The effect of audio distraction in reducing signs of stress and anxiety during pediatric dental treatment: a systematic review and meta-analysis.

AIM: To perform a systematic review to investigate if the use of audio distraction reduces signs of stress and anxiety in paediatric patients undergoing dental treatment. MATERIALS AND METHODS: Search was made in electronic databases (MEDLINE, Scopus, Embase, Web of Science, Scielo, BVS, Springer Link, Science Direct, Cochrane Library, and grey literature) until March 11th, 2024. The eligibility criteria were: paediatric patients under dental treatment; use of audio as a distraction method; comparison between groups with and without use of audio distraction; Clinical trials. The outcomes measured were alterations in the anxiety, fear and/or stress levels. Evaluation of the risk of bias and assessment of the certainty of the evidence (GRADE) were performed. Meta-analysis was conducted for four outcomes, considering 95% confidence interval (CI), random effects and heterogeneity from Tau(2). RESULTS: From 5,495 results, 25 studies composed the narrative sample and 12 composed the meta-analysis. High risk of bias was generally observed. Three results from the meta-analysis showed high heterogeneity and some outcomes presented a statistical association: systolic blood pressure reduction (p = 0.52; CI= -6.05 [-7.50 to -4.60]), pulse rate (p < 0.00001; CI= -4.95 [-9.95 to -3.52]), Venham's test scores (p < 0.00001; CI= -1.24 [-1.79 to -0.68]), and oxygen saturation (p < 0.00001; CI = 0.14 [-0.04 to 0.33]). The outcomes presented "very low" and "low" certainty of evidence. CONCLUSION: Although a low certainty of evidence was observed, our study suggests that audio may be an effective alternative for reducing stress and anxiety and pain perception during non-invasive treatments. Future well-designed studies are necessary. CLINICAL RELEVANCE: Audio distraction presents a potential role as an efficient method to reduce stress in children undergoing dental treatment. More RCTs are necessary to improve the evidence level, considering the main variables related to audio distraction.