Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis

J Dent. 2018 Feb;69:22-31. doi: 10.1016/j.jdent.2017.11.005. Epub 2017 Nov 14.


Objectives: This meta-analysis investigates the efficacy of non-pharmacological interventions in adults undergoing dental procedures under regional or general anesthesia compared to standard care alone or an attention control group on the reduction of mental distress, pain, and analgesic use.

Data sources: To identify relevant papers a comprehensive literature search was carried out in MEDLINE, CENTRAL, Web of Science, and PsycINFO (last search August 2017). Additionally, lists of references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text Database was screened to identify any unpublished material.

Study selection: A total of 29 eligible randomized controlled trials were included, comprising a total of 2.886 patients. Included trials investigated the effects of hypnosis, enhanced information, relaxation, music, or cognitive-behavioral approaches including distraction.

Results: Random effects meta-analyses revealed significant positive treatment effects on the reduction of mental distress (g = 0.58, CI 95% [0.39; 0.76]). Effects on pain relief (g = 0.00, CI 95% [-0.28; 0.28]) and the reduction of analgesic use (g = 0.26, CI 95% [-0.22; 0.73]) were not significant. Because effects on mental distress were substantially heterogeneous, subgroup analyses were run yielding significantly larger effects for studies with low risk of bias compared to studies with high or unclear risk of selection and attrition bias. No significant differences appeared between various types of non-pharmacological interventions.

Conclusions: In summary, benefits of non-pharmacological interventions on reducing mental distress were demonstrated with largest effects being shown for hypnosis. However, further high quality trials are needed to strengthen the promising evidence.

Clinical significance: This systematic review and meta-analysis indicated that non-pharmacological interventions may be beneficial for reducing mental distress in patients undergoing dental procedures and could thus be considered as valuable adjunct to standard care.

Keywords: Dental anxiety; Mental distress; Meta-analysis; Non-pharmacological interventions; Randomized-controlled trials; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Analgesics
  • Attention
  • Cognitive Behavioral Therapy
  • Databases, Factual
  • Dental Anxiety / psychology
  • Dental Anxiety / therapy*
  • Humans
  • Hypnosis / methods*
  • Music Therapy
  • Pain / etiology
  • Pain / psychology
  • Pain Management / methods*
  • Randomized Controlled Trials as Topic
  • Relaxation Therapy / methods*


  • Analgesics