Effectiveness of virtual reality distraction interventions to reduce dental anxiety in paediatric patients: A systematic review and meta-analysis

Objectives: To analyse the effectiveness of virtual reality (VR) distraction intervention for the management of dental anxiety in paediatric patients. Data: Randomised controlled trials (RCTs) of VR distraction interventions for reducing anxiety in paediatric patients, published in English were included. Sources: Seven databases, including PubMed, Web of Science, Scopus, MEDLINE via ProQuest, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials, covering the period between January 2000 and September 2022 were searched. Study selection: A total of 12 RCTs involving 818 participants were included. Quality appraisal was undertaken using the Cochrane risk-of-bias tool for randomised trials by two authors independently. Random-effects model was used to summarise the effects of the interventions and pool data. Conclusions: Results showed that VR distraction interventions were effective in reducing the dental anxiety of paediatric patients. In meta-analysis, the VR distraction interventions had a significant effect on reducing pae-diatric patients' anxiety (SMD =-1.74, 95%CI =-2.46,-1.02, p < 0.001, I2 = 95%), pain (SMD =-1.57, 95% CI =-2.22,-0.91, p < 0.001, I2 = 91%) and heart rate (MD =-10.54, 95%CI =-20.26,-0.81, p = 0.03, I2 = 99%) during dental treatment. However, the evidence of VR in managing dental anxiety would become weak because of the publication bias. Clinical significance: VR distraction interventions could be an effective approach to alleviate the dental anxiety of paediatric patients. Additional well-designed and high-quality RCTs with larger sample sizes are needed to determine the optimal way to deliver VR interventions in paediatric dental clinics.