Comparing Virtual Reality and Audio Analgesia for Reducing Dental Anxiety During Mandibular Third Molar Surgery in Adults: A Prospective Observational Study

Introduction Dental anxiety frequently hinders treatment compliance, particularly during mandibular third molar surgery. Nonpharmacological distractions, such as virtual reality (VR) and audio analgesia, offer promising alternatives for managing anxiety and pain. This study compared the effectiveness of patient self-selected VR and audio analgesia versus no intervention in reducing anxiety and pain, physiological stress markers, and enhancing satisfaction during mandibular third molar surgery in adults. Methods In this prospective observational study, 150 patients aged 17-45 years undergoing impacted mandibular third molar extraction were self-selected into three groups (n = 50 each): VR (immersive calming environments via headset), audio analgesia (relaxing music via noise-canceling earbuds), and control (no distraction). The outcomes assessed included anxiety (Visual Facial Anxiety Scale), pain (Visual Analog Scale), heart rate and blood pressure, and satisfaction (5-point Likert scale) in the preoperative, intraoperative, and postoperative stages. The data were then statistically analyzed. Results The groups showed comparable baseline characteristics and preoperative anxiety (p > 0.05). Postoperatively, VR was associated with the lowest pain scores (median 2) and highest satisfaction (median 5), followed by audio analgesia (pain median 3-4; satisfaction 4) and control (pain median 5; satisfaction 3) (p < 0.001). VR correlated with higher heart rate and blood pressure, indicating possible arousal, and showed significant time-by-group interactions (p < 0.01). Conclusions Patient-preferred VR significantly reduced postoperative pain and increased satisfaction compared with audio analgesia or no intervention during mandibular third molar surgery. Despite higher heart rate and blood pressure in the VR group, subjective comfort was markedly improved. Audio analgesia provided moderate benefits as a simpler alternative. These findings support the use of VR as an effective, nonpharmacological tool to improve patient experience in adult oral surgery.