Evaluation of Virtual Reality Based Distraction on Anxiety and Pain Perception in Paediatric Dental Extraction (VR-PED)

July 3, 2026 updated by: Sultan Qaboos University

"Evaluation of Virtual Reality Based Distraction on Anxiety and Pain Perception in Paediatric Dental Extraction: A Randomized Controlled Trial"

The goal of this clinical trial is to learn if virtual reality distraction can reduce dental anxiety and pain perception in children aged 6-10 years undergoing simple dental extraction. The main questions it aims to answer are:

Does virtual reality distraction lower dental anxiety compared to audio-visual distraction and conventional tell-show-do techniques?

Does virtual reality distraction reduce pain perception during dental extraction?

Researchers will compare virtual reality distraction, audio-visual distraction (2D cartoons with headset), and conventional tell-show-do with verbal distraction to see which method is most effective in improving child cooperation and reducing anxiety and pain.

Participants will:

Wear VR glasses to watch immersive 3D cartoons, or

Watch 2D cartoons with headset, or

Receive the conventional tell-show-do technique with verbal distraction.

Outcome measures will include child dental anxiety (CFSS-DS, VCARS), pain perception (Wong-Baker FACES), physiological parameters (pulse rate, SpO₂), and behavioral cooperation (Frankl scale).

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

168

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 Contact

  • Name: Dr.Zamzam AlQulhati Ali AlQulhati, BDS, MFD ( RSCI)
  • Phone Number: +96895573313
  • Email: zalqulhati@gmail.com

Study Contact Backup

  • Name: Azza AlShidhani Khalid AlShidhani, DclinDent (Ed), MPaeds (RCSEd)
  • Phone Number: +96895692669
  • Email: azzak@squ.edu.om

Study Locations

  • Oman
      • Muscat, Oman
        • Sultan Qaboos University Hospital - Dental & Maxillofacial Department
        • Contact:
          • Azza Khalid AlShidhani, DclinDent (Ed), MPaeds (RCSEd)
          • Phone Number: +96895692669
          • Email: Azzak@squ.edu.om
        • Contact:
        • Sub-Investigator:
          • Mohammed AlAzki, Diploma in Dental Surgery Assi
      • Muscat, Oman
        • The Medical City of Military and Security Service (Dental Center-AlKhoudh )
        • Contact:
        • Contact:
        • Sub-Investigator:
          • Majid AlFori, Diploma in Dental Surgery Assi

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

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Children aged 6 to 10 years
  • Classified as ASA class 1 or 2 (healthy or with mild systemic disease)
  • Those who demonstrated Frankl behavior rating 2 and 3 toward dental procedures
  • Children with NO previous exposure to invasive dental procedure
  • No prior experience using VR glasses
  • Requiring extraction of mandibular deciduous molar under local anesthesia

Exclusion Criteria:

  • ASA 3 and above
  • Those who demonstrated Frankl behavior rating 1 and 4 toward dental procedures
  • Special needs ( intellectual and developmental)
  • Children on psychotropic medication
  • Children wearing glasses
  • Presence of intra-oral swelling

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: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Arm 1: Virtual Reality Distraction
Children wear VR glasses to watch immersive 3D cartoons during dental extraction. Anxiety, pain, and cooperation are assessed using CFSS-DS, Wong-Baker FACES, VCARS, Frankl scale, and physiological parameters
Device: Virtual reality headset
Children wear a virtual reality headset to watch immersive 3D cartoons during dental extraction. This device provides distraction to reduce dental anxiety and pain perception.
Active Comparator: Arm 2: Audio-Visual Distraction
Children watch 2D cartoons with headset during dental extraction. Anxiety, pain, and cooperation are measured using the same scales and physiological parameters as the VR group.
Behavioral: Audio-visual distraction with 2D cartoons
Children watch 2D cartoons with headset during dental extraction. This behavioral technique provides distraction to reduce dental anxiety and pain perception.
Active Comparator: Arm 3: Conventional Tell-Show-Do
Children receive the standard tell-show-do technique with verbal distraction during dental extraction. Anxiety, pain, and cooperation are assessed using CFSS-DS, Wong-Baker FACES, VCARS, Frankl scale, and physiological parameters.
Behavioral: Tell-show-do with verbal distraction
Children receive the standard tell-show-do technique with verbal distraction during dental extraction. This behavioral method is used to reduce dental anxiety and improve cooperation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Child Dental Anxiety (Self-Report)
Time Frame: Time Points: Baseline (before starting the procedure) and post-operative assessments ( after finishing the extraction)
Change in child dental anxiety will be measured using the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS, Arabic version). The CFSS-DS consists of 15 items, each scored from 1 (not afraid) to 5 (very afraid), yielding a total score range of 15 to 75. Higher scores indicate greater dental anxiety (worse outcome). The unit of measure is the CFSS-DS score.
Time Points: Baseline (before starting the procedure) and post-operative assessments ( after finishing the extraction)
Child Dental Anxiety (Observation-based Assessment)
Time Frame: Time points: This scale will be measured at 4 time points during the procedure: T0(baseline)= 15 min before starting the procedure T1= Time of needle penetration T2= Time of extracting the tooth T3= 5 mins after the extraction
Change in child dental anxiety will also be assessed using Venham's Clinical Anxiety Rating Scale (VCARS). This observational scale is scored from 0 (relaxed) to 5 (out of control), with a total score range of 0 to 5. Higher scores indicate greater observed anxiety (worse outcome).
Time points: This scale will be measured at 4 time points during the procedure: T0(baseline)= 15 min before starting the procedure T1= Time of needle penetration T2= Time of extracting the tooth T3= 5 mins after the extraction
3a: Physiological Monitoring - Pulse Rate
Time Frame: Will be measured at 4 time points: T0 ( Baseline)= 15 minutes before the procedure T1= Time of needle penetration T2= Time of extracting the tooth T3= 5 minutes after extraction

Pulse rate will be monitored using a pulse oximeter. The unit of measure is beats per minute (bpm). In children, the normal resting pulse rate varies by age:

Preschool children (3-5 years): ~80-120 bpm

School-aged children (6-12 years): ~70-118 bpm

Adolescents (13-18 years): ~60-100 bpm Higher values during the dental procedure indicate greater physiological arousal (worse outcome).
Will be measured at 4 time points: T0 ( Baseline)= 15 minutes before the procedure T1= Time of needle penetration T2= Time of extracting the tooth T3= 5 minutes after extraction
3b: Physiological Monitoring - Oxygen Saturation (SpO₂)
Time Frame: Will be measured at 4 time points: T0 ( Baseline)= 15 minutes before the procedure T1= Time of needle penetration T2= Time of extracting the tooth T3= 5 minutes after extraction
Oxygen saturation will be monitored using a pulse oximeter. The unit of measure is percentage (%). In healthy children, normal SpO₂ values are typically 95-100% at rest. Lower values indicate poorer physiological status (i.e., worse outcomes).
Will be measured at 4 time points: T0 ( Baseline)= 15 minutes before the procedure T1= Time of needle penetration T2= Time of extracting the tooth T3= 5 minutes after extraction

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain Perception (Self-Report)
Time Frame: at the end of the procedure
Self-reported pain perception will be measured using the Wong-Baker FACES Pain Rating Scale (Arabic version). This scale ranges from 0 (no pain) to 10 (worst pain), represented by facial expressions. Higher scores indicate greater pain intensity (worse outcome), and lower scores indicate less pain intensity (better outcome)
at the end of the procedure
Child Behavior (Observation)
Time Frame: Time Points: Baseline (before the dental extraction procedure) and follow-up assessment at 1 month post-procedure

Child behavior will be assessed using the Frankl Behavior Rating Scale. This scale has four degrees:

  1. (Definitely Negative): Refusal of treatment, forceful crying, fearfulness, or extreme negativism.
  2. (Negative): Reluctant to accept treatment, uncooperative, some negative attitude but not pronounced.
  3. (Positive): Acceptance of treatment, cautious behavior, willingness to comply with the dentist, sometimes with reservation.
  4. (Definitely Positive): Good rapport with the dentist, interested in dental procedures, laughing and enjoying the situation.

The total score range is 1 to 4. Higher scores indicate more cooperative behavior (better outcome).
Time Points: Baseline (before the dental extraction procedure) and follow-up assessment at 1 month post-procedure

Collaborators and Investigators

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

Sponsor

Sultan Qaboos University

Investigators

  • Study Director: Dr. Azza Khalid AlSHidhani, DclinDent (Ed), MPaeds (RCSEd), Pediatric dental clinic , Dental and maxillofacial department (SQUH), University Medical City,
  • Study Director: Dr. Khalifa Mohammed AlAzri, DclinDent (Ed), MPaeds (RCSEd), Pediatric dental clinic, Dental Center (Alkhoudh), The Medical City of Military and Security Services
  • Principal Investigator: Dr. Zamzam Ali Alqulhati, BDS, MFD(RCSI), Oman Medical Specialty Boaered

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

Helpful Links

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 (Estimated)

September 1, 2026

Primary Completion (Estimated)

August 31, 2027

Study Completion (Estimated)

October 1, 2027

Study Registration Dates

First Submitted

June 24, 2026

First Submitted That Met QC Criteria

July 3, 2026

First Posted (Actual)

July 9, 2026

Study Record Updates

Last Update Posted (Actual)

July 9, 2026

Last Update Submitted That Met QC Criteria

July 3, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • PED-VR-2026-A
  • OMSBoard-2026 (Other Grant/Funding Number: Oman Medical Specialty Board)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data (IPD) will not be shared due to ethical considerations in pediatric populations, privacy concerns, and institutional policy. Only aggregated results will be published in peer-reviewed journals and presented at scientific meetings.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

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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