Technology-enhanced behavior guidance reduces dental anxiety, pain, and pulse rate in pediatric patientsDigital tools help reduce anxiety and pain in children's dental visits

Pediatric dental anxiety is common and can compromise cooperation, increase distress, and contribute to avoidance of dental care. Technology-enhanced behavior guidance (virtual reality, augmented reality, biofeedback, and game-based/digital distraction) is increasingly used, but its effectiveness and safety across pediatric dental procedures remain uncertain. To determine whether technology-augmented/digital distraction reduces pediatric dental anxiety/fear and to summarize reported safety/adverse events; secondary objectives were to evaluate effects on pain and physiological arousal (pulse rate). This PRISMA 2020–compliant systematic review and meta-analysis was registered in PROSPERO (CRD420251167094). PubMed, Scopus, Web of Science, Google Scholar, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library were searched from inception to 18 December 2025, with additional searches of citation lists, Shodhaganga, and ISRCTN. Eligible English-language studies Evaluated Technology-enhanced/digital Distraction Interventions in Pediatric Dental Care. One Effect Estimate per Study per Outcome was Extracted at an Intra-procedural time Point. Random-effects meta-analyses Were Conducted Using Standardized Mean Differences (SMDs). Risk of Bias was Assessed Using RoB 2 and ROBINS-I, and certainty was rated using GRADE. Of 675 records identified (590 from databases/registers and 85 from other sources), 61 studies were included qualitatively. For quantitative synthesis, 42 studies contributed to anxiety, 18 to pain, and 30 to pulse rate. Compared with controls, digital distraction reduced anxiety (42 studies; n = 2569; SMD −0.97, 95% CI −1.41 to −0.53; I2 = 93.8%), reduced pain (18 studies; n = 1319; SMD −1.08, 95% CI −1.56 to −0.60; I2 = 92.3%), and reduced pulse rate (30 studies; n = 1727; SMD −0.61, 95% CI −0.99 to −0.23; I2 = 87.9%). Trim-and-fill for anxiety imputed six potentially missing studies and attenuated the pooled effect (adjusted SMD −0.52, 95% CI −1.06 to 0.01). Overall risk of bias was frequently high/with concerns (RoB 2: 25 high, 31 some concerns; ROBINS-I: 4 serious, 1 moderate) and certainty of evidence was very low for all outcomes. Safety reporting was limited; five studies explicitly reported device-related discomfort/adverse effects, with no serious adverse events. Technology-enhanced behavior guidance may reduce dental anxiety, pain, and physiologic arousal, but very high heterogeneity, frequent risk of bias, limited safety reporting, and sensitivity to small-study effects indicate that the magnitude of benefit is uncertain and likely context-dependent. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251167094.