Comparison of Effectiveness of Audio and VR Distraction Techniques in Managing Pediatric Dental Patients

ABSTRACT

Aim:

In order to manage pediatric dental patients, this study set out to assess the effectiveness of two distraction techniques: audio and virtual reality (VR) with tell, show, and do technique (TSD).

Materials and Methods:

Forty-five children aged 6–10 years were selected for the present randomized control trial. They were split into three groups at random. Group 1 control group: tell-show-do, Group 2: audio distraction, and Group 3: VR distraction. Both pretreatment and postoperative anxiety levels were measured by modified Venham’s anxiety rating scale (MVARS).

Results:

In each of the three groups, there was a statistically significant difference between the child’s pre- and post-treatment anxiety levels. VR distraction group experienced the greatest reduction in anxiety.

Conclusion:

All three methods were similarly successful at lowering anxiety while virtual reality distraction outperformed compared to other techniques.

INTRODUCTION

Every dentist faces a significant problem when treating young patients who have dental anxiety. The child’s lack of cooperation may make it difficult to give dental care effectively, which could lower the standard of care. Pediatric dental practice must include the management of the child patient’s behavior. The dentist must use additional behavior management strategies in place of or in addition to communicative management for a youngster who is unable to cooperate.[1]

Relaxation training, tell-show-do, positive reinforcement, diversion, nonverbal communication, hand-over-mouth exercise, parental separation, and pharmacological interventions like conscious sedation and general anesthesia were among the techniques that the American Academy of Pediatric Dentistry had recommended.[2]

Distraction is a non-aversive approach that is gaining popularity today. Distraction is a simple technique to lessen a patient’s anxiety when unpleasant feelings start to appear. Distraction is an approach used to change a patient’s attention away from what they are doing and to pique their interest in something else.[3,4]

The term “virtual reality” (VR) describes “a human–computer interface that allows the user to interact dynamically with the virtual world, which is essentially a computer-generated environment.” Because “it offers more immersive images via the occlusive headsets that project the images right in front of the user’s eyes,” the usage of VR as a distraction tactic may be preferable over different distraction methods. The real world may be obscured based on the type of VR device being utilized by obstructing visual, aural, or both stimuli.[4]

The present current research aims to compare the efficiency of audio distraction technique in comparison with the VR distraction technique among 6–10-year-old children while administrating local anesthesia.

MATERIALS AND METHODS

Total 45 children of both genders satisfying inclusion and exclusion criteria were enrolled for the study.

Inclusion criteria

1. Children having their first visit to dental office

2. Children between 6 to 10 years of age

3. Children requiring under local anesthesia for treatment

4. Children with scores of 3 and 4 on Frankel’s behavior rating scale.

Exclusion criteria

1. Past dental experience

2. Frankel’s behavior rating scale scores of 1 and 2

3. Mentally or physically disabled child.

Selected subjects were divided into three groups at random.

Group 1 (Control Group): This group comprises of 15 children who received conventional TSD technique.

Group 2 (Audio Distraction Group): This group comprises of 15 children, received treatment while listening audio stories/music through headphones during entire course of treatment.

Group 3 (VR Distraction Group): 15 children were placed in this group who were shown audiovisual preparation through VR box presentation during the entire treatment.

Dental procedure

Child was occupied to listen to the audio stories/music or watch cartoon through the VR box (Shinecon VR play) during treatment according to the group in which he/she was enrolled. Topical anesthetic gel was applied at the site of administration of local anesthetic solution. Then, local anesthetic solution was administrated at the rate of 1 ml/minute. Pulp therapy or extraction of the tooth was done after achieving the profound anesthesia.

Evaluation of procedure

Both pre-treatment and postoperative anxiety levels were assessed by the investigator by MVARS. This scale consists of six categories, (range from 0 to 5), where 0 = Relaxed, 1 = Uneasy, 2 = Tense, 3 = Reluctant, 4 = Interference, 5 = Out of contact.

Statistical analysis

With a P value of 0.05 being considered significant, the data were analyzed using SPSS version 22. The Wilcoxon signed-rank test was used for intragroup comparison and the Kruskal–Wallis test was used for intergroup comparison.

RESULT

According to Table 1, a statistically significant reduction in anxiety from pre-treatment to post-treatment levels was seen in all groups. The VR distraction group experienced the greatest reduction in anxiety. However, no statistically significant difference was found between three groups on the intergroup comparison. (P > 0.05).

Table 1.

Comparison of dental anxiety levels

Group	Mean anxiety score		P	Intergroup comparison (Control v/s audio v/s VR)
	Pre-treatment	Post-treatment
Control Group	5	3.5	<0.05	>0.05
Audio Group	5	3.5	<0.05
VR Group	5	2	<0.001

DISCUSSION

The term “VR” refers to a human-computer interface that allows for dynamic user interaction with a computer-generated world. VR makes use of high-tech equipment including head-mounted eyewear, a large field of view, and three-dimensional head-mounted displays (HMD). Due to the occlusive headsets’ ability to show an image directly in front of the user’s eyes and, depending on the model, block off other (visual/audio or both) stimuli, this application may provide a more immersive experience than more conventional forms of distraction. HMD users are unable to observe what is taking place in the real world because they are too preoccupied with what is happening in the virtual one.[3,4]

Children between the ages of 6 and 10 were chosen for the study because they exhibited more disruptive behavior and dental fear, making them harder to manage at dental offices. Participants in the similar age group were included in studies carried out by Chaturvedi S et al. (2016)[5] and Al-Halabi MN and associates (2018).[6]

According to the findings of the current study, all three behavior management strategies were similarly effective at reducing anxiety; however, the VR distraction group outperformed the others in terms of lowering anxiety after treatment. Outcome of our research is in agreement with the research conducted by Panda A et al. (2017),[4] Niharika P and co-researchers (2018)[7] and Gs G and colleagues (2021).[8]

The fundamental idea behind VRD is that it affects pain perception and signaling both directly and indirectly, rather than interrupting pain signals. We can draw the conclusion that youngsters experience less discomfort when they are actively paying attention to VR, which decreases their level of conscious attention.[3,4]

VR has the advantages of being simple to use, easier to control the treatment, safe for patients, and without requiring additional instructions. Additionally, applying this approach repeatedly won’t lessen its beneficial effects, and it may be applied with ease to pediatric patients and, with slight size adjustments, to adults. Additionally, this method is widely acknowledged by both the patient and the healthcare team as having the most benefit.[4,7]

Limitation of study

The present study has some limitations. For example, it would be preferable if various treatment procedures were assessed independently. One of the intriguing aspects of VRD is that it can change behavior over a lengthy period of time. As a result, researchers need to conduct additional studies on VRD with extensive follow-up.

CONCLUSION

The present research work validates the usefulness of VR distraction as a tool for behavior management of anxious pediatric patients. VR distraction can be viewed as a useful approach for behavior modification that decreases children’s anxiety and pain threshold.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.