To assess the evidence about the correlation between objective and subjective methods for evaluating dental anxiety.

Eligibility criteria were defined as follows: Patients (P): individuals in the dental care context; Index test (I): subjective methods; Reference test (R): objective methods; Outcome (O): correlation between methods to dental anxiety evaluation. Searches were conducted in 7 databases and grey literature up to November 2023, without language or date restrictions. The QUADAS-2 tool was employed to evaluate Risk of bias. A random-effects meta-analysis was performed to calculate pooled correlation coefficients between methods on the basis of the objective method analyzed. The GRADE approach was utilized to assess evidence certainty.

A total of 29 studies, with 1891 participants aged 3 to 82 years, were included, with 22 studies participating in the meta-analysis. The Risk of bias was mostly “unclear” due to inadequate methodology detail. Weak correlations were observed between subjective methods and heart rate (r 0.15 [0.08, 0.21], P < .001, I2 = 56%) and alpha-amylase (r 0.25 [0.11, 0.38], P < .001, I2 = 43%. Subjective methods showed a moderate correlation with cortisol analysis (r 0.40 [0.33, 0.47] P < .001, I2 = 72%). No other objective method displayed a significant correlation with subjective methods. The certainty of evidence was very low.

The findings can suggest a correlation between the following subjective and objective methods: ACDAS, DAS, MCDAS, MDAS and Cortisol; CFSS-DS, DAS, MCDAS, MDAS and Alpha-amylase; and DAS, DAS-R, MDAS, S-DAI, Venham Picture Anxiety, Venham Picture Test and Heart rate. Nonetheless, these results lack conclusiveness due to their very low certainty of evidence.

PROSPERO database registration number CRD42022298589.