Effectiveness of virtual reality-based toothbrushing instruction on oral health outcomes: A randomized controlled trial.

BACKGROUND

Oral diseases, significantly driven by dental plaque, remain a major global health concern. Traditional toothbrushing instruction (TBI) methods are often limited in interactivity and long-term skill retention. Recent digital innovations, particularly virtual reality (VR) offer highly interactive educational experiences. This randomized controlled trial (RCT), therefore, aimed to evaluate the effectiveness of VR-based TBI compared to traditional instruction using plaque-disclosing agents.

METHODS

This single-blind, two-arm RCT was conducted at a school of dentistry. Healthy adults aged 20–39 years were recruited and randomly allocated using a computer-generated randomization sequence to either a VR group or control group. The VR group received a structured toothbrushing curriculum delivered through immersive VR (Meta Quest 3), whereas the control group received one-on-one instruction from a dental hygienist using plaque-disclosing agents. The primary outcome was the change in plaque index (PI) from baseline to the two weeks follow-up, and secondary outcomes was oral health knowledge-attitude-behavior (KAB) scores. Participants were blinded to group assignment; however, the investigators who performed the assessments were not.

RESULTS

30 participants were randomized (15 in each group), and all participants were included in the final analysis. The VR group demonstrated a significantly greater mean reduction in PI compared with the control group (0.44 ± 0.48 vs. 0.07 ± 0.26; p = 0.012). Both groups showed improvements in KAB scores. Notably, the VR group achieved significantly greater gain in oral health attitude (39.06 ± 4.80 vs. 38.30 ± 3.66; p = 0.008) and behavior (4.73 ± 1.39 vs. 4.53 ± 1.30; p = 0.004). No harms or unintended events such as dizziness or discomfort was reported.

CONCLUSION

Immersive VR toothbrushing education improved plaque control and enhanced oral health attitudes and behaviors compared with traditional instruction. This approach may also address the limitations of conventional education, including reliance on professionals and restrictions of time and place, and holds promise for broader public health applications. Further research should examine long-term effects and scalability. TRIAL REGISTRATION: : KCT0010914 (Clinical Research Information Service [CRIS]); retrospectively registered on August 19, 2025.