Beyond failure: a case report on brain state changes during virtual reality-induced hypnosis in pediatric patient

Background: Management of fear in anxious patients is challenging, particularly in children. Virtual reality induced hypnosis may help during the procedures, changing vital parameters and brain states. Modifications in brain activity can be easily traced with wearable instruments. Case presentation: An 11-years old boy was scheduled for avulsion of teeth 15 and 25, which were misplaced in the hard palate. Due to his fear of procedure, he was exposed to virtual reality-induced hypnosis. The brain state was continuously monitored, showing light sedation, associated to low spectral edge frequency values, below 20 Hz, indicating a relaxed/hypnotic state. In both sessions, the electrical activity was higher in the right hemisphere compared to the left, which is conceivable in hypnotic state. During the first session, a technical problem ensued, which was detected by the patient and readily managed with additional anesthesia. Despite the negative experience, one week later the hypnotic state was readily induced and tooth extraction was accomplished without any problem. Conclusions: Virtual reality-induced hypnotic state may be an easy and safe procedure to use with anxious patients even in pediatric age. If coupled to brain state monitoring, also adverse events can be promptly managed. In addition, hypnotic state may be induced also after the negative experience due to unexpected problems, prompting for the use of this technique in the dental setting also after initial, partial failure.