| 1. Navit et al6 |
This was a randomized controlled study involving 5 groups of 30 children aged 6–12 years.
Each group listened to different audio distractions during a dental appointment and, at the end of 4 sessions, anxiety levels were measured.
The groups were divided into the following categories:Control group;Instrumental music group;Musical nursery rhymes group;Movie songs group;Audio stories group.
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Venham's picture test and Venham's clinical anxiety rating scale was used to measure subjective feelings of anxiety.
Monitoring of pulse rate using a pulse oximeter.
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There was a significant difference between all the groups for the mean pulse rate, however, no meaningful difference was seen in the Venham's picture test and Venham's clinical rating score. Whilst all the audio distractions were superior in reducing anxiety in comparison to the control group, audio-stories were the most effective.
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This study implemented a clear method to explore the aims and objectives here, however, it only tested 5 types of audio distraction and so the conclusion drawn is ineffective as other types of audio distraction were not tested, ie dialogue.
Patients were selected at random and appropriate inclusion/exclusion criteria were implemented, reducing the influence of participant bias.
Outcome measures were both subjective and objective, thus ensuring reliable results. Furthermore, the statistical significance P value was consistent at <0.001, therefore suggesting little possibility that the results occurred by chance.
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| 2. Alanis J, Mejia C7 |
A randomized controlled study in which 34 adult patients took part.An experimental group underwent dental treatment whilst listening to music and the control group did without. |
Effects of music on anxiety was studied by measuring:Salivary flow;Blood pressure;Heart rate;Oxygen saturation;Body temperature. Student t-test and Chisquared (χ2) was applied to analyse a statistical difference between anxiety responses in the two groups.
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Significant reductions were registered in the salivary flow and cortisol concentration, blood pressure, heart rate and body temperature for the group treated with music therapy. Music therapy had a positive effect on the control of anxiety.
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Patients taking part in this research volunteered and consented but were then randomly assigned to the control or experimental group, thus reducing participant influence on the results.
In this research, saliva flow was measured as an indicator of stress response. This is not a direct indicator of stress and anxiety reducing the accuracy of the results produced.
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| 3. Thomas MV, Zemp M8 |
A randomized controlled study in which 92 dental hygiene patients took part.
The experimental group listened to music while waiting for their dental appointment and the control group waited in silence. Both groups wore headphones while waiting.
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Subjective feelings of:Anxiety;Stress anticipatory pain;Current mood were measured via patient-completed questionnaires, filled out before attending dental appointments.
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Listening to music prior to dental hygiene treatment decreases anxiety levels to a greater extent (9.26%) than waiting in silence (1.98%).
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No significant differences were found between groups with regard to demographic and clinical information, therefore randomization to group allocation was successful.
A major limitation is that patients were aware of the research questions and so were not ‘blind’, so the results may be subject to demand characteristics.
The precision of the results may be affected by the lack of objective measurements of anxiety and stress. The results relied solely on the patients' feedback and anxiety ratings which could be biased due to lack of ‘blinding’.
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| 4. Singh D, Samadi F2 |
A randomized controlled study design was used.
60 patients aged 6–12 years took part.
The experimental group listened to music of their choice during treatment, via headphones and the control group had treatment in the absence of music.
Patients had tooth extractions completed.
Patients had not had previous dental experience.
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Subjective levels of anxiety were measured using the Venham's picture test.
Objective measures of anxiety were assessed by measuring blood pressure and pulse rate.
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Greater reductions in blood pressure, pulse rate and Venham score was seen in the music group. Audio distraction was efficacious in alleviating anxiety of paediatric dental patients
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Participants were able to select the choice of audio distraction themselves. The volume, type of music and patient's level of focus on song selection throughout treatment could have all been confounding variables as the element of self-selected audio input was not addressed in the aims of this research.
The patients were blind to the research group they were in and objective measures of stress and anxiety were taken, as well as subjective records. This increases confidence in the results gained.
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| 5. Erdal Y, Saziye O9 |
A randomized controlled trial in which 98 adult patients took part.
In one group IV midazolam was administered before surgery and, in another patient, chosen music was given via headphones during treatment.
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The following were recorded for the evaluation of pain, sedation level and patient anxiety:The visual analog scale;Haemodynamic measurements;Observer's assessment of alertness/sedation scale;The State and Trait Anxiety Inventory-Trait Anxiety (STAI-TA) test.
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The haemodynamic measurements significantly reduced in the music group (90.9 mm Hg arterial pressure as opposed to 97.2 mm Hg arterial pressure for the midazolam group).
The STAI-TA was significantly lower for the music group.
Music was as effective as midazolam with regard to its sedative and anxiolytic properties and it does not have the side-effects of respiratory depression.
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Demographic and clinical data was collected regrading all participants and were controlled for, ie all patients underwent the same therapy at the same level of complexity.
The experimenters allowed for patient chosen music. This can cause variability in physiological parameters, hence reduces precision of the results.
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| 6. Kim SM, Kim YK10 |
A randomized controlled trial involving 219 patients undergoing Impacted Mandibular Third Molar (IMTM) extraction.
Patients in the experimental group were exposed to music and the control group was not during treatment.
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Anxiety was assessed using the dental anxiety scale, blood pressure, heart and respiratory rate.
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The use of patient-chosen music during surgical extraction of an IMTM significantly lowers patient intra-operative anxiety (F = 4.226, P < 0.05).
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This was well conducted research with clearly outlined aims. The patient sample was relatively large at 219 and all underwent the same treatment. The groups were allocated at random.
The patient's favourite music was sought and downloaded prior to the study so that less time was wasted in the patient selecting music at the appointment and music stimulation was almost instant.
The results carry a P (significance) value of 0.5 and so there is some probability that the results occurred by chance.
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| 7. Eitner S, Sokol B11 |
This was a prospective, comparative study of a novel audio pillow with relaxation music.82 patients awaiting implant surgery took part. |
Self-reported questionnaires were completed (AZI – a German-language questionnaire quantifying fear of dental treatment) and blood pressure readings were taken to measure patient anxiety.
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The audio pillow with relaxation music showed anxiolytic effects in patients during dental implant procedures. A marked reduction in blood pressure and anxiety scores was seen.
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To avoid effects occurring due to the relaxing features of the pillow itself, the control group also used this very pillow but without any audio input.
The researchers' method to investigate the anxiolytic effect of the audio pillow was very thorough. They used a combination of 2 surveys: Dental Anxiety Scale and the Dental Fear Survey and the data were collated to give an accurate picture of the individual's anxiety re treatment.
A drawback is the small sample size of only 82 patients taking part. Application of the conclusion is limited.
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| 8. Lai et al12 |
A randomized controlled trial in which 22 people took part. The experimental group listened to sedative music using headphones throughout their root canal therapy and the control group had head phones on but did not listen to music.
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Heart rate, blood pressure and finger temperature was measured at 10 minute intervals before and during treatment.
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The music group showed a decrease in anxiety score and an increase in finger temperature over time compared with the control group. The research supports the use of soothing music to calm patient anxiety during root canal therapy.
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Initially 66 patients were contacted in order to take part in this research, however only a small sample of 22 were finally recruited.
Blinding of the subjects was not practical and so this may have led to some bias in the results.
Physiological measures were taken at set 10-minute intervals. This is not as accurate as continuous measurement.
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| 9. Lahmaan C, Schoen R13 |
A randomized controlled trial including 87 adult patients recruited at a dental clinic in Germany who took part. Patients were placed in 1 of 3 groups, receiving relaxation, music or no intervention during dental treatment. Anxiety was measured by Patient completed STAI questionnaires
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Efficacy of music therapy compared to relaxation techniques on anxiety in adults undergoing clinical procedures was analysed
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Music therapy showed a 12% reduction in anxiety during dental treatment but relaxation methods showed a greater reduction at 30%.
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Patients were asked to participate in this trial by the researchers.
In this randomized controlled trial, patients were blind but researchers were not. This makes the results prone to investigator bias.
Not all variables were controlled, ie dentists' oral communication – this could affect the patient's response to the questionnaire results.
The inclusion criteria for the study was not clear – most patients did not have a dental phobia.
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| 10. Marwah N, Prabhakar AR.14 |
This was a randomized controlled trial involving 40 children aged 4–8 years.
The experimental group of patients received audio distraction during dental treatment and the control group (a) did not.
The experimental groups were (b) instrumental music and (c) nursery rhymes.
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Anxiety was assessed over multiple visits using:The Venham's picture test;Heart rate was monitored.
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Audio distraction did decrease the anxiety levels in paediatric patients but not to a significant level.
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Patients were monitored over 4 appointments, undergoing a variety of treatment at each appointment. Anxiety measurements were consistent for each patient at appointments. This increases reliability in the results gained as there is less concern that results were gained by a fluke chance.A small sample of 40 patients was recorded. Age was limited to 4–8 years for patients who had little experience of dentistry. The results cannot be generalized to apply to all ages within the paediatric age group |
| 11. Bare LC, Dundes L15 |
This was a prospective study. 121 art students in the US took part.
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The participants were asked to fill out a survey about their preferences in the dental waiting room.
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89% of respondents indicated that music in the background and magazines and books in the dental office were helpful.
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This research gathered data from 121 participants at an Arts College in the US. Only half the respondents were dentally anxious. Results from the other half of participants may lack relevance.
73% of respondent were female. This imbalance in the sample population may lead to gender bias of the results.
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| 12. Aitken JC, Wilson S16 |
This was a randomized controlled trial involving 45 paediatric patients aged 4–6.
Patients had 2 dental visits for restorative treatment and were assigned to either: a no music; up beat music; or relaxing music group.
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Anxiety was measured using parent-reported anxiety via the Corah Anxiety scale and heart rate was measured as well as pain via a visual analogue scale.
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No significant clinical differences were found among the 3 groups during the visits across any variables. 90% of patients stated that they enjoyed the audio distraction and would like to listen to it during their next visit
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Unlike the other studies conducted on paediatric patients, this study questioned parents as well as the patients regarding patient anxiety. Gathering more detailed information helps interpret the results further.
Patients were only subjected to music for 5 minutes during treatment. This does not allow enough time for the effects of music on anxiety to show, thus limiting confidence in the results.
The volume of the audio distraction was kept low to maintain communication with dental staff, however, in doing so, patients were still able to hear the dental equipment around them, rendering the effects of music obsolete.
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| 13. Corah NL, Gale EN17 |
Music and relaxation techniques designed to reduce stress during operative dental procedures were evaluated.
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Patient-completed questionnaires about subjective anxiety were analysed.
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The results suggest that music at best has a placebo effect. Physical relaxation techniques are more effective for reducing patient anxiety and are preferred by women but effective with both sexes.
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Whilst patients were successfully randomly assigned to the control and experimental groups, the data gathered was in the form of questionnaires subject to interpreter bias. A lack of physiological parameters reduces the accuracy of the results.
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| 14. Gordon et al18 |
Literature review of 22 randomized treatment trials aimed at reducing dental anxiety in adults.
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Techniques reviewed included:Cognitive-behaviour therapy;Relaxation technique;Benzodiazepine medication;Music distraction
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Repeated graduated exposure of CBCT had most evidence for its efficacy. It increased patients' sense of control over dental care.
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Only 22 trials were studied as part of this critical review and interpreter bias. A lack of physiological parameters reduces the accuracy of the results: sample sizes were not noted of these. This reduces confidence in the conclusions drawn.
Dental anxiety was measured by different constructs which reduces reliability in results and also may contribute to inconsistent findings across studies.
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| 15. Kyriakoula M, Varouxi G19 |
This was a randomized controlled trial.
200 patients undergoing surgery took part.
100 patients listened to meditation music through headphones during the operation and the control group did not.
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Blood pressure, stress control and heart rate were measured.
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Both groups had a similar stress coping score according to the sense of coherence scale (127.6 for the intervention group and 127.3 for the control group). Heart rate did not differ between the groups but blood pressure was significantly lower in the intervention group, therefore meditation music is a complementary method for blood pressure stabilization in surgery patients.
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The control group did not wear headphones and so were exposed to white noise during treatment. This reduces the validity of the results.
Stress measurements were inaccurate – cortisol levels and serology were not checked which would be the most accurate indicator of stress levels.
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| 16. Koch M, Kain Z20 |
A randomized controlled trial in which 35 surgical patients took part.
In the experimental group, patients listened to their own choice of music via headphones and the other group was a control.
All patients received propofol – the dose of which was monitored.
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Blood pressure, heart rate and subjective level of sedation score were recorded every 10 minutes.
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Patients in the music group required significantly less propofol to achieve a similar degree of sedation (0.3 mg/min vs 1.6 mg/min) and the patients in each group were no different in terms of demographics. |
It is unclear if the requirement for sedative medication was due to music or due to elimination of operating theatre ‘white noise’.
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| 17. Szmuk P, Aroyo N21 |
40 patients aged 40–60 years ASA 1 and 11 underwent a surgical procedure
A randomized controlled trial in which the experimental group listened to soothing music during surgery and the control group did not.
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Record of the concentration of sevoflurane administered during surgery was monitored.
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Patients who listened to music reported less pain but no statistical difference was noted. There was no significant difference in sevoflurane concentration administered to patients of each group and so the use of music during surgery is not supported.
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Not all variables were controlled. Music volume was adjusted according to patient comfort. Higher volumes may have been more effective.
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| 18. Danny W, Chan KW22 |
A randomized controlled study in which 165 patients took part.
Music was delivered in the experimental group via headphones and the control group had head phones without music.
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The amount of sedative medication required was monitored.
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The music group required less propofol when compared to the control group (0.84 mg/kg vs 1.15 mg/kg).
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Sedative medication was delivered in a pre-made bolus which makes it difficult to know exactly how much propofol patients used.
Measures of pain and stress levels were subjective and so limited in reliability.
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| 19. Bonny H23 |
This is a review of physiological and therapeutic responses to music. It is followed by various opinions as to which types of music are most appropriate for music therapy procedures.
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Questionnaires were completed by patients regarding their experience
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The music used in music therapy should have a beat of 60–80 beats per minute, similar to the resting heart rate.
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This research is very old and the methodology is outdated.
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| 20. Bringman H, Giesecke K24 |
A randomized controlled trial involving 372 patients.One group received pre-operative midazolam at 0.05–0.1 mg/kg orally and another had relaxing music. |
The main outcome measure was the State Trait Anxiety Inventory (STAI X-1).
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The decline in the STAI-TA score was significantly greater in the relaxing music group compared with the midazolam group. The score for the music group was 30 after treatment as compared to 34 in the midazolam group.
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A limitation of this study is that the music had an effect from the beginning of the intervention while the onset of midazolam was not immediate
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| 21. Miyata et al25 |
A randomized controlled trial in which 86 patients aged 18–60 took part.
In the experimental group patients listened to music before entering the operating room and the control group waited in silence.
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Heart rate response was measured and a questionnaire given to patients established if they were anxious or not to begin with via a visual analog scale (VAS).
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The results indicate that both VAS and heart rate was lower in patients that listened to music before entering the operating theatre than those who did not. The heart rate reduced by 40% in fearfu patients waiting to enter the room whilst listening to music.
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It was not possible to blind the patients with respect to listening to music.
Determining dental fear based on the questionnaire may not have been accurate. STAI and dental anxiety scale by Corah would have produced more conclusive data.
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