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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 75-81

Influence of music therapy to reduce anxiety during dental procedures in the Department of Prosthodontics


Department of Prosthodontics, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Date of Web Publication28-Dec-2017

Correspondence Address:
Dr. Neelam Abhay Pande
123, Rujuta Apartments, Flat No. 1, Pande-Lay-Out, Khamla, Nagpur - 440 025, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_12_17

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  Abstract 


Background: Music surrounds our lives. Music therapists assess emotional well-being, physical health, social functioning, and communication activities through musical responses. During all types of dental treatments, patients are very much apprehensive about the procedures. In prosthodontics, tooth preparation, patient's anxiety levels can be reduced, if his/her mind is diverted to listen to music, thus getting maximum cooperation.
Aim: To reduce the anxiety levels in patients receiving fixed partial dentures (FPDs), by listening to passive music using earphones. This was a randomized control experimental study.
Materials and Methods: A total of 100 patients requiring FPDs between the ages of 18 and 45 years were randomly selected. Patients dental anxiety scale (DAS) and their blood pressure (BP) as well as heart rate (HR) were recorded before starting the procedure. They were divided into two groups: Group I as control (without music) and Group II (with music, where patients listened to the passive music using earphones throughout the treatment). In both the groups, patient's BP and HR were also recorded at the end of impression making. The data were tabulated. Statistical analysis was performed using Chi-square test and Fisher's exact tests.
Results: From DAS scale analysis, among patients with medium and high levels of anxiety, music had a significant influence on their fear and comfort. Findings of Group I and Group II in hemodynamic variables were also much comparable including dentist's rating and patient's behavior, treatability, and cooperation during the procedure.
Conclusion: The influence of music showed reduced anxiety levels among patients receiving FPDs. It also helped lower the level of tension, better treatability, and better adjustment to the prosthodontic treatment.

Keywords: Anxiety level; fixed prosthodontics; music therapy; patient's cooperation


How to cite this article:
Pande NA, Chahande J, Radke U. Influence of music therapy to reduce anxiety during dental procedures in the Department of Prosthodontics. Indian J Multidiscip Dent 2017;7:75-81

How to cite this URL:
Pande NA, Chahande J, Radke U. Influence of music therapy to reduce anxiety during dental procedures in the Department of Prosthodontics. Indian J Multidiscip Dent [serial online] 2017 [cited 2018 Apr 25];7:75-81. Available from: http://www.ijmdent.com/text.asp?2017/7/2/75/221756




  Introduction Top


Dental treatment and the surrounding dental environment may elicit many different cognitions and emotions among people. For the majority, these feelings include anxiety and discomfort, when facing a situation of dental care. This creates patient's noncooperation. For the fearful people, a visit to dental office is very difficult and usually postponed as long as possible. It often means irregular dental visiting habits with only emergency dental treatments or even sometimes total avoidance which leads to deterioration of dental health as well as increased feelings of anxiety, shame, and inferiority. This is why it is important to diagnose anxiety on time and handle the anxious patients properly. Their treatment and management is not always easy. Therefore, more and more important for the dentist is to develop the skill of assessing of patient's behavior, reason for their problem, and seeking the suitable method for treatment.[1]

During all types of dental treatments, patients are very much apprehensive about the procedures whether it is a simple dental examination, oral prophylactic procedures, restorative or cavity filling/root canal filling procedures, tooth extraction, or tooth replacement procedures. In fixed prosthodontics, during tooth preparation, the noise or sound of the drill makes the patient apprehensive which ultimately affect's patient's cooperation. At the same time, while making the impressions using different impression materials, patients are very much anxious about these procedures. Even after detail explanation about all the procedures, they are not comfortable till the last appointment.

Music surrounds our lives. We hear it on the radio, television, our cars, and home stereos. Even warbling in our bathroom gives us a happy start of the day. Music is also clinically recognized to influence biological responses such as blood pressure (BP), heart rate (HR), respiratory rate, cardiac output, muscle tone, papillary responses, skin responses, and endorphin production. It can entrain the body to calm or to accelerate, depending on the type of music used.

Several authors have explored the impact of listening to music on physiological parameters of stress/anxiety including BP, HR, and biochemical markers.[2] Sedative music can lower the anxiety, pain, tension, and stress levels resulting in less use of anesthetics and pain medication, distraction from thoughts, and higher patient compliance and satisfaction. Simulative music can be a source of motivation both physically and psychologically and becomes a positive reinforcement during physical therapy and rehabilitation.[3]

By definition, music therapy is the systematic application of music in the treatment of physiological and psychological aspects of an illness or disability. It focuses on the acquisition of nonmusical skills and behavior as determined by the board certified music therapist through systematic assessment and treatment planning. In prosthodontics, during tooth preparation, patient's anxiety levels can be reduced, if his/her mind is diverted to listen to music. In the present study, this effect was tried using earphones to get patient's maximum cooperation.

Aim

To reduce the anxiety levels in patients receiving fixed partial dentures (FPDs), by listening to passive music using earphones.

Objective

To evaluate and to assess the effect of music therapy in patients receiving FPDs by listening to passive music using earphones and to assess whether the music influences dental patients tension, behavior, and treatability.


  Materials and Methods Top


Before starting the study, approval from the Institutional Ethical Committee has been taken. A total of 100 patients, both male and female, between the ages of 18 and 45 years were randomly selected. These patients reported to the Department of Prosthodontics, requiring FPDs, irrespective of anterior or posterior tooth or teeth replacement and previous dental visits.

Inclusion criteria

Healthy individuals between the age of 18 and 45 years and patients requiring FPDs irrespective of anterior or posterior tooth/teeth replacement.

Exclusion criteria

Patients <18 years of age, patients without any systemic problems or nervous disorder, medically compromised patients and deaf patients.

Materials

Automatic BP apparatus (Omron SEM 1) was used to record systolic BP (SBP) and diastolic BP (DBP) and pulse oximeter (BPL Cleo) to record HR [Figure 1]. Instruments required for crown preparation are [Figure 2] iPad Music System (Sony Co.) with earphone [Figure 3].
Figure 1: (a) Pulse oximeter (BPL Cleo) to record heart rate. (b) Automatic blood pressure apparatus (Omron SEM 1) to record systolic and diastolic blood pressure

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Figure 2: Instruments required for crown preparation

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Figure 3: iPad Music System (Sony Co.) with earphone

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Methods

Patients requiring FPDs were explained about the complete clinical procedure for tooth preparation. Their dental anxiety scale (DAS) was calculated by Norman Corah's DAS and their BPs (SBP, DBP, and HR) (hemodynamic variables) were recorded before starting the crown preparation.

Patients were randomly divided into two groups. In Group I (without music) considered as control, tooth preparation was started and patient's blood pressure and heart rate were noted after 1 h, i.e., at the end of impression making. Whereas, in Group II (music), patients listened to the passive music using earphones throughout the treatment from tooth preparation till impression-making procedure [Figure 4] and [Figure 5]. The type of music used was varied (e.g., folk, classical, contemporary, or lullaby). In these patients, also, blood pressure and heart rate were noted after 1 h, i.e., at the end of impression making.
Figure 4: Patient listening to passive music using earphones

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Figure 5: Operator working on patient listening to music

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Norman Corah's DAS consists of four items, each of which the patient rates on 1–5 point scale, from calm to terrified. The four dental situations include appointment tomorrow, sitting in the waiting room, sitting in the dental chair just before the treatment, and Patient sitting in the Dental chair after impression making. A patient was asked to imagine being in the situations described. The score for these items varies from 9 to 20. There are three levels of anxiety: score 9–12 - low anxiety but has specific stressors that should be discussed and managed; 13–14 - moderate anxiety; and 15–20 - high anxiety or phobia. It may be manageable with dental concerns assessment but might require the help of a mental health therapist.

Accordingly in the dentist's rating of patient's behavior and treatability where the dentist assesses the patient's adjustment to treatment, by giving the score from 1 to 6 points (from patient's being totally relaxed, to the patient refusing the treatment), there are three levels of patient's treatability: low 5–6 points, medium 3–4 points, and high 1–2 points.

In the patient's tension rating (the degree of tension experienced during dental examination and treatment), the patient answered the questions regarding the tension during treatment. There are three levels of patient's tension: low 1–2, medium 3–4 points, and high 5–7 points.


  Results and Observations Top


Age-wise distribution of patients

In Group I (without music), seven patients were ≤20 years' age group, forty patients were between 20 and 40 years, and seven patients were between 40 and 45 years. Whereas in Group II (with music), three patients were ≤20 years' age group, forty patients were between 20 and 40 years, and seven patients were >40 years [Table 1] and [Graph 1].
Table 1: Age wise distribution of patients

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Considering sex-wise distribution of patients

There were total 25 male and 25 female patients in Group I (without music) whereas 23 male and 27 female patients in Group II (with music) [Table 2] and [Graph 2].
Table 2: Sex wise distribution of patients

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On the basis of dental anxiety scale

In Group I (without music), of 50 patients, 17 had low anxiety, 8 patients had medium anxiety, and 25 patients were highly anxious before treatment. Whereas, in Group II (with music), of 50 patients, 9 patients had low anxiety, 22 patients had medium anxiety, and 19 patients had highly anxious before treatment. [Table 3] and [Graph 3].
Table 3: On basis of anxiety scale DAS

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Observations of hemodynamic changes

In Group I, (without music), patient's values of SBP & DBP as well as HR were more, whereas these values were reduced in each individual in Group II (with music) compared to base line. In group I, out of 50, 12 patients SBP & 13 patients DBP was reduced and there was reduction in HR of 24 patients. In Group II (with music), 13 patients SBP & 12 patients DBP was reduced. At the same time, there was reduction in HR of 25 patients [Table 4], [Graph 4].
Table 4: Hemodynamic changes

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According to the dentist's rating and patient's behavior and treatability

In Group I (without music), of 50 patients, only 12 patients showed high adjustment during tooth preparation till impression procedure. Twenty-two patients showed medium adjustment and 16 patients showed low adjustment, where some of the patients were noncooperated during tooth preparation and impression-making procedure [Table 5] and [Graph 5].
Table 5: Dentist's rating of patients behavior & treatability

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In Group II (with music), these findings were very satisfactory. Twenty-six patients showed high level of cooperation during tooth preparation as well as impression making and they were totally relaxed, 23 with medium level, and only 1 patient showed low level of adjustment during treatment.

Considering patient's rating of degree of tension

In Group I (without music), of 50 patients, 8 patients exhibited low level of tension, 24 with medium level of tension, and 18 patients with high level of tension, whereas these findings in Group II (with music) showed significantly good results. The number of patients with low and medium level of tension during treatment was same, i.e., 20, and only 10 patients had high level of tension till completion of impression procedure [Table 6] and [Graph 6].
Table 6: Patients rating of tension:

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Statistically Chi-test was applied. The data showed significant differences in both the groups. In Group I (without music), SBP, DBP, and HR were increased significantly. Whereas, in Group II (with music), these values were reduced significantly (P< 0.0001) compared to baseline findings.

According to the dentist's rating as well as patient's behavior and treatability and considering the patient's rating of degree of tension, statistically significant differences were seen in both the groups where P < 0.0001 and degree of freedom 2.


  Discussion Top


For over 100 years, it has been known that music has strong influence on human brain waves, which leads people into state of deep relaxation. The results of our study proved that any type of music the patient chosen was effective to reduce anxiety and his cooperation during tooth preparation procedure. Dental anxiety is more specific than general anxiety. It is the patient's response to the stress specific to dental situation. If the dentist is aware of his patient's anxiety level, he is not only forewarned about the patient's behavior but also can take the measures to help alleviate the anxiety during clinical/operative procedures.

In 1969, Norman Corah published a scale for the assessment of dental anxiety. The scale contains four multiple-choice questions, dealing with the patient's subjective reactions which usually takes 3 min about going to dentist, waiting in the dental office for the procedure, and anticipation of drilling.[4]

High scores are not always reflected in overt behavior of patient in the dental office; however, they are nearly always related to how the patients feels about the procedures. In our study, score of 13 or 14 should make the dentist suspicious that he is dealing with an anxious patient. A score of 15 or more almost always indicates a highly anxious patient. Some of these patients were able to prevent their anxiety from interfering with the dentist procedure.

To avoid potentially serious reactions, dentists are obligated to monitor continuously the patients during dental procedures. Monitoring provides three important benefits: first, it helps the dentist detect acute medical emergencies that may require immediate responses; second, monitoring may reveal gradual deleterious trends that can often be easily reversed before true emergency occurs; and third, monitoring can assist the dentist in evaluating the efficacy of any emergency treatment or preventive measures that are rendered.[5]

Studies have proved that relaxing music administered through headphones to patients during root canal treatment decreased the procedure-related anxiety of the patients and significantly increased finger temperature, but does not significantly affect BP and heart rate.[2],[6] Similar type of study was done to evaluate dental anxiety among patients anticipating various dental treatments such as scaling, filling, root canal therapy, periodontal surgery, or extraction. Their results indicated that extractions caused highest score followed by scaling.[7]

The results of this study seem to prove this fact. The findings of group I without music, in hemodynamic variables, there was reduction of SBP in 24% patients, of DBP in 28% patients and 48% reduction was seen in patients HR. In group II with music, 26% patients showed reduction in SBP, 24 % patients DBP and 50 % patients HR was reduced compared to base line.

However, increase in values of these hemodynamic variables is not suggestive of any pathology. It may be due to anxiety and fear or apprehensive nature of the individuals or a normal response of any individual after sitting in the dental chair. In the findings of Group I (without music), considering dentist's rating and patient's behavior and treatability, only 24% patients showed high level of treatability, 44% with medium level, and 32% patients with low level of treatability and cooperation during tooth preparation procedure till impression making. Considering patient's rating of degree of tension, in this group, 36% patients were highly tense, 48% patients had medium tension, and only 16% patients with low tension. In the findings of Group II (with music), considering dentist's rating and patient's behavior and treatability, 52% patients showed high level of treatability, 46% with medium level, and only 2% patients with low level of treatability and cooperation during tooth preparation procedure till impression making. Considering patient's rating of degree of tension, in this group, the percentage of patients with low and medium level of tension was same and it was 40%, whereas patients with high level of tension was only 10%. These findings are significantly less compared to without music group. The patients were adjusted to the situation in the dental office. There are no doubts that the influence of music reaches the human nervous system and starts a number of positive chemical changes in our bodies, resulting in lower level of tension. It was found that the reduction of anxiety by music mostly appears among patients with medium and high level of anxiety. It was also observed in the study that the relaxation of features of music does not depend on age or sex. Reduction in anxiety can be attributed to two reasons: first, the patient will tend to close his eyes to concentrate on the audio presentation, thereby screening out the sight of diagnostic instruments, burs, and impression trays used during tooth preparation procedure, and second, the sound of music will eliminate unpleasant dental sounds of hand piece. These two advantages coupled with the effect of music provided relaxation and allowed the prosthodontist effectively manage the anxious patients. All results showed that music therapy is worth to prosthodontists.


  Conclusion Top


  1. Patients receiving FPDs, who were listening to passive music using earphones, showed reduced anxiety levels
  2. Patients who were listening to music during tooth preparation procedure showed lower level of tension, better treatability, and better adjustment to treatment till impression making procedure
  3. Among patients with medium and high levels of anxiety, music had significant influence on their fear and comfort
  4. The influence of music does not depend on age or sex of individuals
  5. Music seems to be a very useful tool in making the tooth preparation procedure more comfortable for the patients.


Summary

Music has many relaxation benefits, and by changing the moods, it can have a positive influence on a dental patient during prosthodontic treatment. The purpose of this study was to evaluate and to assess the effect of music therapy in patients receiving FPDs by listening to passive music using headphones and to assess whether the music influences dental patients tension, behavior, and treatability. In the present study, patients selected a suitable music of their choice, which also had many relaxation benefits, and by changing the moods, it altered patients approach, it has a positive influence on a patient by making concentration easier, fostering patience and above all existing anxiety.

Patients who were listening to music during the tooth preparation showed lower level of tension, better treatability, and better adjustment to treatment. The role of music therapy is still expanding. Application of passive music during all types of prosthodontic procedures including complete dentures, maxillofacial, and implant prosthodontics will be very much beneficial to patients which not only will make patients cooperative but also increase patient's cooperation and create friendly approach with prosthodontist. Apart from the use of televisions in patients waiting area, the use of listening passive music will definitely be beneficial to patients in reducing anxiety, apprehension, and ultimately making them cooperative.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Iorgulescu G. Music therapy in dental medicine. Int J Music Perform Arts 2015;3:19-24.  Back to cited text no. 1
    
2.
Stabholz A, Peretz B. Dental anxiety among patients prior to different dental treatments. Int Dent J 1999;49:90-4.  Back to cited text no. 2
    
3.
Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc 1978;97:816-9.  Back to cited text no. 3
    
4.
Fukayama H, Yagiela JA. Monitoring of vital signs during dental care. Int Dent J 2006;56:102-8.  Back to cited text no. 4
    
5.
Newton JT. Music may reduce anxiety during invasive procedures in adolescents and adults. Evid Based Dent 2009;10:15.  Back to cited text no. 5
    
6.
Lai HL, Hwang MJ, Chen CJ, Chang KF, Peng TC, Chang FM, et al. Randomised controlled trial of music on state anxiety and physiological indices in patients undergoing root canal treatment. J Clin Nurs 2008;17:2654-60.  Back to cited text no. 6
    
7.
Kim YK, Kim SM, Myoung H. Musical intervention reduces patients' anxiety in surgical extraction of an impacted mandibular third molar. J Oral Maxillofac Surg 2011;69:1036-45.  Back to cited text no. 7
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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