Felemban OM, Alshamrani RM, Aljeddawi DH, Bagher SM. Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial. BMC Oral Health. 2021;21(1):321.
Introduction:
As a clinician, it is paramount to manage your patient’s dental anxiety, as it can often directly affect the patient’s compliance and thus, the effectiveness of treatment. The above randomised control trial researched whether the use of virtual goggles are more effective at easing anxiety in paediatric patients, as opposed to watching a cartoon video on a screen.
Methodology:
A sample of fifty children were randomly assigned to either the test or control group. All subjects were assessed for anxiety whilst undergoing local anaesthetic infiltrations. The treatment was carried out by either postgraduates or paediatric dentistry students. Due to treatment needing to be carried out by the clinician, they could not be blinded. However, it was the responsibility of a chosen dental assistant – who was not involved in the data collection, to keep the group allocation hidden from the clinicians to avoid bias.
All fifty subjects were asked to choose a video from a designated list of cartoons. Half the subjects were part of the test group and therefore watched the video from the virtual reality goggles. The other half were in the control group and watched the chosen cartoon from a screen. Each group received topical anaesthetic, following with a local anaesthetic infiltration. To measure patient’s anxiety the following were observed and recorded:
Heart rate was recorded using a pulse oximeter five time points:
- Once the subject is on the dental chair as a baseline
- When video is on (about 3 min later).
- At topical anaesthesia application (about 2 min later).
- At needle insertion (about 2 min later).
At point (3) the following were also recorded:
- The face, legs, activity, cry, consolability (FLACC) behavioural pain assessment scale (Fig. 1).
Immediately after point (4):
- The subjects were given the Arabic version of Wong- Baker FACES pain rating scale and asked to choose a face that best described their emotional state during the administration of the local anaesthetic.
Figure 1
Results:
The heart rate of the test group proved to be higher at all observed time stamps in a, however only the baseline heart rate was not statistically significant (>0.05). Along with this, it was found that the younger and female subjects had a higher heart rate, as they scored a statistically higher mean score on the FLACC scale.
Conclusion:
Whilst the group allocations were randomised, by chance the test group appeared to be of a younger age. Furthermore, majority of those who were in the test group had never used virtual reality glasses before. This may have contributed to added anxiety. The findings of this study suggests that virtual reality goggles are not more clinically effective at reducing anxiety during local anaesthesia administration, compared to playing media out loud for paediatric patients to watch.
Research Summary Written By: Mina Karadakhy, University of Manchester, BDS