Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial

Abstract

Background Different distraction techniques have been used in dentistry and have shown great results in managing anxious pediatric patients specially during local anesthesia administration. One of the recently invented techniques is virtual reality. The purpose of the study was to evaluate the effect of virtual reality distraction on anxiety and pain during buccal infiltration anesthesia in pediatric patients. Methods Healthy, cooperative 6- to 12-year-old children requiring buccal infiltration anesthesia were randomly assigned to a test or control group. In the test group, local anesthesia was administered while the subjects were watching a cartoon video using virtual reality goggles. Subjects in the control group watched a cartoon video on a screen during the administration of local anesthesia. To assess anxiety in both groups, heart rate was recorded using a pulse oximeter at five time points: (1) once the subject sets on the dental chair as a baseline; (2) when video is on; (3) at topical anesthesia application; (4) during needle insertion; (5) after the administration of local anesthesia. The face, legs, activity, cry, consolability (FLACC) behavioral pain assessment scale and the Wong–Baker FACES pain rating scale were used to assess pain. Results A total of 50 subjects were included with a mean age of 8.4 ± 1.46 years. Twenty-nine (58.0%) of the subjects were females. The mean heart rate at all time points except baseline was significantly higher among the test group compared to the control group. Multiple regression analysis showed that younger subjects and females had higher mean FLACC behavioral pain assessment scale scores (P = 0.034 and P = 0.004, respectively) regardless of the distraction technique used. Younger subjects and subjects with higher baseline heart rate reported higher mean Wong–Baker FACES pain rating scale score (P = 0.031 and P = 0.010, respectively), controlling for all other variables. Conclusion Female subjects and the younger age group were more likely to report higher pain scores during local anesthesia administration regardless of the type of distraction used. Trial registration The study was retrospectively registered in ClinicalTrials.gov with the identifier: NCT04483336 on 23/07/2020.

Augmented, Virtual and Mixed Reality in Dentistry: A Narrative Review on the Existing Platforms and Future Challenges

“…The patient's inability to see the dental practitioner and instruments may be one advantage of VR. The effectiveness of VR distraction treatment may depend on how patients feel in the virtual environment [49]. For this reason, video stimulation and audio simulation may be detrimental in making the users' experience more immersive and by trying to decrease the dental pain [8].…”

Investigating the Effect of Virtual Reality on Reducing the Anxiety in Children: A Systematic Review

“…The characteristics of all the studies included are reported in Table 2. Out of 10 incoming studies, 3 studies (30%) in Korea [2,24,25] and other studies in Brazil [19], Iran [20], Netherlands [21], Saudi Arabia [22], Republic of Korea [1], Spain [23] and China [3]. Studies in two categories of randomized trial (20%) [21,24] and randomized clinical trial (60%) [1-3, 19, 20, 22, 23, 25] Were classified.…”

“…However, in one study, virtual reality was used as an educational tool [1]. In 3 cases (30%) reduction of anxiety in the two groups of control and intervention was not significantly different [19,21,22]. In all studies, the control group received routine care, including routine behavior management techniques and anxiety control pills.…”

“…In 7 of the studies, children and parents were satisfied with the virtual reality intervention in reducing anxiety, and in all 7 cases, users were highly satisfied [1-3, 19, 23-25]. In 3 cases of studies found from virtual reality technology in reducing pediatric anxiety in dentistry [3,19,23], 4 cases before surgery [20,21,24,25], 2 cases related to anxiety before shelf radiography of breasts [1,2] and one case were used during preoperative anesthesia [22].…”

Perceptions and Anxiety Level of Students during Administration of Local Anesthesia

“…5 Recent literature has shown that video demonstration is very effective to improve student confidence in psychomotor skills. 6,7 Real-time virtual reality learning experience has been introduced as an educational tool to enhance the clinical learning of students. 8 Contextually, learners in dental school deliver their first injection directly on patients under supervision of teachers to reduce patients anxiety and build confidence.…”