Boka et al. [[4[4] Boka V, Arapostathis K, Charitoudis G, Veerkamp J, van Loveren C, Kotsanos N. A study of parental presence/absence technique for child dental behaviour management. Eur Arch Paediatr Dent 2017; 18(6):405-9. https://doi.org/10.1007/s40368-017-0313-9 https://doi.org/10.1007/s40368-017-0313-...
]] |
61 |
27 Boys and 31 Girls |
3-8 |
To study the effectiveness of the presence of parents in behaviour management during dental care. Children were randomly divided into two groups. Use of conventional techniques and presence of the parents. If the children behaved non-cooperatively, the parents were asked to leave the dental office. |
Non-pharmacological techniques and presence of parents |
Presence of parents had no interference with dental care. |
Alnamankany [[18[18] Alnamankany A. Video modelling and dental anxiety in children. A randomised clinical trial. Eur J Paediatr Dent 2019; 20(3):242-6. https://doi.org/10.23804/ejpd.2019.20.03.14 https://doi.org/10.23804/ejpd.2019.20.03...
]] |
46 |
23 Boys and 23 Girls |
6-10 |
To assess the effect of video and role modelling on reducing dental anxiety. Use of an anxiety scale prior to dental care. Children were randomly divided into two groups: one group watched the video and the other did not. |
Audio-visual distraction and role modelling |
Children showed less anxiety in the dental office. |
Vishwakarma et al. [[19[19] Vishwakarma AP, Bondarde PA, Patil SB, Dodamani AS, Vishwakarma PY, Mujawar SA. Effectiveness of two different behavioral modification techniques among 5-7-year-old children: A randomized controlled trial. J Indian Soc Pedod Prev Dent 2017; 35(2):143-9. https://doi.org/10.4103/JISPPD.JISPPD_257_16 https://doi.org/10.4103/JISPPD.JISPPD_25...
]] |
98 |
57 Boys and 41 Girls |
5-7 |
To assess the efficacy of the T-S-D technique with live role modelling and compare the techniques during the dental visits. Children were randomly divided into two groups. Phase I (first visit): Group I - children were conditioned to receive several dental procedures using live role modelling followed by oral prophylaxis; Group II-- children were sent to the game room where dental toys and customised dental tools were available along with a cartoon character, followed by oral prophylaxis. Phase II (second visit): after a 7-day interval, all children underwent rotary restorative treatment. |
Role modelling, dental toys and games, and T-S-D technique |
T-S-D technique made children more comfortable and confident during dental care. |
Prado et al. [[20[20] 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 J Paediatr Dent 2019; 29(5):650-68. https://doi.org/10.1111/ipd.12499 https://doi.org/10.1111/ipd.12499...
]] |
- |
- |
- |
To determine whether distraction techniques reduce anxiety and fear of the children and adolescents during dental treatment. Controlled clinical studies on any type of distraction technique for managing dental anxiety and fear in children and adolescents were included. |
Systematic Review |
Distraction decreased anxiety. |
Liu et al. [[21[21] Liu Y, Gu Z, Wang Y, Wu Q, Chen V, Xu X, Zhou X. Effect of audiovisual distraction on the management of dental anxiety in children: A systematic review. Int J Paediatr Dent 2019; 29(1):14-21. https://doi.org/10.1111/ipd.12430 https://doi.org/10.1111/ipd.12430...
]] |
- |
- |
- |
To assess the efficacy of audio-visual distraction technique in the management of dental anxiety in children. |
Systematic Review |
Audio-visual distraction technique was less effective. |
Serra Negra et al. [[22[22] Serra-Negra JM, Abreu MH, Flores-Mendoza CE, Brant MO, Auad SM. The reassuring role of music associated with the personality traits of children during dental care: a randomized clinical trial. Eur Arch Paediatr Dent 2019; 20(5):441-9. https://doi.org/10.1007/s40368-019-00422-y https://doi.org/10.1007/s40368-019-00422...
]] |
34 |
18 Boys and 18 Girls |
4-6 |
To analyse the effect of music on the child's anxiety during dental care. The study involved a cross, randomised, clinical trial with 34 children presenting two caries lesions on the occlusal surfaces of molars. Children were divided into two groups: (G1) in the first session, dental restoration was performed with no music and in the second session with music. Clinical examination was performed in the first session and a modified atraumatic restorative treatment was performed in the second and third sessions. Mozart's 40th symphony was played on earphones. Pulse rate was measured with a wrist oximeter. The Brazilian version of the Eysenck Personality Questionnaire - Junior (EPQ-L) was used to measure the child's personality. |
Music |
Reduced the anxiety. |
Garrocho-Ranchel et al. [[23[23] Garrocho-Rangel A, Ibarra-Gutiérrez E, Rosales-Bérber M, Esquivel-Hernández R, Esparza-Villalpando V, Pozos-Guillén A. A video eyeglasses/earphones system as distracting method during dental treatment in children: A crossover randomised and controlled clinical trial. Eur J Paediatr Dent 2018; 19(1):74-9. https://doi.org/10.23804/ejpd.2018.19.01.14 https://doi.org/10.23804/ejpd.2018.19.01...
]] |
36 |
Not Mentioned |
5-8 |
To assess the efficacy of audio-visual techniques as a way of distraction to reduce anxiety during dental treatment. Cross, clinical trial in which 36 children received different dental procedures in two sessions according to the Frankl II and III scales, with and without audio-visual system. In the control visit, they were exposed to distraction, but conventional non-aversive behaviour management was used. Each dental visit was divided into four phases (explanation, anaesthesia injection, placement of rubber dam/use of tweezers and handpiece at high speed for 5 minutes). Pain in each phase of treatment was measured by using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. Comparison of the results regarding both interventions was statistically analysed by using Wilcoxon signed-rank test. |
Audio-visual glasses for distraction showing animation chosen by the child |
Use of audio-visual glasses did not reduce anxiety. |
Kauer et al. [[24[24] Kaur R, Jindal R, Dua R, Mahajan S, Sethi K, Garg S. Comparative evaluation of the effectiveness of audio and audiovisual distraction aids in the management of anxious pediatric dental patients. J Indian Soc Pedod Prev Dent 2015; 33(3):192-203. https://doi.org/10.4103/0970-4388.160357 https://doi.org/10.4103/0970-4388.160357...
]] |
30 |
Not Mentioned |
4-8 |
To assess the use of audio-visual tools as a way of reducing anxiety during dental care. This study was performed with children according to two age groups, that is, 4-6 and 6-8 years old in the first dental visit. The children of each age group were further divided into 3 subgroups: control, audio distraction and audio-visual distraction (n = 10 each). Each child of all subgroups attended three dental visits. The level of anxiety in each visit was assessed by using a combination of parameters for measurement of anxiety. Data were collected and tabulated for statistical analysis. |
Audio-visual distraction; music and voice control |
Audio-visual distraction made children less anxious. |
Bagattoni et al. [[25[25] Bagattoni S, D'Alessandro G, Sadotti A, Alkhamis N, Piana G. Effects of audiovisual distraction in children with special healthcare needs during dental restorations: a randomized crossover clinical trial. Int J Paediatr Dent 2018; 28(1):111-20. https://doi.org/10.1111/ipd.12304 https://doi.org/10.1111/ipd.12304...
]] |
48 |
22 Boys and 26 Girls |
5-10 |
To assess the distraction technique by using audio-visual tools during dental restoration. Cross, randomised, clinical study. One restoration was performed by using audio-visual glasses and other using conventional behaviour management techniques. Subjective and objective pain was assessed by means of the revised Face Pain Scale (FPS-r) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. |
Audio-visual distraction with cartoon; T-S-D technique; voice tone; positive reinforcement. |
Audio-visual technique did not replace conventional techniques. |
Fakhruddin et al. [[26[26] Fakhruddin KS, Hisham EB and Gorduysus MO. Effectiveness of audiovisual distraction eyewear and computerized delivery of anesthesia during pulp therapy of primary molars in phobic child patients. Eur J Dent 2015; 9(4):470-5. https://doi.org/10.4103/1305-7456.172637 https://doi.org/10.4103/1305-7456.172637...
]] |
60 |
31 Boys and 30 Girls |
4-7 |
To assess the distraction technique with audio-visual tools to decrease anxiety in children undergoing anaesthesia. Clinical, cross, randomised study. Children were randomly divided into two groups and attended two sessions of pulp therapy at 1-week interval. In the session of treatment I, Group A used audio-visual glasses for distraction, whereas Group B watched a video on TV screen only. In the session of treatment II, Group A was submitted to pulp treatment with no audio-visual glasses for distraction, whereas Group B underwent pulp treatment with them. Each session involved pulp treatment of equivalent teeth on both sides of the mouth. In each session, the modified Child Dental Anxiety Scale (MCDAS) (f) was used to assess the level of anxiety before treatment. After the procedure, the children were instructed to rate their pain during treatment according to the Wong-Bakers Faces Pain Scale (WBs). Changes in the wrist oximeter and heart rate were recorded every 10 min. |
Audio-visual glasses for distraction and TV |
Set of techniques made children less anxious. |
Sayed et al. [[27[27] Sayed A, Ranna V, Padawe D, Takate V. Effect of the video output of the dental operating microscope on anxiety levels in a pediatric population during restorative procedures. J Indian Soc Pedod Prev Dent 2016; 34(1):60-4. https://doi.org/10.4103/0970-4388.175516 https://doi.org/10.4103/0970-4388.175516...
]] |
90 |
Not Mentioned |
7-9 |
To assess the use of TV showing a live dental procedure to the children as a way of reducing their anxiety during dental restoration. The study was a cross-sectional, randomised, controlled, clinical trial. Data were obtained during the two visits. The children were randomly divided into two groups. The restorative procedures were performed on one tooth per visit at a 1-week interval. The procedure was shown alive to the patient by using the video output linked to the TV screen. The levels of anxiety were assessed by using Venham Picture scale and writs oximeter. |
Audio-visual distraction and T-S-D technique |
Set of techniques made children less anxious. |
Ghadimi et al. [[28[28] Pinkham JR. Personality development. Managing behavior of the cooperative preschool child. Dent Clin North Am 1995; 39:771-87.]] |
28 |
14 Boys and 14 Girls |
4-5 |
To assess the effect of audio-visual distraction techniques on the anxiety during dental treatment. Cross-clinical, randomised study was conducted with 28 children, who were randomly divided into two groups of 14 each. In Group 1: dental procedure was performed in the first visit while the patients were watching a cartoon, which was used as a visual distraction tool; in the second visit, the dental procedure was performed based on the T-S-D technique. Group 2: visual distraction was used in the second visit, whereas T-S-D technique in the first. Dental procedures were similar in both groups during the visits. Level of anxiety was determined by using the Venham Picture test and pulse rate in the beginning and end of each visit. Patient's behaviour was also measured by using the Frankl's behaviour rating scale (FBRS). |
Audio-visual distraction |
Audio-visual distraction reduced the anxiety. |
Rank et al. [[29[29] Buchanan H, Niven N. Validation of a Facial Image Scale to assess child dental anxiety. Int J Paediatr Dent 2002; 12:47-52.]] |
306 |
Not Mentioned |
4-6 |
To assess the effect of reward on motivation after dental treatment. Randomised, blinded study with systematic convenience sample of 396 children who had no previous dental experience and attended public dental services. Children were divided into control (G1) and experimental (G1) groups, with the latter receiving positive reinforcement with reward after dental care. Projective test was used along with Venham Picture test. |
T-S-D technique |
T-S-D technique decreased anxiety along with frequent visits to the dental office. |
Hine et al. [[30[30] Ghadimi S, Estaki Z, Rahbar P, Shamshiri AR. Effect of visual distraction on children's anxiety during dental treatment: a crossover randomized clinical trial. Eur Arch Paediatr Dent 2018; 19(4):239-44. https://doi.org/10.1007/s40368-018-0352-x https://doi.org/10.1007/s40368-018-0352-...
]] |
40 |
24 Boys and 16 Girls |
3-6 |
To study the use of video to reduce anxiety during dental care of children. The video was created by a dentist using technology available and implemented in a routine clinical setting. The participants were randomly divided into two groups, one watching a brief video with a model and the other watching a control video before the routine dental care. All sessions were recorded in video and then independently evaluated by blinded observers. Behaviour data were recorded at a 15-second interval and physical and vocal interruptions were included as well. Subjective measurements of cooperation were also performed by observers and dental professionals. |
Audio-visual distraction with video on dental care recorded by the dentist |
Video was effective. |
Al-Khotani et al. [[31[31] Rank RCIC, Vilela JER, Rank MS, Ogawa WN, Imparato JCP. Effect of awards after dental care in children's motivation. Eur Arch Paediatr Dent 2019; 20(2):85-93. https://doi.org/10.1007/s40368-018-0394-0 https://doi.org/10.1007/s40368-018-0394-...
]] |
56 |
Not Mentioned |
7-9 |
To assess the distraction technique with audio-visual tools to reduce anxiety in children undergoing dental treatment. Children were randomly divided into two groups: control group with no distraction (CTR) and distraction group (AV). Three visits for dental treatment were provided for each patient. Anxiety and cooperative behaviour were assessed by using the Facial Image scale (FIS), clinical anxiety scale, and modified Venham's clinical ratings of anxiety and cooperative behaviour scale (MVARS). Vital signs, blood pressure and heart rate were monitored. |
Audio-visual distraction with cartoon |
Audio-visual technique did not replace conventional techniques. |
Fakhruddin et al. [[32[32] Hine JF, Hajek RT, Roberts HJ, Allen KD. Decreasing disruptive behaviour during routine dental visits: a video modelling intervention for young children. Int Dent J 2019; 69(4):265-72. https://doi.org/10.1111/idj.12457 https://doi.org/10.1111/idj.12457...
]] |
15 |
7 Boys and 8 Girls |
5-7 |
To assess the distraction technique with audio-visual tools to reduce anxiety in children undergoing anaesthesia. Clinical, cross, randomised study. The children were randomly divided into two groups (Group A, n = 7; Group B, n = 8). The study involved three sessions at a 1-week interval. In session I, the T-S-D technique was used during prophylaxis while the participants watched a film (with sign language) with and without audio-visual glasses. In the final of session I, the smiling face score was used to assess anxiety. In sessions II and III, respectively, both groups underwent pulp treatment of teeth equivalent on both sides of the mouth with and without audio-visual glasses and vice-versa. After the procedure, the children were instructed to rate their pain during the treatment according to the Wong-Bakers Faces Pain Scale (WBs). Changes in the wrist oximeter and heart rate were recorded every 5 min. |
Audio-visual distraction and T-S-D technique |
Audio-visual glasses made children less anxious. |
Guinot Jimeno et al. [[33[33] Bentoski JR, Boynton JR. Guiding the behavior of children in the dental setting. Opportunities for success. J Mich Dent Assoc 2011; 93(1):36-40.]] |
34 |
Not Mentioned |
6-8 |
To assess the parents' perception on the anxiety of their children by using audio-visual resources during dental treatment. This non-randomised cross study was performed in two sessions for restorative treatment. In the last session, the patient watched a cartoon film. |
Audio-visual glasses for distraction |
Audio-visual glasses made children less anxious, but there was little interference of the parents. |