(1) Comparative Effects of Music and Diazepam on Pain and Anxiety During and After Surgical Extraction of Impacted Mandibular Third Molars: A Clinical Trial

Abstract:
Statement of the Problem: Dental anxiety is a prevalent barrier to care, particularly during complex procedures such as the surgical extraction of impacted mandibular third molars. Pharmacologic interventions like diazepam are commonly used to mitigate anxiety, but they carry potential side effects. Non-pharmacologic alternatives such as music therapy offer a potentially safer, patient-centered approach. This study aimed to compare the effectiveness of music and diazepam in managing anxiety and pain during and after third molar extraction.
Materials and

Methods: A randomized split-mouth clinical trial was conducted involving 30 patients (18 females, 12 males; mean age = 25.26 ± 4.68 years) requiring bilateral surgical extraction of impacted mandibular third molars. Each patient underwent two surgical sessions: one under diazepam sedation (5 mg the night before and 1 hour preoperatively), and the other while listening to preferred music. All surgeries were standardized and performed by the same surgeon.
Method of Data Analysis: The primary outcomes were levels of anxiety and pain, measured via the State-Trait Anxiety Inventory (STAI) and Visual Analog Scale (VAS), respectively. Physiologic indicators (heart rate, blood pressure, and SpO₂) were also recorded.
• Sample Size: 30 patients (split-mouth design; 60 surgical sites total).
• Duration of Study: February to June 2024.
• Statistical

Methods: Paired t-tests, Wilcoxon signed-rank tests, Friedman test, regression analysis, and independent t-tests were employed using SPSS v25 (α = .05).
• Subjective Analysis: Pain and anxiety were assessed using validated subjective instruments (VAS and STAI).
Results of Investigation: On the day of surgery, both state (P < .001) and trait (P < .001) anxiety were significantly lower in the music group compared to the diazepam group. After 24 hours, trait anxiety remained lower in the music group (P < .001), while state anxiety differences were not significant (P = .163). No significant between-group differences in pain scores were found at any time point. However, diazepam significantly lowered HR and BP, and increased SpO₂ compared to music (P < .05).
Outcomes Data: The use of music resulted in significantly reduced subjective anxiety levels but did not influence physiologic markers as effectively as diazepam. Pain scores were comparable across interventions. Age and gender had no significant influence on outcomes.
Conclusions Relevant to the Problem: Music, as a non-invasive and patient-preferred intervention, offers comparable pain management and superior anxiety reduction compared to diazepam. Given its safety profile and patient acceptability, music may serve as a viable alternative to pharmacologic sedation in minor oral surgeries.

References:
1. Tan K, Liu H, Huang S, Li C. Efficacy of Music Intervention for Dental Anxiety Disorders: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2023;59(2):209.
2. Berbel P, Moix J, Quintana S. Music versus diazepam to reduce preoperative anxiety: a randomized controlled clinical trial. Rev Esp Anestesiol Reanim. 2007;54(6):355-8.