAL, Web of Science, Cochrane library databases. The last search was run on March 31st, 2021. A list of references of relevant articles and previous reviews were checked. Qualitative and quantitative analyses were performed.
Results: A total of 12 eligible randomized controlled trials were included, and 562 participants in the experimental group and 482 participations in the control group were involved. Anxiety levels decreased more in intervention groups than in control groups (Z = 2.57, P=0.01, SMD= -0.43, 95% CI -0.76 to -0.10). For children and adolescents, there was statistical difference between experimental and control groups [Z= 0.53, P <0.0001, 95% CI -0.79 (-1.10, -0.47)], while there was no such statistical difference in adults [Z= 0.53, P = 0.59, 95% CI -0.06 (-0.28, 0.16)]. There was no statistical difference in vital signs [Z = 1.39, P = 0.16, 95% CI -0.25 ( -0.61,0.10)] and pain levels [Z=0.69, p=0.49; SMD=-0.06, 95% CI (0.27, 0.11)] between intervention and control groups.
Conclusions: Interventions should be used in managing anxiety and fear for dental treatment under local anesthesia. It might be effective for anxiety alleviating for children, while there was a low certainty of evidence that interventions could reduce anxiety levels in adults. Audio-visual distractions might be useful for managing dental fear and anxiety, but pain levels and vital signs could not be improved. High-quality randomized clinical trials are required for further research.