Name: The effect of virtual reality during dental treatment on child anxiety and behavior.
year: 2000
journal: ASDC Journal of Dentistry for Children, 01 May 2000, 67(3):193-6, 160-1
Autor: Sullivan C, Schneider PE, Musselman RJ, Dummett CO Jr, Gardiner D

Abstract:

Virtual reality, a three-dimensional computer generated world, has been shown to relax adults during dental treatment. The purpose of this study was to investigate the effect of virtual reality on the behavior and anxiety of children during dental treatment. The behavior, anxiety and heart rate of twenty-six children, ages five to seven years were evaluated for the first five minutes of two restorative treatment visits. Thirteen children viewed virtual reality at their first restorative visit and not the second, and thirteen children viewed virtual reality at the second restorative visit and not the first. Before and immediately following the restorative visits, each child was instructed to draw a human figure. The restorative appointments were video recorded and heart rate monitored. The drawings and videotapes were rated independently by two examiners. The Koppitz method of evaluating drawings was used to measure anxiety. The Frankl behavior rating scale was used to evaluate behavior. Differences (ANOVA) in behavior (p < or = 0.50) and anxiety (p < or = 0.65) were not significant. The overall pulse rate was significantly lower (ANOVA p < or = 0.001) when the child was wearing glasses and viewing virtual reality. In conclusion, virtual reality during dental treatment had no significant effect on the behavior or anxiety but significantly reduced the pulse.

Name: The Effectiveness of Virtual Reality for Dental Pain Control: A Case Study
year: 2004
journal: CyberPsychology & BehaviorVol. 4, No. 4
Autor: Hunter G. Hoffman, Azucena Garcia-Palacios, David R. Patterson, Mark Jensen, …

Abstract:

The present study explored whether immersive virtual reality can serve as an effective nonpharmacologic analgesic for dental pain. Two patients (aged 51 and 56 years old) with adult periodontitis, a chronic, progressive inflammatory disease that affects gums, ligaments, and bones around the teeth, were studied in the treatment room of a periodontist. Each patient received periodontal scaling and root planing (scraping off/removing plaque deposits below the gum line, hereafter referred to as scaling) under three treatment conditions: (1) virtual reality distraction, (2) movie distraction, and (3) a no-distraction control condition. Condition order was randomized and counterbalanced. For each of the three treatment conditions, five visual analog pain scores for each treatment condition served as the dependent variables. On 0-10 labeled scales, both patients provided sensory and affective pain ratings, and subjective estimates of time spent thinking about his pain during the procedure. For patient 1, mean pain ratings were in the severe range while watching a movie (7.2), or no distraction (7.2) but in the mild pain range (1.2) during the VR condition. Patient 2 reported mild to moderate pain with no distraction (mean = 4.4), mild pain while watching the movie (3.3), and essentially no pain while in VR (0.6) during his periodontal scaling. Although the small sample size limits generalizability, we contend that virtual reality is a uniquely attention-grabbing medium capable of maximizing the amount of attention drawn away from the “real world,” allowing patients to tolerate painful dental procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive nonpharmacologic analgesia for procedural dental/periodontal pain. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed. 

Name: The use of virtual reality for pain control: A review
year: 2009
journal: Current Pain and Headache Reports
Autor: Nicole E. Mahrer & Jeffrey I. Gold

Abstract:

Virtual reality (VR) is a relatively new technology that enables individuals to immerse themselves in a virtual world. This multisensory technology has been used in a variety of fields, and most recently has been applied clinically as a method of distraction for pain management during medical procedures. Investigators have posited that VR creates a nonpharmacologic form of analgesia by changing the activity of the body’s intricate pain modulation system. However, the efficacy of VR has not been proven and the exact mechanisms behind VR’s action remain unknown. This article presents a comprehensive review of the literature to date exploring the clinical and experimental applications of VR for pain control. The review details specific research methodologies and popular virtual environments. Limitations of the research, recommendations for improvement of future studies, and clinical experiences with VR are also discussed.

Name: Virtual reality and pain management: current trends and future directions
year: 2011
journal: PAIN MANAGEMENTVOL. 1, NO. 2
Autor: Angela Li, Zorash Montaño, Vincent J Chen & Jeffrey I Gold

Abstract:

Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body’s intricate pain modulation system. While the exact neurobiological mechanisms behind VR’s action remain unclear, investigations are currently underway to examine the complex interplay of cortical activity associated with immersive VR. Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications, and clinical significance.

Name: Virtual Reality for Persistent Pain: A New Direction for Behavioral Pain Management
year: 2012
journal: Pain. 2012 Nov; 153(11): 2163–2166
Autor: Francis J. Keefe, Ph.D., Dane A. Huling, Michael J. Coggins, Daniel F. Keefe, …

Abstract:

Distraction methods such as counting strategies, visual distraction, and audio distraction are components of many cognitive-behavioral therapies (CBT) protocols for chronic pain [20,34]. The question arises: under what conditions might VR prove particularly useful or necessary as a distraction method for chronic pain? VR may be particularly useful for individuals with persistent pain who have difficulty diverting their attention away from or disengaging their attention from ongoing pain [32]. There is evidence that VR can enhance the level of immersion in a distracting environment and that this occurs even when an individual is experiencing pain (32). Repeated VR trials in which a person with persistent pain is exposed in a laboratory to a highly engaging virtual environment (e.g. SnowWorld [10]) are one way to build confidence in one’s ability to use distraction for pain control. One might expect an enhanced sense of immersion if the VR technology uses head, hand, or body tracking to foster interaction with the scene [19]. New haptic devices potentially enable one to combine visuals, sound, touch, and smell (olfactory displays) that can further enhance a sense of immersion.

Name: Clinical Use of Virtual Reality Distraction System to Reduce Anxiety and Pain in Dental Procedures
year: 2014
journal: Cyberpsychology, Behavior, and Social NetworkingVol. 17, No. 6
Autor: Mark D. Wiederhold, Kenneth Gao, and Brenda K. Wiederhold

Abstract:

Virtual reality (VR) has been used by clinicians to manage pain in clinical populations. This study examines the use of VR as a form of distraction for dental patients using both subjective and objective measures to determine how a VR system affects patients’ reported anxiety level, pain level, and physiological factors. As predicted, results of self-evaluation questionnaires showed that patients experienced less anxiety and pain after undergoing VR treatment. Physiological data reported similar trends in decreased anxiety. Overall, the favorable subjective and objective responses suggest that VR distraction systems can reduce discomfort and pain for patients with mild to moderate fear and anxiety.

Name: The use of immersive virtual reality for pain control during periodontal scaling and root planing procedures in dental hygiene clinic
year: 2018
journal: International Journal of Dental Hygiene
Volume17, Issue1
Autor: Sabha Mahmoud Alshatrat,Rasha Alotaibi,Michele Sirois,Zain Malkawi

Abstract:

Objective: To identify the effect of immersive virtual reality (VR) on pain perception during scaling and root planing procedures (SRP) in dental hygiene clinic.
Methods: Participants were recruited based on inclusion and exclusion criteria. Within-subject/split-mouth design was used in this study. The participants received a full mouth SRP. The participants were divided into two treatment conditions: (a) without VR condition or (b) with VR condition. Blood pressure (BP) and pulse rate (PR) were measured. Level of pain was measured by the Visual Analog Scale (VAS). Participants gave ratings using 0-10 scales with cut points on the scale indicating that (0) none, (1-3) mild, (4-6) moderate or (7-10) severe. Participants were also asked three questions to assess presence, realism and nausea. The immersive virtual environment used for this study was nonviolent and inoffensive.
Results: Data were analysed using SPSS® software. Fifty subjects with a mean age of 36 years completed the study. The Wilcoxon signed-rank test revealed that VAS scores were significantly (P = < 0.05) lower during VR compared without VR condition. Paired t test revealed that on average, participants experienced significantly lower systolic Bp after using VR (M = 113.72, SE = 2.16) than systolic Bp after treatment without VR However, Bp (diastolic) and PR showed no difference. 84% of the participants felt like they went inside the virtual world, 82% felt that the virtual objects seem real to them, and 94% did not feel nausea. 98% of the participants preferred using VR during SRP.
Conclusions: The results of this study indicate that the immersive VR has the potential in becoming a future method for pain control during scaling and root planing procedures.

Name: A scoping review of the use and application of virtual reality in pre-clinical dental education
year: 2019
journal: British Dental Journal volume 226, pages358–366 (2019)
Autor: Ashley Towers, James Field, Christopher Stokes, Stephen Maddock & Nicolas Martin

Abstract:

Introduction Virtual reality (VR) is gaining recognition as a valuable tool for training dental students and its use by dental schools around the world is growing. It is timely to review the literature relating to the use of VR in dental education, in order to ensure that educators are well-informed of current areas of inquiry, and those requiring further investigation, to enable appropriate decisions about whether to employ VR as a teaching tool. Method A scoping review using the method outlined by Arksey and O’Malley was conducted. Both Web of Science and ERIC databases were searched. Inclusion and exclusion criteria were established to filter results. The data were collected and categorised using a custom data collection spreadsheet. Results The review identified 68 relevant articles. Following review, four educational thematic areas relating to the ‘simulation hardware’, the ‘realism of the simulation’, ‘scoring systems’ and ‘validation’ of the systems emerged. Conclusion This paper summarises and draws out themes from the current areas of inquiry in the literature, uncovering a number of weaknesses and assumptions. It recommends areas where additional investigation is required in order to form a better evidence base for the utility of VR in dental education, as well as to inform its future development.

Name: Augmented and virtual reality in dental medicine: A systematic review
year: 2019
journal: Computers in Biology and Medicine
Volume 108, May 2019, Pages 93-10
Autor: T.JodaaG.O.GalluccibD.WismeijercN.U.Zitzmanna

Abstract:

Background: The aim of this systematic review was to provide an update on the contemporary knowledge and scientific development of augmented reality (AR) and virtual reality (VR) in dental medicine, and to identify future research needs to accomplish its clinical translation.
Method: A modified PICO-strategy was performed using an electronic (MEDLINE, EMBASE, CENTRAL) plus manual search up to 12/2018 exploring AR/VR in dentistry in the last 5 years. Inclusion criteria were limited to human studies focusing on the clinical application of AR/VR and associated field of interest in dental medicine.
Results: The systematic search identified 315 titles, whereas 87 abstracts and successively 32 full-texts were selected for review, resulting in 16 studies for final inclusion. AR/VR-technologies were predominantly used for educational motor skill training studies), clinical testing of maxillofacial surgical protocols investigation of human anatomy , and the treatment of patients with dental phobia (n = 1). Due to the heterogeneity of the included studies, meta-analyses could not be performed.
Conclusions: The overall number of includable studies was low; and scientifically proven recommendations for clinical protocols could not be given at this time. However, AR/VR-applications are of increasing interest and importance in dental under- and postgraduate education offering interactive learning concepts with 24/7-access and objective evaluation. In maxillofacial surgery, AR/VR-technology is a promising tool for complex procedures and can help to deliver predictable and safe therapy outcomes. Future research should focus on establishing technological standards with high data quality and developing approved applications for dental AR/VR-devices for clinical routine.

Name: Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis
year: 2020
journal: Journal of Clinical Medicine
Autor: Nansi López-Valverde 1ORCID,Jorge Muriel Fernández 1,Antonio López, …

Abstract:

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.

Name: Reducing anxiety in children with molar incisor hypomineralization using virtual reality – A randomized crossover study
year: 2020
journal: Comptes Rendus de L’Academie Bulgare des Sciences, vol 73, no.11
Autor: Özükoç, Can

Abstract:

The aim of this study was to evaluate the effects of virtual reality (VR) video games on anxiety levels during dental treatments in children with molar incisor hypomineralization (MIH)-affected teeth. The incidence of MIH, characterized by hypomineralized enamel, observed in at least one permanent incisor and molar tooth, varies between 5% and 40%. Dental anxiety is a common condition in children affected by MIH, and this anxiety increases with the severity of hypomineralization.A total of 23 children between the ages of 10 and 12 years played VR video games during their dental treatments. The Children’s Perioperative Multidimensional Anxiety Scale questionnaire was administered before and during the treatments to measure the anxiety levels of the children.Children undergoing treatment while playing VR games were found to be less worried and fearful during their appointments. They exhibited less nervousness, did not think about potential pain from the dental procedure and did not worry about future discomfort. A comparison of these results with those of children who underwent dental treatments without playing VR games revealed a statistically significant difference (p<0.05).Children with MIH-affected teeth who are distracted from dental procedures using three-dimensional VR games experienced less dental anxiety.

Name: Application of virtual reality on non-drug behavioral management of short-term dental procedure in children
year: 2021
journal: 
Autor: Longkuan Ran, Nan Zhao, Lin Fan, Pinping Zhou, Chao Zhang & Cong Yu

Abstract:

Background: Due to the inherent characteristics of immersion, imagination, and interactivity in virtual reality (VR), it might be suitable for non-drug behavior management of children in dental clinics. The purpose of this trial was to measure the role of VR distraction on behavior management in short-term dental procedures in children.
Methods: A randomized clinical trial design was carried out on 120 children aged between 4 and 8 years to identify the comparative efficacy of VR and tell-show-do (TSD) to improve behavioral management during dental procedures. The primary outcomes were evaluated anxiety, pain, and compliance scores in perioperative children. The levels of operative anxiety and pain were assessed using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Wong Baker FACES Pain Rating Scale (WBFS), respectively. The Frankl Behavior Rating Scale (FBRS) was tested before and during dental procedures. The length of the dental procedure was compared between both groups after treatment.
Results: The average anxiety and behavioral scores of the VR group significantly reduced compared with the control. The decreased anxiety score for the VR group and control group were 8 (7, 11) and 5 (5, 7), p < 0.05. The compliance scores of the control group during treatment were 3 (2, 3), and the same in the VR intervention were 3 (3, 4), p = 0.02. A significant reduction in pain was observed when using VR distraction (p < 0.05). Comparing the length of the dental procedure, the VR group (19.0 2 ± 5.32 min) had a shorter treatment time than the control group (27.80 ± 10.40 min).
Conclusion: The use of VR significantly reduced the anxiety and pain of children and the length of the dental procedure and improved the compliance of children that underwent short-term dental procedures without an adverse reaction.
Trial registration: Chinese Clinical Trial Registry, ChiCTR2000029802. Registered on February 14, 2020

Name: Chapter 48 – Virtual reality induced analgesia and dental pain
year: 2021
journal: Treatments, Mechanisms, and Adverse Reactions of Anesthetics and Analgesics
2022, Pages 575-581
Autor: Elitsa Venevaa Ani Belchevaa Ralitsa Raychevab

Abstract:

Distraction is a widely used method of diverting a patient’s attention from painful stimuli. The rationale behind pain reduction caused by distraction is based on the principle that different activities of the central nervous system can play a significant role in the sensory perception of pain stimuli. Virtual reality devices are implemented as non-pharmacological means aiming to distract the patient and reduce their pain. The virtual environment of sights, sounds, and movement immerses the patient in an interactively simulated world and excludes all other visual stimuli in the environment that may act as a stress factor and affect the patient. Despite some limitations of the method, researchers have successfully demonstrated its feasibility and satisfaction in reducing pain associated with dental procedures. The use of VR during dental treatment can increase patient cooperativeness and promote the dentist-patient relationship.

Name: Effect of immersive virtual reality on pain in different dental procedures in children: A pilot study
year: 2021
journal: INTERNATIONAL JOURNAL OF
PAEDIATRIC DENTISTRY
Autor: Sabha Mahmoud Alshatrat,Jumana M. Sabarini,Hanan M. Hammouri, …

Abstract:

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.

Name: Virtual reality-based distraction for intravenous insertion-related distress in children: a study protocol for a randomised controlled trial
year: 2022
journal: BMJ Open v.12(3); 2022 PMC8968513
Autor: Samina Ali,corresponding author1 Manasi Rajagopal,1 Jennifer Stinson,2 Keon Ma, …

Abstract:

Introduction: Intravenous (IV) insertions are among the most performed procedures for children seeking medical care; they are often a painful and stressful experience for both children and their caregivers. Paediatric distress and pain that is inadequately treated may lead to a frightened and uncooperative child, repeated IV attempts and overall frustration with care for both the family and clinical team. We hypothesise that distraction via an immersive virtual reality (VR) experience may reduce the associated distress for children undergoing IV insertions.
Methods and analysis: This two-armed randomised controlled superiority trial will be conducted in a Canadian paediatric emergency department and will aim to enrol 80 children overall. Children will be randomised to receive either departmental standard of care alone or standard of care plus an immersive VR experience. Children 6–17 years of age who are undergoing IV insertion and have topical anaesthetic application will be considered for inclusion. Our primary objective is to compare the reduction of distress between the two study arms. The primary outcome will be the child’s observed distress score as measured by the Observational Signs of Behavioral Distress-Revised tool. Secondary outcomes include the child’s pain intensity and fear, parental anxiety, satisfaction with the IV procedure, as well as adverse events. Recruitment launched in September 2020 and is expected to end in March 2022.
Ethics and dissemination: This study has been approved by the Health Research Ethics Board (University of Alberta). Informed consent will be obtained from parents or guardians, and assent from children. Study data will be submitted for publication irrespective of results. This study is funded through a Women and Children’s Health Research Institute Innovation grant. Purchase of the VR equipment was facilitated through a Stollery Children’s Hospital Foundation small equipment grant.

Name: Augmented Reality and Virtual Reality in Dentistry: Highlights from the Current Research
year: 2022
journal: Applied Sciences Volume 12 Issue 8
Autor: Sidra Fahim 1ORCID,Afsheen Maqsood 2,Gotam Das 3ORCID,Naseer Ahmed ,…

Abstract:

Many modern advancements have taken place in dentistry that have exponentially impacted the progress and practice of dentistry. Augmented reality (AR) and virtual reality (VR) are becoming the trend in the practice of modern dentistry because of their impact on changing the patient’s experience. The use of AR and VR has been beneficial in different fields of science, but their use in dentistry is yet to be thoroughly explored, and conventional ways of dentistry are still practiced at large. Over the past few years, dental treatment has been significantly reshaped by technological advancements. In dentistry, the use of AR and VR systems has not become widespread, but their different uses should be explored. Therefore, the aim of this review was to provide an update on the contemporary knowledge, to report on the ongoing progress of AR and VR in various fields of dental medicine and education, and to identify the further research required to achieve their translation into clinical practice. A literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for articles in peer-reviewed English-language journals published in the last 10 years up to 31 March 2021, with the help of specific keywords related to AR and VR in various dental fields. Of the total of 101 articles found in the literature search, 68 abstracts were considered suitable and further evaluated, and consequently, 33 full-texts were identified. Finally, a total of 13 full-texts were excluded from further analysis, resulting in 20 articles for final inclusion. The overall number of studies included in this review was low; thus, at this point in time, scientifically-proven recommendations could not be stated. AR and VR have been found to be beneficial tools for clinical practice and for enhancing the learning experiences of students during their pre-clinical education and training sessions. Clinicians can use VR technology to show their patients the expected outcomes before the undergo dental procedures. Additionally, AR and VR can be implemented to overcome dental phobia, which is commonly experienced by pediatric patients. Future studies should focus on forming technological standards with high-quality data and developing scientifically-proven AR/VR gadgets for dental practice.