RESUMO
BACKGROUND: Nonpharmacologic interventions may be used to reduce fear and anxiety during dental treatment. OBJECTIVES: To systematically review trials on the effect of nonpharmacologic interventions in behavior, anxiety, and pain perception in children undergoing dental treatment. DATA SOURCES: Medline, Scopus, Web of Science and CINAHL, Google Scholar, and studies' reference lists. PARTICIPANTS AND INTERVENTIONS: Studies performed with children and adolescents that evaluated the effect of interventions on children's behavior, anxiety, and pain perception during dental treatment were included. STUDY APPRAISAL METHODS: Independent quality assessment of the studies was carried out following the classification categories present on the Cochrane Handbook for Development of Systematic Reviews of Intervention. RESULTS: Twenty-two articles, reporting 21 studies, were selected. Most studies tested distraction techniques. Eight studies presented bias and results were not considered. The remaining 13 studies had control groups with inactive controls, and 4 also included a variation of the intervention. Of the 4 studies assessing behavior, 3 found difference between intervention and control. Anxiety was evaluated by 10 studies: 4 found differences between intervention and control and 2 found differences between interventions. Five studies investigated pain perception: 3 found difference comparing active versus inactive interventions. In 1 of the 3, variations in the intervention decreased pain perception. CONCLUSIONS: More research is needed to know whether the techniques are effective for improving behavior and reducing children's pain and distress during dental treatment. However, the majority of the techniques improved child's behavior, anxiety, and pain perception.