NONPHARMACOLOGICAL INTERVENTIONS IN DENTAL PROCEDURES FOR CHILDREN AND ADOLESCENTS WITH NEURODEVELOPMENTAL DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

INTRODUCTION

Children and adolescents with neurodevelopmental disorders (NDDs) frequently experience high dental anxiety and behavioral challenges that complicate routine dental care. Nonpharmacological behavior management strategies have been increasingly implemented; however, their effectiveness has not been comprehensively quantified. This systematic review and meta-analysis aimed to evaluate the effects of nonpharmacological interventions on anxiety and cooperation during dental procedures in pediatric patients with NDDs.

METHODS

A systematic search was conducted in 5 electronic databases: PubMed, EMBASE, CENTRAL, Scopus, and Web of Science from database inception until February 2, 2026. Randomized clinical trials, nonrandomized interventional studies, and observational studies were included, focusing on children and adolescents (age ≤ 21 years) diagnosed with NDDs, who received nonpharmacological behavior management techniques-including sensory-adapted dental environment (SADE), distraction techniques, desensitization and other types of audiovisual interventions-during or before dental treatment. The Risk of Bias 2 (RoB2) tool for randomized controlled trials (RCTs), the ROBINS-I tool for nonrandomized studies of interventions, and the MINORS-tool for single-armed studies were used to assess the risk of bias.

RESULTS

A total of 42 studies involving 1,809 NDD patients were included, with 22 being synthesized for meta-analysis. Audiovisual distractions and SADE were associated with reduced anxiety levels when measured with objective tools (standardized mean difference: -0.70, 95% CI: -1.11 to -0.29), Venham Scale (mean difference: -0.55, 95% CI: -0.91 to -0.18), and improved cooperation according to the Frankl Scale (mean difference: 0.45, 95% CI: 0.22-0.68). Most outcomes were classified as having moderate to very low certainty of evidence.

CONCLUSIONS

Audiovisual distractions and SADEs may serve as effective approaches to both improve cooperation and reduce anxiety during dental care for children and adolescents with NDDs. Clinicians should consider individualized strategies, and continued research is needed to inform dental care protocols for this vulnerable population in everyday practice.