Clinical Effect of Virtual Reality to Relieve Anxiety During Impacted Mandibular Third Molar Extraction Under Local Anesthesia

Purpose: Many patients undergoing dental treatment have experienced pain associated with the treatment and become anxious and/or fearful of treatment Anxiety and fear have conventionally been managed with the use of inhalation anesthesia or tranquilizers. However, their physical effects must also be considered, and they will not be suitable for all patients. The purpose of the present study was to assess the clinical effect of virtual reality (VR) to relieve anxiety during impacted mandibular third molar extraction under local anesthesia. Materials and Methods: We used VR to alleviate anxiety concerning surgical treatment for 51 patients undergoing impacted mandibular third molar extraction under local anesthesia. Fear and anxiety before and after treatment were evaluated by a questionnaire that included a visual analog scale (VAS). The post-treatment questionnaire asked patients to evaluate their satisfaction on a 5-level Likert scale. Heart rate variability (HRV) was also analyzed in the VR group using acceleration plethysmography. Results: Anxiety had decreased among the patients who had used VR (VR group), with a difference of -13.3 +/- 28.7 mm in anxiety measured using a VAS before and during treatment. In contrast, it had increased by 4.0 +/- 22.3 mm in the 49 patients who had not used VR. Furthermore, the post-treatment questionnaire administered to the VR group revealed that 92% had reported that their anxiety had decreased. Objective evaluation by HRV measurement also showed a sympathetic nerve-predominant state before treatment. However, with VR use during treatment, parasympathetic nervous activity was predominant, with a stable balance between the 2. No patient showed symptoms suggestive of cybersickness. Conclusions: These results have shown that the use of VR could be valuable during dental treatment, especially extractions and surgical treatment. (C) 2019 American Association of Oral and Maxillofacial Surgeons