BEHAVIOR MANAGEMENT IN PEDIATRIC DENTISTRY: STRATEGIES TO REDUCE FEAR AND ANXIETY DURING DENTAL CARE

Abstract

This article aimed to critically synthesize recent evidence on behavior management strategies to reduce fear and anxiety in children during dental care. It is a narrative literature review, with searches carried out in October 2026 through online resources indexing PubMed/MEDLINE, the Cochrane Library and SciELO, plus documents from the American Academy of Pediatric Dentistry, resulting in 14 individually verified references. Dental anxiety affects about 23.9% of children and adolescents, with higher prevalence in preschoolers (36.5%). Basic nonpharmacological techniques showed, overall, a trivial-to-small effect; modeling, positive reinforcement, relaxation, tell-show-do combined with audiovisual distraction and cognitive behavioral therapy markedly reduced anxiety, although certainty of evidence was mostly very low. Distraction outperformed tell-show-do, except in invasive procedures, and virtual reality showed marked effects with high heterogeneity. Oral midazolam has moderate-certainty evidence. It is concluded that management should be individualized, stepwise and shared with caregivers, and higher-quality clinical trials are needed.