Pain, and anxiety of pain, for some people are serious problems in dental treatment. It is a common practical experience that even entering a dental surgery office, or the sound of a dental drill, may evoke vegetative correlates of toothache without any underlying disease. This everyday phenomenon suggests the hypothesis of a corresponding activation of pain-related brain areas by virtual dental treatment. Twenty healthy subjects viewed two different video clips presenting a dental treatment from the first-person perspective (simulation movie) and a moving hand holding an electrical toothbrush (control movie). Using functional magnetic resonance imaging, the cerebral hemodynamic responses that occurred during simulation and control movies were compared. Virtual dental treatment was associated with increased activity in pain-related brain areas such as the cingulate cortex, the insula, and primary and secondary somatosensory cortexes (SI, SII). The brain activation pattern indicates not only affective-motivational but also sensory-discriminative pain components during virtual dental treatment in all volunteers. Volunteers with a higher level of dental anxiety showed stronger activation of SI and SII. This may be a result of their higher anticipation of pain.
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