Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia.

Introduction

Anticipation of pain during dental treatment is a frequently reported reason for dental anxiety and fear. Dental anxiety comprises of various physical, mental as well as social components. Anxiety has been defined as a “vague, unpleasant feeling accompanied by a premonition that something undesirable is about to happen”.¹ In the terms of Dental Fear and Anxiety (DFA), Dental anxiety is characterized as significant negative or unpleasant feeling about a dental office and dental procedures; whereas dental phobia is an irrational form of dental anxiety.² Dental anxiety is said to be a major contributor to poor oral health. Several studies have shown that the majority of significant triggers come from the sight, sound, and vibratory sensation of dental drills, and sensation of a local anaesthetic injection which is a major cause; subsequently dental fear is associated with past painful experiences and negative staff behaviour.³ An anxious patient is in a continuous state of restlessness and unease. Children experiencing anxiety during local anesthesia injection gives rise to a significant concern which thus necessitates cognitive - behavioural psychological guidance along with the needed dental treatment.⁴ There are many approaches, including pharmacological and non-pharmacological methods that can be used to reduce children’s perception of pain and anxiety.^5,6 Amongst which the procedures that focuses on cognitive or behavioural methods include practices such as listening to music, dreaming, hypnosis, use of virtual reality goggles, progressive muscle relaxation, and distraction through various interventional techniques.⁷ Attention refers to focusing and processing information from our surroundings. While in anxious state it is important to shift the child’s attention away from the unpleasant stimuli. Distraction works on the principle of diverting the focus and blocking the reception of the unpleasant stimuli that causes anxiety.

Kaleidoscope is an instrument that shows an infinite number of fascinating geometric shapes in the form of a flower, repeating and reflecting images of coloured goggle fragments in the front section in a prism mirroring the inner surface. Increased blinking of the eyes is directly proportional to task difficulty, which in turn produces stress. In a relaxed situation, such as during kaleidoscope viewing, the number of blinks decreases and thus it controls the general physiological excitation.^8,9 Kaleidoscope is being increasingly recognized for its therapeutic and healing value in medical procedures but very few studies on it are available for its use in pediatric dentistry. A study by Aditya et al. was conducted on the pediatric dental population with a kaleidoscope and virtual reality and a positive reduction in VPT scores and pulse rate was reported.¹⁰

Virtual Reality (VR) is a human–computer interface that enables the user to communicate with the computer-generated atmosphere with dynamism. VR actively involves children and is a potent tool in helping children to keep their attention away from frightening and painful procedures. It allows the children to perceive the environment as a safe where they can be free without any risk.^10,11 Atzori et al. (2017) found that VR technology reduced the mean “worst pain” from 3.80 to 2.20, hence indicating that VR can help effectively distract and engage children undergoing dental treatments.¹²

Hence the focus of this study, according to the available literature, is to evaluate and compare the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children.

Discussion

There is a limited literature available regarding the use kaleidoscope as a distraction method for children undergoing dental procedures. Aditya et al. conducted a study to compare various methods of distraction to control anxiety in 60 children between the age group of six - nine years divided into four groups. Group 1 was fidget spinner (FS), Group 2 was kaleidoscope, Group 3 Virtual reality and Group 4 was control group with no distraction. The child’s self-reported anxiety levels using Venham’s picture test (VPT); the pulse oximeter was used to measure physiological signs of oxygen saturation and pulse rate at three intervals i.e. before, during, and after the IANB procedure. The VPT values were lower in the first three groups. Hence it was concluded that Fidget spinner, kaleidoscope, and virtual reality seem to be effective distraction methods and can be recommended as effective approaches to help reduce children’s dental anxiety during IANB procedures.¹³ Tailor et al. found out that when Virtual reality (VR) and on-screen audio-visual distraction techniques were used in the age group of 4-8 years the VPT scores were significantly reduced in VR group as compared to On-screen aid group in the first two visits that included procedures of screening, cavity preparation and L.A. administration.¹⁴ The effect of cartoon display and kaleidoscope in children between the ages of 5-12years was assessed and the anxiety levels were scored using Children’s Fear Scale by Molu and Açıkgöz, during echocardiography procedure. A significant difference is evident in anxiety scores before and during between all the intervention groups and it was concluded that use of kaleidoscope is an effective measure in reducing anxiety.¹⁵ Distraction by Kaleidoscope and VR is a promising area for future research in pediatric dentistry because of the rising interest in non-pharmacological methods for behaviour management.