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The Efficacy of VR Therapy in Reducing Dental Distress among Adults
Experiencing pain during invasive dental procedures, such as dental filling or tooth extraction, is a common phenomenon among patients. Despite routinely using local analgesics to reduce pain during such procedures, patients still experience anxiety and pain. Dental pain during dental procedures may cause behavioral, psychological, and even psychological consequences due to increased dental fear and anxiety (Koticha, Katge, Shetty & Patil, 3). Even though most studies on the efficacy of VR therapy in reducing dental distress are built on the pediatric population, the World Health Organization (WHO) reports fear of dental treatment as a real pathological phenomenon affecting between 15% and 20% of the human population. López-Valverde et al. (3) observe that dental phobia causes patients to reject basic dental treatments such as simple dental check-ups or cleanings. Thus, its management is essential to improve the patient’s quality of life. Integrating VR therapy in dentistry can significantly increase dental procedures’ efficacy and ease, consequently minimizing the patients’ fear or anxiety for such operations. According to (Boeldt et al., 1), exposure to VR therapy permits a gradual, individualized, and controlled treatment, allowing physicians (dentists) to subject their patients to more quality and acceptable treatment.
Physicians, especially dentists, have recommended two pain management techniques for minimizing dental anxiety and pain during dental procedures in adults. These are Tell-Show-Do and Pharmacological techniques. The Tell-Show-Do technique involves behavioral practices such as distraction, modeling, inspiration, and hypnotism. The Pharmacological approach consists of the application of pharmacologic techniques (Aminabadi, 3). Of the various practices recommended for minimizing dental anxiety and pain among adults using the Tell-Show-Do technique, research has proved distraction to be the most effective strategy (López-Valverde et al., (3). For this study, a split-mouth, randomized controlled crossover trial was conducted to clinically compare and evaluate the effectiveness of virtual reality (VR) versus topical anesthesia (TA) in minimizing the perceived pain and anxiety level in adults. Additionally, the study aimed to determine their preferred dental procedure.
In the current study, virtual reality therapy’s efficacy in reducing pain and anxiety during the dental filling or tooth extraction process in adults was established. Findings from the 21 participants in the current study prove that VR is an effective technique in reducing dental distress in adults. These findings are in line with López-Valverde et al., (18) s’ findings who reported VR to have cause reduced anxiety (SMD = -1.75) and pain (SMD = -1.46) on patients undergoing various dental procedures. The findings by López-Valverde et al. are further supported by the findings in Table 5, Table 6, and Fig. 10, that agree with Aminadadi et al., (9)s’ findings on the efficacy of VR therapy in dental procedures. The results in Table 5, Table 6, and Fig. 10 are attributed to the visual distraction from the Samsung Oculus Quset® VR apparatus. According to the findings in Table 5 and Table 6, participants recorded lower dental distress, as evidenced by lower heart rates, while on the Samsung Oculus Quset® VR apparatus than on the topical anesthetic technique. This observation was correct both before and after the dental treatment, as evidenced by the findings in Fig. 10. These observations correlate with Castilo et al. (3)’s findings, who established that distraction during the execution of a dental procedure is the most effective technique in reducing pain and anxiety.
Regarding the patients’ preferred treatment method, the current study established that 71.4% (15 out of 21) of patients chose the VR treatment over the TA treatment (refer to Fig. 11). These findings correlate with López-Valverde et al. (5) and Asvanund (9), who established that 70.23% of adult patients prefer the VR method over the TA method. A possible explanation for this bias is that the VR method is considered to be more fun during their dental treatment (in addition to facilitating the procedure) compared to the TA method (Boeldt et al., 13).
The distraction technique is based on the premise that the perception of pain perception is psychological (Aminadadi et al., 14) in the sense that as a patient directs his attention to a noxious stimulus, his ability to perceive pain is modulated (Koticha et al., 4). Despite the actual mechanism of distraction being incomprehensible, models on cognitive-affective attention can be used to explain it. According to (Aminadadi et al., 14; Koticha et al., 9), man has a limited ability to pay attention. The authors explain that for an individual to perceive pain, s/he must pay attention to the painful stimuli. Therefore, considering the findings in Table 5 and Fig. 10, the participants on VR recorded lower heart rates than those on TA because their perception of pain was decreased while paying attention to the video in the VR apparatus.
According to findings by various studies, including Aminadadi et al. (11) and Nunna et al. (4), an ideal distraction process requires the attention of the patient’s senses (i.e., hearing, vision, touch, as well as active engagement of patient’s emotions). This implies that an ideal distracter requires maximum attention that incorporates auditory, visual, and kinesthetic sensory modalities and optimal emotional participation and involvement of the patient to overcome distraction from a stimulus (Nunna et al., 5). Initially, physicians subjected patients to activities such as listening to music, watching TV, and engaging the patient in non-medical conversations to distract the patient from an anxiety-provoking activity (Westwood, 27). However, as mentioned earlier techniques, comparing the distraction’s effectiveness established that allowing patients to watch videos/films effectively minimizes dental distress among patients (Bauman, 34).
Further results postulated that maximum distraction is yielded by an increase in psychological arousal, thus indicating the extent of psychological engagement or absorption achieved from the stimulus (i.e., video/film) (Westwood, 25). On the other hand, however, (Amadadi et al., 7) suggests integrating the VR technique with conventional pain-relieving methods as the most effective technique for minimizing dental distress among patients. Nevertheless, this study’s findings have demonstrated that the VR technique has a much higher efficacy in reducing dental pain than the TA technique. According to the results of this trial study, psychological techniques, such as applying the VR techniques in dentistry, can significantly help minimize pain during dental procedures with minimal side effects and make dental procedures an enjoyable experience rather than harrowing. Recently, there has been the mass production of VR gadgets, thus increasing their availability and affordability. The mounting interest in applying non-pharmacological techniques in managing pain has made VR therapy a potential healthcare disruptor (Boeldt et al., 13). Klassen et al. conducted a meta-analysis on distraction using music therapy as an alternative method to reduce anxiety and pain in different medical and dental procedures, finding a significant reduction, with an effect size of 0.35.
To sum up, based on this study’s findings, it is evident that the VR technique effectively promotes positive emotions, thus helping patients cope with excruciating dental procedures in a non-anxious manner. According to the findings in this study, patients who interacted with the VR apparatus during various dental procedures observed higher enjoyment levels than those on standard treatment using the TA technique.
Work cited
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Asvanund, Y.; Mitrakul, K.; Juhong, R.O.; Arunakul, M. E_ect of audiovisual eyeglasses during local anesthesia injections in 5- to 8-year-old children. Quintessence Int. 2015, p. 9.
Bauman, Eric B. Game-Based Teaching And Simulation In Nursing And Healthcare. 1st ed., Springer Pub. Co., 2013, pp. 34, 62.
Boeldt, Debra et al. “Using Virtual Reality Exposure Therapy To Enhance Treatment Of Anxiety Disorders: Identifying Areas Of Clinical Adoption And Potential Obstacles.” Frontiers In Psychiatry, vol 10, 2019, pp. 1, 13. Frontiers Media SA, doi:10.3389/fpsyt.2019.00773.
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Klassen, Jeffrey A., et al. “Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials.” Ambulatory Pediatrics 8.2 (2008): 117-128.
López-Valverde, N., Muriel Fernández, J., López-Valverde, A., Valero Juan, L., Ramírez, J., & Flores Fraile, J. et al. (2020). Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis. Journal Of Clinical Medicine, 9(4), 1025. doi: 10.3390/jcm9041025
Nunna, Mahesh et al. “Comparative Evaluation Of Virtual Reality Distraction And Counter-Stimulation On Dental Anxiety And Pain Perception In Children.” Journal of Dental Anesthesia and Pain Medicine, vol 19, no. 5, 2019, pp. 4, 7 The Korean Dental Society Of Anesthesiology, doi:10.17245/jdapm.2019.19.5.277. Accessed 17 Oct 2020.
Shetty, Shilpa et al. “Effectiveness Of Virtual Reality Eyeglasses As A Distraction Aid To Reduce Anxiety Among 6–10-Year-Old Children Undergoing Dental Extraction Procedure”. International Journal Of Clinical Pediatric Dentistry, vol 12, no. 4, 2019, pp. 3, 4. Jaypee Brothers Medical Publishing, doi:10.5005/jp-journals-10005-1640. Accessed 17 Oct 2020.
Westwood, James D. Medicine Meets Virtual Reality 18. 1st ed., IOS Press, 2011, pp. 25, 27.