Virtual Reality in Pediatric Dentistry

April 23, 2026 updated by: Alexander Alcaaz, University of Southern California

The Effect of Virtual Reality on the Behavior of Pediatric Dental Patients During Dental Sealant Application.

Dental Fear and Anxiety is an emotional experiences affecting many children and adolescents which can lead to behavioral problems in the dental setting. The purpose of the proposed study is to investigate the effect of virtual reality on anxiety, behavior, and pain in children undergoing restorative dental procedures. Children enrolled in the study will include patients ages 6-18 who are healthy and require two or more dental sealants (at least one sealant per side). The participants in the study will serve as their own control using a split-mouth cross-over randomized control clinical trial design and will be randomly assigned to receive virtual reality or traditional behavior guidance techniques first during dental sealant placement. The objectives of this study are to explore the associations between the use of virtual reality distraction during dental sealant placement with anxiety based on the change in heart rate, compared with to the control group. This model will include treatment, visit, treatment by visit interaction term as well as a treatment sequence variable. This is a pilot study. Data analyzed will be changed in heart rate between baseline and sealant placement using virtual reality or behavior guidance technique.. No statistical analysis will be conducted except mean and range.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study is a randomized controlled trial with a crossover design. Patients who are visiting the clinic for a comprehensive or periodic dental exam and are found to require two or more dental sealants (at least one sealant per side). The study subjects will include children ages 6-18 who are ASA I or II, as defined by the American Society of Anesthesiologists classification system. The proposed sample size for the study is 40 participants.

The children who are enrolled in the study will serve as both the experimental group and their own control. This is a split mouth design in which children who are enrolled in the study will serve as both the experimental group and their own control. After the child and parent are scheduled for the dental sealant appointment, they will be randomly assigned to receive the virtual reality system as a distraction technique for the first half or the latter half of the appointment (for research purposes). During the time when virtual reality is not used, traditional basic behavior guidance techniques will be used, as is the standard of care.

The virtual reality system being used for research purposes is the RelieVR by Applied VR which includes the goggle headset only. The VR experience will be an immersive experience where the child will interact with the system and navigate their way through a game that will involve bright colors, cartoon-like characters and settings with age-appropriate content. The VR system will be worn for approximately 5-10 minutes during the dental sealant application.

The behavior, and anxiety will be analyzed at specific steps of the procedure including:

  • Baseline (patient sitting in the chair prior to treatment)
  • During sealant placement with Virtual Reality distraction
  • During sealant placement with basic behavior guidance techniques
  • Post Operative (patient sitting upright in chair, 5 minutes after procedure)

The patient's anxiety will be evaluated with a change in heart rate.

Additionally, at the end of each appointment for the duration of the study, the provider will assign the patient a Frankl behavior score 1-5, and record it in the patient's chart, as is the standard of care. The provider will also complete a Healthcare Provider Questionnaire through Qualtrics.

The demographic factors will be collected from the patient's medical chart. The parent will be asked "how many hours of "screen time" (TV, computer, video games, tablet use), would you say that your child is allowed per week?". Parents and patients will also be asked to complete a satisfaction survey post-treatment.

Study Type

Interventional

Enrollment (Actual)

20

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Long Beach, California, United States, 90806
        • Children's Dental Health Clinic
      • Los Angeles, California, United States, 90089
        • Herman Ostrow School of Dentistry Pediatric Department

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

6 years to 18 years (Child, Adult)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Age 6-18
  • ASA I or II
  • Present to the Herman Ostrow School of Dentistry Pediatric Dental Clinic and Children's Dental Health Clinic at Long Beach Memorial Hospital for an initial or periodic exam, and are determined to require two or more dental sealants (at least one sealant per half mouth)

Exclusion Criteria:

Children with visual, auditory, or tactile deficits that would interfere with the ability to complete the experimental tasks

  • Children who are unable to tolerate the RelievRx by AppliedVR will be screened after consenting to research participation by trying on the VR goggles and stating that they are comfortable and willing to proceed with wearing them during their dental appointment.

  • Examples of children who may be unable to tolerate the VR goggles may include:

    • Children who wear glasses and are unable to comfortably adjust the system over their glasses
    • Children who experience dizziness, motion sickness or other discomfort during use
  • Children who remove the VR goggles prior to dental sealant application
  • Children who require pharmacological means to complete dental treatment (nitrous oxide, sedative drugs or general anesthesia)
  • Children with a significant medical history of seizure disorders as flickering from devices can trigger epileptic episodes.
  • Children with developmental disabilities
  • Children with a psychiatric disorder, organic brain syndrome, mental retardation, or other known cognitive/neurological disorders
  • Children that are not English or Spanish speaking

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Virtual Reality
The virtual reality system being used for research purposes is the RelievRx by AppliedVR which is an immersive virtual reality device that includes a goggle headset and remote control. The VR experience will be an immersive experience where the child will interact with the system and navigate their way through a game that will involve bright colors, cartoon-like characters, and settings with age-appropriate content.
Device: Virtual Reality
The VR system will be worn for approximately 5-10 minutes during dental sealant application
Active Comparator: Basic Behavior Guidance Techniques
The control sample will include basic behavior guidance techniques and is standard of care. The use of basic behavior guidance techniques is common in pediatric dentistry and is not unique to this study.
Behavioral: Basic Behavior Guidance Techniques
Basic behavior guidance techniques will be used as a distraction technique when the VR system is not used during the dental sealant application

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Beats Per Minute Change With VR
Time Frame: Time from is from baseline until sealant placement with VR
Behavior and anxiety measured by changed in heart rate were scored at baseline and during sealant placement with virtual reality
Time from is from baseline until sealant placement with VR
Beats Per Minute Change With BBG
Time Frame: Time from is from baseline until sealant placement with BBG
Behavior and anxiety measured by changed in heart rate were scored at baseline and during sealant placement with basic behavior guidance.
Time from is from baseline until sealant placement with BBG

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Parent Satisfaction
Time Frame: 5 minutes after the completion of treatment
Will be evaluated post treatment for the Virtual Reality and standard of care. Satisfaction questions will be asked on a scale on a scale of 1 to 10.
5 minutes after the completion of treatment
Patient Satisfaction
Time Frame: 5 minutes after the completion of treatment
Will be evaluated post treatment for the Virtual Reality and standard of care. Satisfaction questions will be asked on a scale on a scale of 1 to 10.
5 minutes after the completion of treatment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Southern California

Investigators

  • Study Chair: Carla Angela Alvarez, DMD, Herman Ostrow School of Dentistry Pediatric Department

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 17, 2023

Primary Completion (Actual)

June 30, 2024

Study Completion (Actual)

June 30, 2024

Study Registration Dates

First Submitted

October 12, 2022

First Submitted That Met QC Criteria

October 14, 2022

First Posted (Actual)

October 19, 2022

Study Record Updates

Last Update Posted (Actual)

May 18, 2026

Last Update Submitted That Met QC Criteria

April 23, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UP-21-00583

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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