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Effect of music during endodontic treatment on patients’ anxiety: a systematic review of randomized clinical trials

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Abstract

Objectives

Endodontic treatment is one of the most fearful procedures among dentistry, and the use of music during the procedure has been evaluated to control patients’ anxiety. This systematic review has been conducted to provide a synthesis of the state of knowledge in this field and aimed to answer the following question: “Can music therapy reduce patient’s state anxiety during endodontic treatment?”.

Methods

A search was performed in six electronic databases (PubMed, Cochrane Library, Scopus, Web of Science, EMBASE, and Open Gray) for articles published until April 2022. The eligibility criteria, based on the PICOS strategy, were as follows: (P) patients undergoing endodontic treatment; (I) exposure to music; (C) no music; (O) patients’ anxiety; (S) only randomized clinical trials. The risk of bias was analyzed according to the Cochrane Risk of Bias tool for randomized controlled trials (RoB 2). The strength of evidence from the included studies was assessed using the Grading of Assessment, Development, and Assessment Recommendations (GRADE) tool.

Results

Five eligible studies were retrieved. A low to high risk of bias was verified. Descriptive analysis showed an effect in favor of music intervention, with differences among state anxiety, heart rate and blood pressure.

Conclusions

With a very low quality of evidence, dental care professionals may consider playing background music during endodontic treatment since it is a cost-effective and easy alternative to trying to reduce dental anxiety.

Clinical Relevance

Five studies were included in this systematic review and showed, with a very low quality of evidence, that music may reduce state anxiety levels on patients during root canal treatment.

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Data Availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

References

  1. Hittner JB, Hemmo R (2009) Psychosocial predictors of dental anxiety. J Health Psychol 14:53–59

    Article  PubMed  Google Scholar 

  2. Leclaire AJ et al (1988) Endodontic fear survey. J Endod 14:560–564

    Article  PubMed  Google Scholar 

  3. Arntz A, Van Eck M, Heijmans M (1990) Predictions of dental pain: the fear of any expected evil, is worse than the evil itself. Behav Res Therap 28:29–41

    Article  Google Scholar 

  4. Van Wijk AJ, Hoogstraten J (2006) Reducing fear of pain associated with endodontic therapy. Int End J 39:384–388

    Article  Google Scholar 

  5. Zanette G et al (2013) Conscious sedation with diazepam and midazolam for dental patient: priority to diazepam. Minerva Stomatol 62:355–374

    PubMed  Google Scholar 

  6. Huh YK et al (2015) Assessment of patients’ awareness and factors influencing patients’ demands for sedation in endodontics. J Endod 41:182–189

    Article  PubMed  Google Scholar 

  7. Weisfeld CC et al (2021) Dealing with anxious patients: a systematic review of the literature on nonpharmaceutical interventions to reduce anxiety in patients undergoing medical or dental procedures. J Altern Complement Med 27:717–726

    Article  PubMed  Google Scholar 

  8. Lai HL, Good M (2002) An overview of music therapy. J Nurs 49:80–84

    Google Scholar 

  9. Santiváñez-Acosta R, Tapia-López ELN, Santero M (2020) Music therapy in pain and anxiety management during labor: a systematic review and meta-analysis. Medicina (Kaunas) 56:526

    Article  PubMed  Google Scholar 

  10. De Witte M et al (2020) Music therapy for stress reduction: a systematic review and meta-analysis. Health Psychol Rev. https://doi.org/10.1080/17437199.2020.1846580.

  11. Nilsson U (2008) The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J 87:780–807

    Article  PubMed  Google Scholar 

  12. Lam HL et al (2020) Effects of music therapy on patients with dementia-a systematic review. Geriatrics 5:62

    Article  PubMed  PubMed Central  Google Scholar 

  13. Li J, Zhou L, Wang Y (2017) The effects of music intervention on burn patients during treatment procedures: a systematic review and meta-analysis of randomized controlled trials. BMC Complement Altern Med 17:158

    Article  PubMed  PubMed Central  Google Scholar 

  14. Garza-Villarreal EA et al (2017) Music-induced analgesia in chronic pain conditions: a systematic review and meta-analysis. Pain Physician 20:597–610

    Article  PubMed  Google Scholar 

  15. Li Y et al (2020) The effectiveness of music therapy for patients with cancer: A systematic review and meta-analysis. J Acv Nurs 76:1111–1123

    Google Scholar 

  16. Aravena PC, Almonacid C, Mancilla MI (2020) Effect of music at 432 Hz and 440 Hz on dental anxiety and salivary cortisol levels in patients undergoing tooth extraction: a randomized clinical trial. J Appl Oral Sci 28:e20190601

    Article  PubMed  PubMed Central  Google Scholar 

  17. Weijden F et al (2021) The effect of playing background music during dental treatment on dental anxiety and physiological parameters: A systematic review and meta-analysis. Psychol Music. https://doi.org/10.1177/0305735621998439

    Article  Google Scholar 

  18. Lai HL et al (2008) Randomized controlled trial of music on state anxiety and physiological indices in patients undergoing root canal treatment. J Clin Nurs 17:2654–2660

    Article  PubMed  Google Scholar 

  19. Di Nasso L et al (2016) Influences of 432 Hz music on the perception of anxiety during endodontic treatment: a randomized controlled clinical trial. J Endod 42:1338–1343

    Article  PubMed  Google Scholar 

  20. Santana MDR et al (2017) Musical auditory stimulation influences heart rate autonomic responses to endodontic treatment. Evid Based Complementary Altern Med. https://doi.org/10.1155/2017/4847869

    Article  Google Scholar 

  21. Clarke J (2011) What is a systematic review? Evid Based Nurs 14:64

    Article  PubMed  Google Scholar 

  22. Nagendrababu V et al (2020) Glossary for systematic reviews and meta-analyses. Int End J 53:232–249

    Article  Google Scholar 

  23. Page MJ et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  24. Maia LC, Antonio AG (2012) Systematic reviews in dental research. A guideline. J Clin Pediatr Dent 37:117–124

    Article  PubMed  Google Scholar 

  25. Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1

    Article  PubMed  PubMed Central  Google Scholar 

  26. Page MJ, Mckenzie JE, Bossuyt PM et al (2020) Mapping of reporting guidance for systematic reviews and meta-analyses generated a comprehensive item bank for future reporting guidelines. J Clin Epidemiol 118:60–68

    Article  PubMed  Google Scholar 

  27. Sterne JAC et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:14898

    Google Scholar 

  28. Guyatt G et al (2011a) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394

    Article  PubMed  Google Scholar 

  29. Newton JT (2009) Music may reduce anxiety during invasive procedures in adolescents and adults. Evid Based Dent 10:15

    Article  PubMed  Google Scholar 

  30. Ozkalayci O et al (2016) Effects of music on sedation depth and sedative use during pediatric dental procedures. J Clin Anesth 34:647–653

    Article  PubMed  Google Scholar 

  31. Yi-Yueh L et al (2014) Comparative study of auxiliary effect on dental anxiety, pain and compliance during adult dental root canal treatment under therapeutic Chinese music or western classic music. Phys Med Rehabil Kurortmed 24:149–154

    Google Scholar 

  32. Wazzan M et al (2022) The effect of music therapy in reducing dental anxiety and lowering physiological stressors. Acta Biomed 92:e2021393

    PubMed  PubMed Central  Google Scholar 

  33. Mcguinness LA, Higgins JPT (2021) Risk-of-bias VISualization (robvis): an r package and shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12:55–61

    Article  PubMed  Google Scholar 

  34. Maggirias J, Locker D (2002) Five-year incidence of dental anxiety in an adult population. Community Dent Health 19:173–179

    PubMed  Google Scholar 

  35. Ko YL, Lin PC (2012) The effect of using a relaxation tape on pulse, respiration, blood pressure and anxiety levels of surgical patients. J Clin Nurs 21:5–6

    Article  Google Scholar 

  36. Allen K et al (2001) Normalization of hypertensive responses during ambulatory surgical stress by perioperative music. Psychosom Med 63:487–492

    Article  PubMed  Google Scholar 

  37. Miyata K et al (2016) Music before dental surgery suppresses sympathetic activity derived from preoperative anxiety: a randomized controlled trial. JDR Clin Trans Res 1:153–162

    PubMed  Google Scholar 

  38. Packyanathan JS, Lakshmanan R, Jayashri P (2019) Effect of music therapy on anxiety levels on patient undergoing dental extractions. J Family Med Prim Care 8:3854–3860

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mejía-Rubalcava C, Alanís-Tavira J, Mendieta-Zeron H, Sanchez-Perez L (2015) Changes induced by music therapy to physiologic parameters in patients with dental anxiety. Complement Ther Clin Pract 21:282–286

    Article  PubMed  Google Scholar 

  40. Guyatt G, Oxman AD, Vist G et al (2011b) GRADE guidelines: 4. Rating the quality of evidence - study limitations (risk of bias). J Clin Epidemiol 64:1283–1293

  41. Guyatt G, Oxman AD, Kunz R et al (2011c) GRADE guidelines: 7. Rating the quality of evidence ‐ inconsistency. J Clin Epidemiol 64:1294–1302

  42. Guyatt G, Oxman AD, Akl EA et al (2011d) GRADE guidelines: 8. Rating the quality of evidence ‐ indirectness. J Clin Epidemiol 64:1303–1310

  43. Guyatt G, Oxman AD, Kunz R et al (2011e) GRADE guidelines: 6. Rating the quality of evidence - imprecision. J Clin Epidemiol 64:1283–1293

  44. Murad MH et al (2017) Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med 22:85–87

  45. Guyatt G, Oxman AD, Sultan S et al (2011f) GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol 64:1311–1316

  46. Yoon S, Kim YK (2022) Possible oxytocin-related biomarkers in anxiety and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 116:110531. https://doi.org/10.1016/j.pnpbp.2022.110531

  47. Abi-Dargham A (2023) Candidate biomarkers in psychiatric disorders: state of the field. World Psychiatry 22:236–262

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Acknowledgements

The authors deny any conflicts of interest related to this study.

Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Endodontics, School of Dentistry, Rio Grande Do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil

    Carolina Horn Troian-Michel, Lilian Tietz, Aline Teixeira Mendes, Pedro Henrique Marks Duarte, Theodoro Weissheimer, Ricardo Abreu da Rosa & Marcus Vinicius Reis Só

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  1. Carolina Horn Troian-Michel
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  2. Lilian Tietz
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  3. Aline Teixeira Mendes
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  4. Pedro Henrique Marks Duarte
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  5. Theodoro Weissheimer
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  7. Marcus Vinicius Reis Só
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Contributions

Carolina Horn Troian-Michel: conceptualization, data curation, writing main manuscript text;

Lilian Tietz: conceptualization, data curation, writing main manuscript text;

Aline Teixeira Mendes: conceptualization, data curation, writing main manuscript text;

Pedro Henrique Marks Duarte: conceptualization, data curation, writing main manuscript text;

Theodoro Weissheimer: supervision;

Ricardo Abreu da Rosa: English writing review;

Marcus Vinicius Reis Só: supervision.

All authors reviewed the manuscript.

Corresponding author

Correspondence to Carolina Horn Troian-Michel.

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Troian-Michel, C.H., Tietz, L., Mendes, A.T. et al. Effect of music during endodontic treatment on patients’ anxiety: a systematic review of randomized clinical trials. Clin Oral Invest 27, 6321–6332 (2023). https://doi.org/10.1007/s00784-023-05247-0

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  • DOI: https://doi.org/10.1007/s00784-023-05247-0

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