Distraction techniques for managing dental anxiety in children and adolescents

shutterstock_68251921 dental education young girl and nurses

The prevalence of dental fear and anxiety in children has been reported to range from 6% – 42% in different populations. Dental fear and anxiety may involve behavioural, cognitive, emotional and physiological elements and varies between individuals. Distraction techniques overload a patient’s attention capacity helping to reduce anxiety and may be active or passive. Studies suggest that distraction is a low-cost strategy that may have a positive impact on fear and anxiety.

The aim of this review was to assess whether distraction techniques reduce children’s/adolescent’s anxiety and fear during dental treatment.


Searches were conducted in the Medline/PubMed, Web of Science, Scopus, Cochrane Library, the Latin American and Caribbean Health Sciences Literature (Lilacs) and Google Scholar Databases. Randomised controlled trials (RCTs) of distraction techniques for the management of dental anxiety and dental fear under the age of 18 were considered. Study selection, data abstraction and risk of bias assessment was carried out independently by two reviewers. The Cochrane Risk of bias tools was used.  A narrative summary was presented.


  • 20 trials were included.
  • A range of distraction techniques were used; audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys.
  • Dental treatments provided included dental examination, oral prophylaxis, local anaesthesia, dental restoration, endodontic treatment, and extraction.
  • A wide range of instruments were used to assess dental fear and anxiety with most studies using 3 or more instruments.
  • Qualitative analysis suggests that there is very low certainty of evidence that distraction techniques reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure.


The authors concluded: –

The studies available to date in the literature suggest that distraction techniques can be effective in managing children’s and adolescents’ dental anxiety and fear during dental treatment with very low certainty of evidence. Future studies with more homogeneous methodological characteristics and further research comparing different distraction techniques among children with different ages are encouraged.


This review is broader than an earlier review of audio-visual distraction (Dental Elf – Sept 28th, 2018) which included 9 trials and also suggested that distraction was a useful approach. Both reviews highlight the challenges of blinding the patients and personnel to the intervention which means that most of the studies have a high potential for bias. The authors of the current review also highlight the lack of blinding of outcome assessors and selective outcomes reporting as other drawbacks in the available studies.  Study samples ranged from 20 to 176 with most studies not presenting or calculating an appropriate sample size. In addition, a wide range of outcomes were assessed which limited quantitative summary. Future studies would benefit from following recognised standards for  the conduct and reporting of trials and the use of common outcomes sets.


Primary Paper

Prado IM, Carcavalli L, Abreu LG, Serra-Negra JM, Paiva SM, Martins CC. Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials. Int JPaediatr Dent. 2019 Mar 25. doi: 10.1111/ipd.12499. [Epub ahead of print] Review.PubMed PMID: 30908775.

 Review protocol on PROSPERO

Other references

Dental Elf – Sept 28th  2018

Audiovisual distraction for dental anxiety in children?

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