The Effect of Virtual Reality Distraction on Anxiety Level During Dental Treatment Among Anxious Pediatric Patients: A Randomized Clinical Trial

The aim of this study was to evaluate the effect of virtual reality distraction among 6- to 14-year-old anxious children undergoing prophylactic dental treatment by utilizing both subjective (Venham Anxiety and Behavioral Rating Scale (VABRS)) and objective (heart rate and salivary cortisol level) measures.

This two-arms parallel randomized controlled study was conducted at the Department of Pediatric Dentistry at King Abdulaziz University Dental Hospital (KAUDH) between January and May 2022, after obtaining the ethical approval from the Research Ethics Committee of the Faculty of Dentistry (341-11-21) at King Abdulaziz University. The study is reported according to the protocol established by the Consolidated Standards of Reporting Trials (CONSORT) statement (18).

The inclusion criteria were 6- to 14-year-old, healthy children with a history of previous dental treatment. The included subjects also had to have high dental anxiety (high score on a modified version of Abeer Children Dental Anxiety Scale (M-ACDAS)) . Children with visual or auditory deficits, a history of epilepsy, and/or anxiety disorder, and non-Arabic speaking children were excluded.

Records of pediatric patients on the dental treatment waiting list were reviewed and potentially eligible children were contacted via the phone. The aim of the study was introduced to the parents/guardians, and upon agreement to participate, an appointment was scheduled.

Abeer Children Dental Anxiety Scale (ACDAS), a cognitive dental anxiety scale, is the first Arabic validated cognitive dental anxiety scale developed to measure anxiety in children and adolescents. It consists of 19 self-reported questions arranged in a logical order to assess dental anxiety in children (19). In this study, the ACDAS was modified (M-ACDAS), and only seven of the 19 self-reported questions were included to avoid a lengthy questionnaire with the children (Figure 1). Each question can be scored 1, 2, or 3 by choosing between three faces with different expressions. The first face is a smily face and reflects the feeling of being relaxed, happy, and not scared, while the second face represents a neutral feeling; and the third face is a sad face and represents anxious and scared feeling. The children were asked to circle the face that best represented his/her response to the question. Therefore, the total values ranged from 7 to 21. The M-ACDAS was used at the beginning of the scheduled appointment in the waiting area to assess the pre-treatment anxiety level of the potentially eligible children. Those who scored 14 (66.7% of the maximum score) or more were considered anxious and were included in the study. Those who scored less than 14 in the M-ACDAS were excluded from the study.