Table 1 Inclusion and exclusion criteria

Inclusion Criteria

Be between the ages of 6 and 35 years old

At least 2 of their maxillary anterior 6 teeth present

All of their maxillary anterior 6 teeth are stable

All of their maxillary anterior 6 teeth are free of cavities

All of their maxillary anterior 6 teeth are free of hypersensitivity to pain or pressure

Able to read, write, and converse in English (English or Spanish at the Texas site)

Willing and able to provide a signed and dated informed consent/assent form to participate

Willing and available to comply with all study procedures and available for the duration of the study

Exclusion Criteria

Currently have glasses or use contact lenses with a vision correction of ≥ ± 6

Are colorblind

Current injury (including fractures, open cuts, or sores) on their dominant hand

Fixed dental or orthodontic appliance that would interference with us creating a mouthpiece

Unwilling to remove facial cosmetics or attend sessions without facial cosmetics on

Currently on any anti-anxiety or anti-depressant medications

Currently have an inner ear infection

Living in the same household or an immediate family member of an enrolled participant

Currently have a cardiovascular disorder or a pacemaker

Currently have a seizure disorder or epilepsy

History of frostbite or sensitivity to extreme cold

Bleeding disorder or take blood thinners

Vasospastic disorder such as Raynaud’s syndrome or Raynaud’s disease

Gastrointestinal or vestibular disorders that may elevate susceptibility to nausea and dizziness such as Meniere’s disease, hyperemesis gravidarum or severe migraines

Developmental, behavioral, or sensory disorder that would increase discomfort or ability to complete tasks during the study

Prior negative outcome with VR simulation

Diagnosis of Temporomandibular Disorder along with a history of exacerbation of symptoms resulting from routine dental procedures

Medical condition that requires them to avoid mild stress

Any medical condition that elevates risk of falls, dizziness, nausea, or causes a vasovagal reaction

Any other general or oral health concerns