Virtual reality, a three-dimensional computer generated world, has been shown to relax adults during dental treatment. The purpose of this study was to investigate the effect of virtual reality on the behavior and anxiety of children during dental treatment. The behavior, anxiety and heart rate of twenty-six children, ages five to seven years were evaluated for the first five minutes of two restorative treatment visits. Thirteen children viewed virtual reality at their first restorative visit and not the second, and thirteen children viewed virtual reality at the second restorative visit and not the first. Before and immediately following the restorative visits, each child was instructed to draw a human figure. The restorative appointments were video recorded and heart rate monitored. The drawings and videotapes were rated independently by two examiners. The Koppitz method of evaluating drawings was used to measure anxiety. The Frankl behavior rating scale was used to evaluate behavior. Differences (ANOVA) in behavior (p < or = 0.50) and anxiety (p < or = 0.65) were not significant. The overall pulse rate was significantly lower (ANOVA p < or = 0.001) when the child was wearing glasses and viewing virtual reality. In conclusion, virtual reality during dental treatment had no significant effect on the behavior or anxiety but significantly reduced the pulse.