Virtual Reality Distraction vs Nitrous Oxide for Reducing Anxiety and Injection Pain

The purpose of this study was to compare nitrous oxide (N2O) vs virtual reality (VR) as methods for reducing pain and anxiety during a dental injection. The primary objectives were to assess acute changes in stress responses by comparing salivary cortisol levels between the 2 groups and differences in injection pain scores.

A total of 132 female subjects serving as their own control received maxillary lateral incisor infiltration injections with the use of either N2O or a VR headset during separate appointments spaced at least 2 weeks apart. Salivary cortisol samples were collected at 6 times throughout each appointment. Pain scores for needle insertion and solution deposition were recorded. Data were analyzed statistically using Wald and paired t tests.

N2O significantly lowered salivary cortisol concentrations and subsequent physiologic anxiety as compared with VR (P = .0089). However, no significant differences in needle insertion or solution deposition pain scores were found.

Although VR and N2O may be comparable in terms of perceived pain reduction, N2O was a more effective method than VR for physiologic analgesia and anxiolysis.