The effectiveness of virtual reality in reducing preoperative anxiety among oral surgery patients under general anesthesia: a salivary stress biomarker and questionnaire-based study

Abstract Background Preoperative anxiety is a common psychological response to surgical operations affecting the emotional, cognitive and physiological state of the patient. It can be measured by both objective and subjective methods. While the objective methods such as salivary alpha amylase and cortisol levels can give information about the physiological state of the patient, the subjective assessment of anxiety can be measured by questionnaires such as Amsterdam Preoperative Anxiety and Information Scale (APAIS). However, the methods used to treat preoperative anxiety are evolving. Objective This study aimed to investigate the effect of Virtual Reality (VR) on preoperative anxiety in patients undergoing the extraction of all four third molars. Methods A comparative study involving 30 patients who need extraction of all four third molars, randomly assigned to a control or VR group (15 participants per group), was conducted. The VR group received a 15 min immersive VR relaxation session prior to anesthesia induction, while the control group underwent standard preoperative waiting for the same duration. Salivary alpha-amylase and cortisol levels were measured pre- and postintervention measured using enzyme-linked immunosorbent assay (ELISA), and anxiety was assessed via the APAIS. Statistical analysis included paired and independent t-tests. Results Post-intervention APAIS scores were significantly lower in the VR group than in the control group ( p < 0.001). At the end of the experiment, the VR group had lower levels of salivary amylase compared to the control group. However, there was no significant difference between the groups with respect to changes in salivary amylase from pre-intervention (baseline) to post-intervention (after 3 weeks). There was also a decrease in salivary cortisol levels from pre-intervention to post-intervention in both groups. However, there was no significant difference in salivary cortisol levels between the two groups. In summary, VR is a promising, safe, and non-drug method for reducing pre-operative anxiety, demonstrated by significant reductions in salivary amylase levels and APAIS scores. VR has also helped improve patients’ comfort and psychological readiness for undergoing oral surgery, although no significant difference between salivary cortisol levels was found.