Effectiveness of Virtual Reality-Based Toothbrushing Instruction on Oral Health Outcomes: A Randomized Controlled Trial (Preprint)

BACKGROUND Oral diseases, significantly driven by dental plaque, remain a major global health concern. Traditional toothbrushing instruction methods are limited in interactivity and long-term skill retention. Recent digital innovations, particularly virtual reality (VR), present promising opportunities for interactive, self-directed oral health education. OBJECTIVE This randomized controlled trial aimed to evaluate the effectiveness of VR-based toothbrushing instruction (TBI) compared to traditional instruction using plaque-disclosing agents among healthy adults. METHODS A single-blind, two-arm randomized controlled trial was conducted involving 30 adults aged 20-39 years, randomly assigned to either VR or traditional TBI groups. The VR group received a structured curriculum delivered using immersive VR (Meta Quest 3), comprising sequential modules focused on brushing techniques, posterior molar cleaning, systematic brushing sequences, and interactive practice. The control group received conventional one-on-one instruction by a dental hygienist using plaque-disclosing agents. Clinical measurements including plaque index (PI) and bleeding on probing (BOP), and oral health knowledge-attitude-behavior (KAB) questionnaires were assessed at baseline, immediately post-intervention, and two weeks follow-up. RESULTS The VR group demonstrated a significant reduction in plaque index scores compared to the control group at the two-week follow-up (VR, 0.44±0.48; Control, 0.07±0.26; P=.012). BOP scores did not significantly differ between groups (P=.79). Both groups showed improvements in KAB scores; notably, the VR group showed a significantly greater increase in oral health attitude (VR, 39.06; Control, 38.30; P=.01) and behavior scores (VR, 4.73; Control, 4.53; P<.001). No dizziness or discomfort was reported by VR participants. CONCLUSIONS VR-based toothbrushing education significantly improved plaque control skills and positively influenced oral health behaviors and attitudes among adults, showing clear advantages over traditional educational methods. Further research should explore long-term effects, scalability, and cost-effectiveness.