Virtual Reality in Pediatric Dental Anxiety Management: A Systematic Review.

Purpose: To determine if virtual reality (VR) is associated with reduced dental anxiety in neurotypical children and children with special health care needs compared with usual care or other distraction methods. Methods: This systematic review was conducted following PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251126502). A comprehensive search was performed in August 2025 in PubMed, Scopus, LILACS, CAPES, Cochrane Library, ClinicalTrials. gov, and Google Scholar without language or date restrictions. Reference lists of relevant publications were also hand-searched. Two reviewers independently extracted data on study populations, dental procedures, VR type, comparators, outcomes, and findings, with discrepancies resolved by consensus. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for nonrandomized trials; certainty of evidence was evaluated using GRADE. Results: A total of 23 studies met the inclusion criteria. Evidence indicates that VR is consistently associated with a reduction in dental anxiety and improved cooperative behavior in neurotypical children and children with autism spectrum disorder. Findings for children with attention-deficit/hyperactivity disorder, mild intellectual disabilities, or children who are deaf or hard of hearing were heterogeneous and showed mixed or modest effects. Pain outcomes varied significantly across studies, precluding clear conclusions. Conclusions: Virtual reality appears to be a promising adjunct for managing pediatric dental anxiety, particularly in neurotypical children and those with autism spectrum disorder. However, heterogeneity of study designs and limited evidence for other disability groups currently restrict routine clinical implementation. Further rigorous trials are needed to clarify effectiveness across diverse pediatric populations.