Background: Virtual Reality (VR) immerses children in a simulated environment and diverts their
attention away from Dental Fear and anxiety (DFA). Likewise, Positive Pre-Visit Imagery (PPVI)
intervention serves as a psychological preparation vehicle for the Local Anaesthesia (LA) injection
in an attractive approach. Aim: this study aimed to investigate the effect of VR distraction versus
PPVI intervention on children's DFA during LA injection. Design: A quasi-experimental study was
conducted at Pedo-dentist Clinic, Dental Center, Alexandria. A sample of 90 children aged from 4-6
years were observed for their anxious behaviors in the waiting room. Participants randomly received
routine unit care, VR distraction, or PPVI intervention, and their fear and anxious behavioral
responses were quantified during LA injection. Findings: Majority of the VR group (83.3%) and
46.7% of the PPVI group experienced mild fear levels during dental LA injection compared to none
of the children in the control group. Regarding children's anxiety, 36.7% of the VR group and
10.0% of the PPVI group were relaxed during the LA injection, while 43.3% of children in the
control group were out-of-contact during the injection procedure. Conclusion: Both VR distraction
and PPVI intervention showed positive effects and had excellent potential as evidence-based
interventions for minimizing children's DFA during LA injection