Effect of virtual reality and music therapy on anxiety and perioperative pain in surgical extraction of impacted third molars

The role of anxiety in modulating temporal processing and sensory hyperresponsiveness in autism spectrum disorder: an fMRI study

The atypical sensory features and high comorbidity of anxiety disorders in individuals with autism spectrum disorder (ASD) are attracting increasing attention. Among individuals with ASD, those who exhibit heightened sensory hyperresponsiveness tend to show enhanced temporal processing of sensory stimuli, despite no observed differences in stimulus detection thresholds. A previous study reported the role of anxiety in modulating emotion-cued changes of visual temporal resolution in ASD. Building on this, we hypothesized that elevated anxiety might contribute to increased activation of neural circuits for timing perception and sensory hyperresponsiveness. This study included 25 individuals with ASD and 25 typically developed (TD) participants. Using functional magnetic resonance imaging (fMRI), we examined neural activity during a visual temporal order judgment task pre-cued by facial emotions. In the TD group, but not the ASD group, the presence of fearful facial expressions enhanced temporal processing. However, a correlation of anxiety levels with emotion-cued task performance and sensory hyperresponsiveness, respectively, was evident in the ASD group. In the TD group, neuroimaging revealed greater activation of the right caudate compared with that in the ASD group and a functional connectivity between the amygdala and left supramarginal gyrus. Individuals with ASD showed a relationship between anxiety level and activation of the right angular gyrus. Moreover, anxiety mediated the link between right angular gyrus activation and sensory hyperresponsiveness in the ASD group. These findings suggest that enhancement of temporal processing by fear-related cues-reflecting an emotion-timing neural circuit-may be disrupted in individuals with ASD. Heightened anxiety and sensory hyperresponsiveness in ASD may be mediated by brain regions involved in timing perception.

Effect of music intervention on dental anxiety and fear: A bibliometric analysis of RCTs from 2004 to 2024

BACKGROUND

Dental treatments, especially invasive procedures, often induce anxiety and fear, impacting future treatment adherence. Music intervention, a non-pharmacological approach, has shown promise in reducing anxiety and enhancing well-being, but further research is needed to explore its application in dental settings and the influence of factors like music type, duration, and volume.

OBJECTIVE

To assess the effects of music interventions on dental anxiety and fear, analyze research trends, and identify knowledge gaps through a bibliometric analysis of randomized controlled trials.

METHODS

Data from eligible studies were extracted through a comprehensive search. Descriptive bibliometrics, citation analysis, and keyword analysis were performed to assess research outputs, distribution, hotspots, and trends. Different human development indices (HDI) were used to analyze variations in publication year, sex distribution, and interventions across countries.

RESULTS

This study included 46 randomized controlled trials (RCTs) from 2004 to 2024, with a mean annual growth rate of 5.95 %. India, Japan, and Turkey led the research output and citations. Approximately 4112 participants, with 45.68 % males were enrolled. Most RCTs focused on adults (65.22 %) and used passive music interventions (73.91 %). The most common treatment was dental extraction (39.13 %), with classical music being the predominant intervention (60.87 %). The control group were often blank (80.43 %). Various indicators of anxiety and fear have been reported. Significant differences were found in the sex distribution among the different HDI ranks (p < 0.001).

CONCLUSIONS

This study outlined the research profile of music interventions for reducing anxiety and fear during dental treatments, with India, Japan, and Turkey leading in terms of output. The most frequently studied intervention is classical music, which is typically used preoperatively. Notable sex distribution differences were observed across HDI groups. Future research trends should include more extensive trials, personalized interventions, standardized guidelines, and enhanced collaboration to optimize patient engagement and emotional regulation.

Symptomatic irreversible pulpitis and other orofacial pain: overcoming challenges in diagnosis and management

Due to the unique sensory innervation of the teeth and face, orofacial pain can be challenging to diagnose and manage. Odontogenic pain, or 'toothache', is the most common orofacial pain condition and encompasses the vast majority of pain which is presented to dental practitioners. While diagnosis is often straightforward, the clinical picture is occasionally unclear or contradictory, and in these situations, the clinician should be able to consider reasons other than the teeth for the patient's presenting complaint. The primary aim of managing odontogenic pain is to treat the underlying cause, often arising from the dental pulp or periapical tissues; however, several factors can make pre-, intra- and post-operative management of odontogenic pain challenging. This paper will consider key similarities and differences in the clinical presentation of odontogenic pain and other non-odontogenic causes of orofacial pain in order to help practitioners arrive at the correct diagnosis. We discuss evidence-based recommendations for intra- and post-operative management of acute odontogenic pain, and consider the underlying neurophysiological features which make orofacial pain challenging to manage.

The impact of virtual reality on patient experience during wide-awake surgery: a randomized controlled trial

This study aimed to establish whether virtual reality can reduce patient anxiety and improve surgical satisfaction during wide-awake local anaesthetic no tourniquet hand procedures. Previously validated questionnaires were used to assess subjective anxiety and patient satisfaction. Objective anxiety was determined using patient blood pressure and heart rate measured four times during the procedure. The median difference in intra-operative minus pre-operative diastolic blood pressure was significantly lower in the virtual reality group compared with the control group (p = 0.003). There was a significant decrease in heart rate from pre-operative to post-operative within the virtual reality group (p < 0.001). No differences were observed in subjective anxiety or surgical satisfaction between the groups. Virtual reality can benefit wide-awake patients during hand procedures, particularly where patient preference exists.Level of evidence: Level I, Randomized Controlled Trial.

Comparison of melatonin and music therapy as a preoperative anxiolytic for patients undergoing impacted mandibular third molar extraction: a double-blind randomised controlled trial

Dental preoperative anxiety poses significant challenges in healthcare, leading to treatment avoidance and prolonged recovery times. Despite the plethora of pharmacological and psychotherapeutic interventions employed for anxiety management, their relative efficacy remains unclear. This study aims to compare the effectiveness of oral melatonin (6 mg) and music therapy in preoperative anxiety management among patients undergoing surgical extraction of impacted mandibular third molars. A total of 78 patients aged 18-40 years undergoing surgical extraction were selected and randomly assigned into three groups: nil intervention (Group NI) with no intervention, Group ML administered oral melatonin, and Group MT administered 20 min of relaxing music (n = 26). Physiological parameters (pulse rate, blood pressure) and subjective assessments (visual analogue scale for anxiety) were measured on arrival (T1), after the intervention (T2), and after surgical extraction (T3). Salivary cortisol levels, recorded preoperatively and postoperatively, were analysed using ELISA. Results showed significant improvement in physiological parameters for both ML and MT compared with NI (p < 0.05). However, postoperative cortisol levels increased significantly in the NI (0.55 (0.15) - 0.88 (0.32) pmol/ml) and MT groups (from 0.33 (0.15) - 0.62 (0.2) pmol/ml) but decreased in the ML group (from 0.42 (0.19) - 0.3 (0.14) pmol/ml). This indicated a delayed action of melatonin as compared with the immediate impact of music therapy. Understanding the mechanisms and insights obtained can aid in developing advanced anxiety management methods for dental practitioners, thereby enhancing patient care and outcomes in dental practice.

Evaluation of anxiety in a group of adult patients attending a dental surgery unit

BACKGROUND

Dental visits can cause anxiety and fear in some patients. Dental anxiety is considered a state of apprehension tied to a sensation of a loss of control and linked to a feeling that something "terrible" might happen during the dental treatment, this generates discomfort in the patient promoting that some of them avoid the dental visit, which in turns delays seeking treatment thus worsening the prognosis of oral diseases, for this reason the objective of this study is to determine the prevalence of anxiety among individuals attending an initial consultation at a dental surgery unit.

METHODS

The selection of patients was performed during the initial consultation carried out in the Medicine, Surgery and Oral Implantology unit and the following data was registered: hemodynamic parameters (blood pressure, heart rate and oxygen saturation), weight, pain associated to the patient's reason for consultation, past dental experience, also State-Trait Anxiety Inventory/State-scale (STAI-S) and the modified dental anxiety scale (MDAS) questionnaire was applied to determine the level of anxiety. A descriptive analysis, Mann Whitney test, one way ANOVA, and two-way ANOVA were executed for the statistical analysis.

RESULTS

The sample consisted in 143 patients, 81 women and 62 men, the average age was 27.37 years old, a statistically significant difference was found in the average scores of anxiety between the group of men and women (p < 0.05); being the average of anxiety (STAI-S and MDAS) higher in women. A statistically significant difference was found between the values of STAI-S and the pain characteristic, finding that anxiety was higher when the patient had pain at the time of consultation (p = 0.001), although this was not found with the values of MDAS.

CONCLUSION

The results of this study show that dental anxiety remains a significant issue for almost one third of the sample studied, anxiety is higher in women and may not be linked to previous negative dental experiences.

Extended reality technology for alleviating adult dental anxiety: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

To assess the effectiveness of extended reality (XR) technology in reducing dental anxiety in adults, through a systematic review and meta-analysis.

METHODS

Comprehensive electronic and manual searches were conducted to identify randomized controlled trials published up to November 23, 2024, with no restrictions on publication year or language. Key outcomes included changes in anxiety and pain levels and cardiovascular indicators, such as blood pressure, heart rate, and oxygen saturation (SpO2). A random-effects model was used to evaluate the combined effects, with subgroup analyses exploring potential influencing factors. The updated Cochrane Risk of Bias 2 tool was used to assess the risk of bias. Meta-analysis was performed using RevMan 5.4.

RESULTS

Of 1,207 screened records, 52 were retrieved for full-text evaluation, resulting in 10 studies meeting the inclusion criteria. The meta-analysis revealed that XR technology significantly reduced anxiety (mean difference [MD]:3.22, 95 % confidence interval [CI]:3.83 to -2.61; I² = 85 %), pain (MD:1.30, 95 % CI:2.07 to -0.53; I² = 84 %), and blood pressure scores (MD:3.34, 95 % CI:4.76 to -1.92; I² = 2 %). For cardiovascular indicators (heart rate, pulse, and SpO₂), the overall effect size was -3.83 (95 % CI:5.54 to -2.13; I² = 83 %).

CONCLUSIONS

Our findings suggest that XR technology effectively alleviates dental anxiety in adults. However, larger, rigorously designed trials to better understand its impact.

CLINICAL SIGNIFICANCE

XR technology reduces patients' blood pressure, heart rate, pain, and anxiety during dental treatments. Rigorous, large-scale trials are needed to confirm its clinical effectiveness.

The Effect of Immersive Virtual Reality on Dental Anxiety and Intraoperative Pain in Adults Undergoing Local Anesthesia: A Randomized Clinical Trial

AIMS

This study assessed the effect of immersive virtual reality (IVR) on anxiety and intraoperative pain in adult patients undergoing dental extractions with local anesthesia.

METHODS

In a single-blind, randomized clinical trial from September 2022 to December 2023 at a private dental clinic, 190 patients with dental anxiety were randomly assigned to either an IVR or a control group. Primary outcomes-dental anxiety and perioperative pain-were measured using the State-Trait Anxiety Inventory (STAI), Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS) before and after the procedure. Secondary outcomes included heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP), recorded at various stages.

RESULTS

The IVR group showed significant reductions in total anxiety, state anxiety, and MDAS scores compared to the control group (p < 0.001). Pain intensity was also lower in the IVR group (p = 0.03). Additionally, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were consistently lower in the IVR group across different stages. Post anesthesia, the IVR group showed notably lower mean SBP and DBP values (p < 0.001). After surgery, the IVR group also showed lower HR (p = 0.01), SBP (p < 0.001), and DBP (p < 0.001) compared to the control group.

CONCLUSIONS

IVR significantly reduced STAI, STAI-S, and MDAS scores and decreased intraoperative pain compared to the control group.

The Effect of Music Distraction on Dental Anxiety During Invasive Dental Procedures in Children and Adults: A Meta-Analysis

Background: Dental anxiety and odontophobia are common issues, leading to challenges with oral hygiene and dental health. Music distraction offers an effective and side effect-free solution to alleviate pain and increase the acceptability of dental treatments. Our meta-analysis aimed to assess the efficacy of music distraction in reducing patient anxiety during invasive dental procedures in children and adults. Methods: The PubMed, Web of Science, and Embase databases were searched for clinically controlled trials, using the keywords "music" and "dental anxiety". The main outcome measured was the anxiety score. A meta-analysis was conducted using a random-effects model to estimate the standardized mean differences (SMDs). The subgroup analyses were conducted based on age groups, music preferences, and music styles. The research protocol has been registered with PROSPERO (Registration ID: CRD42022357961). Results: A total of 24 controlled clinical trials involving 1830 participants met the inclusion criteria for the meta-analysis. Music distraction significantly reduced dental anxiety during invasive procedures under local anesthesia (SMD, -0.50; 95% CI, -0.80 to -0.21; p = 0.0009; I2 = 83%). Our subgroup analysis revealed that music distraction was more effective in adults (SMD, -0.51; p = 0.0007) than in children (SMD, -0.47; p = 0.13) in reducing dental anxiety. Regarding music selection, music chosen by the participant (SMD, -1.01; p = 0.008) demonstrated more anxiolytic effects than by the author (SMD, -0.24; p = 0.02). Regarding music styles, classical music (SMD, -0.69; p = 0.009) was associated with better anxiolytic effects in adults. Conclusions: Our meta-analysis supports the use of music to alleviate dental anxiety during invasive procedures. Listening to classical or customized music can serve as an effective adjunct to outpatient surgical care in dental clinics.

Does virtual reality reduce anxiety and pain in patients undergoing third molar surgery? A systematic review and meta-analysis

This study aimed to systematically review the literature to evaluate the effectiveness of virtual reality in reducing anxiety and pain in patients undergoing third molar surgeries. Clinical trials evaluating patients who used virtual reality (VR) compared with no VR in the management of pain or anxiety after third molar extractions were included. A literature search was conducted in five electronic databases to identify relevant articles: Medline (PubMed interface), Web of Science, Virtual Health Library, Embase, and Scopus. There were no restrictions on the time or language of publication. The risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB 2.0). A total of six studies were included in the qualitative analysis and three in the quantitative analysis. The results of the meta-analyses on anxiety revealed that patients in the intervention group before VR already showed less anxiety compared to those in the control group (-0.28 [-0.44 to -0.13, 95%CI] I²=24.51%. In the post-intervention evaluation, the group that received VR remained with a lower level of anxiety and a slight reduction compared to the pre-intervention. (-0.34 [-0.49 to -0.19, 95%CI] I²=36.61%. Virtual reality can be a clinical resource in dental care because it seems to cause a small reduction in anxiety, and with still uncertain results in the reduction of postoperative pain in extractions of third molars.

Investigation of the effect of virtual reality distraction in patients undergoing mandibular periodontal surgery: A randomized controlled study

OBJECTIVE

This clinical study aimed to evaluate the effect of virtual reality (VR) technology on anxiety and pain levels in patients undergoing gingivectomy and gingivoplasty procedures.

MATERIALS AND METHODS

The patients were randomized into test (surgery with VR glasses) and control (surgery without VR glasses) groups. Before the surgery, the anxiety level was measured using the modified dental anxiety scale (MDAS), and anticipated pain (AP) was measured by a visual analog scale (VAS). Immediately after the surgery, the pain and discomfort associated with the surgery (VASP), procedure time (T), and time perception (TP) were evaluated. The patients in the test group were requested to assess the immersion (VASI), satisfaction (VASS), perception of reduced anxiety (VASA), and perceived control (VASC). One week after surgery, MDAS was applied to all patients.

RESULTS

This trial was conducted with 41 female and 17 male subjects with a mean age of 29.69 ± 12.32. There were no significant differences between the groups in terms of age, sex, preoperative MDAS, or AP. After surgery, MDAS, VASP, T, and TP failed to differ significantly between the groups. The subject age was positively correlated with VASI, VASS, VASA, and VASC (r = 0.60, p = 0.00; r = 0.44, p = 0.02; r = 0.46, p = 0.02; r = 0.50, p = 0.01, respectively) and negatively correlated with VASP (r = 0.47, p = 0.04).

CONCLUSIONS

VR application did not affect anxiety and pain levels in patients undergoing periodontal surgery. More studies are needed to evaluate VR distraction in periodontal surgeries with diverse age samples and video options.

CLINICAL SIGNIFICANCE

VR does not affect anxiety and pain levels during gingivectomy and gingivoplasty surgeries in the young adult population. It should be evaluated in older age groups. Trial registration ClinicalTrials.gov Identifier: NCT06092177.

Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials

Introduction

Stress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments.

Methods

Studies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes).

Results

A total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety-stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001).

Conclusion

Music therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy.

Systematic review registration

INPLASY, identifier 202312000.

A systematic review and network meta-analysis of virtual reality, audiovisuals and music interventions for reducing dental anxiety related to tooth extraction

BACKGROUND

Tooth extraction is a common procedure performed by oral and maxillofacial surgeons or dentists, often resulting in dental fear and anxiety. The use of relaxing music, audiovisuals, and virtual reality (VR) technologies has been employed to reduce dental anxiety. This network meta-analysis (NMA) aimed to assess the comparative effectiveness of relaxing music, audiovisuals, and VR in reducing dental anxiety associated with tooth extraction.

METHODS

Four electronic databases were searched up to March 8, 2023, to identify randomized controlled trials (RCTs) evaluating different multimedia interventions, including the application of using relaxing music, audiovisuals, and VR technologies for dental anxiety. Studies utilizing various anxiety scales for tooth extraction were considered eligible. The pooled standard mean difference (SMD) and 95% confidence interval (CI) of anxiety scale scores were analyzed using Bayesian NMA.

RESULTS

A total of 11 RCTs were included in this NMA. The Bayesian NMA results demonstrated that relaxing music (SMD = -0.64, 95% CI: -1.04, -0.25) and VR (SMD = -0.54, 95% CI: -1.08, -0.02) were associated with a reduction in dental anxiety, while audiovisuals (SMD = -0.34, 95% CI: -0.97, 0.33) required further consideration. Ranking probabilities indicated that relaxing music might be the most acceptable method for individuals with dental anxiety. The frequentist NMA yielded consistent rankings in a sensitivity analysis.

CONCLUSIONS

Relaxing music shows the greatest potential for reducing dental anxiety related to tooth extraction when compared to other multimedia interventions.