Effectiveness of Virtual Reality Dental Hypnosis in Lowering Dental Anxiety: Brain Wave Analysis Using EEG

Introduction: Dental fear and anxiety (DFA) is a common problem in clinical dentistry, often leading to avoidance of essential treatments and a negative impact on oral health outcomes. Conventional treatments such as pharmacological interventions and behavioral therapies have variable success rates. This study aimed to investigate the effectiveness of Virtual Reality Dental Hypnosis (VRDH), an integrated intervention combining immersive virtual environments and verbal hypnotic suggestions, in reducing dental anxiety and modulating neurophysiological activity as measured by electroencephalography (EEG). Methods A randomized single-blind controlled trial was conducted with 22 military dental patients exhibiting moderate-to-high dental anxiety (Modified Dental Anxiety Scale [MDAS] scores 9–14). Participants were randomly allocated to two groups: VRDH (n = 11) and conventional VR (n = 11). Subjective anxiety levels were assessed using the MDAS, while physiological arousal was evaluated using Galvanic Skin Response (GSR). EEG recordings were collected at three time points (baseline, during intervention, and post-intervention) to analyze alpha (8–13 Hz), theta (4–8 Hz), and beta (13–30 Hz) brain wave activity. Results The initial demographic and anxiety features were similar between groups (p > 0.05). Following intervention, EEG assessments revealed improvements in alpha and theta wave power in the VRDH group (particularly at FP2-LE, F8-LE, FP1-LE, P3-LE, and O1-LE; p < 0.05), indicating heightened states of relaxation and meditation. Conversely, beta wave activity associated with vigilance and anxiety states was significantly decreased in the parietal and occipital regions (P3-LE, O1-LE) in the VRDH group (p = 0.028, p = 0.047), while the control group showed inconsistent or conflicting variations. The GSR and MDAS scores confirmed these neurophysiological findings, thus supporting the calming effect of VRDH. Conclusions This study provides firm evidence that VRDH has a dual psychophysiological effect of reducing subjective anxiety and cortical relaxation, as manifested in brainwave modulation. Unlike conventional VR distraction, the inclusion of hypnotic elements appears to be key to sustained alpha theta augmentation and beta suppression. These findings validate the neurocognitive basis of VRDH as an attentive, immersive intervention with applied utility in the management of dental anxiety. Trial registration: UMIN-CTR UMIN000059291. Registered on 05/10/2025. Retrospectively registered.