Dental Anxiety, Impacted Mandibular Third Molar
Conditions
Keywords
Virtual Reality, Immersive Virtual Environment, Third Molar Surgery, Oral Surgery, Nature-Based Virtual Reality, Art-Gallery Virtual Reality, Nonpharmacological Anxiety Management
Brief summary
This randomized controlled study evaluated whether the content of an immersive virtual reality environment influenced anxiety in adults undergoing surgical removal of an impacted mandibular third molar. A total of 75 patients aged 18-40 years with elevated dental anxiety were randomly assigned in a 1:1:1 ratio to a nature-based virtual reality group, an art-gallery virtual reality group, or a control group receiving conventional care without virtual reality. Participants in the two virtual reality groups wore the same headset and headphones and viewed standardized 360-degree content from the beginning of surgery until completion of the procedure. Anxiety was assessed using the Modified Dental Anxiety Scale, the State-Trait Anxiety Inventory-State subscale, and an 11-point numerical anxiety rating scale. Systolic and diastolic blood pressure, heart rate, and peripheral oxygen saturation were also recorded. Measurements were obtained before local anesthesia, after local anesthesia but before surgery and virtual reality exposure, and immediately after wound closure, as applicable. The study compared changes in anxiety and physiological measures among the three groups and examined whether nature-based and art-gallery virtual reality content produced different responses.
Interventions
BEHAVIORALNature-Based Virtual Reality
Participants viewed standardized investigator-developed nature-based 360-degree immersive content using a virtual reality headset and headphones. The intervention began at the start of surgery and continued until completion of the procedure. Exposure duration was determined by surgical duration and did not exceed 30 minutes.
BEHAVIORALArt-Gallery Virtual Reality
Participants viewed standardized investigator-developed art-gallery 360-degree immersive content using the same virtual reality headset, headphones, audiovisual settings, and exposure period as the nature-based virtual reality group. The intervention began at the start of surgery and continued until completion of the procedure. Exposure duration was determined by surgical duration and did not exceed 30 minutes.
Sponsors
Recep Tayyip Erdogan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Participants were randomly assigned in a 1:1:1 ratio to nature-based virtual reality, art-gallery virtual reality, or conventional care without virtual reality.
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 40 years * American Society of Anesthesiologists (ASA) physical status I * Presence of an impacted mandibular third molar for which surgical removal was indicated * Pell and Gregory Class II, position B impaction * Vertical or mesioangular impaction according to Winter's classification * Preoperative Modified Dental Anxiety Scale (MDAS) score of 11 or higher * Ability to understand the study procedures and complete the questionnaires * Provision of written informed consent
Exclusion criteria
* A systemic or psychiatric condition considered likely to influence anxiety responses * Regular use of medication that could alter anxiety or autonomic responses * Use of antipsychotic or anxiolytic medication * Smoking 10 or more cigarettes per day * Previous surgical removal of an impacted tooth * Acute infection in the operative region * Pregnancy * Severe visual or hearing impairment that could prevent adequate virtual reality exposure * Inability to tolerate or correctly use the virtual reality headset * Surgical duration exceeding 30 minutes * Withdrawal of consent at any stage of the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Modified Dental Anxiety Scale Score | From before local anesthesia (T0) to immediately after wound closure and completion of the procedure (T2), during a single surgical visit | Dental anxiety was assessed using the five-item Modified Dental Anxiety Scale (MDAS). Each item is scored from 1 to 5, producing a total score ranging from 5 to 25, with higher scores indicating greater dental anxiety. The outcome was the change in total MDAS score from T0 to T2, calculated as the T2 score minus the T0 score. |
| Change in State-Trait Anxiety Inventory-State Subscale Score | From before local anesthesia (T0) to immediately after wound closure and completion of the procedure (T2), during a single surgical visit | State anxiety was assessed using the 20-item State-Trait Anxiety Inventory-State subscale (STAI-S). Each item is scored from 1 to 4, producing a total score ranging from 20 to 80, with higher scores indicating greater state anxiety. The outcome was the change in total STAI-S score from T0 to T2, calculated as the T2 score minus the T0 score. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Anxiety Visual Analog Scale Score | At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2) | Momentary anxiety was assessed using the study-designated Anxiety Visual Analog Scale (VAS-A), administered as an 11-point whole-number response scale ranging from 0 to 10. A score of 0 indicated no anxiety, whereas a score of 10 indicated the highest perceived anxiety. Changes in VAS-A scores across T0, T1, and T2 were compared among the study groups. |
| Change in Systolic Blood Pressure | At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2) | Systolic blood pressure was measured in millimeters of mercury (mmHg) using the same automated monitoring device during a standardized five-minute assessment period at each time point. Changes in systolic blood pressure across T0, T1, and T2 were compared among the study groups. |
| Change in Diastolic Blood Pressure | At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2) | Diastolic blood pressure was measured in millimeters of mercury (mmHg) using the same automated monitoring device during a standardized five-minute assessment period at each time point. Changes in diastolic blood pressure across T0, T1, and T2 were compared among the study groups. |
| Change in Heart Rate | At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2) | Heart rate was measured in beats per minute (bpm) using the same automated monitoring device during a standardized five-minute assessment period at each time point. Changes in heart rate across T0, T1, and T2 were compared among the study groups. |
| Change in Peripheral Oxygen Saturation | At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2) | Peripheral oxygen saturation was measured as a percentage (SpO2) using the same monitoring device during a standardized five-minute assessment period at each time point. Changes in peripheral oxygen saturation across T0, T1, and T2 were compared among the study groups. |
Countries
Turkey (Türkiye)
Outcome results
None listed