Immersive Distraction: The Role of Virtual Reality in Managing Pain and Anxiety Among Pediatric Dental Patients — A Comprehensive Review
Virtual Reality in Pediatric Dentistry
Keywords:
Virtual reality, pediatric dentistry, pain management, dental anxiety, behavioral management, immersive distraction
Abstract
Pain and anxiety remain major behavioral barriers to successful dental treatment in children. Virtual Reality (VR)—an immersive digital environment that redirects attention away from unpleasant stimuli—has emerged as a promising non-pharmacological tool for managing dental fear and pain in pediatric patients. This review aims to critically evaluate and synthesize the current evidence regarding the effectiveness, underlying mechanisms, benefits, and limitations of VR in reducing pain and anxiety during pediatric dental procedures. An integrative literature review was conducted across databases until August, 2025. It was found that VR distraction has been shown to significantly lower self-reported pain and anxiety compared with conventional behavioral management techniques. Physiological markers, including heart rate and salivary cortisol, were also reduced in children exposed to VR. Most participants experienced positive emotions, greater comfort, and improved cooperation during dental procedures. However, variability in VR hardware, software content, and study methodologies limits the ability to directly compare results across studies. Additional considerations such as cost, hygiene protocols, and practical implementation pose challenges for routine clinical integration. In conclusion, VR provides a safe, child-friendly, and engaging approach to managing pain and anxiety during pediatric dental procedures. While existing evidence is encouraging, further large-scale, standardized, and long-term studies are needed to confirm its clinical efficacy and feasibility.
References
1. Cianetti S, Lombardo G, Lupatelli E, Pagano S, Abraha I, Montedori A, et al. Dental fear/anxiety among children and adolescents: A systematic review. Eur J Paediatr Dent. 2017;18(2):121–130.
2. Wright GZ, Kupietzky A. Behavior Management in Dentistry for Children. 2nd ed. Wiley Blackwell; 2014.
3. Kupietzky A, Ram D. Child management in the dental office: Behavior modification principles. Isr Med Assoc J. 2005;7(9):629–634.
4. Hoffman HG, Patterson DR, Carrougher GJ. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain. 2000 Sep;16(3):244-50.
5. Melzack R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150(3699):971–979.
6. Garrett B, Taverner T, Masinde W, Gromala D, Shaw C, Negraeff M. A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice. Clin J Pain. 2014 Dec;30(12):1089-98.
7. Shetty V, Suresh LR, Hegde AM. Effectiveness of virtual reality distraction in the management of anxiety and pain during dental procedures in children. Int J Paediatr Dent. 2019;29(5):635–642.
8. Al-Halabi MN, Bshara N, AlNerabieah Z. Effect of virtual reality distraction on pain and anxiety during dental treatment in 5–8 year-old children: A randomized clinical trial. Int J Paediatr Dent. 2020;30(5):676–682.
9. Gold JI, Belmont KA, Thomas DA. The neurobiology of virtual reality pain control: Implications for pediatric populations. J Pain Res. 2007;10(5):123–129.
10. Hoffman HG, Sharar SR, Coda B, Everett JJ, Ciol M, Richards T, et al. Manipulating presence influences the magnitude of virtual reality analgesia. Pain. 2004;111(1–2):162–168.
11. Hoffman HG, Richards TL, Coda B, Bills AR, Blough D, Richards AL, et al. Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI. Neuroreport. 2004 Jun 7;15(8):1245-8.
12. Wiederhold BK, Gao K, Sulea C, Wiederhold MD. Virtual reality as a distraction technique in chronic pain management: A systematic review. Cyberpsychol Behav Soc Netw. 2014;17(6):346–352.
13. Schneider SM, Hood LE. Virtual reality: A distraction intervention for chemotherapy side effects. Oncol Nurs Forum. 2007;34(1):13–20.
14. Li A, Montano Z, Chen VJ, Gold JI. Virtual reality and pain management: Current trends and future directions. Pain Manag. 2011;1(2):147–157.
15. Pakkar P, Mirza MB, Shyam S. Virtual reality as a distraction technique for management of pain and anxiety in pediatric dental patients: A randomized clinical trial. BMC Oral Health. 2024;24:152.
16. Slater M, Wilbur S. A framework for immersive virtual environments (FIVE): Speculations on the role of presence in virtual environments. Presence. 1997;6(6):603–616.
17. Malloy KM, Milling LS. The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin Psychol Rev. 2010;30(8):1011–1018.
18. Chirico A, Lucidi F, De Laurentiis M, Milanese C, Napoli A, Giordano A. Virtual Reality in Health System: Beyond Entertainment. A Mini-Review on the Efficacy of VR During Cancer Treatment. J Cell Physiol. 2016 Feb;231(2):275-87.
19. Arora M, Aggarwal A, Singhal A. Dental fear and its management in children. Eur J Paediatr Dent. 2019;20(4):255–260.
20. Li X, Yan B, Wang Y. Designing engaging virtual reality content for pediatric patients: A usability study. Appl Sci. 2023;13(9):5603.
21. Das DA, Grimmer KA, Sparnon AL, McRae SE, Thomas BH. The efficacy of virtual reality distraction for pain reduction in children during medical procedures. Br J Anaesth. 2005;95(1):97–101.
22. Kwon JS, Lee JY, Choi SH. Application of immersive technology for behavior management in pediatric dentistry. Front Virtual Real. 2021;2:699383.
23. Shetty V, Suresh LR, Hegde AM. Effectiveness of virtual reality distraction in the management of anxiety and pain during dental procedures in children. Int J Paediatr Dent. 2019;29(5):635–642.
24. Hennessy C, Kim J, Sirlin EA. Antimicrobial materials in VR headset design for healthcare. J Hosp Infect Control. 2022;110:35–42.
25. Rizzo AS, Shilling R. Clinical virtual reality tools: The next frontier in healthcare. Virtual Real. 2017;21(1):1–14.
26. Gao K, Wiederhold MD, Wiederhold BK. Clinical applications of virtual environments for pain control. Stud Health Technol Inform. 2014;199:62–67.
27. Eren B, Dursun E. Virtual reality in pediatric dentistry: Systematic review and meta-analysis. Eur Arch Paediatr Dent. 2023;24(1):1–15.
28. Cunningham A, McPolin O, Fallis R, Coyle C, Best P, McKenna G. A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety. BMC Oral Health. 2021 May 7;21(1):244.
29. Eren B, Dursun E. Virtual reality in pediatric dentistry: Systematic review and meta-analysis. Eur Arch Paediatr Dent. 2023;24(1):1–15.
30. Barros Padilha DX, Veiga NJ, Mello-Moura ACV, Nunes Correia P. Virtual reality and behaviour management in paediatric dentistry: a systematic review. BMC Oral Health. 2023 Dec 12;23(1):995.
31. Niharika K, Gupta N, Gokhale N. Effect of virtual reality distraction on dental anxiety and pain perception in children: A randomized controlled trial. J Indian Soc Pedod Prev Dent. 2021;39(3):253–258.
32. Shetty V, Hegde AM. Efficacy of virtual reality distraction in managing dental anxiety among pediatric patients. Eur Arch Paediatr Dent. 2022;23(4):345–352.
33. Deci EL, Ryan RM. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. Guilford Press; 2017.
34. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
35. Wiederhold BK, Riva G. Virtual reality in health care: An editorial. Cyberpsychol Behav Soc Netw. 2019;22(2):75–76.
2. Wright GZ, Kupietzky A. Behavior Management in Dentistry for Children. 2nd ed. Wiley Blackwell; 2014.
3. Kupietzky A, Ram D. Child management in the dental office: Behavior modification principles. Isr Med Assoc J. 2005;7(9):629–634.
4. Hoffman HG, Patterson DR, Carrougher GJ. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain. 2000 Sep;16(3):244-50.
5. Melzack R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150(3699):971–979.
6. Garrett B, Taverner T, Masinde W, Gromala D, Shaw C, Negraeff M. A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice. Clin J Pain. 2014 Dec;30(12):1089-98.
7. Shetty V, Suresh LR, Hegde AM. Effectiveness of virtual reality distraction in the management of anxiety and pain during dental procedures in children. Int J Paediatr Dent. 2019;29(5):635–642.
8. Al-Halabi MN, Bshara N, AlNerabieah Z. Effect of virtual reality distraction on pain and anxiety during dental treatment in 5–8 year-old children: A randomized clinical trial. Int J Paediatr Dent. 2020;30(5):676–682.
9. Gold JI, Belmont KA, Thomas DA. The neurobiology of virtual reality pain control: Implications for pediatric populations. J Pain Res. 2007;10(5):123–129.
10. Hoffman HG, Sharar SR, Coda B, Everett JJ, Ciol M, Richards T, et al. Manipulating presence influences the magnitude of virtual reality analgesia. Pain. 2004;111(1–2):162–168.
11. Hoffman HG, Richards TL, Coda B, Bills AR, Blough D, Richards AL, et al. Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI. Neuroreport. 2004 Jun 7;15(8):1245-8.
12. Wiederhold BK, Gao K, Sulea C, Wiederhold MD. Virtual reality as a distraction technique in chronic pain management: A systematic review. Cyberpsychol Behav Soc Netw. 2014;17(6):346–352.
13. Schneider SM, Hood LE. Virtual reality: A distraction intervention for chemotherapy side effects. Oncol Nurs Forum. 2007;34(1):13–20.
14. Li A, Montano Z, Chen VJ, Gold JI. Virtual reality and pain management: Current trends and future directions. Pain Manag. 2011;1(2):147–157.
15. Pakkar P, Mirza MB, Shyam S. Virtual reality as a distraction technique for management of pain and anxiety in pediatric dental patients: A randomized clinical trial. BMC Oral Health. 2024;24:152.
16. Slater M, Wilbur S. A framework for immersive virtual environments (FIVE): Speculations on the role of presence in virtual environments. Presence. 1997;6(6):603–616.
17. Malloy KM, Milling LS. The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin Psychol Rev. 2010;30(8):1011–1018.
18. Chirico A, Lucidi F, De Laurentiis M, Milanese C, Napoli A, Giordano A. Virtual Reality in Health System: Beyond Entertainment. A Mini-Review on the Efficacy of VR During Cancer Treatment. J Cell Physiol. 2016 Feb;231(2):275-87.
19. Arora M, Aggarwal A, Singhal A. Dental fear and its management in children. Eur J Paediatr Dent. 2019;20(4):255–260.
20. Li X, Yan B, Wang Y. Designing engaging virtual reality content for pediatric patients: A usability study. Appl Sci. 2023;13(9):5603.
21. Das DA, Grimmer KA, Sparnon AL, McRae SE, Thomas BH. The efficacy of virtual reality distraction for pain reduction in children during medical procedures. Br J Anaesth. 2005;95(1):97–101.
22. Kwon JS, Lee JY, Choi SH. Application of immersive technology for behavior management in pediatric dentistry. Front Virtual Real. 2021;2:699383.
23. Shetty V, Suresh LR, Hegde AM. Effectiveness of virtual reality distraction in the management of anxiety and pain during dental procedures in children. Int J Paediatr Dent. 2019;29(5):635–642.
24. Hennessy C, Kim J, Sirlin EA. Antimicrobial materials in VR headset design for healthcare. J Hosp Infect Control. 2022;110:35–42.
25. Rizzo AS, Shilling R. Clinical virtual reality tools: The next frontier in healthcare. Virtual Real. 2017;21(1):1–14.
26. Gao K, Wiederhold MD, Wiederhold BK. Clinical applications of virtual environments for pain control. Stud Health Technol Inform. 2014;199:62–67.
27. Eren B, Dursun E. Virtual reality in pediatric dentistry: Systematic review and meta-analysis. Eur Arch Paediatr Dent. 2023;24(1):1–15.
28. Cunningham A, McPolin O, Fallis R, Coyle C, Best P, McKenna G. A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety. BMC Oral Health. 2021 May 7;21(1):244.
29. Eren B, Dursun E. Virtual reality in pediatric dentistry: Systematic review and meta-analysis. Eur Arch Paediatr Dent. 2023;24(1):1–15.
30. Barros Padilha DX, Veiga NJ, Mello-Moura ACV, Nunes Correia P. Virtual reality and behaviour management in paediatric dentistry: a systematic review. BMC Oral Health. 2023 Dec 12;23(1):995.
31. Niharika K, Gupta N, Gokhale N. Effect of virtual reality distraction on dental anxiety and pain perception in children: A randomized controlled trial. J Indian Soc Pedod Prev Dent. 2021;39(3):253–258.
32. Shetty V, Hegde AM. Efficacy of virtual reality distraction in managing dental anxiety among pediatric patients. Eur Arch Paediatr Dent. 2022;23(4):345–352.
33. Deci EL, Ryan RM. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. Guilford Press; 2017.
34. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
35. Wiederhold BK, Riva G. Virtual reality in health care: An editorial. Cyberpsychol Behav Soc Netw. 2019;22(2):75–76.
Published
2025-12-15
How to Cite
Aravinda , V. S. S., Venkat , M. J., D’souza, O. K., Teja , K. D. V., P., T., & Dukle , S. (2025). Immersive Distraction: The Role of Virtual Reality in Managing Pain and Anxiety Among Pediatric Dental Patients — A Comprehensive Review. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 11(4). https://doi.org/10.21276/ujds.2025.11.4.13
Section
Review Article
