Effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients attending dental clinics - a systematic review and meta-analysis.

OBJECTIVE: The study aims to compare the effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients visiting dental clinics. METHODS: A search was conducted in PubMed, Cochrane databases, Scopus, and Google scholar through August 2024. All the randomized control trials, cohort studies, case control, cross-sectional studies that evaluated the effectiveness of behavioural therapy with inhalational/conscious sedation among children and adults to reduce dental anxiety were included. Outcome assessed was change in the dental anxiety scores as measured by the validated tools. PRISMA guidelines were followed for the meta-analysis. Meta-analysis was conducted using Cochrane Review Manager (Revman) version 5.3. Random effects model was used to compare the two groups in reducing dental anxiety. Quality of the studies included was evaluated using the Risk of Bias Assessment tool and Newcastle-Ottawa tool. Heterogeneity was assessed using I(2) values. Certainty of evidence was assessed using GRADE pro software. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024581013. RESULTS: A total of 940 participants were included in the analysis. Behavioural therapy was significantly more effective than inhalational sedation in reducing dental anxiety among patients prior to the dental treatment (SMD: -0.87; 95% CI: -1.29 to -0.45; P < 0.0001; I(2):78%). Additionally, behavioural therapy demonstrated more effectiveness than inhalational sedation in reducing the dental anxiety among children (SMD: -0.64; 95% CI: -1.16 to -0.11, P = 0.02%; I(2):88%). Certainty of evidence was high among the randomized controlled trials and moderate among the observational studies. CONCLUSION: The findings of this review and meta-analysis suggests that behavioural therapy is more effective than inhalational sedation in reducing dental anxiety specifically among children.