Effectiveness of magic-based (thaumaturgic) techniques in reducing dental anxiety among children across cognitive developmental stages: a systematic review and meta-analysis

Abstract

Background: Pediatric dental anxiety had remained a major barrier to care, with the need for brief non-pharmacologic strategies, especially during local anesthesia. Thaumaturgic techniques had been hypothesized to reduce procedure-proximal anxiety through attentional capture, positive affect, and expectancy modulation aligned with the cognitive developmental stages.
Material and Methods: Six databases were searched (inception to final run), reference lists and grey literature were screened, and authors were contacted for missing data. Two re-viewers independently screened, extracted data and applied Cochrane RoB 2.0. Continuous outcomes were synthesised with random-effects models using mean difference (MD) or standardized mean difference (SMD) with 95% Cis.
Results: Four randomized trials (k = 4; N = 690) met inclusion. Trick-specific syntheses showed that the thumb-and-light routine produced a pooled MD = −3.40 (95% CI −6.18 to −0.61; I² = 95.9%; τ² = 7.76; prediction interval −13.35 to 6.55), the magic coloring book yielded SMD = −2.65 (95% CI −4.02 to −1.29; I² = 81.5%; τ² = 0.80), and the item-prediction routine yielded SMD = −4.73 (95% CI −5.74 to −3.72). Qualitative synthesis showed stage-contingent benefits (visual salience favoured younger children; rule-/prediction-based routines favoured older cohorts), larger effects versus minimal/standard comparators than versus active audio-visual distraction, and greater impact when timed to the injection moment.
Conclusions: Thaumaturgic techniques were associated with clinically meaningful, procedure-proximal reductions in pediatric dental anxiety, with magnitude conditioned by cognitive stage, trick family, and comparator stringency.