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15 September 2023

Music therapy, virtual reality to manage anxiety and pain in dental surgery

Lara Figini

Oral surgery procedures usually cause a high level of anxiety in patients, which can lead to increased pain sensation, as well as acute changes in the autonomic nervous system during the surgical procedure.

The use of analgesic drugs and performing these procedures under sedation or general anesthesia are the preferred approaches to reduce such emotional stress issues.

However, these procedures come with certain risks, side effects, and complications.

To mitigate the effects of anxiety, alternative techniques have been studied, such as psychological distraction through interventions to control anxiety and perioperative pain, which do not involve any risk for the patient.

Music therapy and virtual reality (VR) are some of these methods.

Music therapy involves the use of music to achieve therapeutic goals: the achievement, maintenance and improvement of mental and physical health. Relaxing music that mimics natural sounds, for example, can decrease sympathetic nervous arousal.

Virtual reality, on the other hand, is a procedure that allows the real-time simulation of an environment with which users can intuitively interact through multiple sensory channels. VR manages to create an illusion of presence in virtual environments that allow patients to immerse themselves in a simulated world.

Materials and methods

In a randomized controlled trial published in January 2023 in the Journal of the American Dental Association, the authors evaluated the effect of virtual reality (VR) and music therapy on peri-operative anxiety and pain in patients undergoing extraction of impacted third molars.

A total of 275 patients were evaluated in the study and divided into three groups:

  • Group 1, music therapy intervention group (n = 91)
  • Group 2, VR virtual reality intervention group (n = 93), and
  • Group 3, control group (n = 91) no alternative method adopted.

The Spielberger State-Trait Anxiety Inventory and visual analog scale of pain intensity were adopted for assessments in this study.


Patients in the music therapy and VR groups showed a greater reduction in anxiety level after third molar extraction surgery (total anxiety reduction in the music group: 15.12; 95% CI, 13.16 to 17.08; Rosenthal r, 1.61; P < .001; reduction in total anxiety in the VR group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P <.001; reduction in total anxiety in the control group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P <.001).

Pain intensity after surgery was lower in patients in the music therapy group than in patients in the control group (P = .04). After the intervention, patients in the music therapy and VR groups had a significant decrease in systolic blood pressure (P < .05), diastolic blood pressure (P < .05), and heart rate (P < .05) compared to the control group.


From the data of this study, it can be concluded that music therapy and virtual reality during dental treatments for the extraction of third molars reduce anxiety and even improve the patient's physiological parameters.

For more information: "Effect of virtual reality and music therapy on anxiety and perioperative pain in surgical extraction of impacted third molars."

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