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Background <p>Dental fear and anxiety (DFA) are common in children, which can hinder their access to dental care and lead to poor oral health outcomes. Dental general anesthesia (DGA) is frequently used for uncooperative children or those requiring extensive treatment, enabling efficient care in a single session. However, its psychological effects on DFA—whether it alleviates or worsens anxiety—remain unclear. This highlights the need for a systematic review and meta-analysis to evaluate DGA's impact on children's DFA.</p> Methods <p>A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar up to January 15, 2025, to identify observational and clinical studies on DFA in children (ASA I–II) under 12 years old before and after DGA or compared to those without DGA. Risk of bias was assessed by the NIH quality assessment tool for before-and-after studies without an external control, and the Newcastle–Ottawa scale for case–control and cohort studies. Results were synthesized using standardized mean differences (SMD) and 95% confidence intervals (CI), with evaluations for heterogeneity and publication bias.</p> Results <p>Twelve studies were included in the review, with nine eligible for meta-analysis. Based on the NIH quality assessment tool, four studies were rated as good and three as fair. Three studies received medium quality scores on the Newcastle–Ottawa scale. The analysis revealed no statistically significant changes in DFA after DGA (SMD = -0.7, 95% CI: -1.993 to 0.593, <i>p</i> = 0.289), nor between DGA and non-DGA groups (CFSS-DS: SMD = 0.132; MCDASf: SMD = 0.850). High heterogeneity and possible publication bias were observed. The certainty of evidence was rated as very low by GRADE.</p> Conclusion <p>There was no statistically significant evidence that DGA increases or decreases DFA in children. Due to the variability in outcomes and assessment methods, future research should use standardized tools, consider confounding factors, and include longer follow-up periods to better understand the psychological effects of DGA.</p>

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The effect of dental rehabilitation under general anesthesia on dental anxiety in children: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Elham Keykha,
  • Samira Hajisadeghi,
  • Mohammad Taha Heidari

摘要

Background

Dental fear and anxiety (DFA) are common in children, which can hinder their access to dental care and lead to poor oral health outcomes. Dental general anesthesia (DGA) is frequently used for uncooperative children or those requiring extensive treatment, enabling efficient care in a single session. However, its psychological effects on DFA—whether it alleviates or worsens anxiety—remain unclear. This highlights the need for a systematic review and meta-analysis to evaluate DGA's impact on children's DFA.

Methods

A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar up to January 15, 2025, to identify observational and clinical studies on DFA in children (ASA I–II) under 12 years old before and after DGA or compared to those without DGA. Risk of bias was assessed by the NIH quality assessment tool for before-and-after studies without an external control, and the Newcastle–Ottawa scale for case–control and cohort studies. Results were synthesized using standardized mean differences (SMD) and 95% confidence intervals (CI), with evaluations for heterogeneity and publication bias.

Results

Twelve studies were included in the review, with nine eligible for meta-analysis. Based on the NIH quality assessment tool, four studies were rated as good and three as fair. Three studies received medium quality scores on the Newcastle–Ottawa scale. The analysis revealed no statistically significant changes in DFA after DGA (SMD = -0.7, 95% CI: -1.993 to 0.593, p = 0.289), nor between DGA and non-DGA groups (CFSS-DS: SMD = 0.132; MCDASf: SMD = 0.850). High heterogeneity and possible publication bias were observed. The certainty of evidence was rated as very low by GRADE.

Conclusion

There was no statistically significant evidence that DGA increases or decreases DFA in children. Due to the variability in outcomes and assessment methods, future research should use standardized tools, consider confounding factors, and include longer follow-up periods to better understand the psychological effects of DGA.