Non-pharmacological and physical strategies for managing dental anxiety: a systematic review with implications for dental education.

Authors

Angelika Wawrzyniak, Natalia Sadowska, Maria Pawlak-Mojsiewicz, Natalia Walczuk, Diana Masłyk, Izabela Barczyk, Piotr Skomro, Magdalena Sroczyk-Jaszczyńska, Karina Kijak, Helena Gronwald, Lidia Szczucka, Adam Andrzej Garstka, Danuta Lietz-Kijak

Published in

Public health reviews. Volume 47. Pages 1609316. Epub Jul 31, 2026.

Abstract

Dental anxiety remains a significant barrier to effective oral healthcare, contributing to treatment avoidance and poorer clinical outcomes. This systematic review aimed to evaluate the effectiveness of non-pharmacological and physical interventions in reducing dental anxiety and improving patient cooperation.
A systematic search was conducted in PubMed/MEDLINE, Scopus, Dentistry & Oral Sciences Source, and Google Scholar for studies published between 1971 and 2024. Randomized controlled trials, quasi-experimental, and observational studies assessing non-pharmacological or technology-assisted interventions in children and adults were included. Study selection and data extraction were performed independently by two reviewers. The certainty of evidence was assessed using the GRADE framework.
A total of 126 studies were included in the qualitative synthesis. Interventions were grouped into three categories: technological/physical (e.g., computer-controlled anesthesia, Er:YAG laser, TENS), sensory-relaxation (e.g., aromatherapy, breathing techniques, hypnosis), and digital/interactive (e.g., mobile applications, audiovisual distraction, humanoid robots). The majority of studies reported reductions in anxiety or improvements in patient cooperation. The strongest evidence supported computer-controlled anesthesia systems while moderate-certainty evidence was identified for aromatherapy, laser-based interventions, and audiovisual distraction. Several additional interventions demonstrated potentially beneficial effects, although the certainty of evidence remained limited due to methodological weaknesses.
Non-pharmacological and physical interventions can effectively reduce dental anxiety and enhance treatment acceptance across diverse patient populations. Integrating these strategies into routine clinical practice and dental education may improve patient-centered care and reduce reliance on pharmacological methods. Further high-quality studies are needed to confirm long-term effectiveness and support implementation.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251229878, identifier CRD420251229878.

PMID:
42601922
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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