Comparing Auditory vs Virtual Reality Relaxation in Reducing Dental Anxiety

Caley Mintz¹Kenneth J Spolnik²Drashty Paresh Mody²Ygal Ehrlich²George Eckert³Leslie Flowers²Stuart Schrader^2*

• ¹Endodontist, Indianapolis, IN, USA, Indianapolis, United States
• ²School of Dentistry, Indiana University, Indianapolis, United States
• ³Indiana University School of Medicine, Indianapolis, United States

Approximately 20% of American adults experience dental anxiety, creating a psychological and physiological barrier to dental treatment. There is a clear need for novel approaches to mitigate chair-side anxiety, especially for endodontic treatment appointments. This study aimed to investigate two nonpharmacological dental anxiety management approaches: (1) A brief auditory-alone relaxation (ABR) and a brief virtual reality relaxation (VRR), and their hypothesized effects on dental anxiety and physiological biometric scores. 58 participants needing nonsurgical root canal treatment were assigned randomly to two groups: ABR or VRR. The ABR group received earphones to listen to a guided recording (conscious, diaphragmatic breathing and a guided body scan). The VRR group received Meta Quest 2 virtual reality headsets for a 360° inclusive and integrative experience (ambient music, high-resolution graphic illustrations, and immersive scenery). The participants' self-reported anxiety was assessed before and after treatment through the State Trait Anxiety Indicator (STAI-State & Trait) and Visual Analog Scale (VAS). Biometric traits such as heart rate (HR) and blood pressure were measured before (T0), during (T1), and after (T2) treatment. Both VRR and ABR significantly decreased anxiety, as reported by the STAI-State questionnaire (p = <0.001 for both) and the STAI-Trait questionnaire (p = 0.025 ABR; p = <0.001 VRR), throughout the appointment. The self-reported VAS scores also were reduced significantly from before to after treatment (p = <0.001 for both ABR and VRR). The heart rate also decreased from before to after treatment in both groups (p=0.019 for the ABR group, p=0.026 for the VRR group). Changes in blood pressure showed mixed results with no significant differences between the two groups. This is the first study to investigate the effects of ABR and VRR on dental anxiety. Both the ABR and VRR groups experienced significant reductions in anxiety, pain, and heart rate after intervention. We demonstrated that nonpharmacological techniques, such as ABR and VRR, can be valid, noninvasive approaches to reduce anxiety before dental treatment, specifically endodontic therapy. However, given the small cohort in this study, it will be necessary to reproduce the methods with different types of ABR and VRR applications to validate the results.