(PO59) Virtual Reality Distraction Versus Nitrous Oxide for Anxiety and Injection Pain

Abstract: Nitrous oxide (NO) has long been used for anxiolysis and analgesia. Virtual reality (VR) has been investigated as a non-drug alternative form of pain and anxiety reduction. Some studies have reported that VR may be an effective method for both analgesia and anxiolysis in a dental setting. The purpose of the present study was to compare NO versus VR as methods for pain and anxiety reduction during a dental injection, to examine physiological effects using salivary cortisol, and to explore subject preference. A total of 132 female subjects participated in this study. Subjects served as their own control, receiving two maxillary lateral incisor infiltrations with the administration of NO and VR headset use during separate appointments spaced at least two weeks apart. Subjects rated their pain and anxiety before, during, and after the injection, and salivary cortisol samples were collected at 15-minute intervals throughout the process. Subjects were asked to provide feedback on their preference between the two methods. Data was analyzed statistically using multiple analyses (Wald test, paired t-test, Wilcoxon rank sum). NO inhalation significantly lowered cortisol concentrations compared to VR use. Significant linear and parabolic trends in cortisol fluctuation were identified. No significant differences in reported pain were found. Subjects reported an overall preference for NO. While VR and NO may be comparable in terms of perceived pain reduction, NO is a more effective method than VR for physiological analgesia and anxiolysi.