Brain responses to stimuli mimicking dental treatment among non-phobic individuals: A meta-analysis

Oral Dis. 2019 Jan;25(1):34-43. doi: 10.1111/odi.12819. Epub 2018 Mar 13.


Numerous neuroimaging studies have attempted to identify how the brain responds to stimuli mimicking dental treatment in normal non-phobic individuals. However, results were sometimes inconsistent due to small sample sizes and methodological variations. This meta-analysis employs standardized procedures to summarize data from previous studies to identify brain regions that were consistently activated across studies, elicited by stimuli such as pictures, sounds, or audiovisual footage mimicking those encountered during dental treatments. A systematic literature search was carried out using PubMed and Scopus. The meta-analysis analyzed data from 120 healthy subjects from seven neuroimaging studies. We assessed the risk of bias among the included studies with the Risk of Bias Assessment Tool for Nonrandomized Studies. One study appeared to have a high risk of selection bias, whereas the others were considered to have a low risk of bias. Results revealed three clusters of activation with cluster sizes ranging from 768 mm3 to 1,424 mm3 . Stimuli mimicking dental treatment consistently activated the bilateral anterior insula; right dorsal anterior cingulate, putamen, and medial prefrontal cortex; and left claustrum. This study confirmed that audio and/or visual stimuli mimicking dental treatment consistently activated the fear-related brain regions among healthy subjects, mostly consistent with activations from general anxiety but without the involvement of the amygdala.

Keywords: dental anxiety; dental equipment; emotions; functional neuroimaging; limbic lobe; neurosciences.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anxiety
  • Brain / physiology*
  • Dentistry*
  • Fear
  • Humans
  • Neuroimaging*