title: Can virtual nature improve patient experiences and memories of dental treatment? A study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Dental anxiety and anxiety-related avoidance of dental care create significant problems for patients and the dental profession. Distraction interventions are used in daily medical practice to help patients cope with unpleasant procedures. There is evidence that exposure to natural scenery is beneficial for patients and that the use of virtual reality (VR) distraction is more effective than other distraction interventions, such as watching television. The main aim of this randomized controlled trial is to determine whether the use of VR during dental treatment can improve the overall dental experience and recollections of treatment for patients, breaking the negative cycle of memories of anxiety leading to further anxiety, and avoidance of future dental appointments. Additionally, the aim is to test whether VR benefits dental patients with all levels of dental anxiety or whether it could be especially beneficial for patients suffering from higher levels of dental anxiety. The third aim is to test whether the content of the VR distraction can make a difference for its effectiveness by comparing two types of virtual environments, a natural environment and an urban environment.
  
  
  METHODS
  The effectiveness of VR distraction will be examined in patients 18 years or older who are scheduled to undergo dental treatment for fillings and/or extractions, with a maximum length of 30 minutes. Patients will be randomly allocated into one of three groups. The first group will be exposed to a VR of a natural environment. The second group will be exposed to a VR of an urban environment. A third group consists of patients who receive standard care (control group). Primary outcomes relate to patients' memories of the dental treatment one week after treatment: (a) remembered pain, (b) intrusive thoughts and (c) vividness of memories. Other measures of interest are the dental experience, the treatment experience and the VR experience.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN41442806.
authors.forename: Karin
authors.initials: K
authors.lastname: Tanja-Dijkstra
authors.forename: Sabine
authors.initials: S
authors.lastname: Pahl
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK. mathew.white@exeter.ac.uk.
authors.forename: Mathew P
authors.initials: MP
authors.lastname: White
authors.forename: Jackie
authors.initials: J
authors.lastname: Andrade
authors.forename: Jon
authors.initials: J
authors.lastname: May
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stone
authors.forename: Malcolm
authors.initials: M
authors.lastname: Bruce
authors.forename: Ian
authors.initials: I
authors.lastname: Mills
authors.forename: Melissa
authors.initials: M
authors.lastname: Auvray
authors.forename: Rhys
authors.initials: R
authors.lastname: Gabe
authors.forename: David R
authors.initials: DR
authors.lastname: Moles
mesh_terms: D000223:Adaptation, Psychological; D002985:Clinical Protocols; D016854:Dental Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003793:Dental Restoration, Permanent / Q000523:psychology*; D003794:Dental Restoration, Temporary / Q000523:psychology*; D004739:England; D006801:Humans; D008568:Memory; D017060:Patient Satisfaction; D010775:Photic Stimulation; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D014081:Tooth Extraction / Q000523:psychology*; D016896:Treatment Outcome; D063367:Virtual Reality Exposure Therapy / Q000379:methods*; D014796:Visual Perception