Application of magic distraction therapy for the alleviation of dental fear and anxiety in children younger than 12 years: a systematic review and meta-analysis of randomized controlled trials

Background: Dental fear and anxiety (DFA) in children leads to increased pain sensitivity and challenging behaviors that complicate treatment. Employing magic as a distraction therapy utilizes children's imagination and curiosity to mitigate these effects, yet its systematic evaluation is lacking. This study aimed to evaluate the effect of magic distraction therapy (MDT) in reducing DFA in children and identify the determinants of its efficacy. Methods: This study adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Platform of Registered Systematic Review and MetaAnalysis Protocols (INPLASY202420074). We searched Embase, MEDLINE, Scopus, the Cochrane Central Register of Controlled Clinical Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for randomized controlled trials (RCTs) involving children under 12 years receiving dental treatment with MDT. Studies that combined multiple distraction methods or used hypnosis were excluded. The meta-analysis analyzed the data using a random effects model, with subgroup analysis and meta-regression. The methodological quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results: The analysis included four RCTs involving a total of 180 children aged 2 to 11 years. Overall, 25.0% of the included studies had a low risk of bias, 75.0% had some risk of bias, and none had a high risk of bias. Magic significantly reduced dental anxiety (Hedges' g = -1.236, 95% confidence interval (CI): -1.798 to -0.673, p < 0.001), particularly during treatments involving local anesthesia (p = 0.006), performed concurrently during treatment (p = 0.008), and in younger children (coefficient = -0.2077 per year, p < 0.001). Conclusions: This study supports MDT as an effective approach for reducing DFA in children, highlighting the importance of timing, anesthesia and patient age in optimizing anxiety reduction strategies. Clinical Trial Registration: INPLASY202420074.