Comparative Evaluation of Acupressure and Virtual Reality Distraction for Anxiety Reduction in Children Aged 8-12 Yrs – A Randomized Control Trial”
Keywords:
acupressure, virtual reality, dental anxiety
Abstract
Background and Aim: Anxiety is an obstacle during dental treatment. Acupressure and Virtual reality distraction (VRD) are the newer behaviour modification techniques currently gaining popularity in clinical pediatric dentistry. The purpose of this study is to compare the effect of acupressure and VRD on anxiety in children.
Methods: The current study is a single centered, two arm, explanatory study with parallel design and balanced allocation ratio. A total of 60 children aged 8-12 years meeting inclusion criteria were randomly and equally divide into acupressure (group I) and VRD (group II). Acupressure group was further subdivided into three groups with 10 subjects in each subgroup based on the acupoints selected (EX-HN3, Shen Men, P6). Acupressure beads were employed over the selected acupoints for group I and VRD glasses playing cartoons were put on for group II. Anxiety was measured at four different time intervals at baseline, forty minutes after application of acupressure in group I and five minutes after using virtual reality device in group II, five minutes after local anesthesia, lastly fifteen minutes after completion of treatment. Modified child dental anxiety scale faces version (MCDAS[F]) was used for subjective assessment, Venham’s clinical anxiety rating scale (VCRS) for objective assessment and pulse rate (PR) for physiologic assessment. Recorded values were subjected to statistical analysis.
Results: Both the groups showed significant reduction in anxiety. VRD reduced anxiety to a greater extent than acupressure.
Conclusion: VRD can be used as a successful behaviour modification technique and acupressure can be a viable alternative.
References
1. Avisa P, Kamathan R, Vanjari K, Nuvvula S. Effectiveness of acupressure on dental Anxiety. Pediatr Dent 2018;40(3):177-183.
2. Wang SM, Gaal D, Maranets I, Caldwell-Andrews A, Kain ZN. Acupressure and preoperative parental anxiety: a pilot study. Anesth Analg 2005 Sep;101(3):666-669.
3. Mehta P, Dhapte V, Kadam S, Dhapte V. Contemporary acupressure theraphy: Adroit cure for painless recovery of therapeutic ailments. J Tradit Complement Med 2016;22(7):251- 63.
4. Naik PN, Kiran RA, Yalamanchal S, Kumar VA, Goli S, Vashist N. Acupuncture: an alternative therapy in dentistry and its possible applications. Med Acupunct 2014; 26: 308-14
5. Sun D, Reziwan K, Wang J, Zhang J, Cao M, Wang X et al. Auricular Acupressure Improves Habit Reversal Treatment for Nail Biting. The J of Alternat and Complement Med 2019;25(1):79-85
6. Eijlers R, Utens, E, Staals LM, De Nijs PFA, Berghmans JM, Wijnen RMH et al. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth. Analg 2019 ;129(5): 1344–53 .
7. Raghav K, Van Wijk AJ, Abdullah F, Islam MN, Bernatchez M, De Jongh A. Efficacy of virtual reality exposure therapy for treatment of dental phobia: A randomized control trial. BMC Oral Health 2016 ;16(1): 1-11
8. Scott DS, Hirschman R. Psychological aspects of dental anxiety in adults. J Am Dent Assoc 1982;104:27-31
9. Oosterink FM, De Jongh A, Aartman IH. What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci 2008;116(1):44–51.
10. Yuwannisa M, Runkat J, Indriyanti R. Dental anxiety level of children patient during dental treatment using CFSS-DS questionnaire. Padjadjaran J Dent 2013;25:1–9.
11. Rantavuori K, Lahti S, Hausen H, Seppa L, Karkkainen S. Dental fear and oral health and family characteristics of Finnish children. Acta Odontol Scand 2004;62:207–13
12. Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 2007;7:1.
13. AmruthaVarshini I, Vinay C, Uloopi KS, RojaRamya KS, Chandrasekhar R, Penmatsa C. Effectiveness of pre cooling the injection site, laser biostimulation, and topical local anesthetic Gel in reduction of local anesthesia injection pain in children. Int J Clin Pediatr Dent 2021;14:81 3.
14. Ghalayani P, Mohaghenyan HR, Termee F, Molaesmaeili F. The effect of hypnotism on behaviour control of children during local anesthetic injection. Indian J Dent Sci 2014;6:1-4.
15. Porritt J, Buchanan H, Hall M, Gilchrist F, Marshman Z. Assessing children’s dental anxiety: a systematic review of current measures. Community Dent Oral Epidemiol 2013; 41(2):130-42.
16. Guinot Jimeno F, Yuste Bielsa S, Cuadros Fernández C, Lorente Rodríguez AI, Mercadé Bellido M. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Paediatr Dent 2011;12:239-44
17. Ribeiro MKA, Alcântara-Silva TRM, Oliveira JCM, Paula TC, Dutra JBR, Pedrino GR et al. Music therapy intervention in cardiac autonomic modulation, anxiety, and depression in mothers of preterms: randomized controlled trial. BMC Psychol 2018;6:57.
18. Luo D, Wang X, He J. A comparison between acute pressure block of the sciatic nerve and acupressure: methodology, analgesia, and mechanism involved. J Pain Res 2013;6:589-93
19. Dehghanmehr S, Sargazi GH, Biabani A, Nooraein S, Allahyari J. Comparing the effect of acupressure and foot reflexology on anxiety and depression in hemodialysis patients: A clinical trial. Med SurgNurs J 2019 ;8(4) :e100386
20. Soares MEC, Araújo AS, Pinto ICL, Barbosa LSA, Borsatto MC, Galo R. Effect of acupressure on dental anxiety in children: a pilot study for a randomized clinical trial. J Acupunct Meridian Stud 2022; 15: 307-13.
21. Lindhar PK, Diaz N, Kaur M. Evaluation of Effectiveness of Acupressure in Reduction in Anxiety of Pediatric Dental Patients. J MAR Dent Sci 2022; 5(1):1-7
22. Sisodia M, Kaur H, Garg N, et al. The Effect of Three-point Acupressure Therapy on Anxiety Levels in Children Undergoing Dental Procedures. Int J Clin Pediatr Dent 2024;17(2):16–22.
23. Siasari A, Zamani Afshar M, Sargolzaie F, Saberi N, Dehghanmehr S. The Effect of Acupressure at P6 Point on Anxiety and Depression in Hemodialysis Patients. Compl Med J 2020;10(2):174-83
24. Moosavi S, Mirzaei MA, Reza SP. The effects of acupressure on anxiety nursing, midwifery and operating room students. JGuilan University Med Sci 2009 ;18(71):82-9.
25. Sinha M, Christopher NC, Fenn R, Reeves L. Evaluation of non-pharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatrics 2006;117:1162-8.
26. Aminabadi NA, Erfanparast L, Sohrabi A, et al. The impact of virtual reality distraction on pain and anxiety during dental treatment in 4–6 year-old children: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects 2012;6:117–124.
27. Shetty V, Suresh LR, Hegde AM. Effect of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 5 to 8 Year Old Children. J Clin Pediatr Dent 2019; 43:97–102
28. Ram D, Shapira J, Holan G, Magora F, Cohen S, Davidovich E. Audiovisual video eyeglass distraction during dental treatment in children. Quintessence Int 2010 Sep;41(8):673-679.
29. Sullivan C, Schneider PE, Musselman RJ, Dummett CO Jr, Gardiner D. The effect of virtual reality during dental treatment on child anxiety and behavior. ASDC J Dent for Children 2000;67(3):193–6
30. López-Valverde N, Muriel Fernández J, López-Valverde A, Valero Juan LF, Ramírez JM, Flores Fraile J et al. Use of virtual reality for the Management of anxiety and pain in dental treatments: Systematic review and meta-analysis. J Clin Med 2020 ;9(4):1025-31.
31. Aartman IH, van Everdingen T, Hoogstraten J, Schuurs AH. Appraisal of behavioral measurement techniques for assessing dental anxiety and fear in children: a review. J Psychopath Behav Assessment 1996;18(2):153-71
32. What Part of the Brain Deals With Anxiety? What Can Brains Affected by Anxiety Tell us? . https://www.brainfacts.org/diseases-and-disorders/mental-health/2018/what-part-of-the-brain-deals-with-anxiety-what-can-brains-affected-by-anxiety-tell-us-062918. Accessed 25 february 2025
2. Wang SM, Gaal D, Maranets I, Caldwell-Andrews A, Kain ZN. Acupressure and preoperative parental anxiety: a pilot study. Anesth Analg 2005 Sep;101(3):666-669.
3. Mehta P, Dhapte V, Kadam S, Dhapte V. Contemporary acupressure theraphy: Adroit cure for painless recovery of therapeutic ailments. J Tradit Complement Med 2016;22(7):251- 63.
4. Naik PN, Kiran RA, Yalamanchal S, Kumar VA, Goli S, Vashist N. Acupuncture: an alternative therapy in dentistry and its possible applications. Med Acupunct 2014; 26: 308-14
5. Sun D, Reziwan K, Wang J, Zhang J, Cao M, Wang X et al. Auricular Acupressure Improves Habit Reversal Treatment for Nail Biting. The J of Alternat and Complement Med 2019;25(1):79-85
6. Eijlers R, Utens, E, Staals LM, De Nijs PFA, Berghmans JM, Wijnen RMH et al. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth. Analg 2019 ;129(5): 1344–53 .
7. Raghav K, Van Wijk AJ, Abdullah F, Islam MN, Bernatchez M, De Jongh A. Efficacy of virtual reality exposure therapy for treatment of dental phobia: A randomized control trial. BMC Oral Health 2016 ;16(1): 1-11
8. Scott DS, Hirschman R. Psychological aspects of dental anxiety in adults. J Am Dent Assoc 1982;104:27-31
9. Oosterink FM, De Jongh A, Aartman IH. What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci 2008;116(1):44–51.
10. Yuwannisa M, Runkat J, Indriyanti R. Dental anxiety level of children patient during dental treatment using CFSS-DS questionnaire. Padjadjaran J Dent 2013;25:1–9.
11. Rantavuori K, Lahti S, Hausen H, Seppa L, Karkkainen S. Dental fear and oral health and family characteristics of Finnish children. Acta Odontol Scand 2004;62:207–13
12. Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 2007;7:1.
13. AmruthaVarshini I, Vinay C, Uloopi KS, RojaRamya KS, Chandrasekhar R, Penmatsa C. Effectiveness of pre cooling the injection site, laser biostimulation, and topical local anesthetic Gel in reduction of local anesthesia injection pain in children. Int J Clin Pediatr Dent 2021;14:81 3.
14. Ghalayani P, Mohaghenyan HR, Termee F, Molaesmaeili F. The effect of hypnotism on behaviour control of children during local anesthetic injection. Indian J Dent Sci 2014;6:1-4.
15. Porritt J, Buchanan H, Hall M, Gilchrist F, Marshman Z. Assessing children’s dental anxiety: a systematic review of current measures. Community Dent Oral Epidemiol 2013; 41(2):130-42.
16. Guinot Jimeno F, Yuste Bielsa S, Cuadros Fernández C, Lorente Rodríguez AI, Mercadé Bellido M. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Paediatr Dent 2011;12:239-44
17. Ribeiro MKA, Alcântara-Silva TRM, Oliveira JCM, Paula TC, Dutra JBR, Pedrino GR et al. Music therapy intervention in cardiac autonomic modulation, anxiety, and depression in mothers of preterms: randomized controlled trial. BMC Psychol 2018;6:57.
18. Luo D, Wang X, He J. A comparison between acute pressure block of the sciatic nerve and acupressure: methodology, analgesia, and mechanism involved. J Pain Res 2013;6:589-93
19. Dehghanmehr S, Sargazi GH, Biabani A, Nooraein S, Allahyari J. Comparing the effect of acupressure and foot reflexology on anxiety and depression in hemodialysis patients: A clinical trial. Med SurgNurs J 2019 ;8(4) :e100386
20. Soares MEC, Araújo AS, Pinto ICL, Barbosa LSA, Borsatto MC, Galo R. Effect of acupressure on dental anxiety in children: a pilot study for a randomized clinical trial. J Acupunct Meridian Stud 2022; 15: 307-13.
21. Lindhar PK, Diaz N, Kaur M. Evaluation of Effectiveness of Acupressure in Reduction in Anxiety of Pediatric Dental Patients. J MAR Dent Sci 2022; 5(1):1-7
22. Sisodia M, Kaur H, Garg N, et al. The Effect of Three-point Acupressure Therapy on Anxiety Levels in Children Undergoing Dental Procedures. Int J Clin Pediatr Dent 2024;17(2):16–22.
23. Siasari A, Zamani Afshar M, Sargolzaie F, Saberi N, Dehghanmehr S. The Effect of Acupressure at P6 Point on Anxiety and Depression in Hemodialysis Patients. Compl Med J 2020;10(2):174-83
24. Moosavi S, Mirzaei MA, Reza SP. The effects of acupressure on anxiety nursing, midwifery and operating room students. JGuilan University Med Sci 2009 ;18(71):82-9.
25. Sinha M, Christopher NC, Fenn R, Reeves L. Evaluation of non-pharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatrics 2006;117:1162-8.
26. Aminabadi NA, Erfanparast L, Sohrabi A, et al. The impact of virtual reality distraction on pain and anxiety during dental treatment in 4–6 year-old children: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects 2012;6:117–124.
27. Shetty V, Suresh LR, Hegde AM. Effect of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 5 to 8 Year Old Children. J Clin Pediatr Dent 2019; 43:97–102
28. Ram D, Shapira J, Holan G, Magora F, Cohen S, Davidovich E. Audiovisual video eyeglass distraction during dental treatment in children. Quintessence Int 2010 Sep;41(8):673-679.
29. Sullivan C, Schneider PE, Musselman RJ, Dummett CO Jr, Gardiner D. The effect of virtual reality during dental treatment on child anxiety and behavior. ASDC J Dent for Children 2000;67(3):193–6
30. López-Valverde N, Muriel Fernández J, López-Valverde A, Valero Juan LF, Ramírez JM, Flores Fraile J et al. Use of virtual reality for the Management of anxiety and pain in dental treatments: Systematic review and meta-analysis. J Clin Med 2020 ;9(4):1025-31.
31. Aartman IH, van Everdingen T, Hoogstraten J, Schuurs AH. Appraisal of behavioral measurement techniques for assessing dental anxiety and fear in children: a review. J Psychopath Behav Assessment 1996;18(2):153-71
32. What Part of the Brain Deals With Anxiety? What Can Brains Affected by Anxiety Tell us? . https://www.brainfacts.org/diseases-and-disorders/mental-health/2018/what-part-of-the-brain-deals-with-anxiety-what-can-brains-affected-by-anxiety-tell-us-062918. Accessed 25 february 2025
Published
2026-04-11
How to Cite
Tuppadmath, K., Havale, R., SP, S., Tharay, N., Raj R, shiny, & BM, R. (2026). Comparative Evaluation of Acupressure and Virtual Reality Distraction for Anxiety Reduction in Children Aged 8-12 Yrs – A Randomized Control Trial”. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 12(1). https://doi.org/10.21276/ujds.2026.12.1.8
Section
Original Research Paper
