Immersive and Non-Immersive Virtual Reality Distraction on Pain Perception to Intraoral Injections
1Department of Pedodontics & Preventive Dentistry,Teerthanker Mahaveer Dental College & Research Centre, Delhi Road, Moradabad – 244001, Uttar Pradesh, India
2Department of Pedodontics & Preventive Dentistry, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
DOI: 10.17796/1053-4625-45.6.5 Vol.45,Issue 6,December 2021 pp.389-394
Published: 01 December 2021
*Corresponding Author(s): Ramakrishna Yeluri E-mail: email@example.com firstname.lastname@example.org
Objective: To evaluate the efficacy of immersive VR (IVR) and non-immersive VR (NIVR) distraction on perceived pain during intraoral injections in children undergoing dental procedures. The objective was to introduce 3-dimensional nature of virtual reality during the provoking phase of dental treatment as a means of distraction in children.
Study design: A total of 200 children were selected for the study, 100 for IVR group and 100 for NIVR group. After randomization, children were introduced to Oculus Go Standalone equipment; MCDAS (f), VAS, WBFRS and the treatment procedure using tell show do technique. Group I children were introduced to oculus go standalone headset with hand held controller to play temple run or roller coaster game while in group II, children watched cartoon movies of their choice. Pre-operative & post-operative MCDAS scores were obtained using MCDAS (f) questionnaire in local language. Post-operatively, VAS and WBFRS scores were also obtained. The data was analyzed using independent t-test and chi-square analysis.
Results: Pre-operatively, the mean MCDAS scores were similar in both the groups viz. Group–I (29.20 ± 3.197) and Group–II (29.09 ± 3.803) and is statistically not significant. Post-operatively, the mean MCDAS scores were higher in non-immersive group (20.72 ± 2.822) as compared to immersive group (10.99 ± 2.227). VAS score was higher in non-immersive group (2.72 ± 0.99) as compared to immersive group (0.75 ± 0.88). WBFRS scores were higher in non-immersive group (2.78 ± 1.097) as compared to immersive group (0.82 ± 1.104).
Conclusion: Three-dimensional virtual reality was found to be an effective means of distraction in children undergoing dental procedures and especially during the provoking phase. The significant difference obtained clearly indicates irrespective of immersiveness of virtual reality, anxiety had been decreased and on comparison the pain perception to intraoral injection is less in immersive virtual reality environment. Immersive VR distraction technique can serve as an adjunct to traditional behavior management strategies already available to the pediatric dentist.
Anxiety; Distraction; Immersiveness; Injection; Oculus go; Pain perception; Virtual reality
Supriya Kumari,Rachana Bahuguna,Nishita Garg,Ramakrishna Yeluri. Immersive and Non-Immersive Virtual Reality Distraction on Pain Perception to Intraoral Injections. Journal of Clinical Pediatric Dentistry. 2021. 45(6);389-394.
1. Villemure C, Bushnell MC. Cognitive modulation of pain: how do attention and emotion influence pain processing. Pain, 2002; 93:195-199.
2. McCaul KD, Mallot JM. Distraction and coping with pain. Psychol Bull 1984; 95:516-533.
3. Arntz A, Dreessen L, Merckelbach H. Attention, not anxiety, influences pain. Behav Res Ther , 1991; 29(1):41-50.
4. Melzack R, Wall PD. Pain mechanisms: a new theory. Science,1965; 50:971–979.
5. McCaffrey M, Passero C. Pain management: problems and progress. In: McCaffrey M, Pasero C. (ed.). Pain: clinical manual. 2nd ed, St. Louis: MO: Mosby; PP.1–13,1999.
6. Aitken JC, Wilson S, Coury D, Moursi AM. The effect of music distraction on pain, anxiety and behavior in pediatric dental patients. Pediatr Dent , 2002; 24(2):114-118.
7. Melamed BG, Hawes RR, Heiby E, Glick J. Use of filmed modelling to reduce uncooperative behavior of children during dental treatment. J Dent Res 1975; 54(4):797-801.
8. Wright GZ, Stigers JI. Nonpharmacologic management of children’s behaviors. In: Dean JA, Avery DR, Mc-Donald RE, eds. McDonald and Avery’s Dentistry for the Child and Adolescent. 9th ed. Maryland Heights, Mo: Mosby-Elsevier 27-40, 2011.
9. Chambers DW. Communicating with the young dental patient. J Am Dent Assoc,1976; 93(4):793-799.
10. Fields H, Pinkham J. Videotape modeling of the child dental patient. J Dent Res,1976; 55(6):958-963.
11. Rizzo AA, Kim GJ. A SWOT analysis of the field of virtual reality. Presence 14(2):119-146, 2005.doi:10.1162/1054746053967094.
12. Gold JI, Kant AJ, Kim SH, Rizzo AS. Virtual Anaesthesia: The use of virtual reality for pain distraction during acute medical interventions. Sem AnaesthPeriop Med Pain, 2005; 24(7):203-210.
13. Galimberti C, Ignazi S, Vercesi P, Riva G. Characteristics of interaction and cooperation in immersive and nonimmersive virtual environments. In Riva G, Galemberti C (eds), Towards Cyberpsychology: Mind, Cognitions and Society in the internet age, Amsterdam, IOS Press pp 129-155, 2001.
14. Furman E, Jasinevicius RT, Bissada FN, Victoroff ZK, Skillicorn R, Buchner. Virtual reality distraction for pain control during periodontal scaling and root planing procedures. J Am Dent Assoc , 2009; Dec 140(12):1508-1516.
15. Bailey JO, Bailenson JN. “Immersive virtual reality and the developing child,” in Cognitive Development in Digital Contexts, eds Brooks and F. Blumberg (San Diego, CA: Elsevier), 181–200, 2017.
16. Aminabadi AN, Erfanparast L, Sohrabi A, Oskouei GS, 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 Prospects , 2012; 6:117–124.
17. Al-Khotani A, Bello LA, Christidis N. Effects of audiovisual distraction on children’s behaviour during dental treatment: a randomized controlled clinical trial. Acta Odontol Scand , 2016;74(6):494-50.
18. Adel Zakhary S, Eid M, Wassef N. Audio-visual distraction effect on heart rate in children during dental treatment, a randomized clinical trial. Egypt Dent J,2001; 66(1): 27-34.
19. Javadinejad S, Farajzadegan Z, Madahain M. Iranian version of a face version of the Modified Child Dental Anxiety Scale: Transcultural adaptation and reliability analysis. J Res Med Sci ,2011; 16(7): 872-877.
20. Turk DC, Robinson JP. Assessment of patients with chronic pain-a comprehensive approach. In: Turk DC, Melzack R, eds. Handbook of Pain Assessment, 3rd Edn. New York, NY: Guilford Press, 188–210, 2011.
21. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs , 1988; 14(1): 9-17.
22. Kuchera B. “Oculus Go review”. Polygon. Vox Media, Inc.(1 May 2018) Retrieved 30 August 2019.
23. Kharouba J, Peretz B, Blumer S. The effect of television distraction versus Tell-Show-Do as behavioral management techniques in children undergoing dental treatments. Quintessence Int , 2020; 51(6):486-494.
24. Hoffman HG, Richards TL, Van Oostrom T, Coda BA, Jensen MP, Blough DK et al. The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. AnesthAnalg , 2007; 105(6):1776-83.
25. Dahlquist LM, McKenna KD, Jones KK, Dillinger L, Weiss KE, Ackerman CS. Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychl , 2007; 26(6): 794- 801.
26. Atzori B, Lauro Grotto R, Giugni A, Calabrò M, Alhalabi W, Hoffman HG. Virtual reality analgesia for pediatric dental patients. Front Psychol, 2018; 9: 2265.
27. Sharar SR, Carrougher GJ, Nakamura D, Hoffman HG, Blough DK, Patterson DR. Factors influencing the efficacy of virtual reality distraction analgesia during post burn physical therapy: preliminary results from 3 ongoing studies. Arch Phys Med Rehab , 2007; 88 (12 Suppl 2): S43-S49.
28. Ingersoll BD, Nash DA, Blount RL, Gamber C. Distraction and contingent reinforcement with pediatric dental patients. ASDC J Dent Child, 1984; 51(3): 203- 207.
29. Sullivan C, Schneider PE, Musselman RJ, Dummett CO Jr, Gardiner D. The effect of virtual reality during dental treatment on child anxiety and behavior. ASDC J Dent Child 2000; 67(3):193-6,.
30. Claxton LJ, Ponto KC. Understanding the properties of interactive televised characters. J Appl Dev Psycho, 2013; 34(2): 57–6.
31. Klein SA, Winkelstein ML. Enhancing pediatric health care with music. J Pediatr Health Care , 1996; 10(2):74-81.
32. Prabhakar AR, Marwah N, Raju OS. A comparison between audio and audio-visual distraction techniques in managing anxious pediatric dental patients. J Ind Soc PedodPrev Dent, 2007; 12(3):177-182.
33. Ram D, Shapira J, Holan G, Florella M, Cohen S, Davidovich E. Audiovisual video eyeglass distraction during dental treatment in children. Quintessence Int, 2007; 41:673–679.
34. Van Twillert B, Bremer M, Faber AW. Computer-generated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing changes. J Burn Care , 2007; 28(5):694-702.
35. Hoffman HG, Seibel EJ, Richards TL, Furness TA, Patterson DR, Sharar SR. Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. J Pain , 2006; 7(11):843-850.
36. 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(4):373-378.
37. 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: 15-28.
38. Howard KE, Freeman R. Reliability and validity of a faces version of the modified child dental anxiety scale. Int J Paediatr Dent, 2007; 17(4):281–288.
39. Porritt J, Buchanan H, Hall M, Gilchrist F, Marshman Z. Assessing children’s dental anxiety: a systematic review of current measures. Community Dent Oral Epidemiol , 2013; 41(2):130–142.
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