Background <p>Dental anxiety in children is common and often disrupts dental treatment. Among various psycho-behavioral strategies, distraction techniques—especially virtual reality (VR) have gained increasing attention due to their immersive potential in managing anxiety during dental procedures.</p> Methods <p>A literature search was conducted across five databases (PubMed, ScienceDirect, Google Scholar, Scopus, and Cochrane Library) for studies published between 2013 and 2023. Only randomized controlled trials and interventional studies assessing VR distraction in pediatric dental settings were included.</p> Results <p>Out of 236 identified articles, 15 met the inclusion criteria, encompassing 1,168 children aged 4 to 15. Most studies reported improved behavior, reduced anxiety, and lower pain perception with VR distraction compared to standard care.</p> Conclusion <p>VR distraction appears to be a safe and non-invasive approach that may improve the dental experience for children. However, due to methodological heterogeneity and the overall low certainty of evidence, these findings should be interpreted with caution, and further standardized research is needed to confirm its benefits and optimize clinical protocols.</p> Systematic review registration number <p>This systematic review was based on the methodology of the Cochrane review and followed the PRISMA (preferred reporting items for systematic reviews and metanalyses) guidelines. Before starting this work, the systematic review was declared on the PROSPERO international register of systematic reviews (CRD42023458556) (<a href="https://www.crd.york.ac.uk/prospero/">https://www.crd.york.ac.uk/prospero/</a>) to avoid duplication of subject matter by another author.</p> Clinical trial number <p>Not applicable.</p>