Virtual Reality Videos and Their Effect on Adolescent Anxiety during Orthodontic Treatments: A Parallel Randomized Controlled Trial

Document Type : Original Article


1 Orthodontic Department, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran

2 Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

3 Department of Psychiatry, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran

4 Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran

5 Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

6 Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran


Background: Fear of dental procedures is one of the main reasons why patients tend to avoid dental clinics. The present study aimed to investigate the effect of using Virtual Reality (VR) videos during dental treatments on anxiety levels of the adolescents receiving treatment in dental clinics. Methods: A total of 66 patients aged 12-15 years were referred to the dental clinic at the Orthodontic Department of Birjand University of Medical Sciences. The participants were randomly assigned to two groups (n=33). The patients in the experimental group were engaged in watching a VR clip using a headset, while the control group directly observed the treatment procedure. Beck Anxiety Inventory (BAI) was administered to measure the participants’ anxiety before and after the treatment. SPSS (Version 22) was used to analyze the data. Results: The results of Mann-Whitney U test revealed a statistically significant difference between the anxiety levels of the participants in experimental and control groups (P=0.014). However, the results of Spearman Correlation test did not suggest any significant direct correlation between the participants’ age and anxiety scores after the intervention in control (r=0.002, P=0.992) and experimental (r=0.2755, P=0.122) groups. Additionally, the results of the MannWhitney U test indicated that there was no statistically significant difference between gender and anxiety scores after the intervention in the control (P=0.203) and experimental (P=0.207) groups. Conclusion: The results of the present study showed that the patients receiving VR distraction revealed lower anxiety caused by orthodontic procedures. This finding implies the effectiveness of the VR-based techniques to reduce anxiety during dental treatments.


Milgrom P, Fiset L, Melnick S, Weinstein P. The prevalence and practice management consequences of dental fear in a major US city. The Journal of the American Dental Association. 1988 May 1;116(6):641-7.  doi:10.14219/jada.archive.1988.0030  PMid:3164029
Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: time for a sense of proportion?. British dental journal. 2012 Sep;213(6):271-4.  doi:10.1038/sj.bdj.2012.830  PMid:22996472
Aziz MO, Mehrinejad SA, Hashemian K, Paivastegar M. Integrative therapy (short-term psychodynamic psychotherapy & cognitive-behavioral therapy) and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: A randomized controlled trial. Complementary therapies in clinical practice. 2020 May 1;39:101122.  doi:10.1016/j.ctcp.2020.101122  PMid:32379661
Assunção CM, Losso EM, Andreatini R, de Menezes JV. The relationship between dental anxiety in children, adolescents and their parents at dental environment. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2013 Jul 1;31(3):175. doi:10.4103/0970-4388.117977  PMid:24021328
Marwah, N., A. Prabhakar, and O. Raju, Music distraction-its efficacy in management of anxious pediatric dental patients. Journal of Indian Society of Pedodontics and Preventive Dentistry, 2005. 23(4): p. 168.
doi:10.4103/0970-4388.19003 PMid:16327136
Milsom KM, Tickle M, Humphris GM, Blinkhorn AS. The relationship between anxiety and dental treatment experience in 5-year-old children. British dental journal. 2003 May;194(9):503-6.  doi:10.1038/sj.bdj.4810070  PMid:12835786
Blount RL, Zempsky WT, Jaaniste T, Evans S, Cohen LL, Devine KA, Zeltzer LK. Management of pediatric pain and distress due to medical procedures. 2009.
Malloy, K.M. and L.S. Milling, The effectiveness of virtual reality distraction for pain reduction: a systematic review. Clinical psychology review, 2010. 30(8): p. 1011-1018. doi:10.1016/j.cpr.2010.07.001  PMid:20691523
Ehde DM, Alschuler KN, Day MA, Ciol MA, Kaylor ML, Altman JK, Jensen MP. Mindfulness-based cognitive therapy and cognitive behavioral therapy for chronic pain in multiple sclerosis: a randomized controlled trial protocol. Trials. 2019 Dec;20(1):1-2.  doi:10.1186/s13063-019-3761-1 PMid:31882017 PMCid:PMC6935157
Kellmeyer, P., N. Biller-Andorno, and G. Meynen, Ethical tensions of virtual reality treatment in vulnerable patients. Nature medicine, 2019. 25(8): p. 1185-1188. doi:10.1038/s41591-019-0543-y
Shao X, Yuan Q, Qian D, Ye Z, Chen G, le Zhuang K, Jiang X, Jin Y, Qiang D. Virtual reality technology for teaching neurosurgery of skull base tumor. BMC medical education. 2020 Dec;20(1):1-7.  doi:10.1186/s12909-019-1911-5  PMid:31900135 PMCid:PMC6942358
Himma, K.E. and H.T. Tavani, The handbook of information and computer ethics. 2008: John Wiley & Sons. doi:10.1002/9780470281819
Srivastava, K., R. Das, and S. Chaudhury, Virtual reality applications in mental health: Challenges and perspectives. Industrial psychiatry journal, 2014. 23(2): p. 83. doi:10.4103/0972-6748.151666
PMid:25788795 PMCid:PMC4361984
Bouyer, G., S. Otmane, and M. Essabbah, In virtuo molecular analysis systems: Survey and new trends, in Virtual, Augmented Reality and Serious Games for Healthcare 1. 2014, Springer. p. 51-77.  doi:10.1007/978-3-642-54816-1_4
Meyerbröker K, Morina N, Kerkhof G, Emmelkamp PM. Virtual reality exposure treatment of agoraphobia: A comparison of computer automatic virtual environment and head-mounted display. Annual Review of Cybertherapy and Telemedicine. 2011;9(1):41-5.
Muhlberger, A., G. Wiedemann, and P. Pauli, Efficacy of a one-session virtual reality exposure treatment for fear of flying. Psychotherapy Research, 2003. 13(3): p. 323-336.  doi:10.1093/ptr/kpg030 PMid:21827246
Välimäki M, Hätönen HM, Lahti ME, Kurki M, Hottinen A, Metsäranta K, Riihimäki T, Adams CE. Virtual reality for treatment compliance for people with serious mental illness. Cochrane Database of Systematic Reviews. 2014(10).  doi:10.1002/14651858.CD009928.pub2
Sullivan C, Schneider PE, Musselman RJ, Dummett Jr CO, Gardiner D. The effect of virtual reality during dental treatment on child anxiety and behavior. ASDC journal of dentistry for children. 2000 May 1;67(3):193-6.  PubMed: PMID: 10902078
Elmali H, Akpinar RB. The effect of watching funny and unfunny videos on post-surgical pain levels. Complementary therapies in clinical practice. 2017 Feb 1; 26: 36-41.  doi:10.1016/j.ctcp.2016.11.003
Ahmadpour N, Keep M, Janssen A, Rouf AS, Marthick M. Design strategies for virtual reality interventions for managing pain and anxiety in children and adolescents: scoping review. JMIR serious games. 2020;8(1):e14565. https://doi: 10.2196/14565
Hua Y, Qiu R, Yao WY, Zhang Q, Chen XL. The effect of virtual reality distraction on pain relief during dressing changes in children with chronic wounds on lower limbs. Pain Management Nursing. 2015 Oct 1;16(5):685-91. doi:10.1016/j.pmn.2015.03.001  PMid:25972074
Garrett, B., T. Taverner, and P. McDade, Virtual reality as an adjunct home therapy in chronic pain management: an exploratory study. JMIR medical informatics, 2017. 5(2): p. e11.  doi:10.2196/medinform.7271  PMid:28495661 PMCid:PMC5445235
Aliakbari M, Alipour A, Ebrahimimoghadam H, Fekraty M. The effect of Virtual Reality (VR) on psychological disorders in cancer cases. Military Caring Sciences, 2017. 4(1 (11) #B0057): p. -.  doi:10.29252/mcs.4.1.49
Walco GA, Conte PM, Labay LE, Engel R, Zeltzer LK. Procedural distress in children with cancer: self-report, behavioral observations, and physiological parameters. The Clinical journal of pain. 2005 Nov 1;21(6):484-90. doi:10.1097/01.ajp.0000146166.15529.8b  PMid:16215333
Calderón S, Rincón R, Araujo A, Gantiva C. Effect of congruence between sound and video on heart rate and self-reported measures of emotion. Europe's journal of psychology. 2018 Aug;14(3):621.  doi:10.5964/ejop.v14i3.1593
Al-Khotani, A., L.A.a. Bello, and N. Christidis, Effects of audiovisual distraction on children's behaviour during dental treatment: a randomized controlled clinical trial. Acta Odontologica Scandinavica, 2016.  doi:10.1080/00016357.2016.1206211  PMid:27409593 PMCid:PMC4960510
Prabhakar, A., N. Marwah, and O. Raju, A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients. Journal of Indian Society of Pedodontics and Preventive Dentistry, 2007. 25(4): p. 177. doi:10.4103/0970-4388.37014  PMid:18007104
Ram D, Shapira J, Holan G, Magora F, Cohen S, Davidovich E. Audiovisual video eyeglass distraction during dental treatment in children. Quintessence international. 2010 Sep 1;41(8).  PubMed: PMID: 20657857
Jimeno FG, Bellido MM, Fernández CC, Rodríguez AL, Pérez JL, Quesada JB. Effect of audiovisual distraction on children’s behaviour, anxiety and pain in the dental setting. Eur J Paediatr Dent. 2014 Sep;15(3):297-302.  PubMed: PMID: 25306148
Wiederhold, M.D., K. Gao, and B.K. Wiederhold, Clinical use of virtual reality distraction system to reduce anxiety and pain in dental procedures. Cyberpsychology, Behavior, and Social Networking, 2014. 17(6): p. 359-365. doi:10.1089/cyber.2014.0203
Hoffman, H.G., Virtual-reality therapy. Scientific American, 2004. 291(2): p. 58-65.  doi:10.1038/scientificamerican0804-58  PMid:15298120