Effects of a Virtual Reality Game on Children's Fear and Anxiety During Dental Procedures (VR-TOOTH): A Pilot...

Dental fear and anxiety (DFA) is a condition affecting approximately a quarter of children and adolescents and can cause a lack of cooperation during dental visits. Virtual reality (VR) use during dental care is a potential nonpharmacologic adjunct to better manage DFA in children with special health care needs (SHCN) undergoing dental procedures. This study aims to assess the feasibility and acceptability of VR in pediatric patients with SHCN undergoing dental procedures, as well as their parents and health care providers (HCPs), and evaluate the effect of VR on children's DFA during appointments. This pilot randomized controlled trial conducted at CHU-Ste Justine in Montreal followed a parallel design where participants were randomized into two groups: control (wall-mounted TV) and experimental (VR). The primary outcomes were recruitment rates and completion rates of procedures. DFA was assessed using the Venham Anxiety and Behavior Rating Scales (VABRS) and physiological biomarkers. Descriptive and nonparametric mean comparison tests were used for analyses of demographics, clinical variables, satisfaction, and VABRS. Of the 36 patients approached for recruitment, 25 (69.4%) accepted to participate (13 randomized to the VR group and 12 to the control group). The mean age of participants was 10.2 (±2.8) years and 64% were males. Overall, 77% (10/13) of participants in the VR group tolerated the headset during the procedure. Parental and HCP satisfaction was high: all HCPs indicated they would use VR again; all parents rated the VR intervention with a score of 8/10 or higher. There was no significant difference between groups on VABRS and physiological biomarkers (p > 0.05). This pilot study showed that VR was a feasible and acceptable tool for SHCN children during dental treatments. Parents and HCPs were highly satisfied. However, future studies are needed to verify the impact of VR on children's fear and anxiety during dental procedures.