Table 1.

Previous Research of Virtual Reality (VR) Distraction for Dental Procedures

Title	Method	Results
Improving Dental Experiences Using Virtual Reality Distractions: A Simulations Study16	Participants (n=69) were randomly assigned to one of three VR conditions: active, passive, or control. Each participant was labeled as high or low dentally anxious prior to dental treatment with the VR application.	VR distraction affected on concurrent experiences, such as perceived control, as well as memories after the dental experience had ended. Participants with higher anxiety experienced greater reduction in memory vividness.
The Impact of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 4–6 Year Old Children: A Randomized Controlled Clinical Trial17	120 healthy children aged 4–6 years with no previous anxiety disorder were randomly divided into two even groups. The study consisted of three consecutive treatment sessions. The first visit consisted of fluoride therapy. In the next sessions, the groups received restorative treatment with and without VR eyeglasses in a randomized single blind controlled crossover fashion. Then at the end of each session, the subjects' pain severity was assessed using Wong Baker FACES Pain Rating Scale, and state anxiety was measured by Faces version of the Modified Child Dental Anxiety Scale [MCDAS (f )].	There was a significant decrease in pain perception (p<0.001) and state anxiety scores (p<0.001) with the use of VR eyeglasses during dental treatment.
Virtual Reality Distraction for Pain Control During Periodontal Scaling and Root Planing Procedures18	The authors recruited 38 patients. They used a within-patient/split-mouth design. Patients received scaling and root planing procedures (SRP) under three treatment conditions in three quadrants. The three conditions were control, watching a movie, and VR. After each SRP procedure, patients responded to questions about their discomfort and/or pain by using a visual analog scale (VAS) (range=0 to 10 in which lower numbers indicate less pain or discomfort). The authors also recorded patients' blood pressure (BP) and pulse rate (PR). Patients were asked which of the three treatment modalities they preferred.	The mean (±standard deviation) VAS scores for five questions pertaining to control, movie, and VR were 3.95±2.1, 2.57±1.8, and 1.76±1.4 respectively. Paired t tests revealed that VAS scores were significantly lower during VR compared with the movie (p<0.001) and control (p<0.001) conditions. Similarly, BP and PR were lowest during VR, followed by the movie and control conditions. Patients reported that they preferred the VR condition.
The Effect of Virtual Reality During Dental Treatment on Child Anxiety and Behavior19	The behavior, anxiety, and heart rate of 26 children aged 5–7 years were evaluated for the first 5 minutes of two restorative treatment visits. Thirteen children viewed VR at their first restorative visit and not the second, and 13 children viewed VR at the second restorative visit and not the first. Before and immediately following the restorative visits, each child was instructed to draw a human figure. The restorative appointments were video recorded and heart rate monitored. The Koppitz method of evaluating drawings was used to measure anxiety. The Frankl behavior rating scale was used to evaluate behavior.	Differences (ANOVA) in behavior (p≤0.50) and anxiety (p≤0.65) were not significant. The overall pulse rate was significantly lower (ANOVA; p≤0.001) when the child was wearing glasses and viewing VR.
The Effectiveness of Virtual Reality for Dental Pain Control: A Case Study15	Two patients (aged 51 and 56 years old) with adult periodontitis—a chronic, progressive inflammatory disease that affects gums, ligaments, and bones around the teeth—were studied in the treatment room of a periodontist. Each patient received periodontal scaling and root planing (scraping off/removing plaque deposits below the gum line, hereafter referred to as scaling) under three treatment conditions: (1) VR distraction, (2) movie distraction, and (3) a no-distraction control condition. Condition order was randomized and counterbalanced. For each of the three treatment conditions, five visual analog pain scores for each treatment condition served as the dependent variables. On 0–10 labeled scales, both patients provided sensory and affective pain ratings, and subjective estimates of time spent thinking about his pain during the procedure.	For patient 1, mean pain ratings were in the severe range while watching a movie (7.2) or no distraction (7.2), but in the mild pain range (1.2) during the VR condition. Patient 2 reported mild to moderate pain with no distraction (M=4.4), mild pain while watching the movie (M=3.3), and essentially no pain while in VR (M=0.6) during his periodontal scaling.