Acupuncture for anxiety in dental patients: Systematic review and meta-analysis

Introduction: Dental anxiety affects an estimated 4% to 30% of the adult population in countries world-wide. The objective of this study was to conduct the first systematic review and meta-analysis of randomised controlled trials of acupuncture to reduce anxiety in dental patients. Methods: Online databases (OVID/AMED, Cochrane Library, CINAHL, OVID/Medline, EMBASE, PROSPERO, PsycINFO, PubMED, as well as databases in Chinese, Portuguese, Spanish and German) were searched up to July 2017 for eligible trials involving dental patients receiving an acupuncture intervention with measured anxiety scores. Comparators were placebo, usual care, or another dental anxiety intervention. Included studies were assessed using the Cochrane Risk of Bias Tool. Results: From 129 trials identified as potentially eligible, six trials with 800 patients were included in this review. Two trials (combined n = 249) were rated as moderate-to-high or high quality, both used auricular acupuncture, and were the only two trials to report continuous post-intervention anxiety scores, both using the (80-point) State-Trait Anxiety Inventory (STAI). A meta-analysis comparing acupuncture with no-intervention controls found a statistically significant and clinically relevant reduction in anxiety of -8.43, 95% CI (-11.90, -5.00). A meta-analysis comparing acupuncture to placebo/sham acupuncture found a clinically irrelevant and non-significant reduction of -1.54, 95% CI (-4.73, 1.64), a contrast that might be explained by context effects. Conclusions: There is limited evidence from two good quality trials that auricular acupuncture can achieve a significant and clinically meaningful reduction of anxiety in dental patients. There is no conclusive effect of acupuncture when compared with a sham/placebo control.