Effects of a Virtual Reality Game on Children’s Anxiety During Dental Procedures (VR-TOOTH): Protocol for a Pilot Randomized Controlled Trial
Authors: Wu Wenjia , Le May Sylvie , Hung Nicole , Fortin Olivier , Genest Christine , Francoeur Maxime , Guingo Estelle , St-Arneault Kate , Sylfra Annie , Vu An Kateri , Carmel Janick , Lessard Laurence , Cara-Slavich Stephany , De Koven Katheryn , Paquette Julie , Hoffman Hunter , Asselin Marie-Eve 
Published: September 2023

Background
Dental fear and anxiety (DFA) is a condition that affects approximately one-quarter of children and adolescents. It is a significant cause for pediatric patients to avoid dental care later in adulthood. Lack of patient cooperation due to DFA can create an environment of stress, often obligating dentists to end appointments prematurely and consider alternative pharmacological treatment options. Virtual reality (VR) use during dental care, providing an immersive experience through sensory stimuli, is potentially an additional nonpharmacologic tool to better manage DFA in children with special health care needs (SHCN) undergoing dental procedures.

Objective
This pilot study aims to assess the feasibility and acceptability of VR immersion as a tool to reduce DFA in pediatric special needs patients undergoing dental procedures. The study also aims to gain insight on parent and health care provider perspectives on the use of VR during dental appointments.

Methods
This pilot randomized controlled trial study will follow a parallel design including 2 groups: a control group (clinic’s standard care using a wall TV) and an experimental group (using a VR game). We will randomize 20 participants to either group. Recruitment will be carried out at the dental clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary-quaternary care center that mostly serves pediatric patients with SHCN. The primary outcome will be patient recruitment rates and completion rates of planned procedures. DFA in children will be assessed using both an observation-based proxy assessment with the Venham Anxiety and Behavior Rating Scale and physiological assessments using parameters such as change in heart rate and levels of salivary alpha-amylase as a stress biomarker before and 10 minutes after the procedure. Sociodemographic characteristics, measures of the levels of parent and health care professional satisfaction, occurrence of side effects, and any deviation from normal procedure length will also be collected. Descriptive statistics, nonparametric tests, and effect sizes will be used for demographic and clinical variables and to present parent and health care professional satisfaction levels as well as procedural time.

Results
This study will be conducted from May 2023 to May 2024, with results expected to be available in December 2024.

Conclusions
The pilot study will provide insight on the feasibility and acceptability of VR use in clinical dentistry to reduce DFA for pediatric patients with SHCN. This study will guide future research on VR use in pediatric dentistry and can serve as a framework for a larger randomized clinical trial.

Trial Registration
ClinicalTrials.gov NCT05898100; https://classic.clinicaltrials.gov/ct2/show/NCT05898100

International Registered Report Identifier (IRRID)
DERR1-10.2196/49956