Does immersive virtual reality reduce pain and anxiety in pediatric dentistry? A systematic review and meta-analysis

Abstract

Introduction: There is a bidirectional relationship between anxiety and pain with mutual potentiation. We already have many treatments, pharmacological (anxiolytics, conscious sedation) or not (tell-show-do, hypnosis, music), to control anxiety and/or pain. Of all the digital approaches for the treatment of pain, virtual reality (VR) has for several years been the subject of studies and tests on different types of pain, with promising results. The objective of this meta-analysis is to determine the effects of VR on pain and anxiety in a pediatric population during dental care including minor oral surgery. Materials and method: Our research was carried out using different databases such as PubMed, Web of Science and Cochrane. Review Manager 5.4.1 software was used to perform the quantitative analysis. Randomised controlled trials evaluating pain and/or anxiety in children who received dental treatment and comparing immersive virtual reality to usual care were included. Results: 5 articles were finally selected. Anxiety was measured by the Children's Fear Survey Schedule-Dentale Subscale and by the heart rate which showed a significant reduction of anxiety thanks to the VR (SMD = −0,53, 95%CI = −0,77, −0,28, p<0,0001 and SMD = −0,91, 95% CI = −1,31, −0,51, p<0,00001 respectively). The pain was measured by the Wong-Baker Faces Scale which showed a significant reduction thanks to the VR (SMD = −0,99, 95%CI = −1,24, −0,74, p<0,00001). Discussion: There is a clinical heterogeneity between the studies as well as significant statistical heterogeneity in all the meta-analyses (≥65%). All studies are single-census, with a low number of subjects included (varying from 54 to 104) and a limited age range (from 4 to 12). The population within the studies can be considered heterogeneous since it includes young children and pre-adolescents. Last but not least, it exists a publication bias that decreases the credibility of the results of this review which might influence the validity of the evidence. Conclusion: This meta-analysis is therefore innovative since it is not only the first to carry out a quantitative analysis but also the first to include only VR headsets and to exclude all studies on audio-visual distraction. Our work confirms the very recent interest of immersive VR in reducing pain and anxiety in pediatric dentistry. Nevertheless, further studies are needed to reach a definitive conclusion.