Emelee Jean G. Gutierrez Jenina Marian U. Lim Ma. Edna M. Jimena , DDM

1. The Effect of Music Therapy on Dental Anxiety of Patients Seeking Tooth Extraction from the University of the Philippines, College of Dentistry (UPM-CD) Clinic Emelee Jean G. Gutierrez Jenina Marian U. Lim Ma. Edna M. Jimena, DDM

2. INTRODUCTION An important part of our way of life DENTAL ANXIETY MUSIC Soothing influence EXTRACTION Structured and pleasant to listen to

3. SETTING OF THE STUDY • Done in the Oral Surgery Room of the Clinics • Equipped with the necessary instruments, digital BP and HR monitor, IPods, speakers

4. SIGNIFICANCE • MUSIC as a simple and economical intervention • Can be applied to private clinics • May lead to a better way of managing patients with dental fear • Could encourage patients to seek consultation more

5. Dental Fear/Anxiety Music Therapy Dental Anxiety Management CONCEPTUAL FRAMEWORK

6. STATEMENT OF THE PROBLEM • What is the level of dental anxiety of UPM-CD patients seeking tooth extraction? • What is the comparison of the effect of with or without music therapy on dental anxiety of UPM-CD patients seeking tooth extraction? • What is the patient’s perception on the effect of the music during the treatment?

7. OBJECTIVES General To determine the effect of music therapy on dental anxiety of patients seeking tooth extraction in UPM-CD clinic.

8. OBJECTIVES Specific To determine the level of dental anxiety among UPM-CD patients seeking tooth extraction pre-operatively, during the procedure and after the procedure

9. OBJECTIVES Specific To compare the effect of with or without music therapy on dental anxiety of UPM-CD patients seeking tooth extraction pre-operatively, during the procedure and after the procedure

10. OBJECTIVES Specific To determine the patient’s perception on the effect of the music.

11. HYPOTHESES Ho: Music therapy will not affect the anxiety of patients seeking tooth extraction in UPM-CD Clinic. Ha: Music therapy will decrease the anxiety of patients seeking tooth extraction in UPM-CD Clinic.

12. SCOPE AND DELIMITATION • Participants: patients in the UPM-CD Clinic seeking tooth extraction • Screening focused on the formulated inclusion criteria • Sample size: based on values of related literature using the Simple Interactive Statistical Analysis software

13. SCOPE AND DELIMITATION • Two calibrated operators (the researchers) • Type of music: soft and quiet type for the experimental group • Management of the control group was the same as the conventional way of doing tooth extraction in the college.

14. SCOPE AND DELIMITATION • Basis of the effectiveness of music therapy: blood pressure and heart rate • Other factors: personal problems prior to treatment or previous traumatic dental experiences

15. DEFINITION OF TERMS Dental Anxiety Music Therapy Effectiveness of Music Therapy Complicated Extraction

16. RELATED LITERATURE “Music, even more than the spoken word, lends itself as a therapy because it meets with little or no intellectual resistance, and does not need to appeal to logic or initiate action.” - Harold Green, 1952

17. RELATED LITERATURE Healing properties of music is widely utilized in many different fields of health sciences Effects of music therapy on stress and anxiety reduction in coronary heart disease patients - Bradt & Dileo, 2009 Music therapy as a therapeutic approach to critically-ill cancer patients - Magill, Levin & Spodek, 2008 Effect of music on procedure time and sedation during colonoscopy - Tam, 2008

18. RELATED LITERATURE Music as a stress reliever during dental restorative procedure - Mendoza, 1997 In the Dental field Musical Therapeutics - Green, 1952 Determinants of Dental Anxiety and Coping Modes among Patients in UPCD - Galvez, 1999

19. RELATED LITERATURE a universal phenomenon • Worldwide: • Approx. 25% of patients evade visits and treatments • Approx. 10% reach phobic levels of anxiety • - Facco, et al, 1978 Dental Anxiety

20. RELATED LITERATURE Corah’s Dental Anxiety Scale • Best known and is widely used • Has the psychometric properties needed to measure the level of dental anxiety • - Facco, et al, 1978

21. METHODOLOGY Research Design: Single Blind Experimental Study Simple comparison procedure

22. METHODOLOGY Participants • Twenty-two (22) patients of the UPM-CD Clinic indicated for extraction • Calculated through the • Simple Interactive Statistical Analysis

23. METHODOLOGY Participants Inclusion Criteria • The patients should be healthy adults whose ages range from 20 – 40 years • The patients should have no systemic disease • The patients should not be under any kind of medication

24. METHODOLOGY Participants Inclusion Criteria • The patients should have undergone dental extraction in the past • The teeth to be extracted should be any of the molar teeth. The case should not be complicated (e.g. no root fragment case and teeth with no less than 1/3 bone support)

25. METHODOLOGY Sampling Technique Simple Random Sampling

26. METHODOLOGY Data Gathering • Screening of the patients through answering the Corah’s Dental Anxiety Scale • Only those who scored ≥ 5 points • Screening through the inclusion criteria set • Single-blind: participants were not informed that there will be involvement of music in the study • Signing of informed consent

27. METHODOLOGY Data Gathering • participant was randomly assigned to either: control group or experimental group. • both underwent the conventional extraction procedure • experimental group had the soft and quiet music to listen • script and the steps of the conventional extraction procedure

28. Screening of walk-in patients indicated for extraction Briefing about the study and giving out of consent forms Control Group (Without Music) Experimental Group (With Music) Conventional extraction procedure BPs and HRs taken preoperatively, during, and after the procedure • BPs and HRs taken preoperatively, during, and after the procedure Extraction procedure done with music (soft and quiet type of music) Measuring anxiety level through revised Corah’s Dental Anxiety Scale Measuring anxiety level through revised Corah’s Dental Anxiety Scale Data Analysis Procedural Framework

29. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Results and Statistical Analyses • Table 1. Means of Anxiety Scores

30. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Results and Statistical Analyses • Difference in blood pressure records and heart rates with music (experimental) and without music (control)  multiple T-tests. • P-values less than 0.05 statistically significant. • Statistical Package for the Social Sciences (SPSS) software Version 11.0 for Windows. • Levine’s test for equality of variances  statistically homogenous.

31. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Results and Statistical Analyses • Figure 3. Comparison of Mean Systolic Readings (in mmHg) Pre-operatively, During, and After the Procedure

32. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Results and Statistical Analyses • Figure 4. Comparison of Mean Diastolic Readings (in mmHg) Pre-operatively, During, and After the Procedure

33. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Results and Statistical Analyses • Figure 4. Comparison of Heart Rate (in beats/minute) Pre-operatively, During, and After the Procedure

34. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA RESULTS AND STATISTICAL ANALYSIS Table 2. Summary of Patient’s Answers to Post-treatment Question

35. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion • studies have been conducted to determine the role of music on anxiety in general. • anxious patients experience increase in blood pressure and heart rate esp. when indulged in stressful situations. • dental extraction seems to be one of the apprehensive procedures in dentistry.

36. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion Corah’s dental anxiety scale: Mean level 9.36 : MODERATE ANXIETY

37. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion • Physiological sign of anxiety: heart rate, diastolic and systolic blood pressure • Unlike other studies, the only statistically significant difference was in the systolic readings taken before the procedure between the control and experimental group.

38. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion • Before the procedure, there may be intense anxiety that is perhaps due to increased excretion of aldosterone. • The increase in systolic pressure may be due to adrenergic stimulation of the heart because of the feeling of anticipation on the part of the patients.

39. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion • Somehow, with the introduction of music, it has calmed down the patient by reducing the activity in the sympathetic nervous system with a relaxation response (Harrison, 1996).

40. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion • Guyton (1979) stated that the sympathetic nervous system increases the heart’s activity, and also dilates the coronaries. It has the ability to control the blood vessels in the body – capability to regulate both cardiac output and arterial blood pressure.

41. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion • HEART RATE for the control group has a similar pattern for all three stages (before the procedure, during and after the procedure) • control group has higher values • Heart rate is directly related to the increased blood flow. So if the pressure is high, heart beats faster than usual thus increasing the heart rate.

42. PRESENTATION, ANALYSIS, & INTERPRETATION OF DATA Discussion • About 55% liked the music heard during the procedure • 45% said that the music was able to help in lessening the anxiety they were in • no one answered that they didn’t like the music. • they were able to notice the presence of music even if they were not told about it.

43. SUMMARY OF FINDINGS • The mean anxiety level of the patients who participated in the study is 9.36, which signifies that overall, the study population had moderate anxiety level.

44. SUMMARY OF FINDINGS • The group with music has lower mean blood pressure and mean heart rate records than the group without music. The mean blood pressure difference in the blood pressure and heart rate values taken before the procedure were the only association that was statistically significant. Others have mean difference as well but are not statistically significant.

45. SUMMARY OF FINDINGS • Patient’s perception on the music used is that they liked the type of music and they were able to tell that somehow, the music helped in decreasing their anxiety.

46. CONCLUSION Applying soft and quiet type of music decreases the level of anxiety during extraction procedures as physiological indicators of anxiety (blood pressure and heart rate) were lower in the experimental group. It can be beneficial for patients who will undergo tooth extraction.

47. RECOMMENDATIONS • Different rating scales can be used to measure the level of anxiety of the participants. • Other symptoms of anxiety can be observed and tested as well. • This study should be done in a bigger population to obtain significant statistical results.

48. RECOMMENDATIONS • Other type of music can be used and tested to determine its therapeutic property. • Future study may consider controlling other variables such as the operator and length of the procedure.

49. Thank You!