Effectiveness of Virtual Reality and Lavender Oil Aromatherapy on Anxiety and Pain During Local Anesthesia Administration in Pediatric Dental Patients: A Randomized Controlled Trial

Objectives: Pediatric dental anxiety remains a significant barrier to effective treatment, often peaking during local anesthesia (LA) administration. This randomized controlled trial evaluated the synergistic efficacy of immersive virtual reality (VR) distraction and lavender oil aromatherapy (AT) in mitigating anxiety and pain perception in children during LA. Methods: One hundred twenty healthy, cooperative children (ages 6–12 years) were randomized into four equal groups ( n = 30): Group 1 (VR), Group 2 (AT), Group 3 (combined VR + AT), and Group 4 (control). Physiological anxiety was measured via pulse rate; state anxiety was assessed using the modified six-item State-Trait Anxiety Inventory (STAI-6); and pain perception was quantified using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and Wong–Baker Faces Pain Rating Scale (WBFPRS). Data were analyzed using one-way analysis of variance for parametric variables and Kruskal–Wallis/Mann–Whitney U tests for ordinal data, with all P values corrected to <0.001 where applicable. Results: Baseline anxiety and pulse rates were comparable across all groups ( P = 0.089). Following LA administration, the combined group (VR + AT) demonstrated the most significant reduction in state anxiety (mean STAI-6: 38.67 ± 2.89) compared to VR alone (40.67 ± 7.80), AT alone (43.33 ± 9.10), and the control group (48.33 ± 3.72; P = 0.001). Behavioral pain scores (FLACC) were also significantly lower in the combined group than in the other groups. While all groups showed an increase in anxiety post-LA, the magnitude of the increase was least in the VR + AT cohort, indicating a potent synergistic effect. Conclusion: The integration of VR distraction and lavender AT provides superior anxiety and pain attenuation during intrusive dental procedures compared to single-modality interventions. This multisensory approach offers a nonpharmacological, evidence-based strategy to improve pediatric compliance and behavior management in clinical practice.