Comparing auditory vs. virtual reality relaxation in reducing dental anxiety.

Background: Up to 20% of American adults experience dental anxiety, creating a psychological and physiological barrier to starting, completing, and/or finishing dental treatment. There is a clear need for novel approaches to mitigate chair-side anxiety, especially for endodontic treatment appointments. This study aimed to investigate two nonpharmacological dental anxiety management approaches: (1) A brief auditory-alone relaxation (ABR) period and a brief virtual reality relaxation (VRR) period, and their hypothesized effects on patients' perceived dental anxiety and physiological biometric scores. Materials and methods: Fifty-eight participants who needed nonsurgical root canal treatment were assigned randomly to two groups: ABR or VRR. One group received earphones to listen to a guided, brief relaxation recording that incorporated conscious, diaphragmatic breathing and a guided body scan. The other group received Meta Quest 2 virtual reality headsets to listen and watch 360° inclusive and integrative experiences of ambient music, high-resolution graphic illustrations, and immersive scenery. The participants' self-reported levels of anxiety were assessed before and after treatment after they completed the State Trait Anxiety Indicator (STAI-State & Trait) and visual analog scale (VAS) scales. Additionally, biometric traits such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before (T0), during (T1), and after (T2) treatment. Results: Both VRR and ABR significantly decreased anxiety, as reported by the STAI-State questionnaire (p = <0.001 for both) and the STAI-Trait questionnaire (p = 0.025 ABR; p = <0.001 VRR), throughout the appointment. The self-reported VAS scores also were reduced significantly from before to after treatment (p = <0.001 for both ABR and VRR). The heart rate also decreased from before to after treatment in both groups (p = 0.019 for the ABR group, p = 0.026 for the VRR group). Changes in blood pressure showed mixed results. No significant differences in the blood pressure outcomes were found between the two groups. Conclusion: This is the first study to investigate the effects of ABR and VRR on dental anxiety. Both the ABR and VRR groups presented significant reductions in anxiety, pain, and heart rate after treatment. Our study demonstrated that nonpharmacological techniques, such as ABR and VRR, can be valid, noninvasive approaches to reduce anxiety before dental treatment, specifically endodontic therapy. However, given the small cohort in this study, it will be necessary to reproduce the methods with a larger cohort and different types of ABR and VRR applications to confirm the effects of nonpharmacological interventions on reducing endodontic dental anxiety.