Rhythmic movements mimicking tremor under different metronome conditions.

Dental fear and anxiety in children are defined as the fear and anxiety associated with dental care. It exists in a considerable proportion of children and adolescents and constitutes a major dilemma in the practice of pediatric dentistry []. It is generally the result of a traumatic experience experienced by the child themselves: the child may have been subjected to an unpleasant experience due to a lack of explanation, overly blunt and non-empathetic behavior on the part of the practitioner, or a failure to optimize pain management in the dental chair. In terms of prevalence, anxiety is ubiquitous internationally. According to a study conducted by Elmouatarif F et al. [], 5.3% (DAS 13 to 17) of children aged 8–13 felt moderately anxious, leading 1.7% of them to refuse any clinical examination altogether, and 24% of children aged 4–8 were found to be anxious.To manage these problems of anxiety and pain, traditional methods involve the use of verbal communication, such as storytelling, audio or TV programs, or toys. As these techniques are very practitioner- and patient-dependent, their effectiveness on anxiety and pain is nevertheless rather limited. One of the best-known non-pharmaceutical approaches is distraction, whose success in medical settings is well documented. One of today’s most popular distraction techniques, with which children will be familiar and receptive, is based on computer technology that simulates the physical presence of an individual in a computer-generated 3D environment: virtual reality distraction. The child is immersed in a 3D environment through the use of a headset or 3D glasses, allowing the user to integrate a game program or a walk in a virtual world. Although some studies argue in favor of the use of virtual reality distraction methods in the management of children, as is the case in the clinical trial by Longkuan Ran et al. [], others remain negative as to their efficacy: the clinical trial by Almajed OS et al. [] judges the results to be of very low level of evidence and does not support the clinical interest of these virtual reality distraction techniques in the management of acute pain in children. Given the variability of the evidence in this regard, and in order to better identify the role of virtual reality distraction in managing child behavior in the dental office, a systematic review of the literature is carried out in order to answer the following questions: Does distraction-based management using virtual reality improve children’s behavior during dental care? How effective is it compared with conventional psycho-behavioral approaches and other distraction techniques?