Virtual Reality and Point-of-View Video Modeling for Dental Anxiety in Children

Participants in this group will watch a 1.5-2-minute Point-of-View (POV) video before the dental procedure. The video presents the dental examination and treatment process from a child's perspective and is designed to familiarize the child with the dental procedure before invasive fissure sealant treatment.

Participants will watch a 1.5-2-minute Point-of-View (POV) video before the dental procedure. The video presents the dental examination and treatment process from a child's perspective and is intended to familiarize the child with the dental procedure before invasive fissure sealant treatment.

Participants in this group will use virtual reality (VR) glasses during the dental procedure. Age-appropriate animation or cartoon content will be presented through the VR glasses as an active distraction technique during invasive fissure sealant treatment.

Participants will use virtual reality (VR) glasses during the dental procedure. Age-appropriate animation or cartoon content will be presented through the VR glasses as an active distraction technique during invasive fissure sealant treatment.

Participants in this group will receive the standard Tell-Show-Do behavior guidance technique before and during the invasive fissure sealant procedure. The child will be introduced to the dental procedure using the standard Tell-Show-Do approach.

Participants in the control group will receive the standard Tell-Show-Do behavior guidance technique before and during the invasive fissure sealant procedure. The child will be introduced to the dental procedure using the standard Tell-Show-Do approach.

The Facial Image Scale (FIS) is a self-report measure used to assess dental anxiety in children. It consists of five facial images representing increasing levels of anxiety, scored from 1 to 5. A score of 1 indicates the least anxiety, whereas a score of 5 indicates the highest anxiety. Higher scores indicate greater dental anxiety and therefore a worse outcome.

FIS scores will be recorded at five time points. During the first visit, the FIS will be administered within 1 minute after completion of the dental examination. During the second visit, which will take place 2 weeks after the initial visit, FIS scores will be recorded at four time points: (1) in the waiting area immediately before the dental examination; (2) within 1 minute after the child is seated in the dental chair; (3) within 1 minute after completion of the assigned behavior guidance technique and before dental treatment; and (4) within 1 minute after completion of the invasive fissure sealant procedure.

Dental fear and anxiety will be assessed using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), a 15-item scale scored from 15 to 75. Higher scores indicate greater dental fear and anxiety and a worse outcome. Scores are categorized as low (≤32), moderate (33-37), and high (≥38) dental anxiety. CFSS-DS scores will be recorded within 5 minutes after completion of the dental examination during the first visit and within 5 minutes after completion of the fissure sealant procedure during the second visit, which will take place 2 weeks after the initial visit.

The child's behavior will be assessed using the Frankl Behavior Rating Scale, which consists of four categories scored from 1 to 4: definitely negative (1), negative (2), positive (3), and definitely positive (4). Higher scores indicate more positive behavior and a better outcome.The child's behavior will be observed during the dental examination at the first visit and, at the second visit, during the dental examination before the behavior guidance technique and throughout the fissure sealant procedure, including at treatment completion. The second visit will take place 2 weeks after the initial visit.

Pulse rate (beats per minute, bpm) will be measured at four time points during the second visit: (1) in the waiting area immediately before the dental examination; (2) within 1 minute after the child is seated in the dental chair; (3) within 1 minute after completion of the assigned behavior guidance technique and before dental treatment; and (4) within 1 minute after completion of the invasive fissure sealant procedure.

Oxygen saturation (SpO₂), expressed as a percentage (%), will be measured at four time points during the second visit: (1) in the waiting area immediately before the dental examination; (2) within 1 minute after the child is seated in the dental chair; (3) within 1 minute after completion of the assigned behavior guidance technique and before dental treatment; and (4) within 1 minute after completion of the invasive fissure sealant procedure. Changes in SpO₂ will be evaluated across these time points.

Pain intensity will be assessed using the Wong-Baker FACES Pain Rating Scale, scored from 0 to 10 in increments of 2 (0, 2, 4, 6, 8, and 10). A score of 0 indicates no pain, while 10 indicates the worst pain. Higher scores indicate greater pain intensity and a worse outcome. Pain will be assessed within 1 minute after completion of the invasive fissure sealant procedure during the second visit.

A post-intervention Satisfaction and Experience Questionnaire will be administered to participants in the POV Video Modeling and Virtual Reality (VR) groups within 5 minutes after completion of the fissure sealant procedure to assess their satisfaction, perceptions, and comfort regarding the assigned behavior guidance technique. Items will be answered with "Yes" or "No."