Guided Imagery and Language-Based Strategies for Pediatric Dental Anxiety: A Systematic Review and Meta-analysis with Comparator Trials

Geetanjali Jadhav; Preetam Shah; Rahul Hegde; Anand Shigli; Pawan Herkar; Apurva Borde

doi:10.5455/EJDR.20251016055712

Abstract
Background: Dental anxiety in children compromises care. Guided Imagery (GI) and language-based interventions are proposed as non-pharmacological approaches.
Objectives: To evaluate the efficacy of psychological interventions, including Guided Imagery (GI), language-based strategies (Neuro-Linguistic Programming (NLP)), and audiovisual distraction (AVD), in reducing pediatric dental anxiety.
Methods: This systematic review was reported in accordance with the PRISMA 2020 guidelines. Databases were searched from inception to October 2025. Randomised controlled trials (RCTs) were analysed using random-effects models to calculate standardised mean differences (SMD, Hedges’ g).
Results: One RCT on GI (n=80) showed a large anxiety reduction (SMDg = -1.23; 95% CI: -1.75 to -0.72). A meta-analysis of four AVD RCTs (n=300) showed a significant, moderate reduction (SMDg = -0.65; 95% CI: -0.95 to -0.35). Supportive evidence for language-based strategies was found but not pooled. The certainty of evidence was low.
Conclusions: GI and language-based strategies are promising, low-cost methods for reducing pediatric dental anxiety. However, the current evidence is limited and of low certainty.
Clinical Significance: Based on the available evidence, GI and AVD may serve as effective adjuncts to routine behaviour management in pediatric dentistry.

Key words: Dental anxiety, pediatric dentistry, guided imagery, neuro-linguistic programming, systematic review, non-pharmacological intervention.