Study tests VR hypnosis to ease dental anxiety in children

Iveta Ramonaite, Dental Tribune International

Fri. 25. July 2025

save

STRASBOURG, France: Dental anxiety is a widespread concern in paediatric dentistry, often leading to treatment interruption or even the complete avoidance of dental care. Nitrous oxide–oxygen inhaled sedation (NOIS) remains one of the most commonly used methods to alleviate anxiety and pain in children. However, researchers from France suggest that advances in virtual reality (VR) technology may offer a promising non-pharmacological alternative. By integrating VR with medical hypnosis, the approach could reduce anxiety and discomfort during appointments and make hypnotic techniques more accessible to dental practitioners.

According to clinical and epidemiological studies, between 24% and 30% of preschool-aged children and approximately 28% of school-aged children worldwide experience dental fear. NOIS is the most widely used pharmacological method to reduce anxiety and pain during paediatric dental treatment, particularly in patients over 5 years of age. A recent systematic review and meta-analysis reported that NOIS has a success rate of 91.9% in paediatric procedures. Adverse effects are relatively rare, and nausea and vomiting are the most common.

Despite its effectiveness, NOIS is not without drawbacks. It is a greenhouse gas, and nitrous oxide of medical origin is estimated to contribute to approximately 10% of atmospheric pollution. Besides its environmental effects, some research suggests potential risks for dental personnel owing to chronic exposure to unscavenged nitrous oxide.

Seeking a non-pharmacological alternative, researchers in France are exploring the use of VR technology combined with medical hypnosis to manage dental anxiety in children. Dental Tribune International (DTI) recently reported on a study that examined the growing body of evidence supporting the use of clinical hypnosis in dental settings and demonstrated that it may be a valuable adjunct for managing dental anxiety, acute procedural pain and certain chronic orofacial pain conditions. However, data suggests that its broader application in dentistry is limited by the need for specialised training, extended appointment duration and the cognitive engagement required from patients.

Standardising medical hypnosis for paediatric dentistry

Lead author of a recent study on hypnosis Dr Nhat Minh Do believes that virtual reality offers a controlled, immersive environment that supports the therapeutic goals of hypnosis while being engaging and familiar for children. (Image: Dr Nhat Minh Do)

According to the lead author of the French study, Dr Nhat Minh Do, paediatric dentist at Strasbourg University Hospitals, the project stems from both practical experience and a strong belief in the benefits of medical hypnosis. In his department, the team has long been trained in hypnotic techniques to support children in coping with pain and anxiety. Over the years, they have received an increasing number of referrals for young patients struggling with anxiety, particularly those unable to complete treatment using standard behavioural management techniques. However, he noted that, despite the clear need, formal training in hypnosis remains rare among dental professionals in France.

“Hypnosis is a powerful tool, but its effectiveness largely depends on the practitioner’s training, presence and ability to establish trust. This variability in results can be a limitation in clinical practice,” he told DTI. “We wanted to find a way to make hypnosis more accessible and reproducible so that it can help more children, even in settings where practitioners are not experts in hypnosis.”

“That’s why the idea of combining medical hypnosis with immersive VR was so appealing. We saw in VR a way to standardise the induction process and provide a multisensory experience that could help children disconnect from the dental environment. It was important for us to preserve the therapeutic essence of hypnosis while making it easier to apply it in daily paediatric dental care. This study is the result of that vision,” Dr Do explained.

The researchers will be running a clinical trial to assess the efficacy of the HypnoVR device, a system that delivers a synchronised 3D visual scenario combined with conversational hypnosis via VR goggles and an audio headset. In the study, children aged 7–10 years with dental anxiety will attend two dental appointments and receive either VR hypnosis or NOIS during each procedure. The researchers will then evaluate the efficacy of both methods in enabling completion of treatment, assess how well each child tolerates the intervention and examine whether individual temperament influences outcomes.

“This is one of the few studies to systematically explore how a child’s temperament may influence their response to both pharmacological and non-pharmacological sedation. Early observations from a pilot study have shown high tolerance and satisfaction with VR even in several cases where nausea and vomiting was noted during nitrous oxide sedation,” Dr Do commented.

Beyond anxiety relief

Dr Do is confident that demonstrating comparable efficacy of VR hypnosis to NOIS could revolutionise anxiety management in paediatric dental care. “Such a tool could expand access to effective anxiety management in settings where pharmacological sedation is limited or contra-indicated. It could also reduce environmental impact, improve the patient experience and minimise practitioners’ stress by enabling smoother procedures. Importantly, it would offer clinicians a reliable, standardised and user-friendly way to implement medical hypnosis without the need for specialised training,” he told DTI.

According to him, children today are increasingly accustomed to immersive technologies. Integrating these tools into dental care may not only help reduce anxiety but also foster greater engagement during dental treatment. The researchers encourage continued interdisciplinary collaboration between healthcare providers, engineers and psychologists to optimise the use of immersive technologies for clinical use. “We hope this study will pave the way for a wider adoption of evidence-based, patient-centred innovations in dentistry,” Dr Do concluded.

The study, titled “Efficacy of virtual reality hypnosis versus conscious sedation with nitrous oxide in the management of dental anxiety in pediatric dentistry: Protocol for a prospective randomized controlled trial”, was published online on 9 June 2025 in Trials.