# Virtual Reality Versus Monitor-Based Distraction in Children with Mild Intellectual Disability: A Preliminary Comparative Observational Study

## TL;DR

Virtual reality helps children with mild intellectual disability complete dental treatments more successfully than traditional screen-based distractions.

## Contribution

This study is among the first to compare VR and monitor-based distraction for dental treatment in children with mild intellectual disability.

## Key findings

- VR distraction led to a 78.6% treatment success rate compared to 46.4% with monitor-based distraction.
- The odds of successful treatment were over four times higher with VR than with monitor distraction.
- Gender differences in treatment success were observed but require further investigation due to small sample size.

## Abstract

Background/Objectives: Dental anxiety represents a significant barrier to oral care in children with neurodevelopmental disorders (NDDs), whose sensory sensitivities and behavioral challenges often complicate clinical management and limit access to treatment. Virtual reality (VR) has emerged as a supportive tool to improve the feasibility of dental procedures in this vulnerable population. This study aims to evaluate whether a VR-based distraction approach could facilitate the completion of dental treatment in children with mild intellectual disability (ID). Methods: A prospective comparative observational study was conducted between February and September 2025 involving 56 children aged 11–15 years with mild ID and moderate dental anxiety (Corah Dental Anxiety Scale, DAS: 9–12). Participants were allocated to two groups of distraction approaches—VR distraction (n = 28) using the Oculus Quest 3® headset or a monitor-based cartoon (n = 28)—according to device availability and to maintain balanced group sizes. The primary outcome was treatment success, defined as completion of the restorative dental procedure under local anesthesia within 50 min. Results: Treatment success was achieved in 78.6% of the VR group versus 46.4% of the monitor group (p = 0.026). The odds of successful treatment were more than four times higher with VR compared to monitor distraction (OR 4.12; 95% CI: 1.16–16.47), with a risk ratio of 2.50 (95% CI: 1.14–5.50). Stratified analysis suggested a stronger effect in females (OR 12.25; 95% CI: 1.27–118.36) than in males (OR 2.56; 95% CI: 0.53–12.43). Conclusions: VR-based distraction significantly improved dental treatment success in children with mild ID compared with conventional distraction. Although gender differences were observed, they should be interpreted with caution due to the small sample size. This work lays the foundation for developing both short- and long-term protocols to facilitate dental treatment management and cooperation in patients with NDDs.