International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 14 , ISSUE S2 ( Special Issue (Behaviour Management), 2021 ) > List of Articles

RESEARCH ARTICLE

Comparative Evaluation of the Efficacy of Virtual Reality Distraction, Audio Distraction and Tell-show-do Techniques in Reducing the Anxiety Level of Pediatric Dental Patients: An In Vivo Study

Greeshma SG, Sageena George, S Anandaraj, Shaniya Sain, Deepak Jose, Arjun Sreenivas, GadhaRajendran Pillai, Noufila Mol

Citation Information :

DOI: 10.5005/jp-journals-10005-2106

License: CC BY-NC 4.0

Published Online: 01-02-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Objectives and methods: Children, in the age-group of 6 to 8 years, with moderate level of anxiety, (measured with M-DAS), requiring inferior alveolar nerve block (IANB) for mandibular tooth extraction were selected. Informed consent was obtained from parents. Selected children were allocated randomly into 3 groups virtual reality (VR) distraction group, audio distraction group and Tell-show-do (TSD) group. Pre- and post- distraction anxiety level of children was measured subjectively with facial image scale and objectively with pulse rate and oxygen saturation (measured with pulse oxymeter). Results: There was a statistically significant decrease in pulse rate after distraction (with a p < 0.01) in all the three groups. Postdistraction pulse rate was lowest in the VR distraction group when compared to other groups .While comparing postdistraction pulse rate values in the three groups, the difference in pulse rate between TSD and VR distraction group was significant. But while comparing the pulse rate between audio distraction and TSD group ( p = 0.06), and audio distraction and VR distraction group (p = 0.24) was not statistically significant. Oxygen saturation increased in all the three groups which was statistically significant (p < 0.01). There was a statistically significant difference in the postdistraction oxygen (O2) saturation levels between TSD and audio distraction groups (p < 0.05) with more O2 saturation in audio distraction group. But while comparing the audio distraction with VR group and TSD with VR group, the difference was not significant. Facial image scale (FIS) scores decreased in all the three groups (p < 0.01). Conclusion: The overall results revealed by all the parameters indicate that children were most relaxed in VR group, followed by audio group and were least relaxed in TSD group during dental visits. Hence VR distraction can be considered as a useful technique for behavior management of pediatric patients during a conventional dental treatment.


PDF Share
  1. Aitken JC, Wilson S, Coury D, et al. The effect of music distraction on pain, anxiety and behaviour in Pediatric dental patients. Pediatric Dent 2002;24(2):114–118.
  2. Buchanan H, Niven N. Validation of a facial image scale to assess child dental anxiety. J Paediatr Dent 2002; 12(1):47–52. DOI: 10.1046/j.0960-7439.2001.00322.x
  3. Tunc EP, Firat D, Onur OD, et al. Reliability and validity of MDAS in a Turkish population. Community Dent Oral Epidemiol 2005;33(5):357–362. DOI: 10.1111/j.1600-0528.2005.00229.x
  4. Ilgüy D, Ilgüy M, Dinçer S, et al. Reliability and validity of MDAS in turkish population. J Int Med Res 2005;33(2):252-259. DOI: 10.1177/147323000503300214
  5. Esa R, Hashim NA, Ayob Y, Yusof ZY. Psychometric properties of the faces version of the Malay-modified child dental anxiety scale. BMC Oral Health 2015; 10(15). DOI: 10.1186/s12903-015-0013-y
  6. Paglia L, Gallus S, de Giorgio S, et al. Reliability and validity of the Italian versions of the children's fear survey schedule - dental subscale and the modified child dental anxiety. Eur J Paediatr Dent 2017;18(4):305–312. DOI: 10.23804/ejpd.2017.18.04.08
  7. Messer JG. Stress in dental patients undergoing routine procedures. J Dent Res 1977;56(4):362–367. DOI: 10.1177/00220345770560040301
  8. Hoffman HG, Richards TL, Van Oostrom T, et al. The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anesth Analg 2007; 105(6):1776-1783. DOI: 10.1213/01.ane.0000270205.45146.db
  9. Larry, Kent, Thomson. An Evaluation of Finger Pulse Volume as a Psychophysiological Measure of Anxiety. psychophysiology. 1976.
  10. Krebig SD. Autonomic nervous system activity in emotions: a review. Biol Psychol 2010;84(3):394–421. DOI: 10.1016/j.biopsycho.2010.03.010
  11. Marwah N, Prabhakar AR, Raju OS. Music distraction — its efficacy in management of anxious pediatric dental patients. J Indian Soc Pedod Prev Dent 2005;23:168–170 DOI: 10.4103/0970-4388.19003.
  12. Wiederhold BK, Gao K, Sulea C,et al. Virtual reality as a distraction technique in chronic pain patients. Cyberpsychol, Behav Socl Netw 2014;17(6):346–352. DOI: 10.1089/cyber.2014.0207
  13. Sullivan C, Schneider PE, Musselman RJ, et al. The effect of virtual reality during dental treatment on child anxiety and behavior. ASDC J Dent Child 2000;67(3):193–196.
  14. Parkin SF. The effect of ambient music upon the reactions of children undergoing dental treatment. ASDC J Dent Child 1981; 48:430–432.
  15. Yamini V, Bailwad SA, Nirmala SV, et al. Effectiveness of music distraction in the management of anxious pediatric dental patients. Ann Essences Dent 2010;II:1–5. DOI: 10.5368/aedj.2010.2.2.1-5.pdf
  16. Sivakumar N, Abinash M, Nirmala SVSG, et al. Effectiveness of music distraction in the management of anxious pediatric dental patients. Ann Essences Dent 2010;2.
  17. Lahmann C, Schoen R, Henningsen P, et al. Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial. J Am Dent Assoc 2008;139(3):317–324. DOI: 10.14219/jada.archive.2008.0161
  18. Klingberg G, Raadal M, Arnrup K. Dental fear and behavior management problems in Pediatric Dentistry– A clinical approach 2009; 32–43. DOI: 10.1111/j.1365-263X.2007.00872.x
  19. Eaton JJ, McTigue DJ, Fields HW Jr., et al. Attitudes of contemporary parents toward behavior management techniques used in pediatric dentistry. Pediatr Dent 2005;27:107–113.
  20. Adair SM, Waller JL, Schafer TE, et al. A survey of members of the American Academy of Pediatric Dentistry on their use of behavior management techniques. Pediatr Dent 2004;26:159–166.
  21. Allen KD, Stanley RT, McPherson K. Evaluation of behavior management technology dissemination in pediatric dentistry. Pediatr Dent 1990;12:79–82.
  22. Adair SM. Behavior management conference panel I report – Rationale for behavior management techniques in pediatric dentistry. Pediatr Dent 2004;26:167–170.
  23. American Association of Pediatric Dentistry (AAPD). Guideline on behavior guidance for the pediatric dental patient. AAPD reference manual. 2015; 57(6).
  24. Kreinces GH. Ginott ppsychology applied to pedodontics. J Dent Child 1975;42(2):119–122.
  25. Luisa B, Heather B. Correspondence between dentist and child ratings of dental anxiety in Portugal: a preliminary study. Rev Port Estomatol Med Dent Cir Maxilofac 2011;52. DOI: 10.1016/S1646-2890(11)70004-8
  26. Krishnappa S, Srinath, SKV. Evaluation of facial image scale and Venham picture test used to assess dental anxiety in children. JIAPHD. 2013;11(3):31–35.
  27. Faazila F, Ganesh J. Validation of a facial image scale to assess child dental anxiety. Drug Invention Today. 2018;10(1):2835.
  28. Bansal A, Jain S, Tyagi P, et al. Effect of virtual reality headset using smart phone device on pain and anxiety levels during local anesthetic injection in children with C 6-10 years of age. Paripex - Indian Journal of Research 2018;7(6).
  29. Prabhakar AR, Marwah N, Raju OS. A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients. Indian Soc Pedod Prev Dent 2007;25(4):177–182. DOI: 10.4103/0970-4388.37014
  30. Khandelwal M, Shetty RM, Rath S. Effectiveness of distraction techniques in managing pediatric dental patients. Int J Clin Pediatr Dent 2019; 12(1): 18–24. DOI: 10.5005/jp-journals-10005-1582
  31. Khandelwal D, Kalra M, Tyagi R, et al. Control of anxiety in pediatric patients using “Tell-show-do” method and audiovisual distraction. J Contemp Dent Pract 2018; 19(9):1058–1064. DOI: 10.5005/jp-journals-10024-2381
  32. Wismeijer, AAJ Vingerhoets AJ. The use of virtual reality and audiovisual eyeglass systems as adjunct analgesic techniques: a review of the literature. Ann Behav Med 2005;30(3):268–278. DOI: 10.1207/s15324796abm3003_11
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.