The effect of mindfulness meditation on dental anxiety during implant surgery: a randomized controlled clinical trial.

Dental implant surgery is almost always associated with patient anxiety. Anxiety during dental surgical procedures triggers an increase in sympathetic activity. Mindfulness meditation (MM) is often associated with high levels of relaxation in the form of increased parasympathetic tone and decreased sympathetic activity. However, the effect of MM on dental anxiety is not clear. The current study aimed to show the effects of a MM as a sedative technique during dental implant surgery by examining the State-Trait Anxiety Inventory (STAI-S), bispectral index (BIS), cortisol levels (CL), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and saturation (SpO2) parameters. HR, SBP, DBP, SpO2, BIS score and CLs were compared at the baseline, immediately before-, during-, and immediately after surgery between the test and control groups. We found that the MM resulted in significant decrease in BIS together with positive effects on hemodynamic parameters (decrease of HR, SBP, DBP and increase of SpO2), psychological findings (improvement on STAI-S scores) and biochemical outcomes (decreased CL). In conclusion, the results demonstrate that MM appeared to be a reliable strategy for managing stress during dental implant operation with benefits in psychological, physiological and biochemical outcomes.

Dog-assisted therapy for control of anxiety in pediatric dentistry.

Anxiety is common in pediatric dental care, and affects the behavioral management of children. Animal-assisted therapy (AAT) has been shown to improve children's behavior. However, few studies have applied this technique in dentistry. The aim of the present study was to evaluate the applicability of dog-assisted therapy to control anxiety during pediatric dental treatment. Twenty children were selected from the Pediatric Dentistry Clinic of the Pontifical Catholic University of Campinas (PUC-Campinas), Brazil. Participants were divided into two groups: Control (n = 11; visits = 16), in which children were conditioned by methods routinely used in the clinic; and AAT (n = 9; visits = 23), in which children had contact with a dog therapist first at the reception desk and then again inside the office. The dog therapist stayed beside the dental chair with the child throughout the procedures. Corah's Dental Anxiety Scale (CS) and heart rate (HR) were used for evaluation of child anxiety. The results were tested for normality of distribution with the Shapiro-Wilk method, and subsequently analyzed in BioEstat 5.0. HR results were compared by Analysis of Variance (ANOVA) with Tukey's test, and CS scores, with the Wilcoxon test. There was a significant reduction in HR in the AAT group (p = 0.0069). In the Control group, HR did not change before, during, or after treatment (p = 0.6052). Controls showed a significant increase in anxiety measured by CS before and after treatment (p = 0.0455). In the AAT group, there was no change in CS scores before and after treatment (p = 0.3739). AAT could be an alternative to reduce anxiety during pediatric dental care.

Nonpharmacological Behavior Guidance for the Pediatric Dental Patient.

Purpose: To present evidence-based recommendations on nonpharmacological behavior guidance for the pediatric dental patient. Methods: The work group assessed eight systematic reviews for effectiveness of nonpharmacological behavior guidance techniques in children undergoing preventive care or a dental treatment visit. The key outcomes assessed included cooperative behavior, anxiety, and procedural pain. To formulate the recommendations, the work group used the GRADE framework to obtain consensus on domains such as priority of the problem, certainty of the evidence, balance between desirable and undesirable consequences, patients' values and preferences, acceptability, and feasibility. Results: Overall, the use of basic nonpharmacological behavior guidance techniques resulted in trivial-to-small effect on improvement in behavior or reduction in anxiety. However, for children and adolescents undergoing preventive care, mobile applications and modeling showed large effects in reduction of anxiety. For those undergoing dental treatment, strategies such as modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal-assisted therapy, combined tell-show-do, audiovisual distraction, and cognitive behavior therapy showed large reduction in anxiety. For children and adolescents with special health care needs, audiovisual distraction and sensory-adapted dental environment showed large reduction of anxiety. Conclusions: All the formulated recommendations were conditional and were mostly based on very low certainty of evidence. Conditional recommendations imply that different choices or combinations of behavior guidance techniques may be most appropriate for different patients. Clinicians should use techniques consistent with the parent/patient values and preferences. These recommendations are based on the best available evidence to-date and are intended to aid clinical decision making.

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.

Can music therapy and aroma therapy really reduce dental anxiety and fear?

DESIGN: This study was a randomised controlled trial (RCT) designed to evaluate the effectiveness of music therapy and aromatherapy on reducing dental anxiety and fear in children during a fissure sealant treatment. CASE SELECTION: Participants were selected from three primary schools from the Phitsanulok Province in Thailand. These children were randomly allocated to a (1) Control group (n = 33), (2) Music Therapy Experimental Group (n = 33), (3) Aromatherapy Group (n = 33) and (4) Combination Experimental Group (n = 33). Measures included dental anxiety and fear scores as well as vital signs (blood pressure, heart rate and oxygen saturation level) pre- and post-fissure sealant treatment. DATA ANALYSIS: Descriptive statistics were used for categorical data. Mean and standard deviations were calculated for continuous data. For the four arms, Chi-squared tests and one-way ANOVA were used to compare base line characteristics of the participants. Paired t-tests were used to compare changes within groups in dental anxiety and fear and vital signs pre- and post-treatment. RESULTS: Overall, 128 participants took part in were in the final analysis (32, 33, 31 and 32 in groups 1-4, respectively). In the music therapy group and aromatherapy group, there was a decrease in dental anxiety and fear, blood pressure and increase in oxygen saturation level (p = 0.05). In the combination group, there was a decrease in dental anxiety and fear, heart rate, blood pressure and increase in oxygen saturation level (p = 0.05). A statistically significant interaction effect was found between combination therapy on dental anxiety and fear (F = 22.22; P < 0.001) and oxygen saturation level (F = 17.40; P < 0.001). CONCLUSIONS: The authors conclude that the findings of this RCT suggest that the use of music therapy and aromatherapy reduces dental anxiety and fear in children, and is more effective when used in combination.

The effect of the parental presence-absence technique on children's behaviour in the dental clinic.

BACKGROUND: The presence of the parent could influence the behaviour of the child during the dental visit. The objective of this study was to assess the effect of the Parental Presence- Absence Technique (PPAT) on the behaviour of anxious children receiving dental restoration under local anaesthesia. METHODS: A cohort prospective observational study of a statistically calculated sample size with 80% power, recruited 84 anxious children ages 6-9-year-old who scored ≥26 on the Abeer Children Dental Anxiety Scale (ACDAS) over two visits. Forty-two children were allocated to either the Parental Presence (PP) or the Parental Absence (PA) group to have one composite restoration under local anaesthesia. STATISTICAL ANALYSIS: A two-sample t-test was used to compare differences in the mean of ACDAS between the PP and the PA groups, and between boys and girls. The P-value of ≤0.05 was set for a statistically significant result. CONCLUSION: The use of the PPAT in children aged 6-9- year appears to be an effective method to improve children's behaviour when having dental restorations under local anaesthesia.

Dental pain perception and emotional changes: on the relationship between dental anxiety and olfaction.

BACKGROUND: The purpose of the study was to determine to what extent olfactory aromatherapy reduces the intensity of dental pain and the level of dental anxiety. It also attempted to corelate between olfactory aromatherapy, stages of dental visits, and various dental procedures. METHODS: Female patients were enrolled in a randomized controlled study. Olfactory aromatherapy was performed using lavender oils. Patients were randomly assigned to one of two groups: the lavender group, in which patients inhaled 2% lavender vapors, and the control group, in which patients inhaled water vapors. Pain score, anxiety score, and changes in vital signs were among the predictable variables. Anxiety and pain were assessed using the Modified Dental Anxiety Scale (MDAS), Speilberger State-Trait Anxiety Inventory (STAI), and visual analog scales (VAS). The vital signs were systolic (SBP) and diastolic (DBP), heart rate (HR), respiratory rate (RR), and oxygen saturation (Spo2). Variables were evaluated before inhalations, 20 min after inhalations, at the end of settings, and on the following day. RESULTS: Each group had 175 participants. Pain and anxiety scores were significantly reduced, and all vital signs improved, except for DBP. The MDAS, STAI, and pain scores are reduced by 3.4, 4.2, and 2.4 times, respectively, compared to the control group. Olfactory aromatherapy had the greatest impact during the phase of waiting rooms. CONCLUSION: When compared to the control group, olfactory aromatherapy reduces anxiety scores three to four times more. Pain perception is reduced by twice as much as in the control group. It also significantly reduces the anxiety associated with minor to moderately stressful dental procedures.

Investigation of the effect of music listened to by patients with moderate dental anxiety during restoration of posterior occlusal dental caries.

OBJECTIVE: The aim of this randomized controlled study was to investigate the effect of music therapy during restorative dental treatments on patients with moderate dental anxiety. MATERIALS AND METHODS: Seventy patients were determined to have moderate dental anxiety by the Modified Dental Anxiety Scale (MDAS) and were divided randomly into two groups (n = 35). The first group did not listen to music during their restorative treatment (control group), and the second group listened to music of their choice (experimental group). Systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, and body temperature were measured three times for each patient: once before the treatment, once after their dental caries were removed, and once at the end of the treatment. Salivary cortisol samples were taken from each patient before and after the treatment. The MDAS was re-administered to the patients at the end of the treatment, and the data were analyzed statistically. RESULTS: Only the diastolic blood pressure (P = 0.042) and the MDAS scores of the experimental group (P = 0.001) were significantly lower than the control group at the end of the treatment. CONCLUSION: While music listening did not have an effect on the physiologic parameters of the patients during restorative treatment, it decreased the MDAS scores of the patients. CLINICAL RELEVANCE: Although music therapy did not affect the physiological parameters during the restorative dental treatment, it may help to reduce patients' self reported anxiety level.

Rational thinking as a mediator of the relationship between mindfulness and dental anxiety.

Dental anxiety causes people to postpone or refuse to go to the dentist, which further negatively impacts their quality of life and public health. Previous research has shown that mindfulness is inversely related to anxiety. However, little is known about the relationship between mindfulness and dental anxiety. The current research aimed to explore the relationship between mindfulness and dental anxiety and investigate the mediating role of rational thinking. Two studies were conducted. In study one, 206 Chinese participants completed questionnaires measuring trait mindfulness and dental anxiety (state, responding to a dental treatment scenario). In study two, 394 participants completed questionnaires measuring trait mindfulness, dental anxiety (trait), and rational thinking. The results for both studies showed that mindfulness is negatively correlated with dental anxiety. In study 1, each facet of mindfulness except Non-judging was negatively correlated with dental anxiety with Acting with Awareness having the strongest correlation, while in study 2, only Acting with Awareness was significantly negatively correlated with dental anxiety. Furthermore, rational thinking mediated the effect of mindfulness on dental anxiety. In conclusion, mindfulness is negatively related to both state and trait dental anxiety, and rational thinking mediates the relationship between mindfulness and dental anxiety. Implications of these findings are discussed.

Intraoral clinical examinations of pediatric patients with anticipatory anxiety and situational fear facilitated by therapy dog assistance: A pilot RCT.

OBJECTIVE: To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients. METHODS: The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance. RESULTS: Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population. CONCLUSION: Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care.

Efficacy of two behavioural management techniques during inferior alveolar nerve block administration in pre-school children: a randomised clinical trial.

PURPOSE: To evaluate and compare the efficacy of the hands-eyes-mouth distraction technique (HEM-DT) in reducing anxiety and pain levels and improving the behaviour of pre-school children during inferior alveolar nerve block (IANB) administration to that of the covering patient's vision technique (CPV-T). METHODS: This study included 52 children aged 3-5 years old with primary dentition, no history of receiving local anaesthesia, and whose treatments required an IANB. These children were randomly assigned into two groups: HEM-DT (G1; n = 26) and CPV-T (G2; n = 26). Anxiety and pain levels were assessed using the Facial Image Scale and the Wong-Baker Scale, respectively, while the patient's behaviour was evaluated using the Frankl Behaviour Scale. This study was divided into two sessions including the treatment session (administration of IANB) and the control session (7 days after anaesthesia). Chi-square test, the Mann-Whitney U test and Wilcoxon test were used for statistical analyses. RESULTS: The patients' anxiety levels did not increase 7 days after IANB in G1 (p value = 0.798); however, higher anxiety levels were observed in the G2 group (p value = 0.039). No significant differences in pain levels and behaviour were observed between the groups during administration of anaesthesia (p value > 0.005). CONCLUSION: HEM-DT and CPV-T showed efficacy in terms of pain and behaviour during IANB administration. Pre-school children in the HEM-DT group exhibited lower anxiety levels in the control session. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: ClinicalTrials.gov (NCT02591797). October 28, 2015.

Evaluation of dental anxiety in children with Down's syndrome using dog-assisted therapy: A pilot study.

BACKGROUND: Dental anxiety and fear are the major treatment challenges faced by pediatric dentists. Oral hygiene in children with Down's syndrome is highly compromised in comparison to their healthy counterparts. Animal-assisted therapy, through dogs, has been beneficial in alleviating dental fear and anxiety in healthy pediatric population. AIM: The aim of the study was to assess the impact of dog-assisted therapy (DAT) on children with Down's syndrome undergoing dental examination and fluoride varnish application in dental operatory. MATERIALS AND METHODS: Twenty children with Down's syndrome between 5 and 12 years of age were selected. Group A (intervention group): DAT was carried out in the dental operatory. Group B (control group): Dental treatment was performed in the absence of a therapy dog in the dental operatory. Anxiety levels were evaluated by recording the pulse rate and revised modified faces version of the Modified Child Dental Anxiety Scale (MCDAS[f]). STATISTICAL ANALYSIS: The intergroup comparison of pulse rate was done using an unpaired t-test, whereas the variation in intragroup pulse rate was analyzed using the Analysis of Variance test. The anxiety scores were subjected to a paired t-test for intragroup comparison with P < 0.05 considered to be statistically significant. RESULTS: Reduction in dental anxiety was observed in the intervention group (P < 0.001). CONCLUSION: DAT can be used as an effective behavior management technique for children with Down's syndrome undergoing dental examination and simple dental procedures in the dental operatory.

Effect of Acupressure on Dental Anxiety in Children: a Pilot Study for a Randomized Clinical Trial.

Background: Anxiety is an important problem in children in dental clinics. Acupressure may be a useful tool to assist in dental procedures in anxious children. Objectives: This pilot study was performed to examine the effects of acupressure on dental anxiety in children undergoing restorative procedures. Methods: Fourteen children aged 7-10 years and with at least one primary molar with caries on the dentine were included in the study. The participants also needed to score at least one point on the modified Venham Picture Test (VPTm) for the determination of anxiety. The children were randomly allocated to two groups: group A - non-documented points for the reduction of anxiety and induction of relaxation; group B - documented points (EX-HN3, Shen Men of auricular acupuncture). The anxiety scale was administered on three occasions: prior to the application of acupressure; immediately after sitting in the dental chair to undergo restorative treatment; and after removal of acupressure at the end of the restorative procedure. Heart rate (HR) was measured when each child sat in the dental chair, after the removal of carious tissue, and after the removal of acupressure. Results: After the procedure, HR (as an indicator of anxiety) was statistically significantly lower in group B than group A (p = 0.02). However, there was no significant difference between the groups regarding anxiety before and during the restorative procedure (VPTm and HR: p > 0.05). Conclusion: The children who received acupressure on documented points for the reduction of anxiety had a significantly lower HR after the restorative procedure. No significant between-group difference was found regarding anxiety measured using a psychometric evaluation (VPTm).

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient.

AIM: Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients. METHODS: Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety. CONCLUSION: Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

Effect of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels. MATERIALS AND METHODS: A randomized, controlled, single-blinded, and observational study was conducted with 60 children, aged 8-12, who were recruited to high dental anxiety level (HDAL) and low dental anxiety level (LDAL) groups. Both groups were divided into two equal subgroups (with or without Mozart's music). In the Mozart's music subgroups, children were exposed to Mozart's Sonata for 7 min and toothbrushing training was given accompanied by music. The training was instructed to the second subgroup without listening to Mozart's music. The periodontal measurements were repeated after 15 days. Three-factor variance analysis was used to analyze the data. RESULTS: There was a statistically significant decrease in plaque index (PI) and gingival index (GI) scores in the follow-up visits for all groups (p < 0.05). A statistically significant decrease was found in PI values between groups with or without music in those with HDAL (p < 0.001). However, no statistically significant differences were found between groups with or without music in those with LDAL (p = 0.07). CONCLUSIONS: Listening to Mozart's music before toothbrushing training had a significant effect on plaque removal in children with high dental anxiety, while Mozart's music did not have a positive effect in the group with low dental anxiety. CLINICAL RELEVANCE: The use of Mozart's music may be beneficial in oral hygiene education for children with high dental anxiety levels.

Management strategies for adult patients with dental anxiety in the dental clinic: a systematic review.

Anxiety is an adaptive emotional response to potentially threatening or dangerous situations; moderated by the sympathetic nervous system. Dental anxiety is common and presents before, during or after dental treatment. The physiological response includes an increase in heart rate, blood pressure, respiratory rate, and cardiac output. Consequently, extensive distress leads to avoidance of dental treatment and multiple failed appointments, impacting both oral and general health. Dental anxiety can generate a variety of negative consequences for both the dentist and the patient. Evidence-based strategies are essential for mitigating and relieving anxiety in the dental clinic. Psychotherapeutic behavioural strategies can modify the patient's experience through a minimally invasive approach with nil or negligible side effects, depending on patient characteristics, anxiety level and clinical situations. These therapies involve muscle relaxation, guided imagery, physiological monitoring, utilizing biofeedback, hypnosis, acupuncture, distraction and desensitization. Pharmacological intervention utilizes either relative analgesia (nitrous oxide), conscious intravenous sedation or oral sedation, which can have undesirable side effects, risks and contraindications. These modalities increase the cost and availability of dental treatment.

A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth extraction: A randomized clinical trial.

INTRODUCTION: Behavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety. METHODS: The aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS-DS), Wong-Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness. RESULTS: CFSS-DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p = .02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p = .015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p = .35, p = .305). CONCLUSION: The use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness.

Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial.

PURPOSE: The aim of the study was to compare the effect of a stress ball, an active distraction technique with audio-visual eyeglasses, a passive distraction technique during local anaesthesia administration, on dental anxiety (primary outcome), behaviour and pain levels of children (secondary outcomes). METHODS: In this randomised controlled parallel arm trial involving 123 children aged 8-12 years, who required dental treatment under inferior alveolar nerve block, children were randomly allocated into the following three groups: Group 1: Stress ball, Group 2: Audio-visual eyeglasses, Group 3: Control group (basic behaviour guidance without distraction). Dental anxiety was measured using modified child dental anxiety scale and pulse rate, behaviour was rated using Venham's scale and pain was measured by both self-reporting and observational scales. RESULTS: No significant difference between the groups was observed for dental anxiety, but a significant decrease was seen in dental anxiety scores within all groups. No significant differences were seen between the groups for behaviour ratings and pain scores. CONCLUSION: Use of active stress ball distraction or passive audio-visual eyeglasses during local anaesthesia administration decreased dental anxiety but did not result in a significant improvement in the dental anxiety, behaviour and pain levels when compared to basic behaviour guidance without distraction. CLINICAL TRIAL REGISTRATION: The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2019/04/018768, Dated 24 April 2019).

Seeing the person before the teeth: A realist evaluation of a dental anxiety service in Norway.

Patients with a trauma history, whether sexual abuse or torture, or dental phobia, tend to avoid dental services due to severe dental anxiety. Subsequently, they experience poor oral health, lower quality of life, and poorer general health. In Norway, a specific service (torture, abuse, and dental anxiety [TADA]) targets these patients' dental anxiety through cognitive behavioural therapy (CBT) prior to dental restoration. By exploring patients' experiences with TADA services using a realist evaluation approach, this paper aims to increase our understanding of how this type of service addresses patients' dental anxiety in terms of its mechanisms and contextual factors. Interviews with TADA patients (n = 15) were analysed through a template analysis driven by context-mechanism-outcome heuristics. The analysis revealed that patients value a dental practitioner who provides a calm and holistic approach, positive judgements and predictability elements that lean towards a person-centred care approach. Provided this, patients felt understood and cared for, their shame was reduced, self-esteem emerged, and control was gained, which led to alleviation of dental anxiety. Therefore, our findings suggest that combining CBT with a person-centred care approach helps alleviate patients' dental anxiety. This provides insights into how dental services could be executed for these patients.

The Effect of Music Therapy in Reducing Dental Anxiety and Lowering Physiological Stressors.

BACKGROUND AND AIM: The anxiolytic effects of music have been studied during the past twenty years in different medical therapies. The aim of this study is to evaluate the effect of music therapy on patients' dental anxiety, salivary cortisol, heart rate, blood pressure and body temperature during dental treatment. METHODS: In this randomized control study, 46 patients were randomly selected from the Urgent Care dental clinic who needed urgent endodontic treatment (endodontic access and pulp extirpation). Participants were divided into two groups: intervention group (N=23) which was exposed to slow rhythm melody music and had no lyrics throughout the entire procedure and a control group (N=23) who undergoes the same dental procedure without being exposed to music. Participants' blood pressure, heart rate, body temperature and salivary cortisol were measured before and after the treatment for both groups. RESULTS: Patients in the intervention group showed lower salivary cortisol, blood pressure, heart rate and body temperature compared to those in the control group, however, the differences did not reach to statistical significance. CONCLUSION: -Despite the change in the dental anxiety and stress during treatment with music, the findings of this study could not establish evidence of the effect of music in reducing dental anxiety and lowering physiological stressors. Therefore, further studies with larger sample size may be needed. (www.actabiomedica.it).