Clinical use of virtual reality distraction system to reduce anxiety and pain in dental procedures

Investigation of the effect of virtual reality distraction in patients undergoing mandibular periodontal surgery: A randomized controlled study

OBJECTIVE

This clinical study aimed to evaluate the effect of virtual reality (VR) technology on anxiety and pain levels in patients undergoing gingivectomy and gingivoplasty procedures.

MATERIALS AND METHODS

The patients were randomized into test (surgery with VR glasses) and control (surgery without VR glasses) groups. Before the surgery, the anxiety level was measured using the modified dental anxiety scale (MDAS), and anticipated pain (AP) was measured by a visual analog scale (VAS). Immediately after the surgery, the pain and discomfort associated with the surgery (VASP), procedure time (T), and time perception (TP) were evaluated. The patients in the test group were requested to assess the immersion (VASI), satisfaction (VASS), perception of reduced anxiety (VASA), and perceived control (VASC). One week after surgery, MDAS was applied to all patients.

RESULTS

This trial was conducted with 41 female and 17 male subjects with a mean age of 29.69 ± 12.32. There were no significant differences between the groups in terms of age, sex, preoperative MDAS, or AP. After surgery, MDAS, VASP, T, and TP failed to differ significantly between the groups. The subject age was positively correlated with VASI, VASS, VASA, and VASC (r = 0.60, p = 0.00; r = 0.44, p = 0.02; r = 0.46, p = 0.02; r = 0.50, p = 0.01, respectively) and negatively correlated with VASP (r = 0.47, p = 0.04).

CONCLUSIONS

VR application did not affect anxiety and pain levels in patients undergoing periodontal surgery. More studies are needed to evaluate VR distraction in periodontal surgeries with diverse age samples and video options.

CLINICAL SIGNIFICANCE

VR does not affect anxiety and pain levels during gingivectomy and gingivoplasty surgeries in the young adult population. It should be evaluated in older age groups. Trial registration ClinicalTrials.gov Identifier: NCT06092177.

Modernizing ED Care: Virtual Reality Enhances the Patient Experience during Minor Wide-awake Hand Procedures

Background

Minor procedures in the emergency department (ED) can be distressing for patients. The emergence of virtual reality (VR) offers a promising new tool by immersing patients in an engaging three-dimensional world. Prior studies have shown VR's effectiveness during procedures in reducing pain, anxiety, and procedure duration but have not assessed its efficacy in the ED. This study aims to evaluate the efficacy of VR in managing pain and anxiety during ED minor hand procedures.

Methods

This was a prospective, interventional study at a level I trauma center examining adult patients requiring minor hand procedures. Patients were provided the Oculus Quest 2 VR headset, offering various immersive three-dimensional experiences. Pre- and postprocedure surveys assessed previous VR use, anxiety and pain levels, VR efficacy, and possible adverse effects. Responses were rated on a 10-point Likert scale with paired t tests used to compare scores.

Results

The study included sixteen patients, seven of whom were first-time VR users. Patients experienced a significant decrease in both anxiety and pain levels. Survey results indicated overall benefits from VR in several aspects, with no adverse effects reported, and unanimous patient recommendation of the VR experience to others.

Conclusions

VR is an effective tool to optimize the patient experience during ED hand procedures. The study observed a significant decrease in anxiety and a declining trend in pain levels. Patients believed VR helped manage their pain and would recommend it to others. Given the benefits and high safety profile, VR should become a standard offering in ED minor hand procedures.

The effect of virtual reality glasses on dental anxiety during scaling and root planing in patients with periodontitis: A randomized controlled clinical trial

OBJECTIVES

This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients.

MATERIALS AND METHODS

This randomized controlled split-mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure.

RESULTS

With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = -0.48, p = 0.01).

CONCLUSIONS

The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses.

Effectiveness of virtual reality in relieving anxiety and controlling hemodynamics during oral surgery under local anesthesia: A prospective randomized comparative study

It was the aim of the study to evaluate the contribution of a relaxing immersive experience with virtual reality (VR) goggles in reducing patient anxiety related to wisdom tooth extraction under local anesthesia. A prospective randomized comparative study in consecutive patients scheduled for bilateral wisdom tooth extraction under local anesthesia was carried out between March and December 2022. Both sides were operated upon in the same surgery, but on one side VR goggles were applied (VR), while on the other they were not (noVR). Anxiety was evaluated both subjectively (State-Trait Anxiety Inventory [STAI] and visual analogue scale [VAS]) and objectively (measuring heart rate, blood pressure [BP] and blood oxygen saturation) before (T1) and after each surgical step (T2VR and T2noVR). The study sample consisted of 27 patients: 9 men and 18 women, with an average age of 25.8 ± 6.5 years (range: 18-43). Anxiety as assessed by the STAI and VAS decreased from T1 to T2 (p < 0.001 and p < 0.001, respectively), although to a similar degree regardless of whether VR was used or not. Heart rate showed significant differences influenced by RV exposure (p = 0.013): it increased +2.5 ± 8.8 bpm in the control group and decreased -2.22 ± 7.55 bpm with VR (p = 0.013). Both minimum and maximum BP after surgery were significantly higher in the noVR group (p = 0.002 and p = 0.040, respectively). Regarding minimum BP, VR proved more effective among male patients (p = 0.057) and on starting the procedure using VR (p = 0.055). The results provided evidence of meaningful control of the hemodynamic variables, but less predictable performance in the subjective evaluation of anxiety.

The use of mixed reality technology within the donor collection experience

BACKGROUND

Mixed reality (MR), a form of virtual reality (VR), provides an immersive and interactive experience for the user. Given VR's benefits in patients undergoing needle insertion procedures, MR's usability, impact on anxiety, and safety were evaluated in the blood donation setting.

STUDY DESIGN AND METHODS

Whole blood donors ≥18 years old (yo) were enrolled at two blood centers and provided a MR headset with independently developed software to wear during blood donation. Pre- and post-donation questionnaires were conducted, and reaction data were reviewed. A post-study questionnaire was also completed by staff who assisted donors with MR. Descriptive statistics, bivariate analyses, and multinomial logistic regression were performed, and p values determined statistical significance between variables.

RESULTS

A total of 282 donors completed the study. 84% wanted to try MR because it seemed fun/different/cool/interesting, and most staff (69%) and donors (68%) found MR easy to use. Baseline subjective anxiety, reported by 50.3% (more often in females, first-time donors, and donors <20 yo), was reduced by MR in 68.4% of donors, and there was a 3.6 times higher odds of anxiety reduction with MR. 54% of donors with baseline anxiety would use MR again with the highest future interest in young donors. Donor reactions while using MR were mild and included pre-faint reactions and hematomas.

CONCLUSION

This study demonstrates the potential of MR in reducing donor anxiety, its feasibility during blood donation, and its safety in blood donors. MR is an innovative technology that holds promise to increase donor engagement, satisfaction, and retention.

Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A Split-Mouth Randomized Crossover Clinical Trial

Materials and Methods

This crossover clinical trial was conducted with eligible 6-8-year-old children requiring bilateral mandibular molar pulpotomy. At the first treatment visit, pulpotomy was performed for 15 children using VR glasses distraction while the other 15 children received a pulpotomy without any VR glasses; this trend was reversed at the second session and pulpotomy was performed for the contralateral tooth. Pulse rate (PR) and Modified Child Dental Anxiety Scale (MCDAS) measured the anxiety levels. Wong-Baker Faces Pain Scale (WBFP) assessed the pain perception before and after the intervention. Data were analyzed by Statistical Package for the Social Sciences version 25 using the Mann-Whitney and χ2 tests.

Results

The mean PR was not significantly different between the two groups. However, the test group showed significantly lower scores of MCDAS (P value = 0.02) and WBFP (P value = 0.001) compared with the control group.

Conclusion

The present results suggest that VR headsets can decrease the level of pain and anxiety of patients during primary mandibular pulpotomy. This trial is registered with IRCT20200315046782N1.

The analgesic effects and neural oscillatory mechanisms of virtual reality scenes based on distraction and mindfulness strategies in human volunteers

BACKGROUND

Virtual reality (VR) has been widely used as a non-pharmacological adjunct to pain management. However, there is no consensus on what type of VR content is the best for pain alleviation and by what means VR modulates pain perception. We used three experiments to explore the analgesic effect of VR scenes in healthy adult volunteers.

METHODS

We first compared the effect of immersive VR on pain perception with active (i.e. non-immersive, two-dimensional video) and passive (i.e. no VR or audiovisual input) controls at both subjective perceptual (Experiment 1) and electrophysiological (electroencephalography) levels (Experiment 2), and then explored possible analgesic mechanisms responsible for VR scenes conveying different strategies (e.g. exploration or mindfulness; Experiment 3).

RESULTS

The multisensory experience of the VR environment lowered pain intensity and unpleasantness induced by contact heat stimuli when compared with two control conditions (P=0.001 and P<0.001, respectively). The reduced pain intensity rating correlated with decreased P2 amplitude (r=0.433, P<0.001) and increased pre-stimulus spontaneous gamma oscillations (r=-0.339, P=0.004) by 32-channel electroencephalography. A VR exploration scene induced a strong sense of immersion that was associated with increased pre-stimulus gamma oscillations (r=0.529, P<0.001), whereas a VR mindfulness meditation scene had a minor effect on immersive feelings but induced strong pre-stimulus alpha oscillations (r=-0.550, P<0.001), which led to a comparable analgesic effect.

CONCLUSIONS

Distinct neural mechanisms are responsible for VR-induced analgesia, deepening our understanding of the analgesic benefits of VR and its neural electrophysiological correlates. These findings support further development of digital healthcare.

Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature

BACKGROUND

It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments.

METHODS

The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations.

RESULTS

Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered.

CONCLUSIONS

this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.

Reducing Dental Anxiety in Children Using a Mobile Health App: Usability and User Experience Study

BACKGROUND

Dentistry interventions cause common anxiety and fear problems in children (6-11 years), and according to scientific evidence, this causes a decrease in their quality of life. Therapies mediated by IT-based tools have been shown to positively influence children's mood based on distraction as well as relaxing activities, but there is no evidence of their use to reduce dental anxiety in children.

OBJECTIVE

The aim of this study was to answer the following research question: Does our new children-centered codesign methodology contribute to achieving a usable mobile-based product with a highly scored user experience?

METHODS

A mobile health app was developed to reduce dental anxiety in children using rapid application development following the usage-centered design methodology. Structured interviews were conducted to test the usability and user experience of the app prototype among 40 children (n=20, 50%, boys and n=20, 50%, girls; age 6-11 years) using a children-adapted questionnaire and the 7-point Single Ease Question rating scale. The Smiley Faces Program-Revised questionnaire was used to assess the level of dental anxiety in participants.

RESULTS

There were no significant differences between girls and boys. The task completion rate was 95% (n=19) for children aged 6-8 years (group 1) and 100% (n=20) for children aged 9-11 years (group 2). Group 1 found watching the relaxing video (task C) to be the easiest, followed by playing a video minigame (task B) and watching the narrative (task A). Group 2 found task C to be the easiest, followed by task A and then task B. The average time spent on the different types of tasks was similar in both age groups. Most of the children in both age groups were happy with the app and found it funny. All children thought that having the app in the waiting room during a dental visit would be useful.

CONCLUSIONS

The findings confirmed that the app is usable and provides an excellent user experience. Our children-adapted methodology contributes to achieving usable mobile-based products for children with a highly scored user experience.

Assessment of the Objective Effect of Virtual Reality for Preoperative Anxiety in Interventional Cardiology

The management of anxiety because of upcoming invasive coronary angiography (ICA) remains suboptimal. Previously published studies investigating the potential of virtual reality (VR) for the reduction of anxiety in ICA procedures used a subjective evaluation method. The purpose of this study was to determine whether the use of a VR program before ICA objectively decreases anxiety as assessed by the SD of normal to normal (SDNN). Lower SDNN is associated with worse anxiety. A total of 156 patients referred for ICA after a positive noninvasive test for coronary disease were included in the present randomized study. The interventional group benefited from the use of a VR mask in the transfer room before ICA, whereas the control group underwent the procedure as usual. In both groups, SDNN was measured before ICA. No statistical difference in SDNN was observed between the VR and control groups (45.5 ± 17.8 vs 50.6 ± 19.5, p = 0.12). The preoperative use of a VR mask for anxiolytic purposes in the setting of ICA did not result in a decrease in anxiety.

Effects of preoperative education using virtual reality on preoperative anxiety and information desire: a randomized clinical trial

This study aimed to investigate the effect of preoperative education using virtual reality (VR) on preoperative anxiety and information desire. The participants were randomly assigned to the VR group and control group. The VR group received preoperative education using VR content describing preoperative and postoperative processes and their management, and the control group received preoperative education with traditional verbal education. Preoperative anxiety and information desire were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Additionally, patient satisfaction was investigated. Preoperative anxiety (APAIS-A) and information desire (APAIS-I) scores were statistically significantly different between the VR group and the control group (p < 0.001). Patient satisfaction was not statistically significant (p = 0.147). Preoperative education using VR effectively reduced preoperative anxiety and information desire.Trial registration CRIS, KCT0007489. Registered 30 June 2022. http://cris.nih.go.kr/cris/ .

Contemporary Role and Applications of Artificial Intelligence in Dentistry

Artificial Intelligence (AI) technologies play a significant role and significantly impact various sectors, including healthcare, engineering, sciences, and smart cities. AI has the potential to improve the quality of patient care and treatment outcomes while minimizing the risk of human error. Artificial Intelligence (AI) is transforming the dental industry, just like it is revolutionizing other sectors. It is used in dentistry to diagnose dental diseases and provide treatment recommendations. Dental professionals are increasingly relying on AI technology to assist in diagnosis, clinical decision-making, treatment planning, and prognosis prediction across ten dental specialties. One of the most significant advantages of AI in dentistry is its ability to analyze vast amounts of data quickly and accurately, providing dental professionals with valuable insights to enhance their decision-making processes. The purpose of this paper is to identify the advancement of artificial intelligence algorithms that have been frequently used in dentistry and assess how well they perform in terms of diagnosis, clinical decision-making, treatment, and prognosis prediction in ten dental specialties; dental public health, endodontics, oral and maxillofacial surgery, oral medicine and pathology, oral & maxillofacial radiology, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, prosthodontics, and digital dentistry in general. We will also show the pros and cons of using AI in all dental specialties in different ways. Finally, we will present the limitations of using AI in dentistry, which made it incapable of replacing dental personnel, and dentists, who should consider AI a complimentary benefit and not a threat.

Virtual reality-assisted distraction during transcatheter aortic valve implantation under local anaesthesia: A randomised study

BACKGROUND

A minimal approach, using local anaesthesia alone, has been advocated to promote faster transcatheter aortic valve replacement (TAVR) procedures in intermediate-risk patients. Pre- and periprocedural anxiety and pain remain a concern. Virtual reality (VR) is a form of non-pharmacological distraction that can potentially modulate pain and anxiety. This randomised study explored whether VR reduces pain and anxiety during TAVR without sedation and compared the effects of VR with those of standard care.

METHODS AND RESULTS

Between June 2022 and March 2023, 207 patients underwent transfemoral TAVR (TF-TAVR). Of these, 117 (56.5%) patients were willing to participate in the study and met the educational background and mental status criteria for assessment. Fifty-nine patients underwent TF-TAVR with VR glasses (VR group). Fifty-eight patients underwent standard TF-TAVR without VR (control group; CG). Post-interventional anxiety scores (STAI-S) (31.5 ± 13.4 vs. 38.5 ± 19.2, p = 0.02) and the perceived duration of the procedure (60.1 ± 32.3 vs. 73.0 ± 32.4, p = 0.04) were lower in the VR than in the CG. Procedure time, pain, and anxiety scores (visual analogue scale) were similar between the groups. The complication rate was low and not associated with VR. Post-interventional delirium occurred in nine patients, and was similar between the groups (VR: 4 [6.8%] vs. CG: 5 [8.6%], p = 0.71). No periprocedural strokes were observed.

CONCLUSION

VR for TAVR is feasible and safe and expands the non-drug spectrum of therapy for anxiety and pain in patients undergoing TAVR with a minimalistic approach.

Efficacy of an external cold and vibrating device in reducing discomfort during the administration of an inferior alveolar nerve block in children: A split-mouth randomised crossover study

Background: Local anaesthesia is the backbone of pain management. However, the administration of a local anaesthetic injection itself is considered a painful procedure and triggers fear and anxiety in the patient. Methods: A split-mouth randomised controlled crossover trial was designed to study the efficacy of an "external cold and vibrating" device in reducing discomfort during the administration of an inferior alveolar nerve block (IANB) in children. A total of 40 children who fulfilled the inclusion criteria were evaluated for pain response following administration of IANB with and without the "external cold and vibrating" device. Randomisation was performed to determine whether the subject received the control intervention first or the test intervention first. The intensity of the pain response and discomfort were recorded using the Wong-Baker FACES Pain Rating Scale and the Faces Legs Activity Cry and Consolability scale. Results: There was a statistically significant difference in the pain response between the test group and the control group (p<0.001). Females reported a higher pain response than males, with a statistically significant difference, when the FLACC scores were compared. Conclusions: The "external cold and vibrating" device reduced discomfort during the administration of an IANB in children selected for the study.

The Future of Dental Care: The Manipulation of Dental Instruments & Preparation Towards Automated Tooth Cleaning

Dentistry is an essential practice to maintain the health of the oral cavity. Recent advances in digitization and technology for oral examinations have improved the speed and ease of disease diagnosis and dental treatment. Dental robotics has emerged as a new field of dentistry and offers numerous benefits to dental professionals and society. This paper proposes an innovative design of a dental robot setup with a preliminary study on a head model for the preparation of automated dental exploration in MATLAB and discusses further considerations for automation.

Effectiveness of motion graphic-based narrative therapy with a cognitive-behavioral approach in reducing fluoride varnish therapy anxiety for six-year-old children

BACKGROUND

Fluoride varnish therapy (FVT) is a dental caries preventive service that its effectiveness has been well documented. A lot of children, especially the five-year-old and six-year-old ones, are suffering with anxiety during this service and do not readily allow it. The present study aimed to cast light on the effect of motion graphic-based narrative story with a cognitive-behavioral approach in reducing FVT anxiety among six-year-old children.

MATERIALS AND METHODS

This study was an intervention trial type that was conducted in Ardabil city and among school students. Five children suffering from FVT anxiety were randomly selected for the intervention. First, Venham and Gaulin-Kremer's anxiety scale was completed for them. The motion graphic-based narrative therapy was implemented for six weeks. Session 1 was assigned to filling the questionnaire and collecting data. The motion graphic-based narrative therapy started from the second session. The anxiety scale was filled for the children every ten days for a total of four times. The results were analyzed by Blanchard and Schwarz's progress formula and control charts. The intervention sessions included gathering information, watching motion graphics, relaxation skills, watching the process of performing fluoride varnish therapy, teaching the advantages of fluoride varnish therapy, and in the last session performing fluoride varnish therapy with the technique of attention diversion while watching motion graphics.

RESULTS

The motion graphic-based narrative therapy by the cognitive-behavioral approach proved effective in reducing anxiety. At the end of the intervention sessions, the level of anxiety decreased from 8 to 2.2 and the statistical control chart of the process shows that the intervention process is stable and the stability in order to reduce anxiety and the results are within the control limits.

CONCLUSION

The results show that motion graphic-based narrative therapy can be a psychotherapy method for reducing the symptoms of dental anxiety among children.

Virtual Reality Experience during Labour (VIREL); a qualitative study

BACKGROUND

There is increasing evidence that virtual reality (VR) is effective in the reduction of labour pain. The implementation of alternative methods like VR to reduce labour pain can contribute to reduce patient request for pharmacological pain management methods and associated side effects. The aim of this study is to examine women's experiences, preferences and satisfaction in regard to the use of VR during labour.

METHODS

A qualitative interview study was conducted in a non-university teaching hospital in The Netherlands. Two VR applications, respectively a guided meditation and an interactive game were tested in eligible women with a singleton pregnancy, scheduled for induction of labour. For the primary outcome, patients' VR experience and application preference (meditation vs. game) were examined using a post-intervention questionnaire and a semi-structured interview. Three categories (with sub-categories) were used to guide interviews: "The VR experience", "Pain reduction", and "Usability of the VR application". Labour pain before and directly after VR was evaluated using the NRS score.

RESULTS

Twenty-four women, of whom 14 were nulliparous and ten multiparous, were included and 12 of these women participated in semi-structured interviews. Using within-subject paired t-test comparisons, compared to pain pre-VR, patients reported a highly significant 26% decrease in mean NRS scores during VR meditation (pain pre-VR = 6.71 + - 1.65 vs. pain after VR = 4.96 + - 2.01) [p < 0.001]. Compared to pain before VR game, patients also reported a highly significant 19% decrease in mean NRS scores during VR game (pain before VR game = 6.89 + - 1.88 vs. pain after VR game = 5.61 + - 2.23) [p = 0.001].

CONCLUSION

All women were highly satisfied with VR use during labour. Patients reported a highly significant reduction in pain during the interactive VR game and during meditation, patients preferred guided meditation. These results can contribute to the development of a potential promising new non-pharmacological tool to reduce labour pain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04858984, date of registration: 26/04/2021 (retrospectively registered).

The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review

Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.

VR for Pain Relief

The present chapter explores how immersive virtual reality (VR) systems can be used for pain research and treatment. Pain is a universal, yet entirely subjective and multifaceted unpleasant experience. One of the earliest VR studies on pain highlighted the role of attention in pain modulation. However, the role of body representation in pain modulation has also been described as a crucial factor. Through virtual reality systems, it is possible to modulate both attention to pain and body representation. In this chapter, first we define how immersive VR can be used to create the illusion of being present in immersive VR environments and argue why VR can be an effective tool for distracting patients from acute pain. However, distraction seems to be less useful in chronic pain treatment. Chronic pain can be highly disabling and can significantly impact not only the sufferer's quality of life, but also their perceptions of the bodily self. Close neural connections between the body matrix and pain open a chance for influencing pain through bodily illusions. This chapter explores approaches to inducing body ownership illusions in VR and discusses how they have been applied in pain research. The present chapter also covers a set of practical indications and methodological caveats of immersive VR and solutions for overcoming them. Finally, we outline several promising future research directions and highlight several yet unexplored areas.

[Virtual reality glasses as a distraction aid and anxiety reduction in a 7-year-old girl who underwent a dental extraction procedure. Case report]

Virtual reality in Pediatric Dentistry has enormous potential, in the treatment of phobia of dental treatments, this technology is also promising, since it shows satisfactory results and in the surgical area it has a high potential for complex treatments, allowing predictable and safe results. However, future studies should have to establish technological standards with high data quality and in the development of applications approved for clinical routine. Distraction is a non-pharmacological pain management technique commonly used by Pediatric Dentists to control pain and anxiety. There are some new techniques that use audio and video stimulation and distract the patient by exposing him to three-dimensional videos. These techniques are called virtual reality audiovisual systems. The objective of this case was to evaluate the effectiveness of virtual reality glasses as a distraction aid to reduce anxiety in a 7-year-old girl who attends the pediatric dentistry office to perform a dental extraction procedure.

The Use of Virtual Reality to Reduce Pain and Anxiety in Surgical Procedures of the Oral Cavity: A Scoping Review

PURPOSE

Virtual reality (VR) is considered a nonpharmacological intervention to manage pain and anxiety for different procedures. We aimed to review the literature about the role of VR in reducing pain and anxiety in surgical procedures performed in the oral cavity.

METHODS

A literature review was conducted using Medline and Embase with no restrictions on language or publication date. Our inclusion criteria were articles related to the use of VR to manage perioperative pain and anxiety on procedures in the oral cavity.

RESULTS

Twenty-seven articles met the inclusion criteria. The number of publications increased significantly from 2 studies between 2000-2010 to 25 between 2011 and 2021. Of the 27 included studies, 22 (81.4%) studied patients undergoing dental procedures, and 5 (18.5%) in oral and maxillofacial surgery (OMS). There was heterogeneity in the VR software used in the different studies. Thirteen studies (41.9%) evaluated self or observational assessments of pain and anxiety. Pain alone was evaluated in 9 studies (29%) and anxiety alone in 8 studies (25.8%). Also, 6 studies (19.3%) evaluated physiological parameters such as heart rate and respiratory rate as objective measures of pain and anxiety. In oral surgery studies, VR was effective at reducing acute pain, fear, and anxiety levels.

CONCLUSIONS

There is a paucity of research in OMS compared to dentistry. Given that this specialty involves highly stimulating and anxiety-provoking procedures, OMS could benefit from VR intervention for improved patient care.

Virtual reality in pediatrics, effects on pain and anxiety: A systematic review and meta-analysis update

INTRODUCTION

Medical procedures are often accompanied by pain and anxiety in pediatric patients. A relatively new technique to reduce pediatric pain and anxiety is virtual reality. Virtual reality is both applied as a distraction tool and as an exposure tool to prepare patients for medical procedures. Research into the application of virtual reality in medical settings is rapidly evolving. This meta-analysis is an update of the meta-analysis of Eijlers et al. investigating the effectiveness of virtual reality as an intervention tool on pain and anxiety in pediatric patients undergoing medical procedures.

METHODS

We searched the databases Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and PsycINFO. For each of these databases, different search strategies were developed. The search period from the meta-analysis from Eijlers et al., reaching until April 2018, was extended to December 2020. Pain and anxiety outcomes during medical procedures were compared for virtual reality and standard care conditions for various medical procedures.

RESULTS

The search yielded 1824 articles, of which 13 met our inclusion criteria. Combined with 13 articles of Eijlers' review study, this resulted in 26 articles. Virtual reality was applied as distraction (n = 23) during medical procedures or as exposure (n = 4) before medical procedures. The effect of virtual reality distraction was mostly studied in patients during venous access (n = 10). The overall weighted standardized mean difference for virtual reality distraction was -0.67 (95% CI, -0.89 to -0.45; p < .001) on patient-reported pain (based on 21 studies) and -0.74 (95% CI, -1.00 to -0.48; p < .001) on patient-reported anxiety (based on 10 studies). The effect of virtual reality as an exposure tool on patient-reported anxiety was significant too (standardized mean difference = -0.58; 95% CI, -1.15 to -0.01; p < .05).

DISCUSSION

The current updated systematic review and meta-analysis indicates that virtual reality is a useful tool to reduce pain and anxiety in pediatric patients undergoing a range of medical procedures as it significantly decreases pain and anxiety outcomes when compared to care as usual.

Virtual reality mobility for burn patients (VR-MOBILE): A within-subject-controlled trial protocol

In the acute phase, burn patients undergo several painful procedures. Pediatric burn care procedures conducted in hydrotherapy have been known to generate severe pain intensity and moderate to high levels of anxiety. Hydrotherapy treatments are done with the use of opioids and benzodiazepines for pain and anxiety. Unfortunately, nonpharmacological methods are rarely combined with pharmacological treatments despite evidence showing that distraction can serve as an effective method for pain management and can potentially decrease analgesic requirements in other painful medical procedures. Virtual reality (VR) is a method that uses distraction to interact within a virtual environment. The use of VR is promising for pain reduction in varying settings. Considering the lack of optimal pain and anxiety management during burn wound care and the positive effect of an immersive distraction for painful procedures, using VR for burn wound care procedures may show promising results. This is a within-subject randomized controlled trial design in which each participant will serve as his/her own control. A minimum of 20 participants, aged 7 to 17 years old undergoing a burn care session, will receive both standard and experimental treatments during the same session in a randomized order. The experimental treatment will consist of combining VR distraction using the video game Dreamland® to the current standard pharmacological care as per unit protocol. The control group will only receive the unit's standard pharmacological care. The mean difference in both pain intensity scores and in anxiety between the two different sequences will be the primary outcomes of this study. This study evaluates the effect of VR on burn wound care. If results from this study show a positive effect of VR compared to standard care, this protocol may provide guidance on how to implement this type of immersive care as part of the tools available for distraction of painful procedures for acute burn victims.

The Advances of Immersive Virtual Reality Interventions for the Enhancement of Stress Management and Relaxation among Healthy Adults: A Systematic Review

The rapid changes in human contacts due to the COVID-19 crisis have not only posed a huge burden on the population’s health but may have also increased the demand for evidence-based psychological programs delivered through digital technology. A systematic review, following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines, was therefore conducted to explore the advances in stress management interventions utilizing VR and suggest up-to-date directions for future practice. The relevant literature was screened and the search resulted in 22,312 records, of which 16 studies were considered for analysis. The Methodological Index for Non-Randomized Studies (MINORS) was also employed to assess the quality of the included studies. The results suggest that VR-based interventions can facilitate positive changes in subjective stress levels and stress-related biomarkers. However, special attention should be paid to the development of rigorous VR protocols that embrace natural elements and concepts deriving from traditional treatment approaches, such as cognitive behavioral therapy techniques. Overall, this review aims to empower future researchers to grasp the opportunity that the COVID-19 pandemic generated and utilize digital technologies for strengthening individuals’ mental health. Future projects need to conduct large-scale VR studies to evaluate their effectiveness compared to other mental health interventions.

Participant Observation to Apply an Empirical Method of Codesign with Children

Dental anxiety in children is a well-documented problem in the scientific literature. Tools mediated by Information Technology have been shown to positively influence children’s mood based on distraction as well as relaxing activities. We propose an empirical method of codesign with children to generate app content for reducing dental anxiety. The results are embedded in text through a thick description as an ethnographic technique. The method was applied to 163 children (6–8 years old) from a summer school and a primary school, obtaining multimedia products that were integrated into an app prototype. Finally, although this use case of the presented method is applied to the health field, it can be transferred to any other field of application of codesign to children by using material that is specific to new scenarios.

Virtual Reality and the Mediation of Acute and Chronic Pain in Adult and Pediatric Populations: Research Developments

The use of virtual reality (VR) in the mediation of acute pain in adults has shown real benefit to patients for the past 20 years. This review of the literature provides a descriptive synthesis of the types of VR technology, the mechanisms by which VR mediates pain, and a history of early research in the area. A review of the use of VR to mediate chronic pain in adults, and both acute and chronic pain in pediatric populations follows. The studies reviewed provide mixed results and it is noted that many studies have small sample sizes, are case studies, and do not control for extraneous variables such as the dosage and type of VR technology used. Although VR is an exciting area of inquiry that promises to yield multiple applications, there is a necessity to conduct larger random controlled trials to better understand the use cases for which VR is most effective.

Effect of immersive virtual reality on pain in different dental procedures in children: A pilot study

BACKGROUND

Implementing effective pain management is important to increase patient compliance during paediatric dental procedures.

AIM

This pilot study was conducted to evaluate the effectiveness of virtual reality (VR) on pain perception in dental procedures in children.

MATERIAL AND METHODS

Fifty-four children aged between 5 and 12 years were included. Patients scheduled to receive dental procedures not requiring local anesthesia (eg, fluoride therapy) were assigned to Group A, and patients scheduled to receive painful dental procedures requiring local anesthesia (eg, pulp therapy, teeth extraction) were assigned to Group B. Patients in each group were randomly assigned and were equally likely to either receive VR during their dental procedure, or treatment as usual (without VR). Visual analog scale (VAS), Wong-Baker FACES rating scale, and the 'Face, Legs, Activity, Cry, Consolability' scale (FLACC scale) were used to assess the pain levels during dental procedures.

RESULTS

Patients receiving painful dental procedures requiring local anesthesia reported significant reductions in pain intensity/worst pain during the dental procedure on all subjective and behavioral pain measures of pain intensity with the use of VR distraction technique (P < .05 on each). Patients receiving non-painful dental procedures showed the predicted pattern but no significant reduction in worst pain during VR.

CONCLUSION

The use of VR was found to be an effective distraction tool to ease pain and anxiety in the tested dental procedures, for children receiving painful dental procedures.

#KidsAnxiety and the Digital World

This article discusses child onset anxiety disorders in conjunction with the risks and benefits of the rapidly changing digital world including screen time, social media, and potential treatment platforms. A section includes the impact of pandemic stressors including social distancing, quarantining, the association of the pandemic and youth mental health, and prolonged screen time.

Psychometric Properties of Scared-C Scale in a Romanian Community Sample and Its Future Utility for Dental Practice

The psychological management of children and adolescents in need of pedodontics or orthodontic treatments continues to be an essential objective in dental activity because along with the accuracy of the techniques that are used, anxiety reduction, and knowledge of how to approach the patient are necessary for the treatment to be successful. Therefore, our study aimed to validate the Screen for Child Anxiety Related Emotional Disorders questionnaire, the child version of 41 items (SCARED-C) in the Romanian population for later use in pediatric dentistry. The instrument showed moderate to good internal consistency (α Cronbach from 0.63 to 0.91 for the total scale) and good test–retest reliability (0.70) on a subset of a sample comprising 85 children. A confirmatory factorial analysis (CFA) was conducted to test the factor structure of the Romanian version of the SCARED-C; the results showed that SCARED-C has good psychometric properties that can be used for screening anxiety in Romanian children and adolescents. The implications of using the SCARED-C in dental practice are discussed. Future studies need to be conducted to explore the convergent and discriminative validity of the instrument and its sensitivity to current DSM-V criteria. Application on a pediatric dental sample is also required.

Efficacy of external cold and a vibrating device in reducing pain and anxiety during local anaesthesia

Background and Aim:

To evaluate and compare the efficacy of external cold and a vibrating device in reducing the pain and anxiety amidst children receiving maxillary infiltration anaesthesia over conventional methods.

Method:

A sum of thirty subjects aged between 5 and 10 years who had undergone dental procedures requiring maxillary infiltration were enrolled in the current split-mouth randomised control study. The control intervention constitutes infiltration of 1.8 mL of 2% lignocaine in addition to 1:100,000 adrenaline (Lox, Neon Laboratories Mumbai, India) whereas, the experimental group used external cold and a vibrating device (Buzzy®, MMJ Labs, Atlanta, GA, USA) in annexation to the control protocol. Simultaneous to LA administration, pulse rate was employed as an objective measure and the subjective measure was recorded using RMS Pictorial Scale (RMS-PS) for the child’s discomfort. To document the child’s pain as anticipated by the dentist the revised face, limbs, arms, cry and consolability (FLACC-R) scale was employed.

Result:

Lower pain sensation and anxiety was recorded in the experimental group using Buzzy when compared to control.

Conclusion:

External cold in adjacent with vibrations might be efficient in lowering pain as well as anxiety in children experiencing infiltration dental anaesthesia though further research work is requisite with a larger sample size.

The Effect of Using Virtual Reality During Breast Biopsy on Pain and Anxiety: A Randomized Controlled Trial

PURPOSE

Virtual reality (VR) is a nonpharmacological method used in healthcare settings. This study aimed to determine the effectiveness of distraction through VR on pain and anxiety during fine needle aspiration (FNA) breast biopsy.

DESIGN

This was a randomized controlled trial.

METHODS

A total of 60 Turkish females undergoing FNA breast biopsies were randomly divided into two groups. The patients in the experimental group (n = 30) viewed a specific scenario using VR from one minute before the procedure to the end of the procedure. The patients in the control group (n = 30) were subject to a standard protocol in which no anesthetic was given during the procedure. Immediately after the implementation of the FNA breast biopsy, the pain scores of all patients in groups were measured with the Visual Analogue Scale (VAS), and their anxiety levels were assessed with the State-Trait Anxiety Inventory.

FINDINGS

A statistically significant difference was determined between the post-procedure mean pain scores and average state anxiety scores of the patients in the experimental and control groups (P < .001).

CONCLUSIONS

The use of VR during FNA breast biopsy is effective in reducing pain and anxiety in adult female patients.

The Effect of Virtual Reality Game Preparation for Children scheduled for MRI (IMAGINE): a Randomized Controlled Trial Protocol (Preprint)

Background

It is known that magnetic resonance imaging (MRI) procedures generate fear and anxiety. Children may become restless during scanning, which results in movement artifacts requiring the MRI procedure to be repeated with sedation. Few studies seem to have looked at the effect of immersive virtual reality (IVR) on anxiety in children scheduled for MRI scans and how to identify which children are more responsive.

Objective

The aims of this study are 3-fold: develop an algorithm of predictability based on biofeedback, address feasibility and acceptability of preprocedural IVR game preparation for anxiety management during MRI procedures, and examine the efficacy of IVR game preparation compared with usual care for the management of procedural anxiety during MRI scans.

Methods

This study will have 2 phases. We will first conduct a field test with 10 participants aged 7 to 17 years to develop a predictive algorithm for biofeedback solution and to address the feasibility and acceptability of the research. After the field test, a randomized controlled trial will be completed using a parallel design with 2 groups: an experimental group (preprocedural IVR game preparation) and a usual care group (standard care as per the radiology department’s protocol) in an equal ratio of 49 participants per group for 98 participants. Recruitment will be carried out at a hospital in Quebec, Canada. The experimental group will receive a preprocedural IVR game preparation (IMAGINE) that offers an immersive simulation of the MRI scan. Participants will complete a questionnaire to assess the acceptability, feasibility, and incidence of side effects related to the intervention and the biofeedback device. Data collected will include sociodemographic and clinical characteristics as well as measures of procedure-related anxiety with the French-Canadian version of the State-Trait Anxiety Inventory for Children (score 1-3) and the Children’s Fear Scale (score 0-4). Physiological signs will be noted and include heart rate, skin conductance, hand temperature, and muscle tension. Measures of the level of satisfaction of health care professionals, parents, and participants will also be collected. Analyses will be carried out according to the intention-to-treat principle, with a Cronbach α significance level of .05.

Results

As of May 10, 2022, no participant was enrolled in the clinical trial. The data collection time frame is projected to be between April 1, 2022, and March 31, 2023. Findings will be disseminated through peer-reviewed publications.

Conclusions

Our study provides an alternative method for anxiety management to better prepare patients for an awake MRI procedure. The biofeedback will help predict which children are more responsive to this type of intervention. This study will guide future medical practice by providing evidence-based knowledge on a nonpharmacological therapeutic modality for anxiety management in children scheduled for an MRI scan.

Trial Registration

ClinicalTrials.gov NCT04988516; https://clinicaltrials.gov/ct2/show/NCT04988516

International Registered Report Identifier (IRRID)

PRR1-10.2196/30616

A Randomized Controlled Trial of Virtual Reality in Awake Minor Pediatric Plastic Surgery Procedures

BACKGROUND

Virtual reality has been used to alleviate pain and anxiety in a variety of medical procedures. The authors sought to explore the effects of virtual reality in common awake minor plastic surgery procedures where children may experience discomfort.

METHODS

A randomized controlled trial compared virtual reality to standard-of-care distraction among children aged 6 to 16 years undergoing awake minor plastic surgery procedures at a quaternary children's hospital. Primary outcome was change in Faces Pain Scale-Revised pain score, and secondary outcomes included change in Venham Situational Anxiety Scale score, procedure duration, administration of local anesthetic, and pain/anxiety management satisfaction.

RESULTS

Mean pain and anxiety scores were similar in both groups (p = 0.60 and p = 0.18, respectively), and procedure duration was shorter with virtual reality (22 minutes versus 29 minutes; p = 0.002). Duration remained shorter in a linear regression model accounting for procedure type (p = 0.01). Similar proportions of children received additional local anesthetic after the initial dose (virtual reality, n = 6; standard of care, n = 9; p = 0.19) and median pain management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.41). Median anxiety management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.05). Younger children reported more "fun" than older children with virtual reality (p = 0.02). Surgeons reported interest "using virtual reality again" in 83 percent of cases.

CONCLUSIONS

The use of virtual reality for awake pediatric plastic surgery reduced procedure time but not pain or anxiety compared to standard of care in children aged 6 to 16 years. Virtual reality was safe and well-liked and should be considered as an additional tool. Increased efficiency may allow more cases to be performed.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

Behaviour and Anxiety Management of Paediatric Dental Patients through Virtual Reality: A Randomised Clinical Trial

Clinicians should appreciate the effectiveness of virtual reality (VR) headsets for managing both the anxiety and the behaviour of non-cooperative paediatric patients who require treatment over several dental appointments. The aim of this study was to assess the effectiveness of using a VR headset as a distraction for managing the anxiety and behaviour of paediatric patients during their dental treatment. Eighty patients, aged between five and ten years old and who required dental treatment over three or more appointments, were randomly allocated into two groups. One group used a VR headset during all their appointments, and the other one did not use any distraction technique. The patients were asked to take a Facial Image Scale Test during their first and last appointments to assess their level of anxiety. Additionally, the dentist completed the Frankl Test to quantify the child's behaviour at the beginning and the end of their treatment. The results obtained, both from the group using the VR headset and from the control group, were compared using the chi-square test. The use of a VR headset during dental treatment significantly reduced anxiety (95% of the children were happy) and improved behaviour (100% positive behaviour) as compared with the control group (40% and 57.5%, respectively). A VR headset can effectively distract a paediatric patient, helping to reduce anxiety and manage behaviour during dental treatment.

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

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.

Effectiveness of virtual reality as a distraction on anxiety and pain during impacted mandibular third molar surgery under local Anesthesia

OBJECTIVE

The aim of this study was to assess the effectiveness of Virtual Reality (VR) in reducing anxiety and pain during impacted mandibular third molar extraction under local anesthesia.

METHODS

The study was designed as a prospective clinical study covering 74 respondents over 20 years of age. Surgical extraction of both impacted mandibular third molars was performed in two phases, two weeks apart. In the first phase, surgical extraction of the tooth was performed following the standard procedure (Non VR), and in the second phase (VR), we used VR goggles as an auxiliary tool for distraction during the procedure. Face scale was used to assess the level of pain. Heart rate values were recorded by means of wristbands. After both procedures, the patients filled out a modified post-clinical satisfaction questionnaire.

RESULTS

During the procedure with VR goggles, the respondents had significantly lower pain values during the application of anesthesia, as well as during the surgical extraction of the third molar. There was no statistically significant difference in the level of pain during both surgical procedures with regard to the gender and age. Heart rate values in both phases of the study were not significantly different before the application of anesthesia. When VR goggles were used, the respondents had significantly lower heart rate values before the procedure, as well as during the procedure. Analysis of answers to the post-clinical questionnaire measuring satisfaction with VR technology shows that over 90% of respondents did not experience any VR-related discomfort during the surgery.

CONCLUSIONS

The VR distraction concept applied during impacted third molar surgery under local anesthesia can help reduce the patients' anxiety and acute pain levels.

Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial

AIM

The aim of this study was to determine the effect of using three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures on patients' pain and satisfaction levels during intramuscular benzathine penicillin injection.

DESIGN

A randomized controlled trial.

METHOD

The study population consisted of 91 patients who were prescribed intramuscular benzathine penicillin medication. The participants were stratified by gender and assigned to three groups (control, virtual reality and distraction cards groups). The visual analogue scale was used to assess pain and patient satisfaction. A one-way analysis of variance and Dunnett's post hoc tests were used to compare the pain and satisfaction levels by group.

RESULTS

The mean pain was 6.67 (2.17) in the control group, 4.4 (2.71) in the distraction cards group and 4.93 (3.07) in the virtual reality group and the difference was statistically significant (F = 5.84, p ˂ .01). The average of the satisfaction levels in the groups was 3.57 (2.23) in the control group, 7.13 (2.86) in the distraction cards group and 8.07 (2.55) in the virtual reality group. The difference between the satisfaction levels was statistically significant (F = 25.77, p ˂ .01).

CONCLUSION

The three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures were effective in reducing pain associated with intramuscular benzathine penicillin injection and increasing patient satisfaction.

IMPACT

The results of this study will contribute to evidence-based nursing practices for the pain associated with intramuscular benzathine penicillin injection.

CLINICAL TRIAL REGISTRY

NCT04420559.

Contribution of virtual reality in oral surgery: A literature review

Oral cavity care is very much associated with perceptions of pain and anxiety. Oral health practitioners have many solutions in order to reduce patients' apprehension, and an alternative non-drug technique has increased: the use of virtual reality (VR). The aim of this review is to highlight the contribution of virtual reality headsets in reducing anxiety and pre- and post- operative pain in patients having oral surgery. PubMed and Cochrane Library have been searched for scientific articles with MESH words «virtual reality », « oral surgery », « anxiety » and « pain ». 8 articles were identified and 6 met the inclusion criteria. Among the 6 articles analyzed, 4 were control trials and 2 were methodological descriptions. 2 clinical trials found statistically significant results on the outcome measures of pre-operative and post-operative anxiety and pain felt. The use of VR in oral surgery seems to have an impact in reducing anxiety and pre- and post- operative pain, but more studies are needed to confirm its effectiveness.

The effect of virtual reality on mothers' anxiety during children's circumcision: A randomized controlled study

AIM

The aim of this study was to evaluate the effect of use of virtual reality headsets on mothers' anxiety, by distracting their attention, during their child's circumcision procedure.

DESIGN

This was a randomized controlled intervention study.

METHODS

The study used a pretest and posttest design and was carried out between April 15, 2019, and June 30, 2019, with 60 participants (n = 30 intervention and n = 30 control group). The data were collected using a personal information form, the State Anxiety Inventory and Faces Anxiety Scales. In the study, the participants in the intervention group watched videos through a virtual reality headset.

RESULTS

The socio-demographic characteristics of the intervention group and control group were similar in the pretest, except for the educational level. After the intervention, the intervention group's mean scores on the Faces Anxiety Scale, heart rate and respiration rates were significantly lower than those of the control group, but the difference between the mean State Anxiety Inventory scores was insignificant.

CONCLUSION

Distraction using videos produced by virtual reality headsets is effective in reducing mothers' moderate level anxiety. It is recommended that further studies should be conducted in different ambulatory surgery procedures.

Immersive virtual reality vs. non-immersive distraction for pain management of children during bone pins and sutures removal: A randomized clinical trial protocol

AIMS

To examine the efficacy of an immersive virtual reality distraction compared with an active non-immersive distraction, such as video games on a tablet, for pain and anxiety management and memory of pain and anxiety in children requiring percutaneous bone pins and/or suture removal procedures.

DESIGN

Three-centre randomized clinical trial using a parallel design with two groups: experimental and control.

METHODS

Study to take place in the orthopaedic department of three children hospital of the Montreal region starting in 2019. Children, from 7-17 years old, requiring bone pins and/or suture removal procedures will be recruited. The intervention group (N = 94) will receive a virtual reality game (Dreamland), whereas the control group (N = 94) will receive a tablet with video games. The primary outcomes will be both the mean self-reported pain score measured by the Numerical Rating Scale and mean anxiety score, measured by the Child Fear Scale. Recalls of pain and anxiety will be measured 1 week after the procedure using the same scales. We aim to recruit 188 children to achieve a power of 80% with a significance level (alpha) of 5%.

DISCUSSION

While multiple pharmacological methods have previously been tested for children, no studies have evaluated the impact of immersive virtual reality distraction for pain and anxiety management in the orthopaedic setting.

IMPACT

Improved pain management can be achieved using virtual reality during medical procedures for children. This method is innovative, non-pharmacological, adapted to the hospital setting, and user-friendly.

TRIAL REGISTRATION

NCT03680625, registered on clinicaltrials.gov.

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

(1) Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. (2) Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: “virtual reality”, “distraction systems”, “dental anxiety” and “pain”. Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used and in standard care situations. (3) Results: 32 studies were identified, of which 8 met the inclusion criteria. The effect of VR in children was significant, both for anxiety (standardized mean difference (SMD) = −1.75) and pain (SMD = −1.46). (4) Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.

Virtual versus jaw simulation in Oral implant education: a randomized controlled trial

BACKGROUND

This research aims to investigate the evaluation methods of teaching oral implant clinical courses and estimate the effectiveness of a virtual simulation platform.

METHODS

Eighty second- and third-year undergraduates in Lanzhou University were recruited and randomized to either three experimental groups or one control group. The subjects undertook theoretical examinations to test their basic level of knowledge after training in similarly unified knowledge courses. Each student group then participated in an eight-hour operating training session. An operation test on pig mandible was conducted, followed by a second theoretical examination. The assessment consists of three distinct parts: a subjective operating score by a clinical senior teacher, an implant accuracy analysis in cone-beam computed tomography (angular, apical, and entrance deviation), and comparison of the two theoretical examinations. Finally, students completed a questionnaire gauging their understanding of the virtual simulation.

RESULTS

There was no significant difference between the four groups in first theoretical examination (P > 0.05); the second theoretical scores of the V-J and J-V group (62.90 ± 3.70, 60.05 ± 2.73) were significantly higher than the first time (57.05 ± 3.92, P < 0.05), while no difference between the V (57.10 ± 3.66) and J (56.89 ± 2.67) groups was found. Thus, the combination of V-J was effective in improving students' theoretical scores. The V-J and J-V groups had higher scores on operation (73.98 ± 4.58, 71.85 ± 4.67) and showed better implant precision.

CONCLUSION

Virtual simulation education, especially with a jaw simulation model, could improve students' implantology achievements and training. Currently study found that the V-J group may performed better than the J-V group in oral implant teaching.

Robotic approach to the reduction of dental anxiety in children

OBJECTIVE

We introduced a humanoid robot for the use of techno-psychological distraction techniques in children aged 4-10 to reduce their anxiety and improve their behaviour during dental treatment.

MATERIALS AND METHODS

Two hundred children (98 boys, 102 girls; mean age: 6.5 ± 1.66 years) appointed for first time for dental caries were included and randomly divided into two groups [N = 100 for each group; RG: Robot Group (accompanied by the robot), CG: Control Group (without robot accompaniment)]. Half of the children were treated under local anaesthesia (infiltration anaesthesia) (n = 50 within each group) and half of the children were treated without any local anaesthesia (n = 50 within each group) within each group. The success rate of the new robotic distraction technique was evaluated by using Parental Corah Dental Anxiety Scale, Facial Image Scale (FIS), physiological pulse rate and Frankl Behaviour Rating Scale (FBRS).

RESULT

Pulse rates, which measured during treatment and after treatment, were statistically higher in CG than in RG (p < .05). After dental treatment, the FIS score was significantly higher in CG than RG (p < .05). 88.3% of the children in RG stated that they wanted the robot to be with them at the next treatment session.

CONCLUSIONS

Robotic technology can successfully help in coping with dental anxiety and stress, and helps children to behave better in dental office.

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: “virtual reality”, “distraction systems”, “dental anxiety” and “pain”. Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used, and in standard care situations. Results: 31 studies were identified, of which 14 met the inclusion criteria. Pain levels were evaluated in four studies (n = 4), anxiety levels in three (n = 3) and anxiety and pain together in seven (n = 7). Our meta-analysis was based on ten studies (n = 10). The effect of VR was studied mainly in the pediatric population (for pain SMD = −0.82). In the adult population, only two studies (not significant) were considered. Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.

Effectiveness of Virtual Reality Eyeglasses as a Distraction Aid to Reduce Anxiety among 6-10-year-old Children Undergoing Dental Extraction Procedure

Introduction

Distraction is commonly used nonpharmacologic pain management technique by pedodontists to manage pain and anxiety. There are some new techniques which uses audiovideo stimulation and distract the patient by exposing him or her to three-dimensional videos. These techniques are referred to as virtual reality audiovisual systems. The aim is to evaluate the effectiveness of virtual reality eyeglasses as a distraction aid to reduce anxiety of children undergoing extraction procedure.

Objective

The aim of this study is to evaluate the effectiveness of virtual reality eyeglasses as a distraction aid to reduce anxiety of children undergoing dental extraction procedure.

Materials and methods

Thirty children of age 6–10 years (n = 60) with bilateral carious primary molars indicated for extraction were randomly selected and divided into two groups of 30 each. The first one was group I (VR group) (n = 30) and group II (control group) (n = 30). Anxiety was measured by using Venham's picture test, pulse rate and oxygen saturation. Anxiety level between group I and group II was assessed using paired “t” test.

Results

The mean pulse rate values after extraction procedure in group I were 107.833 ± 1.356 and group II were 108.4 ± 0.927 respectively. The pulse rate values in intergroup comparison were found statistically significant p = 0.03.

Conclusion

The virtual reality used as a distraction technique improves the physiologic parameters of children aged 6–10 years but does not reduce the patient's self-reported anxiety according to Venham's picture test used.

How to cite this article

Koticha P, Katge F, et al. Effectiveness of Virtual Reality Eyeglasses as a Distraction Aid to Reduce Anxiety among 6–10-year-old Children Undergoing Dental Extraction Procedure. Int J Clin Pediatr Dent 2019;12(4):297–302.

Low-Cost Virtual Reality Headsets Reduce Perceived Pain in Healthy Adults: A Multicenter Randomized Crossover Trial

Objectives: Recent studies have established the usage of virtual reality (VR) to help alleviate acute and chronic pain. VR technology can be cost prohibitive and cheaper alternatives are desired. In this study, a Google Cardboard headset ($15) combined with a smartphone was used as a low-cost VR device to assess efficacy in altering the perception of pain. Materials and Methods: The cold pressor test, a minimal-risk method, was used to simulate pain. Participants immersed their hands into ice water, with and without VR, in a crossover manner, and their pain perception data were recorded. Results: Forty-eight healthy volunteer participants completed the study between 2017 and 2018. Participants were randomized to right hand control, left control, right experimental, and left experimental groups, respectively, before the crossover. Data collected included pain threshold (time at which participants first reported pain), pain tolerance (time at which participants removed their hand), and pain intensity (highest reported pain level on a [1-10] scale). Approximately two-thirds of participants had improvements in pain threshold and pain tolerance with a mean improvement of +13.0 seconds (P = 0.0045) for pain threshold and +29.8 seconds (P = 0.0003) for pain tolerance. Pain intensity had a reduction of 0.43 points (P = 0.0371). Conclusion: Our results demonstrate that inexpensive VR devices, such as the Google Cardboard headset used in this study, may be a safe, portable, and cost-effective way to alter the perception and improve tolerance of pain.