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

Objectives 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. Methods 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. Results 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. Conclusion 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. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251229878 , identifier CRD420251229878.