Patients experiencing severe dental fear or phobia benefit from a form of exposure therapy that involves repeatedly encountering anxiety-inducing situations, such as facing an injection needle or hearing the sound of a dental drill. However, this therapy often involves an in-person dental visit -- a barrier some patients are reluctant or unwilling to face.
The study authors hypothesized that these patients could instead use virtual reality to expose themselves to a simulated dental office. They described how their virtual reality exposure therapy (VRET) regimen benefited two patients in the August issue of the Journal of the California Dental Association.
"Using VR for treatment of phobias involves controlled exposure of phobic patients to the virtual sights and sounds of their fear-provoking stimuli," wrote the authors, led by Kumar Raghav Gujjar, BDS, MDS, from the Charles Sturt University School of Dentistry and Health Sciences in Australia (CDA Journal, August 2019, Vol. 47:8, pp. 513-520). "VRET integrates real-time computer graphics and body-tracking devices to systematically expose patients to an immersive, interactive, and highly controllable computer-generated virtual environment with rich sensory visual, olfactory, and auditory cues within a contextually relevant setting."
The researchers' VRET system consists of a VR headset that immerses patients in a virtual dental operatory. The system walks patients through a hierarchy of potentially anxiety-inducing scenarios:
- The patient sits in a simulated dental chair and looks at nearby dental tools and instruments.
- A dentist walks toward the patient as if about to do a procedure.
- The dentist brings a dental mirror toward the patient as if about to do a procedure.
- The dentist caries a dental drill without an audible sound.
- The dentist caries a dental drill with an audible sound.
Patients go through the scenes in order. They do not advance from one scene to the next until their level of distress falls to minimal or none, and they can repeat scenes as necessary. Therapy is considered successful when a patient can go through all five scenarios in a single session.
“VRET resulted in noteworthy reductions in state anxiety, dental trait anxiety, and behavioral avoidance.”
— Kumar Raghav Gujjar, BDS, MDS, and colleagues
The researchers tested the VRET system on two patients at an oral health center in Kota Damansara, Malaysia.
The first patient, a 40-year-old woman, had a painful lower right molar. She reported high dental anxiety scores and a history of avoiding the dentist.
Over three sessions, the patient worked her way through the five scenes until she could complete them all without signs of fear. Her dental anxiety scores decreased from the first visit, and the patient later went on to schedule her dental appointment, which included scaling, extractions, and restorations.
The second patient, a 10-year-old girl, went through all five scenes in a single VRET session. The 23-minute session reduced her dental anxiety scores, and she went on to successfully undergo scaling and restorations.
"In the present report, VRET resulted in noteworthy reductions in state anxiety, dental trait anxiety, and behavioral avoidance," the authors wrote. "The self-reported measures were validated by patients' behavioral changes when they scheduled their dental appointments and underwent dental treatment. In addition, both patients had no dental phobia at the six-month follow-up."
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