Escaping into a virtual world of Second Life is showing promise as a way to divert real world pain when visiting the dentist, according to a thesis project at the Case Western Reserve University School of Dental Medicine.
Student Elena Furman, specializing in periodontics at the dental school, looked at alternative distraction therapies to reduce pain in her patients during the intensive cleaning process of scaling and root planing to rid gums and teeth of bacteria and plaque.
Furman reported the study's findings in her dissertation, "Virtual Reality Immersion for Pain Control during Periodontal Treatment."
"Between 15 and 33 percent of periodontal patients experience pain," said Furman.
But she noted that many patients also feel discomfort from injections to relieve the pain or have needle phobias, and so alternative ways to make the patient comfortable are important. Also the numbing effects of pain medications can last for as long as two hours after treatment and can result in bites or burns in the mouth.
While treating 38 patients between the ages of 18 and 79, Furman had her patients wear a PC 3D Pro goggle—the kind people use to play computerized games—and also hold a finger-controlled computer mouse.
Furman divided the mouth into quarters to give each patient the opportunity to experience the different distraction therapies.
During work on one quadrant, patients saw no visual images through the goggles and became their own control group. Patients were distracted during the treatment in the other areas by watching a 20-minute clip from the movie Cars and in another by concentrating on moving a virtual person called an avatar through a botanical garden in a Second Life virtual community by using the finger-controlled mouse.
While treating the patients, they held the mouse under a surgical gown to prevent Furman from determining which scenario the patient received.
Prior to getting treatments, Furman had each patient take an anxiety test and watch a demonstration video of how Second Life works. Following the treatment, she had patients rank pain on a scale from 0 to 10, with 10 being the strongest. Those without any distractions ranked pain the highest. Pain was lowest for those individuals who entered Second Life.
Roma Jasinevicius, associate professor of dental medicine and one of Furman's thesis advisers, said they were surprised at how people, regardless of age, adapted to the new technology. "The oldest patient enjoyed concentrating on moving the avatar," she said.
Jasinevicius added that as patients become proficient with moving through Second Life, the virtual world can be changed to continually challenge the patient and divert attention away from the dental procedure. Avatars also can have their appearances, age, gender and ethnicities changed as well as the virtual environment to make Second Life new for the patient.
Virtual reality distraction therapy has been used in medicine with burn victims, cancer patients and in physical therapy, but very little research has been done in dental medicine.
This was one of the largest studies to examine the use of virtual reality in dentistry. Three prior studies focused on reducing pain in pediatric patients, another used virtual reality to reduce pain in 10 patients receiving restoration treatments and the third was conducted at the University of Washington on two periodontal patients.
According to Furman, the pediatric study showed no significant changes in pain for children but the other studies did.
Furman replicated and expanded Hoffman's study.
After graduating in August with her master's degree in periodontics, she plans to enter private practice.
Will she use the technology with her patients? Definitely, Furman says.
Periodontal disease impacts up to 50 percent of the population in forms from mild to severe. Untreated periodontal disease has been linked to diabetes, preterm births and fetal death and heart disease.
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