Does Virtual Reality Reduce Dental Treatment Stress in Patients With Dental Anxiety? A Comparison With Nitrous Oxide Sedation: A Crossover Study.

AIMS: This study aimed to compare the effects of virtual reality (VR) and nitrous oxide (N2O) sedation on anxiety and stress in patients with dental anxiety.

METHODS AND

RESULTS

Eight patients with dental anxiety (five women; mean age, 41 years) with scores ≥ 19 on the Japanese version of the Modified Dental Anxiety Scale underwent three interventions: VR (natural landscapes and ambient music), N2O (30% N2O/70% oxygen), and no intervention (control). Autonomic nervous activity, including low frequency (LF), high frequency (HF), and the LF/HF ratio, was measured. VR significantly reduced LF and LF/HF levels compared to those of the control (p < 0.05), suggesting lower sympathetic nervous system activity, whereas N2O had no effect (p = 0.88, 0.46, respectively). VR and N2O increased HF levels compared to those of the control (p < 0.05), reflecting enhanced parasympathetic activity. Subjective anxiety was lower for VR and N2O interventions (p < 0.05). VR immersion ratings indicated that most participants experienced moderate-to-high immersion levels.

CONCLUSION

VR is an effective, noninvasive option for managing dental anxiety, suggesting greater reductions in sympathetic-related markers than those of control and, in some analyses, N2O, in this small crossover sample. Its accessibility and lack of pharmacological side effects support its integration into patient-centered care, particularly for mild-to-moderate dental anxiety.