Assessment of Efficacy of Virtual Reality Distraction in Reducing Pain Perception and Anxiety in Children Aged 6-10 Years: A Behavioral Interventional Study

Effect of audio and virtual reality distraction on the dental anxiety of children with mild intellectual disability

BACKGROUND AND AIM

Intellectual disability, is a neurodevelopmental disorder that typically manifests early in childhood and consists of both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. It can be categorized into mild, moderate, severe, and profound based on its severity. Cognitive impairment may be observed predominantly in children with intellectual disabilities. Marked deficits in areas of learning, planning, communication, social participation, and personal independence in children with mild intellectual disabilities make behavior guidance and communication a challenge during dental treatments. The aim was to evaluate and compare the use of two different distraction tools, audio, and virtual reality (VR) on the dental anxiety of children with mild intellectual disability during dental treatment.

METHODS

Twenty children diagnosed with mild intellectual disability were equally divided into two groups. A cross-over study design consisting of two appointments 1 month apart was employed. In the first appointment, audio and VR distractions were provided to participants in Groups 1 and 2, respectively, and the distraction tools provided to the participants were interchanged in the second appointment. A trained observer recorded physiological parameters (pulse rate and oxygen saturation) and observational parameters (Venham's anxiety rating scale) during both appointments at three-time intervals. Statistical intra-group and inter-group comparison analyses were performed using Friedman's and Mann-Whitney U tests.

RESULTS

A decrease in pulse, increase in oxygen saturation levels, and a decrease in Venham's Anxiety Rating Scores (statistically significant p < .05 / highly significant p < .01) was observed on introducing the distraction techniques in Groups 1 and 2 in both appointments. A statistically non-significant difference (p > .05) in physiological and observational parameters was observed between Groups 1 and 2 in both appointments.

CONCLUSION

Audio and VR distraction techniques can be employed for behavior guidance in children with mild intellectual disability during restorative dental procedures.

Virtual Reality Distraction: A Novel Behaviour Management Technique

Virtual reality distraction (VRD) is developing technologies for behavior management that can assist a child in adjusting to the dental setting and provide high-quality dental care. The purpose of this literature is to shed light on VRD and its application to the treatment of pediatric dental patients.

The Effectiveness of Virtual Reality in Controlling Pain and Anxiety Levels in Four-to-Six-Year-Old Children During Dental Treatment

Background and objective Oral health is critical for children's overall well-being; however, dental anxiety often leads to the avoidance of necessary dental care among children. Virtual reality (VR) has emerged as a successful adjunctive tool in various clinical settings, including pain management. This cohort study explores the use of VR technology in reducing anxiety and pain perception during dental procedures for children. The primary objective of this study was to assess the efficacy of VR distraction in managing pain and anxiety levels in children aged four to six years during dental procedures. Additionally, the study aimed to compare children's anxiety levels with and without VR eyeglasses. Methodology This single-blind, crossover clinical trial was conducted at the Dental Complex of King Faisal University, Al Ahsa, Kingdom of Saudi Arabia. Of the 200 children screened initially, 20 aged four to six years who met the inclusion criteria were selected, and ethical approval for the study was obtained. The study comprised two groups: a control group and an experimental group. Dental procedures were conducted both with and without the use of VR, employing a split-mouth design. Results Our findings provide important insights into the clinical impact of using VR technology to alleviate children's anxiety during dental clinic visits. In our study, we used ANOVA and Tukey's post hoc test to evaluate the effect of VR glasses on vital metrics in children during dental procedures. Our results showed no significant differences before and after using the VR glasses, indicating limited effectiveness in reducing anxiety in this context. Conclusion Based on our findings, we reject the assumption that VR devices are highly effective in diverting children's attention and reducing their anxiety and pain during dental procedures; we recommend further investigations to identify potential confounding factors that could modulate the utility of VR in medical settings.

Assessment of Different Distraction Behavioral Methods in Pediatric Dental Clinic: A Systematic Review

Dental anxiety is one of the main problems dentists may face during the treatment of pediatric dental patients; therefore, clinicians tend to perform different behavior management techniques to reduce dental anxiety in children. This review aimed to systematically compare and evaluate the published literature regarding the effects of distraction techniques on anxiety, pain perception, and patient experience during dental practice. A detailed electronic search was conducted on 3 databases including PubMed, Google Scholar, and Cochrane Library. The databases were searched for articles published in the English language between 2015 and 2022. Among 102 studies, 27 studies fulfilled the criteria of eligibility and were included in this study to be analyzed. Numerous approaches have been proposed for the reduction of dental anxiety, out of which the use of audio-visual aids and instruments, active distraction such as tablets, smartphones, and virtual reality glasses showed governance in decreasing the children's anxiety followed by cognitive and behavioral methods.

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.

Comparative evaluation of the effect of audio and virtual reality distraction on the dental anxiety of healthy and mild intellectually disabled children

Context

Dental environment is one of the most anxiety-provoking stimuli for children, which makes patient management a constant challenge in both typically growing and intellectually disabled children. Distraction is a nonpharmacological technique to manage anxiety in children during dental treatment.

Aim

This study compares the effect of audio and virtual reality (VR) distraction on the dental anxiety of healthy and mild intellectually disabled children.

Methods

Forty children aged 6-14 years were divided into two groups (Group I: children with mild intellectual disability and Group II: healthy children). Groups I and II were further subdivided into two subgroups of 10 children each, based on the distraction technique given to them during the first appointment. After 1 month, we carried out a cross-over of the subgroups. Anxiety levels were measured using physiological and observational parameters at three-time intervals.

Statistical Analysis

Performed using paired t-test for the intergroup comparison and Wilcoxon Signed Rank test for the intra-group comparison.

Results

A decrease in the pulse rate, improvement in oxygen saturation levels, and lower Venham's anxiety rating scores were observed on introducing audio and VR distraction in all the subgroups. The inter-group comparison revealed that audio and VR were more effective in healthy children than children with mild intellectual disabilities.

Conclusions

Audio and VR distraction techniques can be employed successfully to reduce anxiety in children with mild intellectual disability and healthy children undergoing dental restorative treatment.

[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.

Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique

Aim

To compare freezed cone and 5% lignocaine as a numbing agent before intraoral injection and evaluate the effect of virtual reality distraction (VRD) as a distraction technique in reducing pain perception in children.

Study design

Around 60 children of 6-11 years old undergoing treatment for the extraction or any pulp therapy of primary tooth were selected. Freezed cone and 5% lidocaine were used to decrease the pain during local anesthesia (LA). VRD was used as a distraction method and to analyze the pain perception, Wong-Baker Faces Pain Rating Scale was used.

Materials and methods

Each child was randomly assigned to receive ice as a topical anesthetic or lignocaine 5% as a topical anesthetic agent. The pain perception was evaluated after the injection of 2% lignocaine hydrochloride (HCL). The primary researcher evaluated the pain during injection using the sound, eye, motor (SEM) scale. The pain experienced during injection was evaluated using Wong-Baker Faces Pain Rating Scale.

Results

In the freezed cone group with the VRD technique, maximum responded to the less pain score. On the contrary, many responded to higher pain scores in the freezed cone group without the VRD technique.

Conclusion

It was concluded that the VRD technique can be used for distraction and the frozen ice cone can be an alternative method to reduce the pain perception during LA.

How to cite this article

Singh R, Gupta N, Gambhir N. Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique. Int J Clin Pediatr Dent 2022;15(5):558-563.

Effect of Virtual Reality on Pediatric Pain and Fear During Procedures Involving Needles: Systematic Review and Meta-analysis

Background

Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear.

Objective

The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques.

Methods

A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children.

Results

From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] –2.37, 95% CI –3.20 to –1.54; Z=5.58; P<.001) and fear (IV –1.26, 95% CI –1.89 to –0.63; Z=3.92; P<.001) in children in the experimental groups.

Conclusions

The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles.

Virtual reality (VR) to reduce anxiety in children in the plaster room: a study protocol for a randomised controlled trial

Background

Paediatric fractures are highly prevalent and are most often treated with plaster. The removal of plaster is often an anxious experience for children. Virtual reality (VR) has proven to effectively distract children and reduce their anxiety in other clinical settings. This study aims to investigate the effect of VR on the anxiety level of children with fractures that undergo plaster removal or replacement in the plaster room.

Methods

This study is designed as a randomised controlled trial (RCT). The sample size is 270 patients, aged 5 to 17 years, with a fracture of the upper or lower extremity treated with plaster. The intervention group will be distracted with VR goggles and headphones during the replacement or removal of the plaster, whereas the control group will receive standard care. As a primary outcome, the level of anxiety will be measured with the Child Fear Scale (CFS). Secondary outcomes include anxiety reduction (difference between CFS after and CFS before plaster procedure) and Numeric Rating Scales (NRS) pain and satisfaction. Additionally, the children’s fastest heart rate during the procedure will be recorded. An unpaired samples t-test or a Mann-Whitney U test (depending on the data distribution) will be used to analyse the data.

Discussion

When completed, this trial will provide evidence on the potential role of VR in children with fractures treated with plaster. The purpose is to increase the quality of healthcare by decreasing anxiety and possibly pain perception of children during a plaster procedure.

Trial registration

Netherlands Trial Register NL9065. Registered on 27 November 2020

Psychological behavior management techniques to alleviate dental fear and anxiety in 4-14-year-old children in pediatric dentistry: A systematic review and meta-analysis

Child's uncooperative behavior can impede the efficient delivery of dental care. Therefore, in spite of exceeding availability of behavior management techniques there is a need to search for a psychological behavior management technique that effectively reduces fear and anxiety during dental treatment and instill a change in child's attitude toward the treatment and is also acceptable by the parents. The aim of our systematic review is to determine the efficacy of various psychological behavior management techniques in managing a child's behavior in pediatric dentistry by assessing the fear and anxiety levels, ease of use by the clinician, application in various operative procedures, and parental acceptance. A systematic search was conducted by two reviewers in databases PubMed, Google Scholar, Scopus, Web of Science, and Cochrane for the studies published from January 1, 2011, to December 31, 2020. Studies included were clinical studies which evaluated the efficacy of various psychological behavior management techniques by evaluating the fear and anxiety levels and the changes in behavior during dental treatment in children aged between 4 and 14 years. The studies selected were then assessed for quality with the help of predetermined criteria which categorized the studies into high, medium, and low. Through search strategy, 7147 articles were yielded. After screening through titles and abstracts, 60 nonduplicated articles were selected which were further screened for full text. At the end, 15 articles were included in systematic review and 3 articles for meta-analysis. It was concluded that all the psychological behavior management techniques aided in reduction of fear and anxiety. In noninvasive procedures, conventional psychological behavior management techniques can be effective but in invasive procedures other newer psychological behavior management techniques showed better results. The aspect of parental acceptance regarding various techniques was not discussed in any of the included studies.

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.

Virtual reality for pediatric periprocedural care

PURPOSE OF REVIEW

Commercial availability of virtual reality headsets and software has exponentially grown over the last decade as it has become more sophisticated, less expensive, and portable. Although primarily used by the general public for entertainment, virtual reality has been adopted by periprocedural clinicians to improve patient experiences and treatments. The purpose of this review is to explore recently reported evidence for virtual reality effectiveness for pediatric periprocedural care and discuss considerations for clinical implementation.

RECENT FINDINGS

In the preprocedure setting, practitioners use virtual reality to introduce children to periprocedural environments, distract attention from preprocedural vascular access, and increase cooperation with anesthesia induction. Intraprocedure, virtual reality decreases sedation requirements, and in some instances, eliminates anesthesia for minor procedures. Virtual reality also augments pain reduction therapies in the acute and extended rehabilitation periods, resulting in faster recovery and improved outcomes. Virtual reality seems to be well treated for pediatric use, given close clinical care and carefully curated content.

SUMMARY

Given the multiple clinical applications of virtual reality to supplement pediatric periprocedural care, practitioners should consider developing clinical programs that reliably provide access to virtual reality. Future research should focus on identification of patient characteristics and types of software that yield optimal patient outcomes.