## 3 Results and Discussion
To verify the effectiveness of VR goggles, a clinical study was conducted in 2010 with 120 children aged 5 to 10 years with a need for surgical procedures requiring anesthetic injection in the lower arch. The children were divided into a control group consisting of 35 boys and 24 girls using nitrous oxide and an audiovisual or study group consisting of 30 girls and 31 boys using a distraction technique involving VR goggles with headphones [35]. When obtaining the results of the study, they observed that the general behavior of the audiovisual group was qualified as excellent, while the qualification obtained by the patients in the control group was very good, which is significantly inferior to the other group. At the end of the treatments, it was indicated that 85% of the children in the audiovisual group indicated maximum satisfaction, so the authors support the use of VR goggles for behavioral management in cases where pharmacological means are not feasible but indicate certain limitations to consider:  
1. Whether the patient wears glasses and whether VR glasses can be worn over the patient's glasses without discomfort;
2. The size of the glasses and the child, as they may be too large for very small patients. A clinical article published in 2012 studied 48 healthy children between 5 and 7 years old. They divided the patients into two groups of 42 children each, creating a control group in which only the SAY-SHOW-DO technique was used and a study group in which the distraction technique was applied using VR goggles with headphones. The researchers wanted to test the efficacy of the VR goggles when applying inferior alveolar nerve anesthesia [36]. The study showed preinjection scores for fear and pain of 0.19 in the study group and 0.12 in the control group. The difference was noted during the administration of anesthesia, where the control group scores were 3.71 and the study group scores were 2.67, confirming that the difference was statistically significant. The authors also indicated that the study group showed lower levels of pain, thus supporting the efficacy of VR goggles. A study conducted in 2016 by Dr. [PERSON] gathered 40 children aged 6-10 years with a need for three types of treatments (oral prophylaxis, restorative treatment and pulectomies) [37]. They divided the participants into two groups: one study group comprised 20 patients who were fitted with VR goggles and hearing aids, and the other had a total of 20 patients who were treated with conventional behavior management techniques. The results were divided by treatment, and the following results were obtained:  
* Oral prophylaxis: the study group obtained a mean pain score of 0.35, significantly lower than that of the control group, which was 1.10, and the pulse rate results were not statistically significant between the two groups. * Dental restoration: the mean pain score was 1.25 for the study group and 2.05 for the control group, which makes it statistically significant; the pulse rate was lower for the study group with a total of 113.35, whereas it was 117.7 for the control group, a statistically significant difference. * Pulpectomy: the study group had a lower score of 2.20, while the control group had a score of 3.55, which is statistically significant; the score obtained for the pulse frequency for this type of treatment was not statistically significant. Based on these results, they were able to conclude that the use of VR goggles is a promising technology that provides an alternative way to reduce anxiety in children. In another study conducted between 2018 and 2019, they used a total of 68 healthy patients between 6 and 8 years old, who were randomly divided into two groups, the first with 34 patients who used the audiovisual medium Rimax IVision 5.0 to visualize cartoons and the second with 34 patients who played PlayStation video games. The anxiety of each patient was evaluated using the modified Corah dental anxiety scale at the beginning and at the end with the Venham image scale. The heart rate was also taken into account [2].