## 3 Results and Discussion  
Pediatric dentists have long used oral analgesics and anesthetics, but with poor results in controlling the anxiety of child patients, since these only control pain during treatment. These drugs do not help to alleviate fear, stress and anxiety, and for these reasons, new methods and treatments have begun to be considered to alleviate dental anxiety [20]. Some patients delay treatment because of concerns about going to the dentist and unfounded myths about general anesthesia. The accumulation of all of these situations eventually leads to a poor prognosis and possible long-term dental problems [32]. For this reason, throughout this time, numerous authors have carried out various studies based on the use of distraction techniques in order to avoid this fear. One of the numerous techniques is the audiovisual distraction technique [12]. From the oldest research articles to the most modern ones, we are going to give a broad view of the use of the audiovisual distraction technique. We have focused on studies in children between 4 and 10 years old, ages where it is considered useful to apply distraction techniques [33]. The majority of the articles have a mean age of 7 years old for the children participating. Dr. [PERSON] conducted a study in 1981 on the heart rate, self-report and clinical classification to see whether distraction by television programs was reliable in children of different ages with high levels of anxiety in the office. This is considered the oldest effort in audiovisual distraction, as far as we know. In their research, they used two groups, a distraction group and a control group, and found that younger patients suffered from higher anxiety. The results did not show evidence that television programs modified the responses of younger children, possibly because their age made it difficult for them to maintain their concentration [33]. Dr. [PERSON] developed an imaging method to assess the pain of children during dental treatments [33], and this method was used in many other articles. With the huge development advances that audiovisual devices have made since the year 2000, there have been many different studies with these new devices. Figure 1: Flow chart and inclusion and exclusion criteria. [PERSON] conducted a study in 2007 with 60 children aged 4 to 8 years with no previous dental experience. He divided them into three groups--one control, one using auditory distraction methods and the last using visual distraction methods--and evaluated anxiety levels using the Venham imaging method, pulse rate and oxygen saturation. The results of the investigation showed that between the control group and the audio group, there were no significant differences in the reduction of anxiety, while the audiovisual methods were the most effective, thanks to the fact that a multisensory distraction is obtained, which helps to maintain the child's concentration on a screen and to eliminate external sounds at the same time [28]. In order to obtain reliable results, we have to know what mainly produces anxiety in children in a pediatric dentistry consultation without a distraction method. Therefore, in a study conducted in 2018 on child anxiety before dental treatment, 152 children between 7 and 18 years of age were surveyed. A descriptive statistical analysis was performed by dividing the survey into 14 different situations that usually cause or increase anxiety. With the results, they were able to conclude that \"injections\" are the cause of the greatest increase in anxiety, along with \"turbine drills\", \"the visualization of the drills\", \"the noise of the rotators\", \"the instruments in their mouth\" and \"having to go to the hospital\". This made the authors realize that most of the factors that produce anxiety are of a visual or auditory nature, and therefore, isolating these two senses would have solved the problem to a great extent [34].