Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

Nansi López-Valverde, Jorge Muriel Fernández, Antonio López-Valverde, Luis F Valero Juan, Juan Manuel Ramírez, Javier Flores Fraile, Julio Herrero Payo, Leticia A Blanco Antona, Bruno Macedo de Sousa, Manuel Bravo, Nansi López-Valverde, Jorge Muriel Fernández, Antonio López-Valverde, Luis F Valero Juan, Juan Manuel Ramírez, Javier Flores Fraile, Julio Herrero Payo, Leticia A Blanco Antona, Bruno Macedo de Sousa, Manuel Bravo

Abstract

Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age.

Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: "virtual reality", "distraction systems", "dental anxiety" and "pain". Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used, and in standard care situations.

Results: 31 studies were identified, of which 14 met the inclusion criteria. Pain levels were evaluated in four studies (n = 4), anxiety levels in three (n = 3) and anxiety and pain together in seven (n = 7). Our meta-analysis was based on ten studies (n = 10). The effect of VR was studied mainly in the pediatric population (for pain SMD = -0.82). In the adult population, only two studies (not significant) were considered.

Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.

Keywords: dental anxiety; distraction systems; pain; virtual reality.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Increasing tendency of publications, according the U.S. National Library of Medicine database, using “dental phobia” as the keyword.
Figure 2
Figure 2
Flow chart of the study selection process. PRISMA (Preferred Reporting Items for Systematic Review and meta Analyses) [16].
Figure 3
Figure 3
Risk of bias.
Figure 4
Figure 4
Forest plot for anxiety in Children.
Figure 5
Figure 5
Forest plot for Anxiety in Adults.
Figure 6
Figure 6
Forest plot for pain in Children.
Figure 7
Figure 7
Forest plot for Pain in Adults.

References

    1. López-Valverde A., Montero J., Albaladejo A., Gómez de Diego R. The discovery of surgical anesthesia: Discrepancies regarding its authorship. J. Dent. Res. 2011;90:31–34. doi: 10.1177/0022034510385239.
    1. Sweta V.R., Abhinav R.P., Asha R. Role of Virtual Reality in Pain Perception of Patients Following the Administration of Local Anesthesia. Ann. Maxillofac. Surg. 2019;9:110–113.
    1. Ougradar A., Ahmed B. Patients’ perceptions of the benefits of virtual reality during dental extractions. Br. Dent. J. 2019;227:813–816. doi: 10.1038/s41415-019-0939-6.
    1. Carl E., Stein A.T., Levihn-Coon A., Pogue J.R., Rothbaum B., Emmelkamp P., Asmundson G., Carlbring P., Powers M.B. Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J. Anxiety Disord. 2019;61:27–36. doi: 10.1016/j.janxdis.2018.08.003.
    1. Eijlers R., Utens E., Staals L.M., de Nijs P.F.A., Berghmans J.M., Wijnen R.M.H., Hillegers M.H.J., Dierckx B., Legerstee J.S. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth. Analg. 2019;129:1344–1353. doi: 10.1213/ANE.0000000000004165.
    1. Gujjar K.R., van Wijk A., Kumar R., de Jongh A. Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial. J. Anxiety Disord. 2019;62:100–108. doi: 10.1016/j.janxdis.2018.12.001.
    1. Raghav K., Van Wijk A.J., Abdullah F., Islam M.N., Bernatchez M., De Jongh A. Efficacy of virtual reality exposure therapy for treatment of dental phobia: A randomized control trial. BMC Oral Health. 2016;27:25. doi: 10.1186/s12903-016-0186-z.
    1. Wiederhold M.D., Gao K., Wiederhold B.K. Clinical use of virtual reality distraction system to reduce anxiety and pain in dental procedures. Cyberpsychol. Behav. Soc. Netw. 2014;17:359–365. doi: 10.1089/cyber.2014.0203.
    1. Tanja-Dijkstra K., Pahl S., White M.P., Andrade J., Qian C., Bruce M., May J., Moles D.R. Improving dental experiences by using virtual reality distraction: A simulation study. PLoS ONE. 2014;2:e91276. doi: 10.1371/journal.pone.0091276.
    1. Dahlquist L.M., McKenna K.D., Jones K.K., Dillinger L., Weiss K.E., Ackerman C.S. Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychol. 2014;26:794–801. doi: 10.1037/0278-6133.26.6.794.
    1. Schneider S.M., Hood L.E. Virtual reality: A distraction intervention for chemotherapy. Oncol. Nurs. Forum. 2007;34:39–46. doi: 10.1188/07.ONF.39-46.
    1. Malloy K.M., Milling L.S. The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin. Psychol. Rev. 2010;30:1011–1018. doi: 10.1016/j.cpr.2010.07.001.
    1. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–1017. doi: 10.1097/00000542-200204000-00031.
    1. Dixon R.A., Kenyon C., Marsh D.R., Thornton J.A. Midazolam in conservative dentistry. A cross-over trial. Anaesthesia. 1986;41:276–281. doi: 10.1111/j.1365-2044.1986.tb12788.x.
    1. Foley J. The way forward for dental sedation and primary cares? Br. Dent. J. 2002;193:161–164. doi: 10.1038/sj.bdj.4801512.
    1. Hutton B., Ferrán Catalá-López F., Moher D. The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med. Clin. 2016;16:262–266. doi: 10.1016/j.medcli.2016.02.025.
    1. Higgins J.P.T., Altman D.G., Sterne J.A.C. In: Cochrane Handbook for Systematic Reviews of Interventions. Higgins J.P.T., Green S., editors. The Cochrane Collaboration; London, UK: 2006. [(accessed on 20 October 2019)]. version 5.1.0. Chapter 8. Available online: .
    1. Vandenbroucke J.P., von Elm E., Altman D.G., Gøtzsche P.C., Mulrow C.D., Pocock S.J., Charles P., James J.S., Matthias E. STROBE Initiative. Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. PLoS Med. 2007;4:e297. doi: 10.1371/journal.pmed.0040297.
    1. Tanja-Dijkstra K., Pahl S., White M.P., Andrade J., May J., Stone R.J., Bruce M., Mills I., Auvray M., Gabe R., et al. Can virtual nature improve patient experiences and memories of dental treatment? A study protocol for a randomized controlled trial. Trials. 2014;22:90. doi: 10.1186/1745-6215-15-90.
    1. Al-Halabi M.N., Bshara N., AlNerabieah Z. Effectiveness of audio visual distraction using virtual reality eyeglasses versus tablet device in child behavioral management during inferior alveolar nerve block. Anaesth. Pain Intensive Care. 2018;22:55–61.
    1. Bentsen B., Svensson P., Wenzel A. Evaluation of effect of 3D video glasses on perceived pain and unpleasantness induced by restorative dental treatment. Eur. J. Pain. 2001;5:373–378. doi: 10.1053/eujp.2001.0256.
    1. Asl Aminabadi N., Erfanparast L., Sohrabi A., Ghertasi Oskouei S., Naghili A. The Impact of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 4-6 Year-Old Children: A Randomized Controlled Clinical Trial. J. Dent. Res. Dent. Clin. Dent. Prospect. 2012;6:117–124.
    1. Nunna M., Dasaraju R.K., Kamatham R., Mallineni S.K., Nuvvula S. Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children. J. Dent. Anesth. Pain Med. 2019;19:277–288. doi: 10.17245/jdapm.2019.19.5.277.
    1. Niharika P., Reddy N.V., Srujana P., Srikanth K., Daneswari V., Geetha K.S. Effects of distraction using virtual reality technology on pain perception and anxiety levels in children during pulp therapy of primary molars. J. Indian Soc. Pedod. Prev. Dent. 2018;36:364–369. doi: 10.4103/JISPPD.JISPPD_1158_17.
    1. Shetty V., Suresh L.R., Hegde A.M. Effect of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 5 to 8 Year Old Children. J. Clin. Pediatr. Dent. 2019;43:97–102. doi: 10.17796/1053-4625-43.2.5.
    1. Al-Khotani A., Bello L.A., Christidis N. Effects of audiovisual distraction on children’s behaviour during dental treatment: A randomized controlled clinical trial. Acta Odontol. Scand. 2016;74:494–501. doi: 10.1080/00016357.2016.1206211.
    1. Mitrakul K., Asvanund Y., Arunakul M., Paka-Akekaphat S. Effect of audiovisual eyeglasses during dental treatment in 5–8 year-old children. Eur. J. Paediatr. Dent. 2015;16:239–245.
    1. Asvanund Y., Mitrakul K., Juhong R.O., Arunakul M. Effect of audiovisual eyeglasses during local anesthesia injections in 5- to 8-year-old children. Quintessence Int. 2015;46:513–521.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Lawrence Erlbaum Associates; New York, NY, USA: 1988.
    1. Yamashita Y., Shimohira D., Aijima R., Mori K., Danjo A. Clinical Effect of Virtual Reality to Relieve Anxiety During Impacted Mandibular Third Molar Extraction Under Local Anesthesia. J. Oral Maxillofac. Surg. 2019;26:31343–31346. doi: 10.1016/j.joms.2019.11.016.
    1. Hill K.B., Chadwick B., Freeman R., O’Sullivan I., Murray J.J. Adult Dental Health Survey 2009: Relationships between dental attendance patterns, oral health behaviour and the current barriers to dental care. Br. Dent. J. 2013;214:25–32. doi: 10.1038/sj.bdj.2012.1176.
    1. Seligman L.D., Hovey J.D., Chacon K., Ollendick T.H. Dental anxiety: An understudied problem in youth. Clin. Psychol. Rev. 2017;55:25–40. doi: 10.1016/j.cpr.2017.04.004.
    1. De Stefano R. Psychological Factors in Dental Patient Care: Odontophobia. Medicina. 2019;8:55. doi: 10.3390/medicina55100678.
    1. Fiorillo L. Oral Health: The First Step to Well-Being. Medicina. 2019;7:55. doi: 10.3390/medicina55100676.
    1. Bolton D., Dearsley P., Madronal-Luque R., Baron-Cohen S. Magical thinking in childhood and adolescence: Development and relation to obsessive compulsion. Br. J. Dev. Psychol. 2002;20:479–494. doi: 10.1348/026151002760390819.
    1. Thompson S.G., Higgins J.P. How should meta-regression analyses be undertaken and interpreted? Stat. Med. 2002;21:559–573. doi: 10.1002/sim.1187.
    1. Klassen J.A., Liang Y., Tjosvold L., Klassen T.P., Hartling L. Music for pain and anxiety in children undergoing medical procedures: A systematic review of randomized controlled trials. Ambul. Pediatr. 2008;8:117–128. doi: 10.1016/j.ambp.2007.12.005.
    1. Uman L.S., Chambers C.T., McGrath P.J., Kisely S. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst. Rev. 2006;18 doi: 10.1002/14651858.CD005179.pub2.
    1. Uman S.L., Birnie K.A., Noel M., Parker J.A., Chambers C.T., McGrath P.J., Kisely S.R. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst. Rev. 2013;10 doi: 10.1002/14651858.CD005179.pub3.
    1. Birnie K.A., Noel M., Chambers C.T., Uman L.S., Parker J.A. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst. Rev. 2018;10 doi: 10.1002/14651858.CD005179.pub4.
    1. Hoffman H.G., Sharar S.R., Coda B., Everett J.J., Ciol M., Richards T., Patterson D.R. Manipulating presence influences the magnitude of virtual reality analgesia. Pain. 2004;111:162–168. doi: 10.1016/j.pain.2004.06.013.
    1. Yu M., Zhou R., Wang H., Zhao W. An evaluation for VR glasses system user experience: The influence factors of interactive operation and motion sickness. Appl. Ergon. 2019;74:206–213. doi: 10.1016/j.apergo.2018.08.012.
    1. Schienle A., Scharmüller W., Leutgeb V., Schäfer A., Stark R. Sex differences in the functional and structural neuroanatomy of dental phobia. Brain Struct. Funct. 2013;218:779–787. doi: 10.1007/s00429-012-0428-z.
    1. Klages U., Kianifard S., Ulusoy O., Wehrbein H. Anxiety sensitivity as predictor of pain in patients undergoing restorative dentalprocedures. Community Dent. Oral Epidemiol. 2006;34:139–145. doi: 10.1111/j.1600-0528.2006.00265.x.
    1. Lin C.S., Wu S.Y., Yi C.A. Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis. J. Dent. Res. 2017;96:153–162. doi: 10.1177/0022034516678168.
    1. Astramskaitė I., Juodžbalys G. Scales used to rate adult patients’ psycho-emotional status in tooth extraction procedures: A systematic review. Int. J. Oral Maxillofac. Surg. 2017;46:886–898. doi: 10.1016/j.ijom.2017.03.015.
    1. Eijlers R., Legerstee J.S., Dierckx B., Staals L.M., Berghmans J., van der Schroeff M.P., Wijnen R.M., Utens E.M. Development of a Virtual Reality Exposure Tool as Psychological Preparation for Elective Pediatric Day Care Surgery: Methodological Approach for a Randomized Controlled Trial. JMIR Res. Protoc. 2017;6:e174. doi: 10.2196/resprot.7617.
    1. Jain A., Suprabha B.S., Shenoy R., Rao A. Association of temperament with dental anxiety and behaviour of the preschool child during the initial dental visit. Eur. J. Oral Sci. 2019;127:147–155. doi: 10.1111/eos.12606.
    1. Stenebrand A., Wide Boman U., Hakeberg M. Dental anxiety and temperament in 15-year olds. Acta Odontol. Scand. 2013;71:15–21. doi: 10.3109/00016357.2011.645068.
    1. Lundgren J., Elfström M.L., Berggren U. The relationship between temperament and fearfulness in adult dental phobic patients. Int. J. Paediatr. Dent. 2007;17:460–468. doi: 10.1111/j.1365-263X.2007.00880.x.
    1. Bergdahl M., Bergdahl J. Temperament and character personality dimensions in patients with dental anxiety. Eur. J. Oral. Sci. 2003;111:93–98. doi: 10.1034/j.1600-0722.2003.00028.x.

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