Journal of Clinical and Diagnostic Research. 2023 Jul, Vol-17(7): ZC43-ZC46 43 43 DOI: 10.7860/JCDR/2023/60060.18204 Original Article Dentistry Section Use of Augmented Reality in Alleviating Dental Anxiety among Paediatric Patients: A Randomised Control Study INTRODUCTION Dental anxiety is defined as a cognitive-emotional response to a stimulus or an experience associated with dental treatment [1]. It not only leads to the rejection and avoidance of dental procedures but can also impact an individual’s overall growth and development [2, 3]. Although it can be managed through pharmacological interventions as general anaesthesia [4,5], non-pharmacological interventions such as musical distraction are gaining more acceptance from parents, patients, and practitioners due to the disadvantages associated with pharmacological approaches, such as nausea and vomiting [6]. Distracting a patient’s attention away from noxious or unpleasant stimuli is a non-pharmacological intervention commonly used in clinical practice to reduce pain, anxiety, and fear during the medical procedures [7, 8]. Augmented Reality (AR) may be an effective and relevant tool for diverting patients’ attention away from clinical procedures, particularly among younger populations who have grown up with such technologies [9]. AR is a rapidly emerging technology that overlays digital objects onto real-world environments, viewed in real-time through a smartphone, tablet, or headset [10]. While the preoperative use of Virtual Reality (VR) and other technologies has been well-documented in dental literature regarding pain and anxiety reduction [11], there is currently no documented study on the potential uses of AR in managing dental anxiety. However, AR likely offers more advantages compared to other technologies, as it enhances the existing environment by adding virtual elements rather than creating complete immersion in a virtual world, as seen in VR. Additionally, AR requires active involvement from the users rather than simply being exposed to soothing music or watching movies/cartoons [12-14]. To date, AR remains largely untapped as a method for managing dental anxiety, particularly for paediatric patients. The present study aims to examine the efficacy of using AR to alleviate dental anxiety through patient-reported surveys. Dental anxiety will be measured using the Turkish version of Corah’s Dental Anxiety Scale (DAS), the most widely used psychometric instrument for measuring dental anxiety. The DAS was originally developed by Corah NL et al. [15]. The study aims to explore the level of dental anxiety among children aged 6-14 years, considering factors such as age, gender, and treatment status. Additionally, it investigates whether the preoperative use of AR can alleviate dental anxiety in this age group. MATERIALS AND METHODS The present randomised controlled study was conducted at a private dental clinic in Bahcesehir, Istanbul, Turkey. The study duration was two months, from March 2021 to May 2021. The study included 511 paediatric dentistry patients (53.4% girls and 46.6% boys) aged between 6-14 years. Participants were selected using simple randomisation. The study protocol and all procedures were approved by the Ethics Committee of Bahçes¸ehir University, Istanbul, Turkey before the start of the study (letter no. E-20021704- 604.02.02-50236). Keywords: Anxiety-reducing techniques, Dental anxiety scale, Distraction GILMAN YUCEL 1 , BURCU DEMIR 2 , FERRUH SEMIR SMAIL 3 , PINAR SELCIK YAYIM 4 ABSTRACT Introduction: The management of anxiety and fears in patients receiving medical treatment has always been a significant issue. Patients with dental anxiety are challenging to manage in dental offices, as they may require more time for treatment and are often dissatisfied with their dental care, especially among paediatric dental patients. Although Augmented Reality (AR) has not been widely used in dentistry, it is theoretically believed to have a role in alleviating dental anxiety among paediatric patients. Aim: The aim of this study is to explore the level of dental anxiety among children aged 6-14 years, based on age, gender, and treatment status. Additionally, the study aims to investigate whether the preoperative use of AR can alleviate anxiety. The effect of AR on anxiety was evaluated using Corah’s Dental Anxiety Scale (DAS). Materials and Methods: This randomised controlled study was conducted at a private clinic in Bahcesehir, Istanbul, Turkey. The study duration was two months, from March 2021 to May 2021. The study design aimed to compare the level of anxiety among paediatric patients in an AR exposure condition with those in a control condition. A total of 511 paediatric patients were randomly assigned to either the control group or the intervention condition (i.e., preoperative AR experience versus no preoperative AR experience). A questionnaire survey, including demographic questions and the DAS, was conducted to compare the DAS scores between patients who engaged in the AR experience and those who did not. The data were analysed using the Chi-square test, the Kruskal-Wallis test, and the Mann-Whitney U test. Results: The control group consisted of 134 females and 118 males, while the experimental group consisted of 139 females and 120 males. The mean DAS scores differed based on age (p<0.001). The median DAS score of the 10-14 years age group was lower than that of the 6-8 years age group. The mean DAS score was significantly lower in the group that received AR intervention compared to the control group (p<0.001). The median DAS score was 6 for those with AR experience, while it was 10 for those without it. Conclusion: The preoperative use of AR applications was found to be effective in reducing dental anxiety among children in this study. AR shows promise as a tool that has not been sufficiently utilised among anxiety-relieving techniques for paediatric patients.