Non-pharmacological and Physical Strategies for Managing Dental Anxiety: a Systematic Review with Implications for Dental Education

ObjectivesDental 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.MethodsA 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.ResultsA 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.ConclusionNon-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.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251229878, identifier CRD420251229878.