Virtual Reality Distraction vs Nitrous Oxide for Reducing Anxiety and Injection Pain.

Objective: The purpose of this study was to compare nitrous oxide (N2O) vs virtual reality (VR) as methods for reducing pain and anxiety during a dental injection. The primary objectives were to assess acute changes in stress responses by comparing salivary cortisol levels between the 2 groups and differences in injection pain scores.

Methods: A total of 132 female subjects serving as their own control received maxillary lateral incisor infiltration injections with the use of either N2O or a VR headset during separate appointments spaced at least 2 weeks apart. Salivary cortisol samples were collected at 6 times throughout each appointment. Pain scores for needle insertion and solution deposition were recorded. Data were analyzed statistically using Wald and paired t tests.

Results: N2O significantly lowered salivary cortisol concentrations and subsequent physiologic anxiety as compared with VR (P = .0089). However, no significant differences in needle insertion or solution deposition pain scores were found.

Conclusion: Although VR and N2O may be comparable in terms of perceived pain reduction, N2O was a more effective method than VR for physiologic analgesia and anxiolysis.