--- title: "Retraction: Sensory art therapies for dental anxiety — PLOS One systematic review withdrawn" id: "plos-one-10-retraction-effect-of-sensory-art-therapies-on-root-canal-treatment-anxiety-and" canonical_url: "https://medichelpline.com/clinical-feed/plos-one-10-retraction-effect-of-sensory-art-therapies-on-root-canal-treatment-anxiety-and" content_type: "clinical_feed_article" specialty: "Dentistry" source_name: "PLOS ONE (Medicine)" source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357077" published_at: "2026-08-27T14:00:00.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Retraction: Sensory art therapies for dental anxiety — PLOS One systematic review withdrawn ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-10-retraction-effect-of-sensory-art-therapies-on-root-canal-treatment-anxiety-and - **Specialty:** [Dentistry](https://medichelpline.com/clinical-feed/dentistry.md) - **Primary Source:** PLOS ONE (Medicine) - **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357077) - **Published At:** 2026-08-27T14:00:00.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - A PLOS One systematic review and meta-analysis titled “Effect of sensory art therapies on root canal treatment anxiety and high dental anxiety in adults” was retracted by the PLOS One Editors following methodological concerns raised after publication. The retraction notice lists multiple specific problems that undermine the validity and reliability of the reported results. - Major concerns included excessive heterogeneity from combining diverse interventions under the umbrella term **sensory art therapies** (virtual reality, aromatherapy, music therapy, chromotherapy, yoga, aerobic exercise), which reduces interpretability of pooled effects and the validity of meta-analytic pooling. - At least one included study did not meet the predefined participant criteria in the review’s PICOS framework: it enrolled routine dental care patients with a range of anxiety levels rather than adults specifically undergoing root canal treatment or with high dental anxiety/dental phobia. - Two included studies evaluated interventions (aerobic exercise and yoga) that do not match the review’s defined intervention type (sensory-based art therapies). Those two studies were not included in the meta-analysis, but their inclusion in the review raised concerns about selection criteria consistency. - The review reported eight outcome-specific meta-analyses, each based on a small number of studies (n = 2–6). Multiple subgroup entries from the same studies were included in several outcomes, risking disproportionate influence of single studies on pooled estimates. - There was an inconsistency in reported **GRADE** certainty for heart rate between figure and table, and the authors reported upgrading certainty for some outcomes (VAS, HR, salivary cortisol) based on effect size magnitude. Editorially, upgrading for RCTs on that basis is not permitted, changing the overall certainty range from the report’s “very low to high” to “very low to low.” - One study was entered multiple times in a meta-analysis (four entries for the same study vs the same 30-person control group), representing repeated measurements from the same participants as independent data points. This violates the independence assumption of meta-analysis and inflates sample size and weight. - PLOS One sought independent expert and statistical advice; both advisors agreed the validity and reliability of the published results were in question, prompting the Editors to retract the article. Three authors responded without stating agreement or disagreement; one author was unreachable or did not respond. - The retraction notice cites the original article and the included studies involved in the concerns and clarifies that the editors withdrew the paper because of the methodological issues documented. ## Clinical Analysis & Structured Key Points Retraction: Effect of sensory art therapies on root canal treatment anxiety and high dental anxiety in adults: A systematic review with meta-analysis | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Metrics Comments Media Coverage Reader Comments After publication of this article [ 1 ], concerns were raised about the methodology. Specifically: The authors used an umbrella term (sensory art therapies) for several highly variable interventions such as virtual reality, aromatherapy, music therapy, chromotherapy (color therapy), but also yoga and aerobic exercise. This heterogeneity makes it unclear which intervention type, if any, drives the observed effects, and limits the validity of the pooled analyses and the interpretability of the results. One study [ 2 ] included in the systematic review and meta-analysis [ 1 ] does not appear to meet the predefined participants (P) criterion of the PICOS framework specified in the Methods section. Specifically, the systematic review defined eligible participants as adult patients with symptoms related to dental root canal treatment, high dental anxiety, or dental phobia, whereas [ 2 ] also included patients undergoing routine dental care who were not necessarily receiving root canal treatment and did not necessarily have high dental anxiety or dental phobia, but rather a range of dental anxiety levels from none or low to high. Two studies [ 3 , 4 ] included in the systematic review [ 1 ] do not appear to meet the predefined intervention (I) criterion of the PICOS framework specified in the Methods section. Specifically, the systematic review defined eligible interventions as art therapy, including sensory based art therapies targeting the five senses, whereas [ 3 ] and [ 4 ] evaluated aerobic exercise and yoga, respectively, instead. These two studies were not included in the meta-analysis. The authors conducted eight outcome-specific meta-analyses, each based on a small number of studies (n = 2, 4, 2, 4, 3, 6, 6, 3; Figs 3 and 4), raising concerns about the robustness of the pooled estimates. This concern is further compounded by the inclusion of multiple subgroups from the same studies in six outcomes, which may disproportionately influence the results. There is a discrepancy in the GRADE rating for heart rate (HR) between Fig 5 (moderate) and Table 5 (high). Additionally, editorial follow-up with the first author revealed that certainty of evidence was upgraded for visual analogue scale (VAS), HR, and salivary cortisol (SC) on the basis of effect size magnitude. According to the Cochrane GRADE Book, however, upgrading on this basis is not permitted when the included studies are RCTs. Correcting for this, the certainty of evidence range changes from the reported “very low to high” to “very low to low.” The study in [ 5 ] was included as four entries (a-d) in Fig 4 for both systolic and diastolic blood pressure, each compared against the same 30-person control group. The first author clarified that these four entries correspond to two intervention groups (Chinese and Western music), each measured at two appointments within a single root canal treatment course. Treating repeated measurements on the same individuals, compared repeatedly against the same controls, as independent data points violates the independence assumption underlying meta-analysis and inflates both the effective sample size and the weight given to this study. The PLOS One Editors sought advice from an independent expert and a Statistical Advisor with expertise in systematic reviews and meta-analyses regarding the concerns outlined above. Both agreed with the Editors’ conclusion that the validity and reliability of the published results are in question. In light of this assessment, the PLOS One Editors retract this article. XL, SG, and GH responded but expressed neither agreement nor disagreement with the editorial decision. JW either did not respond directly or could not be reached. References 1. Guo S, Luo X, Wang J, Huang G. RETRACTED: Effect of sensory art therapies on root canal treatment anxiety and high dental anxiety in adults: A systematic review with meta-analysis. PLoS One. 2025;20(9):e0328917. pmid:40892734 View Article PubMed/NCBI Google Scholar 2. Lahti S, Suominen A, Freeman R, Lähteenoja T, Humphris G. Virtual reality relaxation to decrease dental anxiety: Immediate effect randomized clinical trial. JDR Clin Trans Res. 2020;5(4):312–8. pmid:31962052 View Article PubMed/NCBI Google Scholar 3. Lindenberger BL, Plag J, Schumacher S, Gaudlitz K, Bischoff S, Bobbert T, et al. Clinical and neurobiological effects of aerobic exercise in dental phobia: A randomized controlled trial. Depress Anxiety. 2017;34(11):1040–8. pmid:28556577 View Article PubMed/NCBI Google Scholar 4. Verma MR, Rao RD, Langade D, Jain AK, Guha A, Mohan M. Assessment of yogic relaxation techniques for its anxiolytic effects in patients requiring endodontic treatment: A prospective, randomized controlled study. J Conserv Dent. 2021;24(2):209–13. pmid:34759592 View Article PubMed/NCBI Google Scholar 5. Fukamachi A, Koizumi H, Nagaseki Y, Nukui H. Postoperative extradural hematomas: computed tomographic survey of 1105 intracranial operations. Neurosurgery. 1986 Oct;19(4):589–93. pmid:3785596 View Article PubMed/NCBI Google Scholar Citation: The PLOS One Editors (2026) Retraction: Effect of sensory art therapies on root canal treatment anxiety and high dental anxiety in adults: A systematic review with meta-analysis. PLoS One 21(8): e0357077. https://doi.org/10.1371/journal.pone.0357077 Published: August 27, 2026 Copyright: © 2026 The PLOS One Editors. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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