Effectiveness of virtual reality interventions for the management of dental anxiety and pain in pediatric patients: an umbrella review of systematic reviews

Abstract Background and aim Dental anxiety affects 13.3–36.5% of children. Virtual reality (VR) distraction is a promising non-pharmacological intervention, but published systematic reviews report inconsistent conclusions. This umbrella review (an overview of systematic reviews) aims to integrate and critically appraise the evidence on VR effectiveness for dental anxiety and pain in pediatric patients. Methods Following JBI methodology and PRISMA 2020, six databases were searched on 2 May 2026. Two reviewers independently screened, extracted data, and assessed quality with AMSTAR-2 and ROBIS. Overlap was quantified using the Corrected Covered Area (CCA), and evidence certainty with GRADE. Results Ten systematic reviews (59 unique immersive-VR RCTs, approximately 3,000 pediatric participants) were included. AMSTAR-2 ratings were High in 5/10, Low in 2/10, and Critically Low in 3/10 reviews. The CCA, restricted to immersive-VR trials, was approximately 14.1% (high overlap). VR reduced dental anxiety and pain compared with no intervention (anxiety SMD: −1.74 to − 0.47; pain SMD: −1.57 to − 0.58), but not consistently superior to other distraction techniques. In the only network meta-analysis, VR ranked fourth for anxiety (SUCRA 57.87%) behind music, aromatherapy, and games. VR did not significantly reduce dental anxiety in the extraction subgroup, and effects were larger in children > 8 years. No serious adverse events were formally reported. Heterogeneity was substantial (I² > 75% in most pooled analyses), and GRADE certainty ranged from Very Low to Low. Conclusions VR distraction appears to be beneficial compared with no intervention or routine care but not consistently superior to other distraction techniques. No serious adverse events were reported, but harms were insufficiently assessed. Pediatric dentists should consider VR as one option in a tailored, multi-modal strategy, with selection guided by patient age, procedure type, and device characteristics. Systematic review registration This umbrella review was prospectively registered in PROSPERO (registration number CRD420261371168).